NHS GRAMPIAN
Infection Control Committee
Minutes from meeting held on 14th July 2010
The Board Room, ARI
11.00 – 13.00
Present:
Dr Annemarie Karcher, Consultant Microbiologist / Infection Control Doctor
Pamela Harrison , Infection & Prevention Control Manager
Dr Helen Howie, CHPM, Public Health
Dr Pamela Molyneaux, Consultant Virologist
Tommy Ovens, Public Forum Representative
Jenny Ingram, SPSP Lead for NHSG
Gillian Macartney, Specialist Antibiotic Pharmacist
Issie Graham, Lead Systems Manager, Dr Gray’s, Moray (deputising for Andrew Fowlie)
Dr Elizabeth Murphy, Consultant in Occupational Health
Eunice Chisholm, Lead Nurse
Dr Alexander McKenzie, Consultant
Vince Shields, Divisional General Manager (deputising for Dr Pauline Strachan)
Elizabeth Kemp, Pharmacist, Pharmacy
John Brett, Head of Health & Safety for NHSG
Jenny Gibb, Head of Nursing, Mental Health & Learning Disability Service
Lynn Young, Dental Nurse Manager, University of Aberdeen Dental School & Hospital
Anneke Street, PA to Infection Control Manager (Minute taker)
1 / Introduction and Apologies /
AMK opened the meeting. Apologies were received from :
Roelf Dijkhuizen Karen Wares
Helen Robbins Beryl MacLean
Heather Kelman Gary Mortimer
Roy Browning Elinor Smith
Caroline Hind Sandy Dustan
2 / Minutes of last meeting 20th May 2010 /
Minutes from the meeting 20th May 2010 were ratified with the following amendments
HH asked for the wording on page 6 – 6.2 Local Guidance to be changed. Please amend wording to “Group A Streptococcus has been implemented”.
JI asked for the wording on Page 6 – 6.1 Recent CJD Incident to be changed. Please amend the wording to read “Datix and Clinical Government & Risk Management are involved”. / AS
AS
Item / Subject / Action to be taken and Key Points raised in discussion / Action
3 / Matters Arising / 3.1 Hand Hygiene Audio Message in toilets
· PEH fedback to the Committee that this had been investigated via Corporate Comms and it has been found that the audio device was ordered by a member of estates and the wrong message installed. The remote control for the device has been lost but a new one ordered and when this arrives the message will be changed. This is the only message that is giving incorrect advice within ARI.
4 / Standing Items / 4.1 Surveillance Report (HAI-RT)
· The new HAI-RT was submitted.
This report will be the new template to be submitted to the Government, Board & Clinical Governance Committee.
SABS/C-diff cases have now been split by hospital and GP figures are included in “out of hospital” graphs.
IG expressed concerns around the number of C-diff cases stated for Dr Gray’s and queried whether these had, perhaps, been counted twice. IG was not happy for these figures to become public knowledge until they have been discussed and reviewed.
PEH replied that these were the figures received from Surveillance and agreed to review them.
AMK also added that there will be initial difficulties in attributing the cases to the correct location due to Health Facilities Scotland guidelines.
PEH confirmed that a new definition on CDI cases had been received. This states that the number of patients C-diff positive within 48 hours of discharge would be attributed to the hospital and that these patients must be symptomatic and toxin positive. PEH will liaise with IG regarding her concerns regards this and cleaning compliance figures.
HH asked for the wording surrounding Antibiotic Prescribing guidelines for Acute & Primary Care to be made clearer and AM agreed. PEH to amend.
PM considered the wording under the Outbreaks section to be vague and asked for this to be changed.
PEH to be more detailed on laboratory testing information in this section.
4.2 Infection Control Work Plan
· The NHSG Infection Control Work Plan was submitted
This was not discussed.
4.3 Risk Control Plan
· The NHSG Rick Control Plan was submitted.
Very High
AMK discussed the Very High risk surrounding the systems in place for identifying cleaned equipment.
PEH feedback that Eleanor Murray is still working on this and that Vernacare tape was only ever a temporary measure. Other area trials include cards within poly pocket envelopes and clean/dirty areas within the ward.
IG informed the Committee that Dr Gray’s Hospital is trialling a new way of working using laminated sheets but queried whether it would be a ward decision on best practice or should the same system be in place Grampian wide.
VS replied that he felt different ways of working, for different areas, was not the way forward. The challenge will be standardisation for NHSG as a whole and decisions require to be made.
AMK suggested that PEH discuss this at the next ICM network meeting. / PEH/IG
PEH
PEH
PEH
Item / Subject / Action to be taken and Key Points raised in discussion / Action
· PEH replied that it has been discussed at previous meetings and other Health Boards are having the same issues as NHSG - some use Vernacare in addition to other systems.
PEH will continue to liaise with Stewart Rogerson regarding decontamination.
Highs
AMK queried whether the Workload of the ICT risks should be shown as very high due to the impending HEI visit to RACH in September.
PEH replied that this had been downgraded recently. An ICN post is being put through vacancy control although, due to budget cuts, this is resource shifting from the Surveillance Nurse post. She would like to see ICNs attending more meetings at operational level to enable them to support ward staff and managers more efficiently. The H1N1 virus did put extra pressure on the team but wastage within the department is being looked into with regard to streamlining. The Team are coping with the workload at present but extra pressures would pose significant problems. AMK and PEH to discuss.
AMK confirmed that she is awaiting feedback on the Risk Assessment of Patient Management. 2 questions are being trialled in Wards 7 & 8 DG and piloting has not yet finished.
PEH fedback that there is no protocol / policy surrounding the Risk Assessment of Maintenance Projects or Clear Allocation of Cleaning. An update is required from GM and Audrey Bell before attempting to downgrade this risk level.
AMK stated that attendance at mandatory/statutory training under Education – Mandatory Training needs to be looked into.
PEH replied that various ways were being sought and implemented on the providing of training to make staff attendance / completion easier e.g on-line training but due to pressures on the ICT delivery of training may become a new risk.
JI suggested using Cleanliness Champions to deliver training within their departments.
HH was concerned about the dates within the report being 2009. PEH to update.
Mediums
PEH fedback that Paul McKay now deals with the CDI/SABS figures on the Performance Management System. More feedback is required before this risk level is reduced.
AMK felt that staff were confused with the number of audits being performed with regard to the Audit and Surveillance risk.
IG fedback that Diane Vass is involved in these audits following the HEI visit to Dr Gray’s Hospital. She will question staff on this and feedback any issues/problems.
Policies and Procedures will remain a medium risk.
PEH informed the Committee that, with regards to Procurement, the majority of pieces of equipment and all nursing supplies purchased would have had ICT input.
/
AMK/PEH
GM/AB
PEH
Item / Subject / Action to be taken and Key Points raised in discussion / Action
With regard to Communication PEH stated that the Communication Strategy was not yet ratified and an update was required.
The Committee agreed that the likelihood of occurrence of the Procurement and Communication risks on page 6 of the report should downgraded by the next ICC meeting.
4.3 Outbreaks
· vCJD Incident
vCJD Outbreak Incident reports were submitted and HH explained the content.
VS stated that he felt the Significant Event Analysis report was the most significant and suggested that progress made surrounding the actions should be fedback to the ICC at the next meeting.
HH reported that this incident has highlighted a gap surrounding systems in place and confirmed that the 2008 endoscopy guidance document has been updated but assurances must be made to the ICC that mechanisms are in place for the future.
VS stated that the Clinical Risk Management Committee and the ICC have requested evidence that actions have been followed up. He confirmed that the action plan will be updated and this will be looked at Grampian wide.
HH asked who would lead this, highlight outstanding actions and ensure implementation.
VS replied that, formally, this would be Pauline Strachan and confirmed that the action plan is now being worked to, across Grampian (including Dentistry). He also confirmed that the consent form had been completed.
With regard to the recommendations of CJD incident report written by Maria Rossi the following people will be actioning
1) Completion and Review of actions across NHSG
2) Implementation of CMO guidance across NHSG
3) Clarification of the role of ward teams, IC and PH – AMK and HH have met and this has been addressed.
· PM fedback on various other incidents that have confirmed by Labs, since the Committee last met.
These included
1) A liver transplant patient not isolated on admission
2) Chickenpox incident at AMH
3) A staff member exhibiting a rash which later proved to be Shingles
4) Several incorrect diagnoses of Measles being made within Primary Care
5) Various Norovirus incidents including children on school trip by coach and an outbreak on an oil platform
/ VS/PS
Terry O’Kelly
5 / Reporting to Clinical Governance and Board / · The Board will be receiving the new HAI-RT report.
PEH feedback that RSD preferred that the report be submitted to the Clinical Governance Committee prior to being presented to the Board. This may not be possible. PEH to investigate
/ PEH
Item / Subject / Action to be taken and Key Points raised in discussion / Action
6 / AOCB /
6.1 Vaccination Season
· EM updated the Committee on changes to the Flu Vaccination procedure this year.
NHSG will no longer be vaccinating Local Authority Staff unless a monetary arrangement can be reached.
All NHSG staff will continue to be offered the vaccination as in previous years.
7 / Date of next meeting / · 9th September 2010, 11.00 – 13.00 – Conference Room, MacGillvray Centre, AMH
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