NHS GRAMPIAN
Infection Control Committee
Minutes from meeting held on 20 March 2013
Board Room, Aberdeen Royal Infirmary
11.00 – 13.00
Present:
RSD - Dr Roelf Dijkhuizen, Medical Director
PEH – Pamela Harrison, Infection Prevention and Control Manager
JA - Jane Adam, Public Forum Representative
SG – Steven Glass, Head of Procurement & Logistics (attending for Gary Mortimer)
AMK – Dr Anne Marie Karcher, Infection Control Doctor / Medical Microbiologist
AM – Dr Alexander Mackenzie, Infectious Diseases Consultant
NH–Neil Hendry, Practice Education Facilitator (deputising for Gladys Buchan)
FM - Fiona McDonald, Antibiotic Pharmacist
MR – Dr Maria Rossi, Consultant – Public Health Medicine
PM – Dr Pamela Molyneaux, Consultant Virologist
ES - Elinor Smith – Director of Nursing & Quality
JG - Jenny Gibb – Head of Nursing – Mental Health & Learning Disabilities
CC – Christina Cameron – Business Manager CITY CHP (attending for Heather Kelman)
AS - Anneke Street, PA to Infection Control Manager(Minute taker)
1 / Introduction and Apologies /
RSD opened the meeting. Apologies were received from :
Tommy Ovens (TO) Karen Wares(KDW) Jenny Ingram (JI) Stewart Rogerson (SR) Heather Kelman (HK) Johnathon Lofthouse (JL) Roy Browning (RAB) Amanda Croft (AC) Jane Ormerod (JO)
Deirdre O’Brien (DOB) Eleanor Murray (EM)
2 / Minutes of last meeting
17January 2013 /
The minutes from the 17 January 2013 were ratified by the Committee with a small amendment made to Standing item 4 – Risk Control Plan (item NHSGICC3) to include the word Measles. / AS
3 / Matters Arising
Item 3.1
Item 3.2 /
CJD
AMK updated the Committee on this subject, confirming that, several meetings have now taken place and it is felt that the system has strengthened considerably. Communication remains good and global awareness is much improved. Momentum needs to be sustained and will be monitored.
RSD thanked Terry O’Kelly and Amanda Croft for their continued assistance and asked for this item to be removed from next meetings agenda.
Sector Reporting to the Committee
RSD reiterated the importance of introducing sector reporting to the Committee at each meeting and asked for comments from around the table.
Item / Subject / Action to be taken and Key Points raised in discussion / Action
3 / Matters Arising cont… / Both MR and CC welcomed the suggestion with CC replying that this system works well, prompting thought and discussions and ultimately solutions can be offered, although both MR and JA commented on the lack of sector attendance at recent meetings.
AMK thought these reports to be beneficial with the non Acute inspections being planned.
RSD agreed and asked for these reports to be produced via a simple paper, to which PEH suggested using the Clinical Governance Committee template.
RSD asked for the template to be produced and sent to all sectors including Public Health.
PM raised the issue of occasionally not being sure of where to raise issues surrounding Virology.
RSD replied that depending on the issue they should be raised within the Acute Sector or Public Health template.
Sector reporting to be present for the next Infection Control Committee meeting in May.
NH spoke on Gladys Buchan’s paper regarding preparations for HEI Community Inspections.
To date the HEI Audit Tool is now being used and audits completed in all but one of the Community Hospitals with good results although some questions can be viewed as ambiguous. Senior Charge Nurse Audit Tool training has been well attended and training is to be cascaded as required. The Dress Policy is now being reinforced due to 100% compliance not yet being reached and there have also been recent issues at TurriffHospital surrounding Hand Hygiene non compliance. DOB recently held a Problem Assessment Group meeting at the hospital and lessons have been learned.
NH is also planning to discuss Hand Hygiene compliance surrounding student nurses with colleagues at RobertGordonsUniversity; the issue here is that nurses are being taught the correct procedures but bad practice has been highlighted on the wards.
PEH also informed the Committee of a situation regarding Hand Hygiene non compliance within Aberdeen Royal Infirmary. A Problem Assessment Group meeting will be held presently and suggested that perhaps the student mentor on that particular ward needs to be present also.
The escalation and reporting flowchart has been distributed to all areas.
NH also spoke on the subject of the aesthetics of various hospitals not being compliant and fedback that discussions are ongoing with the Estates Department, as to how various issues can be resolved, to bring hospitals up to minimal compliance; capital investment is needed for significant improvement.
PEH suggested that an update is required from GM on the HAI Capital Fund situation due to the HEI Inspections being imminent.
SG replied that this has been discussed as a risk and processes are needed for identifying issues as soon as possible.
NH stressed that improvements have been made but there is still a long way to go; at present informal visits are being concentrated on, highlighting various issues to staff.
JA raised the issue surrounding plugs in sinks. NH replied that unless the sink was a designated wash basin for patients then plugs should be removed.
AMK interjected explaining that this was to try and encourage good practice and to help educate patients on using sink etiquette within their own homes.
PEH suggested that it was difficult, within a community hospital setting, to ascertain whether a sink was a designated wash basin for patients or purely a hand hygiene basin. NH agreed with this statement.
RSD asked the Committee to focus on the philosophy of continuing improvement and stressed that the HEI should be able to witness these stages of improvement..It would now be helpful to know which community hospitals are not compliant and asked that these are identified to the Committee via the Sector Reports. / General Managers
CHP General Managers
Item / Subject / Action to be taken and Key Points raised in discussion / Action
3 / Matters Arising cont… / PEH will speak to GM regarding risk assessments for Community hospitals.
RSD asked for this subject to be brought back to the Committee for the next meeting. / PEH
4 / Standing Items
Item 4.1 / HAI Report for NHSG CGC (Template)
This report was not examined in full but certain areas were discussed.
PEH informed the Committee that this template is specifically being sent to the Clinical Governance Committee and that, on this occasion, due to timing it was not able to be discussed by the Committee at a meeting prior to submission. She asked whether the Committee was happy with the method being used to populate the template.
MR replied that the template looked promising and asked where the content was pulled from. PEH replied that this was pulled from the Risk Control Plan.
RSD commented on the full HAI Report noting that the organisation is doing well surroundingStaphylococcus aureus bacteraemias with NHS Grampian being 20% lower than other Boards across Scotland; MRSA bacteraemias also being lower by 45%
Clostridium difficile infections are still at acceptable levels but seem to have plateaued. RSD asked what the reasons for this may be.
AMK replied that she has spoken to GMac regarding this and 3 possible issues were highlighted – the use of proton pump inhibitors, reoccurrences of infection (a registrar is at present completing a project on patients who may be susceptible) and the pre-prescribed use of Cipro at travel clinics for oil workers who travel abroad regularly.
RSD asked for these 3 factors to be concentrated on, to ascertain whether they can be reduced and therefore lower the rate of Clostridium difficile infections.
RSD also expressed concern regarding Hand Hygiene non compliance within 2 hospitals and stressed that issues need to be addressed here and Problem Assessment Group (PAG) meetings called.
PEH fedback that PAG meetings had been called. Divisional General Managers (or alternative) are expected to chair these meetings and they should be attended by a multidisciplinary team and appropriate ward staff. These meetings have a standard agenda with discussions being focused on a) Logistics (staffing, environment etc)
b) Mentorship and c) Capability issues. A further meeting will be held at a later date where actions / plans will be discussed and should compliance fail again, these issues will be escalated to the General Manager.
RSD remarked on the outbreaks of Influenza and Pertussis, stressed that lessons should be learned from these incidents and asked for comments from the Committee.
PM, again, reiterated that the problem often occurs when staff come to work unwell and suggested that staff need to be more aware.
AMK suggested that clinicians need to be more proactive in diagnosis and isolation of patients admitted with or displaying respiratory symptoms.
MR reminded the Committee that the Influenza outbreak at Woodend GeneralHospital was via in hospital transmission and that awareness needs to raised. She also confirmed to the Committee that Public Health have asked for managers to be more aware with regard to staff working with flu like symptoms.
Item / Subject / Action to be taken and Key Points raised in discussion / Action
4 / Standing Items cont…
Item 4.2
Item 4.3
Item 4.4
Item 4.5 / The issue was also raised regarding sickness management and staffing levels when staff members are unwell with flu like symptoms.
MR replied that clarity on sickness absence type was being dealt with by Gail Thompson, the Infection Prevention & Control Team and DOB.
A lengthy discussion then ensued regarding whether a Chronic Cough Policy could or should be established and subsequently it was decided that this would not be the best course of action due to too many contributory factors.
RSD asked for ideas on an organisational message and AMK is to formulate the narrative for this giving clear guidance to staff on not attending work whilst ill.
AM asked whether the Infection Prevention & Control Team were working on Respiratory guidance.
AMK replied that Health Protection Scotland are aware of new viruses occurring but their guidance is still in draft form at present and she feels that it would be difficult to introduce at this time; this must be agreed nationally before rollout
RSD stressed that the following measures must be concentrated on
1)Think Influenza
2)Vaccination procedures
3)Action points must be taken forward from outbreak meetings
HAI Work Plan 2012/13
PEH has updated the report but it was not discussed at this meeting.
Risk Control Plan
PM raised, again the risk that ward staff will be unable to access data on patients when Apex is switched off and will not be able to obtain data further back than 3 months from Skystore. RSD will investigate this further with Steve Baguley.
Health Protection Scotland Exception Reports
There have been non since the last meeting
MRSA Screening Compliance
This subject was not discussed due to time constraints. / AMK
RSD
5 / New Business / There was no new business to discuss.
6 / Reporting to Clinical Governance Committee & Board / RSD asked for the management of non compliance surrounding hand hygiene to be added to the template.
RSD also felt that reassurance and good practice should be included in the report. This should not be in excessive detail but should highlight NHS Grampian’s continuing efforts and resulting success in the downward trend of certain Healthcare Associated Infections. / PEH
PEH
Item / Subject / Action to be taken and Key Points raised in discussion / Action
7 / AOCB / No other business was raised by the Committee members on this occasion.
8 / Date of next meeting /
14 May 2013 11.00 – 13.00 in the Board Room, Aberdeen Royal Infirmary.
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