NHS GRAMPIAN
Infection Control Committee
Minutes from meeting held on 17th May 2011
The Conference Room, Dugald Baird Centre, AMH
11.00 – 13.00
Present:
Roelf Dijkhuizen, Medical Director
Pamela Harrison, Infection & Prevention Control Manager
Tommy Ovens, Public Forum Representative
Gillian Macartney, Specialist Antibiotic Pharmacist
Jenny Ingram, SPSP Lead for NHSG
Gladys Buchan, Lead Nurse , North Aberdeenshire LCHP
Alexander MacKenzie, Consultant in Infectious Diseases
Pamela Molyneaux, Consultant Virologist
Karen Wares, Local Health Board Co-ordinator
Sandy Thomson,Lead Pharmacist, Dr Gray’s, Moray (deputising for Andrew Fowlie)
Roy Browning, Infection Control Senior Nurse
Caroline Hind, Development Pharmacist
Kathy Coutts,(deputising for Alan Pilkington / Mary McAuley)
Jane Adam, Public Forum Representative
Karen Stewart, Neo Natal Unit, AMH
Lynn Young, Dental Nurse Manager, University of AberdeenDentalSchool & Hospital
Stewart Rogerson,Head of Decontamination, NHSG (deputising for Gary Mortimer)
Heather Kelman, General Manager, Aberdeen City CHP
Elinor Smith, Director of Nursing NHSG
Dr Anne Marie Karcher, Medical Microbiologist / Infection Prevention & Control Doctor
Anneke Street, PA to Infection Control Manager(Minute taker)
1 / Introduction and Apologies /
RSD opened the meeting. Apologies were received from :
Vince Shields Helen Howie John Brett
Amanda Croft Jenny Gibb
Kathy Coutts informed the Committee that Ken McLay has now retired and Weldon Holesby is now the Clinical Director for Royal Aberdeen Children’s Hospital.
RSD welcomed Gladys Bucan – Lead Nurse, North Aberdeenshire LCHP who will now be sitting on the Committee in place of Eunice Chisholm. Also welcomed was Jane Adam - Public Forum Representative.
The Committee introduced themselves to both Gladys and Jane.
2 / Minutes of last meeting
17th May 2011 / Minutes from the meeting 17th May 2011 were ratified with no amendments.
Item / Subject / Action to be taken and Key Points raised in discussion / Action
3 / Matters Arising / There were no formal matters arising on the Agenda but RSD fedback that HH has been advised, by VS, on progress regarding the Measles SBAR.
RSD also requested that the recommendations resulting from the SBARbe added to the Risk Control Plan.
AMK informed the Committee that the poster submitted by OHS for the Champions Challenged poster competition included information on the decision to carry out immunity testing on staff, in future, rather than vaccination.
/ PEH
4 / Standing Items / 4.1 Surveillance Report (HAI-RT)
The HAI-RT was submitted.
PEH commented that she had changed the format of the report to show highlights split by sites for ease of reading. She summarised some of the report stating that within NHS Grampian as a whole CDIs have continued to fall since the last report, MSSA bacteraemias have fallen to their lowest rates in more than 12 months, although MRSA bacteraemias remain stable. The most recent cleaning compliance figures demonstrate a static picture of compliance accroos the NHS Grampian as a whole.
Aberdeen Royal Infirmary’s CDI rates continue on a downward trend, MSSA bacteraemia rates fell to their lowest in over 12 months and MRSA bacteraemias remain stable with only 1 case reported in the last 5 months.
JA queried the meaning of the word “stable”. RSD replied that this would be classed as between 0 and 2 cases per month and asked PEH to make this clear in the report. PEH to add.
Dr Gray’s Hospital have had no CDI cases since October 2010. There was a single MSSA bacteraemia case in March but this was the first since October 2010. There had been no MRSA bacteraemias for 8 months and hand hygiene compliance remains very high, with a compliance score of 98% in March 2011.
WoodendHospitalhad had no cases of MSSA since November 2010 or MRSA in the last 15 months. The rate of CDI remains stable.
The Community Hospitals section still contains infections, if any, from Royal Aberdeen Children’s and AberdeenMaternityHospital as the low rates would result in graphs containing no data. RSD asked for this to be made clear in the title of the section.
These figures show no cases of SABs since November 2010 with one case of MRSA in 15 months. The dramatic reduction in CDIs is maintained.
The rates of infection in the Out of Hospital section continues to be challening but CDI rates diagnosed outwith hospital or within 48 hours of being admitted appeared to be dropping again from January onwards. MSSA bacteraemias rates appeared to be fairly erratic being relatively high in January and March but with only 3 cases being present in February. However MRSA bacteraemias remain stable with either 0 or 1 case present monthly since November 2010.
RSD fed back to the Committee that the report had been very well received by the Board and that members found the graphs and the summary beneficial. / PEH
PEH
Item / Subject / Action to be taken and Key Points raised in discussion / Action
4 / Standing Items cont…. /
The last published figures (Oct – Dec 2010) showed NHS Grampian to have exceeded the SABS HEAT target for 2010/11. The latest HPS quarterly figures show that the reported SAB rate for NHS Grampian was 0.376 episodes per acute occupied bed days; this is slightly higher than the national average of 0.368
MRSA bacteraemia figures are promising and are lower than the national average at 0.045 although the MSSA bacteraemia rate is higher at 0.330.
ES queried as to whether the figures on page 2 of the report were statistically significant. RSD responded that although they were useful the trends shown by the graphs were of more importance and easier, for most, to view and be able to digest. In addition, due to NHS Grampian missing the 2010/11 HEAT target, we should commence monitoring our progress against the 2011/12 target now and include this in future reports.
AMK raised the subject of the official definition of Acute bed days. This has not yet been defined fully and AMK is waiting for clarification from David Henderson from Health Protection Scotland to ensure correct figures are submitted.
HK also informed the Committee that there had been a debate regarding this issue at a recent National Taskforce meeting. NHS Grampian need to know what we are monitoring and a strong evidence base is required.
RSD offered his help, should it be needed,to progress this issue.
SAB 90 Day Rapid Response Improvement Programme
PEH went on to feedback on the SAB 90 Day Rapid Improvement Programme which we are being supported on by Health Protection Scotland, NHS Education for Scotland (NES) and NHS Quality Improvement Scotland.
Interventions have been implemented and progress made
- Accident and Emergency continue to monitor compliance of their PVC checklist and their newly implemented PVC maintenance bundle.
- Ward 16 (Oncology) introduced a CVC maintenance bundle and have achieved 100% compliance.
- Wards 50 & 51 (Cardiothoracic) have begun using the PVC maintenance bundle and monitoring is about to commence.
- Members of the Infection Prevention & Control Team and Professional Development have undertaken awareness training sessions for junior doctors. This will be ongoing as further support has been secured.
- 6 areas across 3 hospitals – Aberdeen Royal Infirmary, Royal Cornhill & Aberdeen Royal Children’s Hospitals are now testing the new hand hygiene audit tool to monitor their own compliance.
- The PVC maintenance bundle and insertion checklist, blood culture packs and Chlorhexidine washes have now been rolled out across all General Surgery wards and the outcome is being monitored.
PEH summarised that the above programme has been extremely beneficial in bringing various core teams together and whilst the programme is drawing to an end the group will continue to work together to ensure that the long term aims are met and continued.
GB queried whether more areas would be involved with the programme in the future.
/ PEH
Item / Subject / Action to be taken and Key Points raised in discussion / Action
4 / Standing Items cont… /
PEH replied that more consolidation was required first. Further interventions would be being looked into around SABs that occur in non-healthcare settings.
The weekly surveillance of SABS is continuing but during the identification of source we are still finding approximately 50% of cases are not healthcare related.
RSD asked for an overview of these 50%. PEH to compile.
Work is continuing around CDIs and the last quarterly report, published by HPS, showed that NHS Grampian were slightly higher than the national target of 0.34. NHS Grampian is sitting at 0.38.
RSD commented that he felt there was a good chance that we would meet the target for 2010/11.
Hand Hygiene
PEH reported that Hand Hygiene continues to do well with figures for March 2011 showing 97% compliance.
4.2HAI Work Plan 2011/12
The HAI Work Plan 2011/12 was submitted.
PEH asked the Committee to discuss this report as requests were being made by the HEI for a copy of the work plan.Guidance was required prior to submitting a copy as to whether the Committee felt this was appropriate. Some of the sections were also not fully completed and required discussion and advice. Prior suggestions had been undertaken and a critical dependancies column had been added.
Actions 1.2.1 & 1.2.2
PEH and RSD to liaise on action 1.2.1 and 1.2.2.
GM reported that the Secondary Care Prescribing guidelines are now completed and the Primary Care ones are almost ready. GM and PEH to discuss
ST queried as to whether the Paediatric Guidelines had been finalised. GM to supply text on this.
Action 1.4.1
TO replied that the HAI PFPI Group were actively progressing involvement in groups and Committees but it was agreed that there are gaps surrounding the Antimicrobial Management Group. PEH will progress representation.
CH also described some patient information leaflet work which was ongoing and GM agreed to draft text for this.
Action 2.3.1
Amanda Croft has volunteered to take this forward on behalf of NHS Grampian. She has met with Jackie Ley who has offered support on measures already in place. This now requires implementation. An SBAR will be completed.
Action 2.5.1
This requires to be looked at nationally. ES will advise on this.
SR commented that a domestic monitoring tool is already in place and RAB reported that the protocol was already present and being adhered to. PEH to insert text. /
PEH
RSD/PEH
PEH/GM
GM
PEH
GM
PEH
Item / Subject / Action to be taken and Key Points raised in discussion / Action
4 / Standing Items cont… /
Action 2.6.1
PEH fedback that this was already being taken forward
Action 2.7.1
This requires input and discussion with SR and the HAI Education Group; current training needs to be reviewed.
SR fedback that there is a protocol in place at present but it has been criticised. SR and PEH to discuss.
Action 3.3.1
This is being looked into nationally. PEH to discuss with Health Protection Team.
HK asked for the wording to read “non hospital NHS settings”. PEH to amend.
Action 3.6.1
The remit of the Policy Review Group has been expanded but work could be done on better support for implementation of protocols.
Action 3.12.1
RSD felt that this action was on the horizon with the work done by the SAB90 group. JI and PEH to liaise regarding progress.
Action 4.1
This action is waiting for national guidance.
RSD informed the Committee that NHS Grampian structures have been reassessed since the HEI inspections and no further action will be required until the HDL has been reviewed.
PEH to amend text in this section.
Actions 4.2.1 & 4.2.2
This action is linked to guidance and protocols and a review of communications is required. PEH to enter text on progress.
Action 4.3.1
PEH to produce a report in July 2011. Previous report submitted in October 2010.
Action 4.4.1 & 4.4.2
This is soon to be completed.TO suggested this be brought up at the Community Forum discussions by Laura Gray.
RSD suggested that the real question was “how is the public involved”. This requires monitoring and feedback on hospital service and requires to be discussed more frequently by the Committee.
Karen Stewart attending from the Neonatal Unit informed the Committee that they have a “Friends of the Special Nursery” group. These are parents who offer their help in regard to hand hygiene audits being performed. Karen would liaise with PEH on this.
Regarding patient experience, Linda Oldroyd could be approached for advice on patient questionnaires.
/
SR/PEH
PEH/HPT
PEH
JI/PEH
PEH
PEH
PEH
Karen Stewart/PEH
Item / Subject / Action to be taken and Key Points raised in discussion / Action
4 / Standing Items cont… /
HK suggested the CHP Partnership Form become involved and another suggestion was feedback could be sought from the Scottish Health Council.
Action 4.8
National work on this is ongoing. Support has been offered to Health Boards by HPS, QIS, HFS etc in relation to outbreaks, incidents etc.
RSD asked for this action to be removed from the document.
Actions 5.1.1 & 5.1.2
PEH to insert text regarding the progress of these actions.
Action 5.3.1
A mandatory programme has been decided on.
Action 6.4.2
There is still work to do surrounding death certification and guidance to medical staff / doctors. A mechanism is also required to inform IPCT. PEH is dealing with this.
Action 6.4.3
This subject needs to be discussed to ascertain whether it’s practical to use the national tool or to have a local process.
Action 6.5.1
This action has been completed
Action 7.2.1
RSD requested the word “dashboard” be used in this instance. This dashboard has been designed and is being trialled, at present, by the Board and regularly reviewed.
ES reported that it has been progressed through various groups and work has developed in Moray already. Each ward is aware of their quality indicators.
ES to word text in this section.
Action 7.4.1 & 7.4.2
The progress section on this actionrequires to be completed.
We are aware and need to identify who requires to be trained. The Antimicrobial Group will support this action and oversee the progress.
Care Homes must also be included and the Health Protection Team needs to be liaised with regarding this.
Action 7.8.1
PEH to investigate this.
HH requested that incidents and outbreaks be included in the HAI-RT for this point forward.
PEH to include these in the next report and HH will provide monthly reports. These are to be included in the report and discussed by the Committee.
/
PEH
PEH
PEH
ES
SM
PEH
HH
Item / Subject / Action to be taken and Key Points raised in discussion / Action
RSD requested that this report be submitted for information at the next meeting but the Risk Control Plan would, instead, be discussed at length.
4.3 Risk Control Plan
The NHSG Risk Control Plan was submitted but not discussed due to lack of time.
4.4Outbreaks / Incidents
PM reported that RSV infections were present in ward 16 ARI. There is to be a meeting on 18th May to discuss this. It may be that staff are working whilst carrying a cold or visitors are attending the hospital whilst ill and are spreading the infection. Due to the patients in ward 16 being immunocompromised this infection can be life threatening.
It was also reported that Norovirus is mostly prevelant in Nursing Homes at present.
Norovirus has been present this year but has not been as severe as in 2010 at Dr Gray’s Hospital and WoodendHospital.
NHSG is more prepared for 2012 with a public awareness poster having been developed. Unfortunately this was slightly too late for the 2011season but will be used next year in all locations.
PEH fed back that there had been no other outbreaks since the last time the Committee met.
Important issues surrounding vCJD were discussed at length during the last meeting and AMK/Henry Watson were to be meeting with RSD to take these forward. / PEH
5 / Reporting to Clinical Governance and Board /
The HAI-RT was agreed and will be submitted to the Board.
6 / AOCB /
None.
7 / Date of next meeting / 12th July 2011, 12.00 – 14.00 The Conference Room, Dugald Baird Centre, AMH
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