NHS GRAMPIAN
Infection Control Committee
Minutes from meeting held on 14 May 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
KDW – Karen Wares, Local Health Board Co-ordinator
JA - Jane Adam, Public Forum Representative
GM – Gary Mortimer, Head of Estates
DOB – Dr Deirdre O’Brien, Infection Control Doctor / Medical Microbiologist
AM – Dr Alexander Mackenzie, Infectious Diseases Consultant
GB – Gladys Buchan,Operational Lead Nurse, Aberdeenshire LCHP
GMacGillian Macartney, Antibiotic Pharmacist
MR – Dr Maria Rossi, Consultant – Public Health Medicine
PM – Dr Pamela Molyneaux, Consultant Virologist
FD – Frances Dunne – Senior Service Manager , Intermediate Care (attending for Heather Kelman)
KT – Keith Thomson–Head of Health & Safety
EM – Eleanor Murray – Quality Lead Nurse, Acute Sector
AS - Anneke Street, PA to Infection Control Manager(Minute taker)
1 / Introduction and Apologies /
RSD opened the meeting. Apologies were received from :
Jenny Gibb (JG) Stewart Rogerson (SR) Heather Kelman (HK) Johnathon Lofthouse (JL)
Roy Browning (RAB) Jane Ormerod (JO) Katherine Targett (KT) Sandy Thomson (ST)
Elinor Smith(ES) Anne Marie Karcher (AMK) Sue Swift (SS)
2 / Minutes of last meeting
14 May 2013 /
The minutes from 14 May 2013 were ratified by the Committee with no amendments.
3 / Matters Arising
Item 3.1 /
Community CDI
DOB prepared and submitted a paper to the Committee which members agreed was very informative. Some of the findings concluded that during the period September 2012 - April 2013 25% of the cases that occurred could not be attributed to antibiotic use and that some recurrent cases could be attributed to long term steroid use. DOB also fedback that the research party involved would now begin analysing data for a 24 month period.
RSD agreed that the report was very helpful and hoped that the findings would enable NHS Grampian to ascertain more causes of Clostridium difficile infections and assist in the further reduction of them.
Item / Subject / Action to be taken and Key Points raised in discussion / Action
4 / Standing Items
Item 4.1 / Sector Reports – Acute
EM produced and submitted this report to the Committee.
New areas of concern
1 (a) A lack of consistency of managerial ownership still exists surrounding environmental audits. Progress will be difficult to advance if non compliant areas are not challenged effectively; appropriate questions need to be asked with regard to progress and problems encountered and the flowchart present on the Infection Prevention and Control web page needs to be used for escalation. EM has spoken to Divisional Unit Operational Managers and General Managers on this issue and will continue to do so. Audits continue to be performed quarterly. RSD felt that the upcoming HEI visit will focus managers’ minds on this issue and hopefully promote ownership with regard to non compliance.
1(b)The National Dress Code will be up for review on 23 September 2013 and EM suggested the authors be given feedback from NHS Grampian before it is reviewed and ratified again. RSD was keen for this to happen and suggested that the National and Local Dress Code policies were looked at together to formulate this feedback. Non compliance should also be taken seriously. FD notified the Committee that the Partnership Group were to be collating feedback on this and EM will take advice from this Group.
1 (c)There should be vigilance regarding the Influenza H7N9 virus that has been reported inChinasince
March 2013. It would only take 1 traveller to bring this virus into Grampian and EM queried whether there was planned action/guidance, should this occur, from Health Protection for General Practitioners etc. PM voiced concern regarding information to junior members of medical staff with regard to the H7N9 virus. MR stated that dissemination of information was being cascaded down through medical staff and RSD suggested also using the Deanery to help with the distribution.
1 (d) The measles outbreak in England and Wales is still a concern. Laboratory services here are not immediately able to test at short notice for large members of staff who may not have known immune status.
RSD asked for an update on the currentprotocol on exposure. MR fedback on this and stated that the national guidance from the Scottish Government was being released today but she was unaware of any confirmed guidance outwith incident management. NHS Grampian’s uptake on the MMR vaccine is slightly better than in England and Wales but advice to healthcare workers needs to be more clear – immunity is assumed by 2 MMR vaccinations and an offer of an extra MMR can be given should an incident occur. RSD stressed NHS Grampian must be following national guidance and be compliant with this and suggested that a meeting be organised to discuss and ensure local compliance and preparation, should a situation occur. This meeting should include the Health Protection Team, Occupational Health, Virology, the Infection Prevention and Control Team and a non clinical manager. SM also stressed the importance of a targeted approach to areas of high risk where patients are more susceptible.
1 (e) Novel Coronavirus is still an issue and has been since September 2012. / MR
Item / Subject / Action to be taken and Key Points raised in discussion / Action
4 / Standing Items cont… / Progress against areas of concern previously reported
2 (a) Hand hygiene compliance is still an issue in a number of areas. RSD queried the escalation process and whether it was being used effectively. EM fedback that there is a flowchart process in place but so far only 1 Problem Assessment Group (PAG) meeting has been called. Decisions need to be taken with regard to these meetings much more quickly and within 2 weeks of non compliance; this must be a priority.
Sector Reports – Aberdeenshire CHP
GB produced and submitted this report to the Committee.
New areas of concern
1 (a)Are Community hospital prepared for HEI inspections? GB reported that education and training has been fore front in the last few months and local audits have been completed by all Community Hospitals. Area results have been compiled and submitted to Area Managers at their face-to-face meeting and recommendations will be agreed, including a future audit programme. There are still issues surrounding environmental problems such as doors missing from areas or no locks on existing doors. There is also some work still to be done surrounding cleaning of equipment but Area Managers will be taking responsibility for this. For areas not 90% compliant action plans are in place. With regard to facilities there are 243 items to be risk assessed. There are still discrepancies surrounding the Dress Code also e.g hair tied back but not off the collar. The former HEI Short Life Working Group, has been reviewed and is now known as the Aberdeenshire HAI Group. This group will extend offers for others to join in due course. GM requested that Facilities be invited to sit on this Group.
1 (b)The National Influenza Vaccination Schools Programme has raised the issue of staff transporting sharps bins within private vehicles. KT confirmed that work is being undertaken with specific emphasis on colleagues using private cars for sharps transportation and findings will be shared as soon as they become available. KT confirmed that school nurses were not, at present, breaching legislation. KDW also informed the Committee that the National Influenza Group met this morning and this issue was also on their agenda.
Progress against areas of concern previously reported
2 (a) This issue surrounded patients in TurriffHospital being identified with MRSA and the fact that hand hygiene scores within the hospital were below the compliant rate of 90%. A Problem Assessment Group meeting was requested by DOB and held on 18 March after which an action plan was put in place. Hand hygiene audit results are now 100% and communication with other professionals e.g Allied Healthcare Professionals and Pharmacists has improved.
Item / Subject / Action to be taken and Key Points raised in discussion / Action
4 / Standing Items cont…
Item 4.2 / Sector Reports – Aberdeen City CHP
FD produced and submitted this report to the Committee
New areas of concern
2 (a) FD reported to the Committee on the recent Influenza outbreak at Woodend General Hospital and stressed that staff awareness has been raised with regard to symptoms and actions to be taken should symptoms present again (who to contact etc.)
2 (b) This risk surrounded the availability of the medication Oseltamivir for patients and staff when required out of hours. DOB replied that this is being discussed by the Working Group after it was raised at the recent debrief meeting.
2 (c) Bed spacing within one of the wards affected could have had a contributory effect to the resent outbreak. FD reported that an SBAR was completed and sent to the General Manager. A walkround was then completed by the Chief Operating Officer and the General Manager; the decision was then made that bed numbers could be reduced.
2 (d) The situation this ward being used as a thoroughfare may also have been a contributing factor and therefore an SBAR was completed. The introduction of doors has now been supported.
RSD thanked members for these reports and asked the Committee if they thought specific information, concerning Aberdeenshire’s preparations for an HEI inspection and the measles guidance should be reported to the Clinical Governance Committee. This was agreed.
GM suggested that Water and Waste agenda items/issues should also be reported and posed the question as to whether a Facilities sector Report was required. RSD agreed that it was.
PEH was concerned regarding the process of issues being escalated up through the Management structure not being implemented. GB replied that the process was amended for local use within the Shire .
GB will send this to PEH for information.
HAI Work Plan 2013/14
PEH reported that the Infection Prevention and Control team met to discuss this report and some outstanding issues have been carried forward into the 2013/14 report.
Delivery Area 1 – Antimicrobial Prescribing & Resistance
GMac reported that there were additional guidelines to be added to the report. GMac will email this information
to PEH
Delivery Area 2 – Cleaning, Decontamination and the Build Environment
Action 2.2 - Potential integration of existing FMT to infection control environmental audit
The national Facilities Management Toolwas produced to collectEstates and Domestic monitoring data. EMfelt that a national environmental tool is required soon in order to have this data included in LanQuip. Perhaps this could be suggested to the HEI Team on their impending visit to Aberdeen Royal Infirmary in June? / GB
GMac
Item / Subject / Action to be taken and Key Points raised in discussion / Action
4 / Standing Items cont… / EM stressed that a timescale is needed for the introduction of a national tool for planning purposes. PEH replied that hopefully this should be confirmed within the next 2 months.
Action 2.3 - Develop and implement a standardised cleaning system for cleaning patient equipment
KDW reported that this was still being discussed by the National Decontamination Group but is hopefully almost decided. The issue remains the use of cleaning wipes. Medical staff have been invited along to comment on this.
Action 2.5 – Review of evidence base for isolation and terminal cleaning
Action 2.7 – Training requirements for those responsible for cleaning and decontamination
These have been added due to agreements surrounding the model policy. There is work to be done on these.
Action 2.8 – Review HAI Scribe for controlling risk in the Built Environment
The HAI Scribe process is robust and fit for purpose but the Infection Prevention and Control Team need to be involved earlier in SCRIBE processes.
Delivery Area 3 – Infection Prevention and Control Guidance and Practice
Action 3.1 - Development and implementation of a single audit tool
There is still ongoing work to ensure Lanqip and BOXI systems can work together
Action 3.5 – National Infection Prevention and Control Guidance will be reviewed
PEH to discuss this with GM
Action 3.6 – Development and ongoing review of HAI policy and guidance compendium
Good links have been established with National guidance and are present on the NHSG Intranet
The date in the timescale column for Action 3.1 requires to be amended to December 2013
Action 3.7 – Prioritise Key Policy and Guidance for Infection Prevention and Control in Community
Local implementation is being considered here. PEH to discuss with the Health Protection Team
Action 3.12 – Development and implementation of education and training on aseptic technique, wound management, invasive devices and specimen taking
There is still some work to be done surrounding aseptic technique training and the HAI Education Group are looking into rolling out other training programmes.
GM queried whether he could add emerging actions surrounding guidance in practice to this delivery area.
PEH confirmed that additions can be made.
Delivery Area 4- Organisational Structures
Action 4.1 – Development of a National framework for healthcare associated infection
NHSG have now been waiting for national guidance on this since 2011. The local Infection Prevention and Control policy requires to be reviewed.
Action 4.8 – Ongoing implementation and review of National support framework for NHS Boards
This is an ongoing review. / PEH/GM
PEH
PEH
Item / Subject / Action to be taken and Key Points raised in discussion / Action
4 / Standing Items cont…
4.3
4.4
4.5 / Delivery Area 5 – Staff and Leadership
Action 5.3 – Review of Infection Prevention and Control competencies required
National Infection Prevention and Control competencies are applicable to all healthcare workers. There is work to be done to decide how we incorporate these competencies into job descriptions and Personal Development Plans (PDPs)
Action 5.7 – Development of surveillance and epidemiology skills and capacity at NHS Board level
Discussion centred around who required epidemiology training. Courses were run by Health Protection Scotland but staff found attendance problematic RSD asked for the action to be re worded to reflect who required this training.
Delivery Area 6 – Quality Improvement
Action 6.5 – Delivery of improvement methodology training in all Infection, Prevention and Control disciplines
This action requires more work to be undertaken at present. Staff will be discussing Personal Development Plans in due course and identifying quality improvement measures for next year.
Delivery Area 7 – Surveillance
There has been a substantial amount of work and various actions carried over from last year under this delivery area. MR raised the issue of risks surrounding dental practitioners. PEH fedback that discussions had been had with regard to the new inspection processes and it had been confirmed that no further input was required.
RSD agreed that systems were in place for the future but stressed that NHS Grampian must take responsibility for NHS patients.
Risk Control Plan
This report was submitted to the Committee but not discussed on this occasion.
Health Protection Scotland Exception Reports
There were none received.
MRSA Screening Compliance
This is going to be investigated further as Key Performance Indicators have now been introduced.
RSD asked for this to be put on the agenda for the next meeting. / PEH
PEH
5 / New Business
5.1 / Water Safety – Reporting to Board, Governance & Island Boards
A CEL (CEL 08(2013) has been received by the Chief Executive regarding Water sources and the potential risk to patients in high risk units; this is revised guidance.
GM reported to the Committee that the Water Safety Group is up and running and that this group will also discuss the Pseudomonas guidance attached. The Committee was formerly known as the Legionella Group and was formed to work on completing the action plan regarding the Legionella tool. There should be annual reporting on this subject and the Infection Control Committee should feed this information to the Board via the Infection Control Annual Report.
Item / Subject / Action to be taken and Key Points raised in discussion / Action
5 / New Business cont..
5.2 / RSD confirmed that he was happy for progress to be reported onthrough the Infection Control Committee via the Work Plan and that this would be looked at during the next meeting.
GM also queried whether NHS Grampian should be providing water safety advice to NHS Orkney and NHS Shetland as neither of these Boards have Water Safety Groups.
DOB replied that Shetland already has its own Infection Prevention and Control Doctor but AMK should be able to clarify and feedback on this.
Waste Management
RSD asked for this to be added to Risk Control Plan. / AMK
6 / Reporting to Clinical Governance Committee & Board
6.1
6.2 / HAI Report to the Board
PEH reminded the Committee that the Clinical Governance no longer receive this report in this format and went on to explain the new funnel graphs (pages 3, 4& 5) used for Staphylococcus aureus bacteraemia and Clostridium difficile surveillance; it was felt that these were more self explanatory and easier to understand rather than the amount of text, regarding rates, that was previously used.
RSD replied that he found funnel plots helpful but unfortunately they are not understood easily by the general public and some text would be needed for explanation.
PEH will remove the graphs from the report.
PEH also spoke to the Committee on the HEAT Targets and the Woodend General Hospital Estates Monitoring, (which is now above the National Compliance level) at 95%.
GMac pointed out that the narrative on page 2 of the report was out of date.PEH will update this.
HAI Report to Clinical Governance Committee (Template)
The Sector reporting information has been added to this report and RSD also felt it would be beneficial to add areas of good practice.
GB also requested that the addition of the Aberdeenshire assurance team be added to the template.
A verbal update needs to be given to the Committee with regard to Progress (h) regarding CJD as this risk requires to be reviewed. PEH will update text boxes prior to the report being submitted. / PEH
PEH
PEH
PEH
7 / AOCB / No other business was raised by the Committee members on this occasion.
8 / Date of next meeting /
17 July 2013 11.00 – 13.00 in the Conference Room, MacGillivray Centre, AberdeenMaternityHospital
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