NHS GRAMPIAN
Infection Control Committee
Minutes from meeting held on 13th November 2012
Conference Room, MacGillivray Centre, AMH
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
SR – Stewart Rogerson,Decontamination Lead for NHSG
AMK – Dr Anne Marie Karcher, Infection Control Doctor / Medical Microbiologist
RAB – Roy Browning, Infection Prevention & Control Senior Nurse
AM – Dr Alexander Mackenzie, Infectious Diseases Consultant
DOB – Deirdre O’Brien, Medical Microbiologist
GB - Gladys Buchan, Lead Nurse, North Aberdeenshire LCHP
Anneke Street, PA to Infection Control Manager(Minute taker)
1 / Introduction and Apologies /
RSD opened the meeting. Apologies were received from :
Helen Howie (HH) Jenny Gibb (JG) Pamela Molyneaux (PM) Tommy Ovens (TO)
Gary Mortimer (GM) Lynn Young (LY) Jane Ormerod (JO) Sue Swift (SS) Gillian Macartney (GMac)
Elinor Smith (ES) Sandy Thomson (ST) Frances Dunn (FD) Jenny Ingram (JI) Elizabeth Murphy (EM)
Katherine Targett (KT) Eleanor Murray (EM)
2 / Minutes of last meeting
11th September 2012 /
The minutes from the 11th September were ratified by the Committee with no amendments.
3 / Matters Arising
Item 3.1 /
CJD
AMK updated the Committee on this subject and confirmed that a meeting between herself, Amanda Croft and Terry O’Kelly is imminent.
RSD queried whether updated procedures were now in place and AMK replied that the situation was no looking more positive. Labs have had more queries from staff, patients seem to be being brought to the attention of the relevant people and clinicians and staff are checking patient’s histories.
SR informed the Committee that the National Decontamination Panel will be disbanded as of 7th December and all decontamination decisions will be made at local level. This will be the responsibility of the Chief Nursing Officer. NICE Guidelines must be applied at local level.
Item / Subject / Action to be taken and Key Points raised in discussion / Action
4 / Standing Items
Item 4.1 / HAI Report
Pamela summarised the report for the Committee members.
NHS Grampian
Monthly Hand Hygiene audit results show compliance has remained above 95% since October 2011.
Cleaning and estates monitoring compliance remains stable and above the 90% target. The score has been affected by some issues at Woodend. SR commented that this should improve during December as a number of wards are to close and this will give an opportunity to concentrate on improving facilities in other areas of the hospital
Clostridium difficile infections for August and September were 17 and 15 respectively
There were 14 Staphlococcus aureus bacteraemias in August and 13 in September
Aberdeen Royal Infirmary
Monthly ward Hand Hygiene audits show compliance above 95% up until September 2012. During September there were 2 wards that did not meet the target and have been closely monitored and supported since to enable them to achieve compliance.
PEH updated the Committee regarding these wards and explained that an action plan was developed and daily audits were performed for a week. These areas were still not compliant and therefore the escalation process was used and compliance was addressed.
Cleaning and estates monitoring compliance remains well above the 90% target.
Clostridium difficile infection cases numbered 3 in August and 6 in September.
Staphlococcus aureus bacteraemia cases numbered 3 in both August and September.
There has been a single case of MRSA bacteraemia in the last 12 months
Dr Gray’s Hospital
Hand Hygiene compliance still remains very high.
Cleaning and estates monitoring results are also above the 90% target
There was a single Clostridium difficile infection case In August but none in September
There were 2 MSSA bacteraemias in August but none in September
WoodendHospital
Hand Hygiene compliance remains about the 95% target.
Item / Subject / Action to be taken and Key Points raised in discussion / Action
4 / Standing Items cont… / Cleaning monitoring compliance remains stable and estates monitoring remains just below the 90% target, although this is steadily improving.
Single Clostridium difficile infections were diagnosed in August and September but there have been no Staphlococcus aureus bacteraemias since the last report.
Community Hospitals
There were no Clostridium difficile infections or Staphlococcus aureus bacteraemia cases in either August or September.
Out of Hospital
There were 12 Clostridium difficile infections in August and 8 in September which had been diagnosed out with or within 48 hours of being admitted to hospital.
Staphlococcus aureus bacteraemias totalled 9 in August but dropped to 4 in September.
More than 50% of Clostridium difficile infection cases and 60% of Staphlococcus aureus bacteraemias in August and September were diagnosed out with or within 48 hours of being admitted to hospital
Staphlococcus aureus (including MRSA)
PEH informed the Committee that figures from the last Health Protection Scotland report showed NHS Grampian to be within the average for Scotland and back on trajectory to meet this years target, as shown on the graph on page 8 of the report.|
Following the last HEI inspection and the subsequent video conference with Health Protection Scotland an offer has been received from Health Protection Scotland to offer some assistance with our Staphlococcus aureus bacteraemias. PEH is to organise a meeting with Evonne Curran to discuss a way forward.
Clostridium difficile
NHS Grampian are well ahead of target at present but AMK did remind the Committee that additional recording for age range, 15 – 64 years,would be commencing shortly and these figures may not be as complimentary. This may be due to the nature of business within Aberdeen (oil industry workers) and the high student population.
Hand Hygiene
NHS Grampian continue to be 95% compliant within the national audits and local results will not change that figure; we are comfortably above the national target.
Cleaning and Estates Monitoring
Health Facilities Scotland and the Woodend Hospital Management Team are in contact regarding the compliance at Woodend.
Healthcare Environment
Overall, the feedback from the latest HEI inspection has been positive with only 6 requirements noted in the report. One of these was in relation to personal protective equipment (PPE) and specifically regarding glove / PEH
4 / Standing Items cont…
Item 4.2
Item 4.3 / selection; the Infection Prevention and Control Team have done a lot of work surrounding staff’s correct selection of gloves recently.
PEH fedback that there has been substantial work done surrounding Standard Infection Control Precautions, communication and ensuring that environmental processes are leaner than before.
Annette Rankin visited Aberdeen Royal Infirmary on 23rd October 2012 and was escorted by EM to various areas. During the visit Annette requested to see the monitoring of the Patient Equipment Cleaning Standard Operating Procedures (SOPs) and was reassured that they were being utilised.
RSD commented that he had heard numerous comments, from staff, regarding the frequency of checking and inspecting. Perhaps a reduction in frequency should be sought ?
PEH replied that the checks will be reduced. The Tool has been reviewed and is now shorter in length and with reduced duplication and an action planning mechanism is now in place for the Acute Sector Management Team to discuss recurrent issues.
RSD stressed that documented evidence is required that issues are being discussed at the appropriate level and asked that PEH inquire at the next Management Team meeting how decisions and implementation of them, with regard to recurring issues is being checked, discussed and documented.
Norovirus
AMK informed the Committee that she was having a meeting with the Infection Prevention & Control Team that afternoon to discuss the number of staff and patients affected this week.
RAB also made the point that Norovirus was particularly prevalent within the Community at present and that it cannot be discounted that anyone could be admitted to hospital with enteric symptoms.
AMK stressed that staff are now more aware and more samples are being submitted earlier to labs which is a positive step. The problem continues that the alcohol gel present is not effective against the virus and she suggested that a higher strength gel (containing copper) may be of more use, although this would have cost implications. She was to raise this at the next Infection Prevention & Control Team meeting.
RSD queried whether the Emergency Care Centre was using the higher strength gel as this may minimise a patient’s stay in hospital and was this gel being used within other Boards in Scotland.
RSD asked that a judgement be made within a couple of days whether this change in product would be beneficial and if decided that it would, a gradual implementation of the product into the Emergency Care Centre could commence.
AMK and PEH to investigate further.
Surgical Site Infection (SSI) Surveillance
PEH feedback that the SSI rates within NHS Grampian are lower than the average across Scotland.
Orthopaedic procedures have been being monitored for some time now but the numbers are minimal and PEH feels that it may be beneficial for another procedure to be monitored.
RSD agreed and stated that he would be happy to take this suggestion to the National Group if another procedure was suggested.
HAI Work Plan 2012/13
This report has been extensively updated by PEH but the was not discussed due to the lack of Operational members at the meeting.
Risk Control Plan
This report was not discussed / PEH
AMK/PEH
4 / Standing Items cont…
Item 4.4
Item 4.5 / Health Protection Scotland Exception Reports
There have been non since the last meeting
MRSA Screening Compliance
Fiona MacKenzie’s report showed that screening compliance remains too low, with issues on who to swab and which sites.
RSD asked the Committee for suggestions on how to progress with this and DOB suggested that this be taken back to medical staff.
AMK felt that the system has become chaotic within high risk areas. Nursing staff do not have access to Labs systems and Senior House Officers are changing every 16 weeks. Perhaps a “flag” on TrakCare could be devised to inform staff which patients should be swabbed ?
RSD asked that gaps in the high risk areas are prioritised and procedures put in place to deal with these discrepancies – they must be reconciled. RSD to approach Clinical Leads.
PEH will speak to EM and Hazel Whyte with regard to using Hazel’s tool that is in operation at Dr Gray’s. This tool monitors the correct swabbing of the correct patients.
AMK suggested a lead for this but PEH replied that since this was no longer a project there was no lead, as such and remains under the remit of the Infection Prevention and Control Team.
To this DOB offered to take on responsibility for certain areas and discuss the issues with medical staff. / RSD
PEH
5 / New Business
5.1 / Antimicrobial Management Team Annual Report
AM spoke to the report and praised GMac on it being a very thorough and comprehensive document.
6 / Reporting to Clinical Governance Committee & Board / The Antimicrobial Management Team Annual Report and the HAI Report will be submitted.
7 / AOCB /
No other business was raised.
8 / Date of next meeting /
17th January 2013 11.00 – 13.00 in the Conference Room, MacGillivray Centre, AberdeenMaternityHospital
1