NHS GRAMPIAN
Infection Control Committee
Minutes from meeting held on 13th September 2011
The Board Room, ARI
11.00 – 13.00
Present:
Dr Roelf Dijkhuizen, Medical Director, NHSG
Pamela Molyneaux, Consultant Virologist
Pamela Harrison, Infection Prevention and Control Manager
Gillian Macartney, Specialist Antibiotic Pharmacist
Roy Browning, Senior Infection Prevention and Control Nurse
Kathy Coutts,Theatre Manager, RACH (deputising for Alan Pilkington/Mary McAuley)
Jane Adam, Public Forum Representative
Stewart Rogerson,Head of Soft FM Services (and Decontamination Lead) (attending for Gary Mortimer)
Neil Hendry, Practice Educator Facilitator, North Aberdeenshire CHP (attending for Gladys Buchan)
Helen Howie, Consultant in Public Health Medicine, Health Protection Team
Dr Elizabeth Murphy, Consultant in Occupational Health
Jenny Ingram, Patient Safety Programme Manager
Gail Thomson, Business Manager (deputising for Julie Fletcher)
Elinor Smith, Director of Nursing ,NHSG
Dr Alexander MacKenzie, Consultant in Infectious Diseases
Vincent Shields, General Manager, Acute Sector
Jane Ormerod, Head of Professional Development (and HAI Education Lead)
Dr Anne Marie Karcher, Medical Microbiologist / Infection Prevention & Control Doctor
Anneke Street, PA to Infection Control Manager(Minute taker)
1 / Introduction and Apologies /
PEH opened the meeting. Apologies were received from :
Tommy Ovens Karen Wares Caroline Hind Jenny Gibb
Amanda Croft Julie Fletcher Gladys Buchan Lynn Young
2 / Minutes of last meeting
17th May 2011 /
Minutes from the meeting 12th July 2011 were ratified with the following amendments.
HH asked for the wording on Page 1 item 3 to be changed. She would be providing updates on outbreaks within the hospital setting only.
3 / Matters Arising /
There were no formal matters arising on the agenda .
Item / Subject / Action to be taken and Key Points raised in discussion / Action
4 / Standing Items / 4.1Surveillance Report (HAI-RT)
The HAI Report was submitted.
PEH summarised the report which showed, across NHSG,MSSA bacteraemias rose to their highest level in 7 months in June but fell again to well below the 15 monthly averageof 13 in July with 9 cases occurring in this month. Clostridium difficile infections also rose slightly in July but are still much lower than for the same period in 2010.
MRSA bacteraemias remain stable at one case per month in June and July.
Aberdeen Royal Infirmary
Within Aberdeen Royal Infirmary there was a slight increase in Clostridium difficile infections in June but the number of cases fell again to below the 15 month average of 4 per month in July; 2 cases occurred within July.
The number of MSSA bacteraemias rose to their highest level in 5 months in June but fell to below average in July.
MRSA bacteraemias remain stable only 1 case per month for June and July was reported.
Dr Gray’s Hospital
Here there have been no cases of Clostridium difficile since October 2010.
There was only a single case of MSSA bacteraemias in June and July and only 1 case of MRSA bacteraemia in the last year has been reported.
WoodendHospital
Clostridium difficile infections remain stable at between 0 - 2 per month over the last year.
There have been no MSSA bacteraemias in June or July and a single case of MRSA bacteraemia in the last 15 months.
Community Hospitals
The reduction in Clostridium difficile infections is being maintained with only single cases in June and July, occurring in Fleming and Royal Cornhill hospitals.
No cases of Staph aureus bacteraemia have occurred since November 2010 and only 1 case of MRSA in the last 15 months.
Out of Hospital
The number of cases of Clostridium difficile presentingoutwith hospital or within 48 hours of being admitted rose in June but fell again to 8 in July.
MSSA bacteraemias rose to their highest level in June but fell again dramatically in July and the number of MRSA bacteraemias remains stable with single cases only in June and July.
HEAT Targets
NHS Grampian exceeded the Staphylococcis aureusbacteraemia HEAT target for 2010/11 by 46 cases although, as published in the Health Protection Scotland Quarterly report for January – March 2011, NHS Grampian’srate was favourable at 0.283 episodes per 1000 acute occupied bed days (AOBDs), as opposed to NHS Scotland as a whole where the rate was 0.326.
Item / Subject / Action to be taken and Key Points raised in discussion / Action
4 / Standing Items cont…. /
The MRSA bacteraemia rate was 0.423 episodes per 1000 AOBDs compared with 0.053 for NHS Scotland as a whole and for MSSA bacteraemias the rate was 0.260 cases per 1000 AOBDs compared to 0.273 in NHS Scotland showing that both MRSA and MSSA bacteraemia rates were lower than the national average for this quarter.
AMK will provide guidance around clearer wording of this data being recorded in the report.
ES requested that it was made clearer in the title that RoyalCornhillHospital was included in the Community Hospitals section. She also queried where Paediatrics and AberdeenMaternityHospital were included.
PEH replied that statements were made, to this effect, on the scorecard for Community Hospitals. There is a new template imminent and due to the reorganisation of Acute services PEH agreed to look at this again.
VS suggested avoiding “batching” hospitals together and that there may be a possibility of individual clinical specialties assessing each occurrence.
RSD replied that the national template was helpful locally and suggestions were always welcome but the layout of the report is dependent on the number of incidents within hospitals, as graphs showing zero data would not be helpful.
RSD asked the Committee if they felt the progress on the reduction of Clostridium difficilerates was favourable.
AM replied that NHS Grampian was ahead of target and felt that the HEAT target was achievable.
AMK feedback that there are still pockets of cases within the Community and felt that reduction here would be the biggest test.
RAB felt that the Community rates were mostly Practice related and informed the Committee that prescribing within the Community has been discussed at the Infection Prevention and Control weekly surveillance meetings; as a result letters are now sent to practices when patients are tested positive for a CDI. These letters suggest the limited use of the 4 C’s.
RSD asked for views on the MSSA rates and AMK replied that she felt this continued to be device related. In certain areas bundles are not being followed and Chloraprep is not being used for CVC insertion.
PVC training for FY1 and FY2s has been arranged through September – November. FY2s will attend separate training with certificates given for compliance. In the target areas, meetings are being held with staff but at present, the Point Prevelance Survey, that the Infection Prevention and Control Department are undertaking, is taking priority.
JI advised the Committee that Carol Low and Eleanor Murray are working on maintenance bundle documentataion.
RSD concluded that the following should be a priority
- look into prescribing within the Community in relation to Clostridium difficile
- training regarding the correct insertion technique and monitoring of bundle maintenance in relation to MSSA
Item / Subject / Action to be taken and Key Points raised in discussion / Action
4 / Standing Items cont… / Hand Hygiene
PEH feedback that NHS Grampian continues to perform well and the compliance now sits at 96%
Cleaning and the Healthcare Environment
The NHS Scotland National Cleaning Compliance Report for quarter 4 shows NHS Grampian, as a whole, to be above 90% compliant with Woodend Hospital slightly below the target level. This has been explained and is due to staffing levels. New staff are now in post and have been trained.
Outbreaks and Incidents
Both the CJD and TB incidents were discussed under Items 5.3 and 5.4.
4.2 HAI Work Plan 2011/12
The HAI Work Plan 2011/12 was submitted.
PEH informed the Committee that she had updated the report and cross referenced it with the Risk Control Plan.
Antimicrobial Prescribing and Resistance
Item 1.3 - Todevelop a joint action plan to address the treatment and surveillance of staphylococcus aureus bacteraemias.
We are still awaiting SAPG’s algorithm and will not meet the local deadline.
Cleaning, Decontamination and the Built Environment
Item 2.3 – Develop and implement a standardised system for cleaning patient care equipment
There is still a lack of a cleaning schedule. Amanda Croft is taking this forward with Health Protection Scotland and the timeline has been amended to November 2011.
Item 2.6 – National Guidance for procurement of reusable and communal equipment
A section requires to be added to the Medical Equipment form. PEH to progress this.
Infection Prevention and Control Guidance and Practice
Item 3.1 – Development and implementation of a single audit tool to assess hand hygiene compliance
JI reported that Carol Low, Patient Safety Co-ordinator was working with Karen Wares, Hand Hygiene Co-ordinator on this. It has been decided that the 5 criteria to measure hand hygiene technique which are currently being rolled out will not change. There was some confusion over whether the national audit tool had been finalised and PEH will confirm.
Item 3.6 – Development and ongoing review of HAI policy and guidance compendium
This is an ongoing review. The Policy Group have expanded their remit and are still awaiting the Health Protection Scotland model policy. This will be adopted for use by NHS Grampian.
Organisational Structures
Item 4.3 – Production of an annual healthcare associated infection annual report
PEH will progress this. The report will be drafted and sent out, via email, for comment.
Staff & Leadership
Item 5.3 – Review & Develop framework and resources for mandatory education
Roll out of the Hand Hygiene e-learning online training package is still encountering problems and many enquiries are being received by the IPCT as to how to access it. There is still a considerable investment of time into this training package by the IPCT.
Quality Improvement
Item 6.4 – Develop guidance on certification of deaths
National guidance on this issue is still awaited. The Infection Prevention and Control Teamcontinue to receive enquiries from the Procurator Fiscal requiring more information on certain cases. It would be beneficial for the medical staff to provide notification of deaths caused by an HAI to be notified to the IPCT.
RSD proposed that NHS Grampian use this opportunity to advocate a better system of reporting.
PEH posed the question of patients who died within the Community and not in a hospital setting. Who would report the death to the IPCT in these cases?
HH suggested that updated guidance was required and stated that there is work ongoing regarding HAI deaths that is being led by the Scottish Government.
RSD was aware of this work being headed by Bob Masterton in Ayrshire and Arran regarding rewriting the “CEL” but stressed that death certification was not a specific part of this work. This could take up to 1 year.
HH suggested that the Infection Prevention and Control Department take this forward as a process of reporting and recording is required.
RSD requested that this be added to the Workplan.
Surveillance
Item 7.4 –Introduction of annual Point Prevalence Survey
PEH informed the Committee that the survey was underway and should be completed, ahead of schedule, before the end of October. Time and esources used are being collated so that clinical/ cost effectiveness can be assessed. . It has been acknowledged that we are collecting more data, within the Point Prevalence Survey, than was stipulated by Health Protection Scotland with theGovernmentasking for extra information such as number of single rooms available for use.
Item 7.7 – Continuing development & support of the National MRSA Screening Programme
There has been good progress made with regard to the new screening protocol – Hazel Whyte is leading this and is currently working on ensuring risk assessment information follows the patient during ward moves / PEH
PEH
PEH
Item / Subject / Action to be taken and Key Points raised in discussion / Action
4 / Standing Items cont… / 4.3Risk Control Plan
PEH confirmed that this had been cross referenced with the Work Plan.
5 / New Business / 5.1Letter regarding Decontamination Policy Advisory Group
This paper has been put out and comments are invited by 23rd September 2011.
No issues were raised.
5.2Influenza Pandemic Preparedness Update
HH stated that the Committee needs to be kept up to date with this. There is a new Influenza Pandemic Preparedness Strategy out for comment at present; comments are requested by the end of the year. There are proposals to devise a Major Infectious Diseases plan also. Preparedness has improved over the years and lessons have been learned such as the previous plan was too prescriptive and required a more flexible approach. Any outcomes on the plan will not be known until the next outbreak occurs.
PM informed the Committee that, this year, the Labs will be working a 6 day a week testing service.
5.3TB Incident Report
HH submitted this paper and stated that awareness on these recommendations needed to be raised and a decision made on how to take forward.
AM replied that the presence of tuberculosis must be a clinical judgement with a sputum sample submitted and x-rays performed.HH agreed and suggested the message should be “think TB” as this incident could perhaps have been prevented had the possibility of tuberculosis been considered prior to the patient being moved within the hospital
RSD asked the Committee how they felt this message could be spread - perhaps with the help of a poster.
EM felt that education was the key and AM agreed. HH offered her help with this. SM and HH to liaise.
VSfelt that results from this report would help in the future and the provision of more single rooms and less patient movement in the ECC would also be a positive step.
EM felt that blood testing would be the way to progress but and suggested putting forward a business case.
PM replied that the issue for Labs would be staffing levels to cope with the extra samples submitted.
5.4 CJD Incident Report
This incident occurred in April 2011 and as a result a comprehaensive investigation was undertaken. A Significant Event Analysis (SEA) has been completed and AMK, HH and Dr Henry Watson have met to review all outstanding actionsone being the risk assessment questions contained in the admission documentation. The main issue remains to ensure all “at risk” patients are identified.
RSD stressed that it was important for the Committee to receive these reports to enable it to report to the Clinical Governance Committee and at the regular Board meetings.
HH felt that information on these incidents should be included in the HAI report and has supplied PEH with this information to be included in the Annual Report.
/ AM/HH
Item / Subject / Action to be taken and Key Points raised in discussion / Action
5 / New Business cont… /
AMK replied that she thought that Surgical Sight Infection data should be included and PEH replied that this can be found in the Health Protection Scotland Quarterly Report.
VS said he felt uncomfortable with regard to the data on a national report basis and RSD suggested that NHS Grampian needs to be aware if it is an “outlier”. The Infection Control Committee needs to discuss the Health Protection Scotland exception reports and they are to be included on the agenda.
6 / Reporting to Clinical Governance Committee and Board / The HAI Report, with suggested amendments, will be presented to the Clinical Governance Committee and Board.
6 / AOCB / EM raised the issue of measles and informed the Committee that Occupational Health have been engaged in a proactive screening campaign. To date 1000 people have been offered the screening procedure and so far only 50 have declined..
7 / Date of next meeting /
15th November 2011, 10.00 – 12.00 The Conference Room, Dugald Baird Centre, AMH
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