NHS GRAMPIAN
Infection Control Committee
Minutes from meeting held on 17th January 2012
The Board Room, ARI
11.00 – 13.00
Present:
RSD - Dr Roelf Dijkhuizen, Medical Director, NHSG
PEH – Pamela Harrison, Infection Prevention and Control Manager
GMAC - Gillian Macartney, Specialist Antibiotic Pharmacist
RAB - Roy Browning, Senior Infection Prevention and Control Nurse
CR - Caroline Reid, Acting Clinical Nurse Manager (deputising for Alan Pilkington / Susan Swift)
JA - Jane Adam, Public Forum Representative
GM - Gary Mortimer,Head of Estates for NHSG
HH - Helen Howie, Consultant in Public Health Medicine, Health Protection Team
EM - Eleanor Murray, Unit Nurse Manager, Acute Sector (deputising for Vince Shields)
ST - Sandy Thomson,Lead Pharmacist, Dr Gray’s Hospital, Moray (deputising for Andrew Fowlie / Amanda Croft)
KT - Keith Thomson, Interim Head of Head & Safety for NHSG
KDW – Karen Wares, Hand Hygiene Co-ordinator
JG – Jenny Gibb, Head of Nursing, Mental Health & Learning Disability Service
Anneke Street, PA to Infection Control Manager(Minute taker)
1 / Introduction and Apologies /
PEH opened the meeting. Apologies were received from :
Tommy Ovens (TO)Caroline Hind (CH) Pamela Molyneaux (PM)Stewart Rogerson (SR) Jenny Ingram (JI) Alexander MacKenzie (AM) Amanda Croft(AC) Julie Fletcher (JF)Gladys Buchan (GB) Lynn Young (LY) Elinor Smith (ES) Elizabeth Kemp (EK) Caroline Hind (CH) Jane Ormerod (JO)
2 / Minutes of last meeting
15th November 2011 /
Minutes from the meeting 15th November 2011 were ratified with no amendments.
3 / Matters Arising
Item 3.1 /
TB SBAR Report
HH stated that the SBAR report had previously been submitted to the Committee. There was a requirement for screening which had been undertaken but issues were still present, i.e. not suspecting TB and no sputum samples being taken or sent to labs for testing. Public Health had written to all GPs and Consultants to raise awareness and totry and emphasise the message “Think TB”.
There have been 2 subsequent incidents. During the first, TB was not picked up on and subsequently a delay in diagnosis occurred. No SBAR for this incident has been compiled as yet – AMK and AM to liaise on this. Extra training has been undertaken by the specialist TB nurse.
For the second incident a risk assessment had been completed, screening offered.
ST commented that he had not seen correspondence received within Dr Gray’s Hospital and this will be discussed at the upcoming Senior Staff Committee meeting. / AMK/AM
Item / Subject / Action to be taken and Key Points raised in discussion / Action
3 / Matters Arising
Item 3.2 / HH informed the Committee that a formal review will be undertaken.
EM replied that the correspondence may not have been received by nursing staff within the Acute sector and
suggested that the letter sent should also be forwarded to Elinor Smith for dissemination to the relevant staff.
Antimicrobial Management Team Annual Report
This report was submitted
GMAC opened by stating that the report had been submitted to the Committee for comment and advice as to where else it should be submitted.
The report showed many improvements with guidelines being brought up to date and data showing the reduction in the prescribing of 4 Cs has been maintained across NHSG; in addition MRSA and C-diff cases have also seen a reduction.
Since 2009 a 20% reduction in cost can be seen across NHSG and this is thought to have been primarily due to the intravenous to oral antibiotic switch, although overall prescribing will also have had an impact.
Within Primary Care GMAC reported that the Empirical Guidelines are imminent and that data shows a 50% reduction in the prescribing of the 4 Cs.
Other work underway includes an audit being undertaken in the admissions ward and a new local
Gentomicin / Vancomicin Policy has been launched, although Health Boards across Scotland are working towards aligning policies.
Challenges outlined in the report refer to problems with obtaining bed day data and the reduction of Antibiotic Pharmacist resource.
RSD commented that this report shows great achievement across the board and stated that there has been an enormous clinical response to change.
EM queried whether there was anything else to be done with regard to HEI requirements.
GMAC replied that the Empirical Guidelines should have been updated in November 2011 and are slightly behind but the Paediatric Empirical posters have now been printed and laminated by Infection Prevention and Control and are being distributed at present.
JA queried as to what was being done about the problems obtaining bed data. This is being looked into and raised with IT; although there has had to be prioritisations made due to new systems coming online recently (PMS) and work / training surrounding this has taken precedence.
RSD congratulated everyone who has worked so hard on this report and its contents and agreed that the report should be submitted to the Clinical Governance Committee along with the HAI Report. / HH
GMAC
4 / Standing Items
Item 4.1 / HAI Report
The HAI Report was submitted.
PEH summarised the headlines which showed, across NHSG, hand hygiene audit results are unavailable at present due to problems with obtaining data. Hopefully, in future, the Patient Safety System being launched in March will help combat this problem and will also be able to show data on opportunity and technique. At present the bi-monthly report shows hand Hygiene sitting at 99% for Grampian.
Across NHSG the Cleaning and Estates monitoring compliance remains above the national target of 90% although the Health Facilities Scotland report shows issues at Woodend GeneralHospital.
The number of Clostridium difficile infections across NHSG remained at the 12 month average of 13 cases, the number of Staph aureus bacteraemias fell to a 9 month low showing 7 cases and there has only been 1 case of MRSA in the last 2 months.
Item / Subject / Action to be taken and Key Points raised in discussion / Action
4 / Standing Items cont… / Aberdeen Royal Infirmary
Within Aberdeen Royal Infirmary Clostridium difficile infections remained slightly above the 12 month average of 3.4 whereas the total Staph aureus bacteraemias remained slightly lower than the 12 month average of 4.1. There were no MRSA bacteraemias between August and November 2011.
Both the cleaning and estates monitoring compliance have increased over the reporting period October – November 2011.
As with all hospitals ward level hand hygiene audit results are, at present, unavailable.
Dr Gray’s Hospital
There was a single case of Clostridium difficile in October 2011 and 2 Staph aureus bacteraemias – 1 MRSA and 1 MSSA.
Cleaning and estates monitoring compliance remains above the 90% national target.
WoodendHospital
There were no Clostridium difficile infections or Staphaureus bacteraemias in October or November.
Cleaning compliance monitoring remains above 90% but estates monitoring has not yet reached the target.
GM explained that this was partly due to the age and condition of the buildings onsite and single room allocation. Most of the Boards in Scotland are experiencing the same problems with issues surrounding investment and repairs; GM feedback that he has responded to Health Facilities Scotland to this effect.
Estates monitoring compliance remains at amber and the challenge remains to progress to green status.
Community Hospitals
There was only 1 case ofClostridium difficileinfection at RoyalCornhillHospital in November 2011 and no Staphaureus bacteraemias occurred in of the other hospitals.
Out of Hospital
The number of cases of Clostridium difficile infectiondiagnosedout with hospital or within 48 hours of being admitted rose slightly in October and November 2011.
MSSA bacteraemias fell slightly in November 2011 and there have been no MRSA bacteraemias since April 2011.
RSD commented that he felt the maintaining of low MRSA figures was the result of the MRSA Screening Programme. Fiona MacKenzie has also circulated a report on the breakdown of compliance data which was very helpful and he requested that this be distributed to the Committee members. The report shows that NHS Grampian is a third to half way compliant but there is still work to be done.
EM suggested that the Unit Operational Managers also receive Fiona MacKenzie’s report for their own information / dissemination. RSD agreed this should be done.
HEAT Targets
The Health Protection Scotland Quarterly report for July - September 2011, NHS Grampian’s rate was favourable at 0.257 episodes per 1000 acute occupied bed days (AOBDs), compared with NHS Scotland as a whole where the rate was 0.304. / PEH
AS
Item / Subject / Action to be taken and Key Points raised in discussion / Action
4 / Standing Items cont…
Item 4.2 / The MRSA bacteraemia rate was 0.015 episodes per 1000 AOBDs compared with 0.038 for NHS Scotland as a whole and for MSSA bacteraemias the rate was 0.242 cases per 1000 AOBDs compared to 0.266 in
NHS Scotland showing that both MRSA and MSSA bacteraemia rates were lower than the national average for this quarter.
The same report for patients 65 years and over also showed that NHS Grampian’s Clostridium difficile rate was lower, at 0.27 episodes per 1000 total occupied bed days (TOBDs), than Scotland as a whole which showed 0.32 showed episodes per 1000 total occupied bed days (TOBDs). This is the third consecutive quarter where the NHS Grampian rate has been lower than the national rate.
Hand Hygiene
NHS Grampian continues to perform well and the compliance now sits at 99%; at this time this figure only measures “opportunity”.
Cleaning and Estates Monitoring
The NHS Scotland National Cleaning Compliance Report for quarter 2 shows NHS Grampian, as a whole, to be 93.8% compliant.
Healthcare Environment Inspectorate (HEI)
PEH stated that the recent unplanned HEI visit at Dr Gray’s Hospital had gone well and that the feedback was good, although requirements are expected. An action plan will be developed presently.
RSD suggested that staff, from the visited hospital/area should be included in the feedback and/or praise given by the HEI. Unconstructive press reporting affects all NHS Grampian staff and can lead to feelings of negativity and frustration therefore it may prove beneficial for staff to be kept “in the loop” with regard to HEI visits. This can be achieved via the Annual Report and with correspondence sent out globally, to all staff, by Richard Carey.
Outbreaks and Incidents
Norovirus prevalence figures are sent to Health Protection Scotland on a weekly basis (every Monday) with a “snapshot” of instances on that day.
HH queried as to whether the TB incidents should have been included under this section. RSD felt it was prudent to have all reports and SBARs finalised before being reported on.
HAI Work Plan 2011/12
The HAI Work Plan 2011/12 was submitted.
Antimicrobial Prescribing and Resistance
Item 1.3.1 – Todevelop a joint action plan to address the treatment and surveillance of staphylococcus aureus bacteraemias.
SAPGs algorithm has been received and has been discussed at the weekly Infection Prevention and Control Team meeting. GMAC has also contacted Clinical Effectiveness and was advised that the proposed communication method was appropriate. GMAC requested NHSG support in promoting the guideline.
Item / Subject / Action to be taken and Key Points raised in discussion / Action
4 / Standing Items cont… /
Cleaning, Decontamination and the Built Environment
Item 2.4.1 – Review allocation of cleaning duties to domestic & nursing staff
The cleaning duties review is complete
Item 2.4.2 – Roll out cleaning “exception report” system that has been trialled in RACH
There is still no update on the rollout of the system in RACH. PEH and GM to liaise and also discuss the rollout status within Dr Gray’s & AberdeenMaternityHospital.
Item 2.5.1 – Develop system for sign off of terminal cleaning by SCN
Systemis in place and being monitored although the sign off is still in development as there is no mechanism for the SCN, as yet. This was raised by the HEI in a previous visit.
GM to deal with this then action can be closed.
Infection Prevention and Control Guidance and Practice
Item 3.3.1 – Develop local protocol for hand hygiene in non hospital settings
HH confirmed thatpractice had been put in place in 2011 and the 2012 version is now being impact assessed. This action can be closed.
Item 3.12.1 – Work with SPSP, IPC, practice Education and Tissue Viability colleagues to implement education on aseptic technique
The SAB90 work in ongoing as is training for junior doctors; NES have also produced a package of training.
RSD considered that this action has not yet been completed due to little support from clinicians.
RSD and AMK are still progressing this.
PEH to obtain an update from AMK.
Organisational Structures
Item 4.1.1 – Review Infection Control Policy and structures when new HDL is reissued
RSD informed the Committee that the HDLs are being reviewed, at present, by the Government. The timescale for review is by 2012.
Item 4.3.1 – Produce HAI Annual Report
PEH asked for the Committee to approve the Annual Report and close this action.
Staff & Leadership
Item 5.1.1 – Complete eKSF process for all members of IPCT
Item 5.1.2 – Implement the IPS competencies within PDPs
There is slow progress with eKSF. This is being worked on
Item 5.3.1 – Implement Mandatory Training Programme
This resource is present – Hand Hygiene e-learning package available to complete
/ PEH/GM
GM
RSD/AMK
PEH
Item / Subject / Action to be taken and Key Points raised in discussion / Action
4 / Standing Items cont…
Item 4.3
Item 4.4 / Item 5.3.2 – Incorporate HAI Risk Assessment of patients into clinical induction
The development of a Standard Infection Control Precautions e-learning package is progressing well with a pilot being undertaken at present. A small amount of work is still to be donearound agreeing staff “families” this applies to. This action should be able to be closed soon.
Item 5.3.3 – Review Role of the Cleanliness Champion
This has been rolled out.
Quality Improvement
Item 6.4.1 – Review Current guidance on death certification
Item 6.4.2 – Develop system to ensure IPCT are aware of all deaths attributed to HAI
6.4.3 – Implemement Root cause Analysis process for DCI & SAB
There is still a large piece of work to be complete surrounding these actions. Parts are in place with regard to National Death Certification Guidelines – Nick Fluck and PEH to discuss a putting a mechanism in place for allowing the Infection Prevention and Control Team to be aware of HAI attributable deaths at home / considerable time after infection was diagnosed.
PEH to move target date to December 2013.
Surveillance
Item 7.2.1–Develop a quality dashboard that includes HAI Information
The Quality, Governance and Risk Team are working on this, this is continual development. It is hoped that LanQip will replace this. PEH to liaise with those involved for an update.
Item 7.7.1 – Embed MRSA Screening for all in-patients
The target for this action is end of March / early April 2012.
PEH to update action.
Risk Control Plan
Risk QIS 4a.1 – Cleaning
PEH queried whether these high level risks could be closed due to the recent Patient Equipment Standard Operating Procedures being finalised.
EM replied that an audit had been completed NHSG wide for the acute sector and quality assurance is still required. Checklists are still an ongoing issue. KDW/Amanda Croft/EM to meet to discuss.
RSD is not confident to close this risk
EM to provide PEH with text and this will be discussed at the next meeting – perhaps risk can be reduced then.
Health Protection Scotland Exception Reports
None to be discussed
/ PEH/Nick Fluck
PEH
PEH
PEH
EM/KDW
Item / Subject / Action to be taken and Key Points raised in discussion / Action
5 / New Business
Item 5.1
/
Hand Hygiene Protocol/National Dress Code/Hand Hygiene measurement Plan – Bare Below the Elbow
The discussion began with RSD informing the Committee that Laura Gray had queried the rule that anyone present in a clinical area must be bare below the elbow - what constitutes a clinical area and is this patient contact specific? RSD felt that the message was very important but must be consistent.
Laura Gray had mentioned that Unit Operational Managers were querying as to whether this was a stipulation for ALL staff within a clinical area and/or the parameters of this.
KDW replied that wards audit this differently. Some audits have shown a fail when a staff member, who is not dealing with a patient, is not bare below the elbow. KDW also stressed that the definition of a clinical area is anywhere past the doors to the ward.
RSD stressed he thought that this to be unworkable. If a clinician is not dealing with a patient and only speaks to a nurse at the nurses station what should be the rule here? This needs to be made clearer to staff.
JG admitted that this is a constant problem within RoyalCornhillHospital as patients are not often in beds. The hospital has worked hard on its hand hygiene recently and suggested that there should be a definition of the wording “clinical area”.
RSD suggested that AMK should revisit this and word a definition.
/ AMK
6 / Reporting to Clinical Governance Committee and Board / The HAI Report, with suggested additions and the Antimicrobial Management Team Annual Report will be presented to the Clinical Governance Committee and Board.
7 / AOCB
Item 7.1 / HAI Annual Report 2011/12
HH asked for the wording Public Health, on the contents page, to be changed to Incidents and Outbreaks. PEH to amend.
RSD suggested that the Committee have a timeframe of a week to read over the report and then it will be finalised.
City Hospital – Tea and Coffee Distribution
JA raised the issue of domestic staff helping with the tea /coffee distribution within City Hospital and as a result the nursing staff then not being aware of patient’s fluid intake and the recording of this information within patient notes.
GM confirmed that it was being dealt with and that those duties were being separated away from Domestic Services.
EM also confirmed that trials are being undertaken with regard to this and work is progressing.
Leaflets
JA also raised the issue of Health Protection Scotland no longer supplying various leaflets to NHS Boards. She feels that NHS Grampian, having to print its own supply should be a costing issue and not wholly acceptable.
PEH feedback that we are, at present, due to receive the artwork and funding has been secured for a limited number of leaflets to be printed. This is the only option available.
Legionella
HH informed the Committee that there had been a suspected case (not confirmed latterly) of Legionella within Aberdeen Royal Infirmary.
There has been a Health & Safety Executive visit along with an Incident Management Team meeting held.
/ PEH
Item / Subject / Action to be taken and Key Points raised in discussion / Action
7 / AOCB cont….. /
HH and AMK to discuss further.
HH and AMK also to meet and discuss with Pauline Strachan.
The question is whether this incident was acted upon too quickly and whether, in future, specialised lab results should be waited for before any action is taken.
KT fedback that Legionella water testing is to be done sporadically and during 2010/11 Boards have been issued with improvement notices.
GM will obtain text and feedback from the Health & Safety Executive.
/ HH/AMK
HH/AMK/ Pauline Strachan
GM
7 / Date of next meeting /
22nd March 2012, 11am – 1pm in the Conference Room, MacGillivray Centre, AMH
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