Healthcare Associated Infection Bimonthly Report

January 2013

Section 1– Board Wide Issues

Key Healthcare Associated Infection Headlines

NHS Grampian

  • Monthly ward hand hygiene audit results for October and November 2012 show that compliance remained at or over 95% across NHS Grampian.
  • Cleaning and estates monitoring compliance remains stable and above the 90% target.
  • Clostridium difficile infection (CDI) case numbers for October and November were 10 and 11 respectively.
  • There were 16Staphylococcus aureusbacteraemias (SABs) in October and 13 in November.

Aberdeen Royal Infirmary

  • Monthly ward hand hygiene audits show that compliance remained above national 90% target during October and November but fell below the local 95% inNovember. Wards that did not meet the target were closely monitored and supported to achieve compliance both by senior management and the Infection Prevention and Control Team (IPCT).
  • Cleaning and estates monitoring compliance remains above the 90% target.
  • The number of CDI cases numbered 2 in October and 1 in November.
  • There were 6 SABs in October and 1 in November.

Dr Gray’s Hospital

  • Monthly ward hand hygiene audit results for October and November 2012 show that compliance remained at or over 95% in Dr Gray's Hospital.
  • Cleaning and estates monitoring results are comfortably above the 90% target.
  • There were no cases of CDI in October and November.
  • There were single cases of MSSA bacteraemia in October and November.

WoodendHospital

  • Hand hygiene compliance remains above the 95% compliance target.
  • Cleaning monitoring compliance remains stable and estates monitoring compliance remains just below the national 90% target.
  • There were no cases of CDI in Woodend Hospital in October and Novemberonly a single case of S aureus bacteraemia in October. There have been no cases of MRSA bacteraemia in the 12 months up to the end of November.

Community Hospitals

  • Due to the size of these hospitals and the number of SABs and CDIs, AberdeenMaternityHospital, RoyalCornhillHospital, Royal Aberdeen Children's Hospital and Roxburgh House figures are included in this scorecard.
  • There were 2 cases of CDI and 2 SABs in November.

Out of Hospital

  • There were 8 cases of CDI in October and 8 in November diagnosed out with or within 48 hours of being admitted to hospital.
  • SABs numbered 8 in October and 9 in November.

Staphylococcus aureus (including MRSA)

Staphylococcus aureus Bacteraemia Surveillance

At the time of writing, the Health Protection Scotland(HPS) quarterly report on the surveillance of Staphylococcus aureus bacteraemia between 1 July and 30 September had not been published.

Current HEAT Status

As the above report has not been published, it is not possible to provide an update on the current HEAT status. Local data suggests that NHS Grampian should remain close to trajectory, however.

Clostridium difficile

Clostridium difficile Infection Surveillance

At the time of writing, the Health Protection Scotland(HPS) quarterly report on the surveillance of Clostridium difficile infection between 1 July and 30 September had not been published.

Hand Hygiene

At the time of writing, NHS Hand Hygiene Campaign 22nd Bi-monthly Hand Hygiene Audit report had not been published.

Cleaning and the Healthcare Environment

Cleaning and Estates Monitoring

At the time of writing, the Health Facilities Scotland(HFS) National Cleaning Compliance Report Quarter 2 results had not been published.

Healthcare Environment

The recent Healthcare Environment Inspectorate (HEI) visit to Royal Aberdeen Children’s Hospital on 6 December 2012 is due to be reported on 11 February 2013. Initial verbal feedback included:

  • Improvement has been made against previous requirements.
  • The infection control nurse is accessible at RACH. Senior charge nurses reported that they are aware of the ICN’s role and can contact her and feel supported by her.
  • Senior charge and the senior radiographer in X-ray seemed knowledgeable and empowered in their roles in relation to infection prevention and control.
  • Poster-style information was consistently displayed showing audit and surveillance information in a child-friendly way.
  • All mattresses checked were clean. However, still some clarity was required around the documentation for the bed space checks. On the positive side, all staff spoken with were aware of their role and what should happen to the bed space when a patient is discharged.
  • All policies and procedures were in date, and intranet access to the infection control manual was clear to all staff spoken with.
  • Patients and parents felt confident and fed back that isolation practice and hand washing is good. This was also observed in relation to patients in isolation with appropriate precautions in place, and staff taking opportunities to wash their hands. One exception was found in HDU, where there was a lack of signage alerting staff and visitors to a patient in isolation in one of the cubicles. Staff quickly resolved this when it was drawn to their attention.
  • The Peripheral Venous Catheter (PVC) care bundle was inconsistently applied and documentation inconsistently completed. However, the inspectors saw no practice issues when checking PVCs.
  • Fridge temperature recording was inconsistent, particularly in food fridges. Gaps were noted in temperature recording for drug fridges in some wards too.
  • The hospital was clean, and positive feedback was gained from patients and parents about the cleanliness of the hospital.

This feedback was discussed at a special meeting of the RACH HAI Group and an action plan commenced in anticipation of the HEI Report.

Incidents and Outbreaks

Norovirus Prevalence

Monday Point Prevalence Surveillance figures are reported to Health Protection Scotland. These capture the significant outbreaks of Norovirus in NHS Grampian and the prevalence of Norovirus activity in close to real time. They are not, and should not be interpreted as data for benchmarking or judgement. The data can be used for the assessment of risk and Norovirus outbreak preparedness only.

During Octoberand November2012 the following instances of Norovirus were submitted:

On Monday1 October, 1 hospital in NHS Grampian had 1 ward and no bays closed with 4 patients and 0 staff members affected.

On Monday 8 October, 1 hospital in NHS Grampian had 1 ward and no bays closed with 5 patients and 3 staff members affected.

On Monday 15 October, 2 hospitals in NHS Grampian had a total of 3 wards and no bays closed with 11 patients and 2 staff members affected.

On Monday 22 October, 1 hospital in NHS Grampian had 1 ward and no bays closed with 3 patients and 0 staff members affected.

On Monday 29 October, 0 hospitals in NHS Grampian had wards or bays closed.

On Monday 5 November, 0 hospitals in NHS Grampian had wards or bays closed.

On Monday 12 November, 2 hospitals in NHS Grampian had a total of 6 wards and no bays closed with 27 patients and 20 staff members affected.

On Monday 19 November, 4 hospitals in NHS Grampian had a total of 6 wards and no bays closed with 38 patients and 20 staff members affected.

On Monday 26 November, 1 hospital in NHS Grampian had 1 ward and no bays closed with 4 patients and 3 staff members affected.

In order to raise awareness of the impact of Norovirus and aid decision making when admitting and transferring patients, the Infection Prevention and Control Team now issue a daily (Mon-Fri) SITREP report to all senior managers, lead clinicians and senior charge nurses throughout NHS Grampian.

Data on the numbers of wards closed due to confirmed or suspected norovirus is available from HPS on a weekly basis at:

Other HAI Related Activity

Surgical Site Infection (SSI) Surveillance

NHS Grampian participates in the Surgical Site Infection (SSI) surveillanceprogramme that is mandatory in all NHS boards in Scotland. All NHS boards are required to undertake surveillance for hip and knee arthroplasty and caesarean section procedures as per the mandatory requirements of HDL (2006) 38 and CEL (11) 2009. In addition NHS Grampian carries out surveillance for in-patient breast surgery.

Readmission surveillance is carried out using prospective readmission data on orthopaedic and breast procedure categories under inpatient surveillance up to 30 days post operatively. Post discharge surveillance until day 10 post operation is also carried out for all caesarean sections performed.

Last available quarter (1 July to 30 September 2012)

Category of Procedure / Number of operations / Number of Infections / NHS Grampian SSI rate (%) / National dataset SSI rate (%)
Breast Surgery / 176 / 1 / 0.6 / 0.3
Caesarean section / 417 / 5 / 1.2 / 1.9
Hip arthroplasty / 181 / 1 / 0.6 / 0.5
Knee arthroplasty / 172 / 0 / 0 / 0.1

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Healthcare Associated Infection Reporting Template (HAIRT)

Section 2 – Healthcare Associated Infection Report Cards

The following section is a series of ‘Report Cards’ that provide information, for each acute hospital [and key community hospitals] in the Board, on the number ofcases ofStaphylococcus aureusblood stream infections (alsobroken down into MSSA and MRSA) and Clostridium difficileinfections, as well as hand hygiene, cleaning and estates monitoring compliance. In addition, there is a single report card which covers all community hospitals [which do not have individual cards], and a report which covers infections identified as having been contracted from outwith hospital. The information in the report cards is provisional local data, and may differ from the national surveillance reports carried out by Health Protection Scotland and Health Facilities Scotland. The national reports are official statistics which undergo rigorous validation, which means final national figures may differ from those reported here. However, these reports aim to provide more detailed and up to date information on HAI activities at local level than is possible to provide through the national statistics.

Understanding the Report Cards – Infection Case Numbers

Clostridium difficileinfections (CDI)and Staphylococcus aureusbacteraemia(SAB) cases are presented for each hospital, broken down by month. Staphylococcus aureusbacteraemia(SAB) casesare further broken down into Meticillin SensitiveStaphylococcus aureus (MSSA) and Meticillin Resistant Staphylococcus aureus (MRSA). Data are presented as both a graph and a table giving case numbers. More information on these organisms can be found on the NHS24 website:

Clostridium difficile:

Staphylococcus aureus:

MRSA:

For each hospital the total number of cases for each month are those which have been reported as positive from a laboratory report on samples taken more than 48 hours after admission. For the purposes of these reports, positive samples taken from patients within 48 hours of admission will be considered to be confirmation that the infection was contracted prior to hospital admission and will be shown in the “out of hospital” report card.

Understanding the Report Cards – Hand Hygiene Compliance

Good hand hygiene is crucial for infection prevention and control. More information can be found from the Health Protection Scotland’s national hand hygiene campaign website:

Hospitals carry out regular audits of how well their staff are complying with hand hygiene. The first page of each hospital report card presents the percentage of hand hygiene compliance for all staff inboth graph and table form.

Understanding the Report Cards – Cleaning Compliance

Hospitals strive to keep the care environment as clean as possible. This is monitored through cleaning compliance audits. More information on how hospitals carry out these audits can be found on the Health Facilities Scotland website:

The first page of each hospital Report Card gives the hospitals cleaning compliance percentage in both graph and table form.

Understanding the Report Cards – ‘Out of Hospital Infections’

Clostridium difficileinfectionsand Staphylococcus aureus (including MRSA) bacteraemiacasesare all associated with being treated in hospitals. However, this is not the only place a patient may contract an infection. This total will also include infection from community sources such as GP surgeries and care homes and. The final Report Card report in this section covers ‘Out of Hospital Infections’ and reports on SAB and CDI cases reported to a Health Board which are not attributable to a hospital. Given the complex variety of sources for these infections it is not possible to break this data down in any more detail.

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