Healthcare Associated Infection Bimonthly Report

January 2015

Section 1– Board Wide Issues

Key Healthcare Associated Infection Headlines

NHS Grampian

  • Monthly ward hand hygiene audit results for October and November 2014 show that compliance remained at or over 95% across NHS Grampian.
  • Cleaning monitoring compliance scores were 94% in October andNovember.
  • Estatesmonitoring compliance scores were 97% in Octoberand 96% in November.
  • Clostridium difficile infection (CDI) case numbers for October and November were 12 and 17respectively.
  • There were 16Staphylococcus aureus bacteraemias (SABs) in October and 8 in November.

Aberdeen Royal Infirmary

  • Cleaning and estates monitoring compliance remains above the 90% target.
  • The number of CDI cases numbered 4 in October and 5 in November.
  • There were 3 SABs in October and 2 in November.

Dr Gray’s Hospital

  • Cleaning and estates monitoring compliance remains above the 90% target.
  • There were single cases of CDIin Octoberand November.
  • There were 0 cases of SAB in October or November

WoodendHospital

  • Cleaning and estates monitoring compliance remains above the 90% target.
  • There were 0 cases of CDI in October and a single case in November
  • There were 0 cases of SAB in Octoberor November.

Other Hospitals

  • Due to the size of these hospitals and the number of SABs and CDIs, AberdeenMaternityHospital, RoyalCornhillHospital, Royal Aberdeen Children's Hospital, Roxburgh House and all Community Hospitals figures are included in this scorecard.
  • The number of CDI cases numbered 0 in October and 2 in November.
  • There were 3 cases of SAB in October and 1 in November.

Out of Hospital

  • There were7 cases of CDI in October and 8 in November diagnosed out with or within 48 hours of being admitted to hospital.
  • SABs numbered 12 in October and 6 in November.

Staphylococcus aureus (including MRSA)

Staphylococcus aureus Bacteraemia Surveillance

Health Protection Scotland published their quarterly reports on the surveillance of Staphylococcus aureus bacteraemia (SAB) in Scotland, July - September 2014 on 13 January 2015.

The following table and graphs demonstrate NHS Grampian’s rate of SABs compared with all other Boards in Scotland. In summary, NHS Grampian experienced higher than average rates of S aureus bacteraemia in the most recent quarter for the first time in 2 years. However, NHS Grampian has the third lowest rate of the mainland health boards.

Each new case continues to be discussed at a weekly multidisciplinary team meeting involving Infection Prevention and Control Doctor(s), Infection Prevention and Control Nurses, Surveillance Nurse, Antimicrobial Pharmacist, Infection Unit Nurse and a microbiology registrar. If any issues are identified, a meeting is held with staff from the area concerned, and an SBAR is produced.

The following measures have been put in place:

  • The reinforcement of bundles and aseptic technique
  • Trial (which commenced in November 2014) to reduce the number of contaminated blood cultures
  • Comments on lab reports to ensure patients receive the optimal duration of treatment

S aureus bacteraemia cases and incidence rates: Q2 2014 (April to June 2014) compared to Q3 2014 (July to September 2014)

S aureus bacteraemia cases and incidence rates: year ending September 2013 compared to year ending September 2014. Bold outline denotes statistically significant changes

Funnel plot of S aureus bacteraemia rates for all NHS boards in Scotland against acute occupied bed days (x100 000), 1 July2014 to 30September 2014

Funnel plot of MRSA bacteraemia rates for all NHS boards in Scotland against acute occupied bed days (x100 000) 1 July 2014 to 30September 2014

Funnel plot of MSSA bacteraemia rates for all NHS boards in Scotland against acute occupied bed days (x100 000)1 July 2014 to 30 September 2014

Clostridium difficile

Clostridium difficile Infection Surveillance

Health Protection Scotland also published their quarterly reports on the surveillance of Clostridium difficile infections (CDIs) in Scotland, April - June 2014 on 2 October 2014.

The following tables and graphs demonstrate NHS Grampian’s rates of CDI compared with all other Boards in Scotland, with data broken down for age groups 65 years and 15-64 years.

In summary, NHS Grampian’s total in-patient activity (including Community Hospitals) is the 4th highest for patients aged 65 and over and 3rd highest for patients aged 15-64. In patients aged over 65 years, NHS Grampian’s rate of CDI is above the average for the whole of Scotland for the second quarter in a row.. In patients aged 15-64 years, the rate is considerably below average and overall NHS Grampian has the third lowest rate of the all the health boards.

As with S aureus bacteraemias, each new case is discussed at a weekly multidisciplinary team meeting involving Infection Prevention and Control Doctor(s), Infection Prevention and Control Nurses, Surveillance Nurse, Antimicrobial Pharmacist, and a microbiology registrar – the Infection Unit Nurse is not present for the CDI case discussions. By close investigation of each case and typing of the organisms – when indicated – the Infection Prevention and Control Team is assured that the recent increase in infections is not due to any outbreaks.

The following measures have been put in place or reinforced:

  • Positive laboratory results are now phoned to General Practices, as well as in-patient areas
  • Discussion with doctors takes place to ascertain if the patient has symptoms suggestive of CDI. Treatment and further advice is then given
  • Reinforcement of the treatment of recurrent episodes as per treatment guidelines

CDI cases and incidence rates in patients aged 65 years or over: Q2 2014 (April to June 2014) compared to Q3 2014 (July to September 2014)

CDI cases and incidence rates by in patients aged 65 years or over: Year ending September 2013 compared to year ending September 2014. Bold outline denotes statistically significant changes

Funnel plot of CDI incidence rates in patients aged 65 years and overfor all NHS boards in Scotland in Q3 2014

Funnel plot of CDI incidence rates in patients aged 15-64 years for all NHS boards in Scotland in Q3 2014

Hand Hygiene

The NHS Hand Hygiene Campaign came to a close in August 2013. NHS Boards are now required to publish locally collected quality assured data and these are contained within the scorecards towards the end of this report.

Cleaning and the Healthcare Environment

Since the last report, the Healthcare Environment Inspectorate has conducted 0 inspections in NHS Grampian.

All HEI inspection reports for NHS Grampian are available at:

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 October and November 2014 the following wereclosed due to norovirus:

On Monday 10 November, 3 wards were closed with 23 patients affected

Data on the numbers of wards closed due to confirmed or suspected norovirus are 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 until August 2014.

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 (01/07/14 – 30/09/14)

Category of Procedure / Number of operations / Number of Infections / NHS Grampian SSI rate (%) / National dataset SSI rate (%)
Breast Surgery / 110 / 0 / 0.0 / 0.0
Caesarean section / 462 / 3 / 0.6 / 1.2
Hip arthroplasty / 208 / 0 / 0.0 / 0.8
Knee arthroplasty / 191 / 0 / 0.0 / 0.3

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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 of Staphylococcus aureusblood stream infections (alsobroken down into MSSA and MRSA) and Clostridium difficile infections, as well as hand hygiene and cleaning 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 difficile infections (CDI) and Staphylococcus aureus bacteraemia (SAB) cases are presented for each hospital, broken down by month. Staphylococcus aureus bacteraemia (SAB) casesare further broken down into Meticillin Sensitive Staphylococcus aureus (MSSA) and Meticillin Resistant Staphylococcus aureus (MRSA). 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.

Targets

There are national targets associated with reductions in C.diff and SABs. More information on these can be found on the Scotland Performs website:

Understanding the Report Cards – Hand Hygiene Compliance

Hospitals carry out regular audits of how well their staff are complying with hand hygiene. Each hospital report card presents the combined percentage of hand hygiene compliance with both opportunity taken and technique used broken down by staff group.

Understanding the Report Cards – Cleaning Compliance

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

Understanding the Report Cards – ‘Out of Hospital Infections’

Clostridium difficile infections and 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.

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NHS BOARD REPORT CARD – NHS Grampian

Staphylococcus aureus bacteraemia monthly case numbers

Dec 2013 / Jan 2014 / Feb
2014 / Mar 2014 / Apr 2014 / May 2014 / Jun 2014 / Jul 2014 / Aug 2014 / Sept 2014 / Oct 2014 / Nov 2014
MRSA / 2 / 2 / 0 / 1 / 0 / 0 / 0 / 3 / 1 / 1 / 2 / 1
MSSA / 7 / 11 / 8 / 10 / 12 / 18 / 8 / 12 / 15 / 16 / 14 / 7
Total SABS / 9 / 13 / 8 / 11 / 12 / 18 / 8 / 15 / 16 / 17 / 16 / 8

Clostridium difficile infection monthly case numbers

Dec 2013 / Jan
2014 / Feb
2014 / Mar 2014 / Apr 2014 / May 2014 / Jun 2014 / Jul 2014 / Aug 2014 / Sept 2014 / Oct 2014 / Nov 2014
Ages 15-64 / 0 / 1 / 1 / 4 / 0 / 2 / 1 / 3 / 3 / 4 / 5 / 4
Ages 65 plus / 3 / 8 / 3 / 11 / 9 / 11 / 8 / 10 / 11 / 12 / 7 / 13
Ages 15 plus / 3 / 9 / 4 / 15 / 9 / 13 / 9 / 13 / 14 / 16 / 12 / 17

Hand Hygiene Monitoring Compliance (%)

Dec 2013 / Jan
2014 / Feb
2014 / Mar 2014 / Apr 2014 / May 2014 / Jun 2014 / Jul 2014 / Aug 2014 / Sept 2014 / Oct 2014 / Nov 2014
AHP / 97 / 98 / 98 / 98 / 99 / 99 / 99 / 98 / 99 / 98 / 98 / 100
Ancillary / 96 / 95 / 97 / 93 / 96 / 95 / 98 / 98 / 97 / 95 / 96 / 99
Medical / 94 / 95 / 95 / 96 / 94 / 93 / 96 / 96 / 96 / 94 / 93 / 96
Nurse / 96 / 97 / 98 / 97 / 99 / 99 / 99 / 99 / 98 / 98 / 98 / 99
Board Total / 96 / 97 / 98 / 97 / 98 / 98 / 98 / 98 / 98 / 97 / 97 / 98

Cleaning Compliance (%)

Dec 2013 / Jan
2014 / Feb
2014 / Mar 2014 / Apr 2014 / May 2014 / Jun 2014 / Jul 2014 / Aug 2014 / Sept 2014 / Oct 2014 / Nov 2014
Board Total / 93 / 94 / 94 / 94 / 93 / 93 / 94 / 94 / 94 / 94 / 94 / 94

Estates Monitoring Compliance (%)

Dec 2013 / Jan
2014 / Feb
2014 / Mar 2014 / Apr 2014 / May 2014 / Jun 2014 / Jul 2014 / Aug 2014 / Sept 2014 / Oct 2014 / Nov 2014
Board Total / 96 / 95 / 96 / 96 / 96 / 96 / 96 / 96 / 96 / 97 / 97 / 96

NHS HOSPITAL A REPORT CARD – Aberdeen Royal Infirmary

Staphylococcus aureus bacteraemia monthly case numbers

Dec 2013 / Jan
2014 / Feb
2014 / Mar 2014 / Apr 2014 / May 2014 / Jun 2014 / Jul 2014 / Aug 2014 / Sept 2014 / Oct 2014 / Nov 2014
MRSA / 0 / 1 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 1
MSSA / 0 / 5 / 2 / 4 / 5 / 4 / 2 / 2 / 6 / 8 / 3 / 1
Total SABS / 0 / 6 / 2 / 4 / 5 / 4 / 2 / 2 / 6 / 8 / 3 / 2

Clostridium difficile infection monthly case numbers

Dec 2013 / Jan
2014 / Feb 2014 / Mar 2014 / Apr 2014 / May 2014 / Jun 2014 / Jul 2014 / Aug 2014 / Sept 2014 / Oct 2014 / Nov 2014
Ages 15-64 / 1 / 0 / 0 / 2 / 0 / 1 / 0 / 0 / 0 / 2 / 0 / 0
Ages 65 plus / 0 / 6 / 1 / 3 / 2 / 4 / 3 / 2 / 3 / 3 / 4 / 5
Ages 15 plus / 1 / 6 / 1 / 5 / 2 / 5 / 3 / 2 / 3 / 5 / 4 / 5

Cleaning Compliance (%)

Dec 2013 / Jan
2014 / Feb 2014 / Mar 2014 / Apr 2014 / May 2014 / Jun 2014 / Jul 2014 / Aug 2014 / Sept 2014 / Oct 2014 / Nov 2014
Hospital Total / 89 / 92 / 93 / 94 / 93 / 93 / 94 / 94 / 94 / 94 / 94 / 94

Estates Monitoring Compliance (%)

Dec 2013 / Jan
2014 / Feb 2014 / Mar 2014 / Apr 2014 / May 2014 / Jun 2014 / Jul 2014 / Aug 2014 / Sept 2014 / Oct 2014 / Nov 2014
Hospital Total / 96 / 96 / 97 / 96 / 97 / 97 / 98 / 98 / 97 / 98 / 98 / 98

NHS HOSPITAL B REPORT CARD – Dr Gray’s Hospital

Staphylococcus aureus bacteraemia monthly case numbers

Dec 2013 / Jan
2014 / Feb
2014 / Mar 2014 / Apr 2014 / May 2014 / Jun 2014 / Jul 2014 / Aug 2014 / Sept 2014 / Oct 2014 / Nov 2014
MRSA / 0 / 1 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0
MSSA / 0 / 1 / 0 / 0 / 0 / 1 / 0 / 0 / 0 / 0 / 0 / 0
Total SABS / 0 / 2 / 0 / 0 / 0 / 1 / 0 / 0 / 0 / 0 / 0 / 0

Clostridium difficile infection monthly case numbers

Dec 2013 / Jan
2014 / Feb
2014 / Mar 2014 / Apr 2014 / May 2014 / Jun 2014 / Jul 2014 / Aug 2014 / Sept 2014 / Oct 2014 / Nov 2014
Ages 15-64 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0
Ages 65 plus / 0 / 0 / 0 / 0 / 0 / 1 / 0 / 0 / 0 / 0 / 1 / 1
Ages 15 plus / 0 / 0 / 0 / 0 / 0 / 1 / 0 / 0 / 0 / 0 / 1 / 1

Cleaning Compliance (%)

Dec 2013 / Jan
2014 / Feb
2014 / Mar 2014 / Apr 2014 / May 2014 / Jun 2014 / Jul 2014 / Aug 2014 / Sept 2014 / Oct 2014 / Nov 2014
Hospital Total / 95 / 95 / 93 / 94 / 94 / 94 / 94 / 94 / 93 / 93 / 94 / 94

Estates Monitoring Compliance (%)

Dec 2013 / Jan
2014 / Feb
2014 / Mar 2014 / Apr 2014 / May 2014 / Jun 2014 / Jul 2014 / Aug 2014 / Sept 2014 / Oct 2014 / Nov 2014
Hospital Total / 97 / 98 / 98 / 98 / 98 / 98 / 98 / 98 / 98 / 98 / 98 / 98

NHS HOSPITAL B REPORT CARD – Woodend Hospital

Staphylococcus aureus bacteraemia monthly case numbers

Dec 2013 / Jan
2014 / Feb
2014 / Mar 2014 / Apr 2014 / May 2014 / Jun 2014 / Jul 2014 / Aug 2014 / Sept 2014 / Oct 2014 / Nov 2014
MRSA / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0
MSSA / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0
Total SABS / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0

Clostridium difficile infection monthly case numbers

Dec 2013 / Jan
2014 / Feb
2014 / Mar 2014 / Apr 2014 / May 2014 / Jun 2014 / Jul 2014 / Aug 2014 / Sept 2014 / Oct 2014 / Nov 2014
Ages 15-64 / 0 / 0 / 0 / 1 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0
Ages 65 plus / 0 / 0 / 0 / 1 / 2 / 1 / 0 / 0 / 0 / 0 / 0 / 1
Ages 15 plus / 0 / 0 / 0 / 2 / 2 / 1 / 0 / 0 / 0 / 0 / 0 / 1

Cleaning Compliance (%)

Dec 2013 / Jan
2014 / Feb
2014 / Mar 2014 / Apr 2014 / May 2014 / Jun 2014 / Jul 2014 / Aug 2014 / Sept 2014 / Oct 2014 / Nov 2014
Hospital Total / 95 / 93 / 95 / 93 / 94 / 94 / 94 / 93 / 94 / 94

Estates Monitoring Compliance (%)

Dec 2013 / Jan
2014 / Feb
2014 / Mar 2014 / Apr 2014 / May 2014 / Jun 2014 / Jul 2014 / Aug 2014 / Sept 2014 / Oct 2014 / Nov 2014
Hospital Total / 93 / 90 / 91 / 90 / 88 / 90 / 92 / 91 / 92 / 95 / 94 / 94

OTHERNHS HOSPITALS REPORT CARD

The other hospitals covered in this report card include:

Aberdeen Maternity Hospital

Royal Cornhill Hospital

Royal Aberdeen Children's Hospital

Roxburgh House

All Community Hospitals

Staphylococcus aureus bacteraemia monthly case numbers

Dec 2013 / Jan
2014 / Feb
2014 / Mar 2014 / Apr 2014 / May 2014 / Jun 2014 / Jul 2014 / Aug 2014 / Sept 2014 / Oct 2014 / Nov 2014
MRSA / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 2 / 1
MSSA / 0 / 0 / 2 / 1 / 0 / 1 / 0 / 0 / 1 / 0 / 1 / 0
Total SABS / 0 / 0 / 2 / 1 / 0 / 1 / 0 / 0 / 1 / 0 / 3 / 1

Clostridium difficile infection monthly case numbers

Dec 2013 / Jan
2014 / Feb
2014 / Mar 2014 / Apr 2014 / May 2014 / Jun 2014 / Jul 2014 / Aug 2014 / Sept 2014 / Oct 2014 / Nov 2014
Ages 15-64 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 1
Ages 65 plus / 0 / 0 / 1 / 1 / 1 / 0 / 0 / 2 / 3 / 3 / 0 / 1
Ages 15 plus / 0 / 0 / 1 / 1 / 1 / 0 / 0 / 2 / 3 / 3 / 0 / 2

NHS OUT OF HOSPITAL REPORT CARD

Staphylococcus aureus bacteraemia monthly case numbers

Dec 2013 / Jan
2014 / Feb
2014 / Mar 2014 / Apr 2014 / May 2014 / Jun 2014 / Jul 2014 / Aug 2014 / Sept 2014 / Oct 2014 / Nov 2014
MRSA / 2 / 0 / 0 / 1 / 0 / 0 / 0 / 3 / 1 / 1 / 2 / 0
MSSA / 7 / 5 / 4 / 5 / 7 / 11 / 6 / 10 / 8 / 8 / 10 / 6
Total SABS / 9 / 5 / 4 / 6 / 7 / 11 / 6 / 13 / 9 / 9 / 12 / 6

Clostridium difficile infection monthly case numbers

Dec 2013 / Jan
2014 / Feb
2014 / Mar 2014 / Apr 2014 / May 2014 / Jun 2014 / Jul 2014 / Aug 2014 / Sept 2014 / Oct 2014 / Nov 2014
Ages 15-64 / 2 / 1 / 1 / 1 / 0 / 1 / 1 / 2 / 3 / 2 / 5 / 2
Ages 65 plus / 0 / 2 / 1 / 6 / 4 / 5 / 5 / 7 / 5 / 6 / 2 / 6
Ages 15 plus / 2 / 3 / 2 / 7 / 4 / 6 / 6 / 9 / 8 / 8 / 7 / 8

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