Report to the Trust Board

Transcription

1 Southport & Ormskirk Hospital NHS Trust Report to the Trust Board Date of Board Meeting 26 January 2011 AGENDA ITEM: 7a Title of Report EXECUTIVE SUMMARY of the REPORT (please outline the purpose of this report and the key issues for consideration) DIPC Monthly Report The purpose of this report is to update Board members on Trust performance against all mandatory infection control surveillance targets, to give an overview of general IP and IC performance and to highlight any areas of concern. The Trust continues to perform well against the MRSA bacteraemia trajectory but this month for the first time since July 2009 it is over trajectory for our internal stretch target. We remain well within the externally imposed target. All CD cases continue to be extremely carefully monitored with in individual high level route cause analysis meetings and heighten surveillance and cleaning in areas where there have been clusters. To date no cases within cluster areas have been shown to he linked which is reassuring. In addition to MRSA bacteraemias the Trust monitors all hospital acquired bacteraemias and the trend continues downward. There has been no significant change in prevalence of antimicrobials in the Trust. Impressive performance in some areas has been mirrored by deterioration in others and these areas are being closely monitored with regular spot audits and actions as results dictate. There has been a pleasing reduction in medical device utilisation in most areas. Completion of adequate numbers of hand hygiene audits continue to be challenging to wards. Excellent performance in some areas is difficult to interpret because of low numbers. In an attempt to improve data collection the audit system was changed in December This month s DIPSI report includes a report of compliance against the MRSA and C Difficile pathways. Pathway compliance in medicine has caused some concern and these issues are being addressed. December 2009 was a difficult month in terms of IP&C because of a high level of throughput including a surge in H1N1 influenza and problems secondary to the severe weather conditions. These issues are summarised in the final section of the report. Prepared by (author of report) Presented by (Executive Director) ACTIONS REQUIRED (to note, endorse, approve recommendations etc) Martin Kiernan, Consultant Nurse Dr G R Boocock, Medical Director Dr Geraldine Boocock, Medical Director To note the content of the report

2 Which Strategic Objective(s) are supported by this paper Is this on the Trust s Risk Register? If yes, please provide details Are they any financial implications? If yes, please provide details 1, 2, 5 No No Previous Meetings If applicable, please insert the date this paper was presented to the relevant Committee/Meeting:- Finance & Performance Committee Audit Committee Risk Committee Quality Committee Senior Executive Management Team Other (please state)

3 Southport and Ormskirk Hospital NHS Trust Infection Prevention and Control Team Performance Report January 2011 MRSA 1 C.difficile 2 Hospital-acquired Bacteraemia (All Organisms) 3 Antimicrobial Prescribing 6 Medical Device Utilisation 7 Hand Hygiene Audit Results 9 Commode Cleanliness 10 MRSA and C.difficile Pathway Compliance December For further information on any specific clinical area, please contact the Infection Prevention and Control Team or see the relevant spreadsheets in the Infection Performance Monitoring section on the Trust Intranet

4 MRSA Bacteraemia Update from Mandatory Surveillance 5 4 Hospital MRSA Total Cases for Year MRSA Trajectory - 12 Month Total Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Summary The target for 2010/11 is four cases. As at the end of December 2010 the Trust is under Trajectory with one case. April-Jun July-Sep Oct-Dec Total The number of hospital-attributed cases for the year 2010/11 is: 1 case 0 cases 0 cases 1 case Key findings from Hospital-attributed Root Cause Analyses No infections reported in December. It is now nine months since the last case Page 1

5 C. difficile Update from Mandatory Surveillance C diff vs Trajectory Cd Trajectory - 12 Month Total (Target) Cd attributable to Trust Trajectory to achieve Stretch Target 60 Rolling total Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Month Commentary The Trust reported nine cases of hospital-attributed C. difficile in December. As a result of this increase the Trust is over trajectory to achieve a reduction of 10% in cases when compared with the previous year. Hospitalacquired C. difficile trends by ward are available on the Trust Intranet in the Infection Performance section available via the main index, both on an individual and dashboard basis Page 2

6 Hospital-acquired Bacteraemia (All Organisms) This section includes information on hospital-acquired bloodstream infection and is based upon clinical judgement of the source of the infection. Ward Organism Source of Bloodstream Infection 9b Escherichia coli Unknown 9a Escherichia coli Unknown 10b Escherichia coli Urinary Catheter 11b Escherichia coli Unknown 11b Coagulase neg Staphylococcus PICC Line Ward Jan Feb Mar Apr May June July Aug Sep Oct Nov Dec Total HDU EAU G (Orth) E (Gynae) B PIU MAT CCU a A a NNU b b b b a b b ITU SIU a Total Page 3

7 12-monthly Rolling Total of Hospital-acquired Bacteraemia (All Cause) Cases in previous 12 months Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Causes of Hospital-acquired Bloodstream Infection in No. Cases Urinary Catheter Central Line Soft Tissue PICC Other Urinary Tract Cause Surgical Wound Peripheral Venous Catheter Pneumonia (Inc VAP) Commentary Although data demonstrating this trend are only available from July 2010, there has been a continual fall in the 12-monthly rolling total of hospital-acquired bloodstream infections that is shared across all divisions. Medicine has reduced from 54 cases in the 12-months to June 2010 to 41 cases in the period to December Surgery reduced from 20 to 16 and the former Specialist Services from 13 to 10 Page 4

8 Ward 7b has made the most significant reduction from 10 cases in the year to June 2010 to 4 in the year to Dec 2010 The most prevalent cause of infection relates to indwelling urinary catheters (14 cases) 13 Cases in total relate to the use of intravascular catheters Increasing and appropriate use of PICC lines across the organisation (21,750 PICC Days in 2010) means that this is likely to be a challenge for the Trust going forward Page 5

9 Antimicrobial prescribing ABX December Average 2010 Average 2009 Change on Year 9a 15% 11.1% 14.8% - 25% 14b 43% 30.9% 36.3% % 14a 24% 27.3% 29.6% - 7.8% 7a 21% 22.2% 23.7% - 6.3% 7b 27% 24.5% 25.5% - 3.9% G (Ortho) 11% 8.7% 8.8% - 1.1% 9b 33% 24.3% 24.5% - 0.8% 15a 29% 32.4% 30.9% % 15b 24% 30.2% 26.7% % 11b 31% 26.1% 23.0% % 10b 40% 27.5% 23.1% % E (Gynae) 8% 14.25% 9.74% % A 10% 7.8% 3.6% % Spinal 14% 11.4% 4.5% % Average 24% 21.6% 20.9% 3.35% Key: Green = Lower than 2009 Pink = Small increase on 2009 Red = Large increase on 2009 (>5% change) Commentary Over the course of the year there has been a small overall increase in the prevalence of antibiotics in use in the Trust, with half of areas reducing usage and half increasing (in some cases by more than double). Ward 9a has made the most impressive reduction from an already comparatively low 14.8% in 2009 to 11.1% in 2010, a 25% reduction overall. Page 6

10 Medical Device Utilisation The IPC Team conduct weekly prevalence audits of device usage in order to provide wards with a measure of utilisation of potentially hazardous medical devices. Ward teams are able examine the potential for device usage reductions to a minimum in comparison with past trends and peers. Urinary Catheter Usage Ward December Average 2010 Average 2009 Change over Year 9a 13% 13.7% 19.7% - 30% G (Ortho) 11% 16.1% 22.0% - 27% 11b 7% 12.6% 16.9% - 25% 14a 15% 24.9% 31.3% - 20% 7b 13% 14.5% 17.5% - 17% 15a 11% 17.7% 21.0% - 16% 7a 13% 11.8% 13.8% - 14% A 27% 17.2% 20.0% - 14% E (Gynae) 11% 18.7% 20.5% - 9% 9b 17% 14.3% 14.7% - 3% 10b 9% 13.0% 13.3% - 2% 14b 15% 15.5% 14.1% + 10% 15b 30% 30.9% 28.1% + 10% Spinal 56% 56.8% 44.4% + 28% Trust Average 18.6% 21.42% 18.94% + 13% Average minus SIU 13.91% 16.74% 18.06% - 7% Key: Green = Lower than 2009 Pink = Small increase on 2009 Red = Large increase on 2009 (>5% change) Urinary Catheters Although urinary catheter usage has overall grown from 18.9% in 2009 to 21.4% in 2010 if the Spinal Unit data are removed from the figures the rest of the Trust has reduced catheter usage from 18% to 16.7%, which is a 7% reduction in prevalence. Eleven out of 14 areas have reduced usage and the most significant fall has been on ward 9a which reduced from 19.7% to 13.7%, a 30% reduction. Special mention should also be made of ward 14a s progress with a reduction from 31.3% to 24.9% (data which also includes high figures in the early part of the year and does not fully reflect the recent very low figures). Page 7

11 Ward Peripheral IV Device Usage December Average 2010 Average 2009 Change over Year 9a 8% 13.3% 19.7% - 32% A 3% 2.9% 4.0% - 28% Spinal 4% 5.5% 7.4% - 26% 10b 17% 22.7% 27.1% - 16% 7a 23% 19.2% 22.7% - 15% 14a 26% 27.2% 31.6% - 14% 11b 28% 28.5% 32.8% - 13% 15a 16% 27.% 28.7% - 6% 9b 25% 20.1% 20.5% - 2% 14b 20% 22.8% 21.1% + 8% 15b 48% 37.6% 33.3% + 13% G (Ortho) 24% 27.8% 23.6% + 18% 7b 18% 21.8% 17.4% + 25% E (Gynae) 28% 38.0% 26.6% + 43% Trust Average 20.67% 21.0% 23.1% -9% Key: Green = Lower than 2009 Pink = Small increase on 2009 Red = Large increase on 2009 (>5% change) Peripheral IV Lines The prevalence of peripheral IV catheters has fallen from 23.1% to 21% when compared with the previous year, which is a fall of 9%. The majority of wards (9/14) have made significant reductions and the most significant reduction was on Ward 9a with 19.7% in 2009 falling to 13.3% in 2010 (a 30% reduction) Page 8

12 Hand Hygiene Audit Results Ward/Dept Jun Jul Aug Sep Oct Nov December 2010 Compliance OPD ODGH 100% 100% Neonatal Unit 100% 100% 100% 100% X-Ray S port 100% 100% 100% A Ward 100% 100% 100% Children s Ward % Paediatric Unit failed to complete audit 100% Paed AED 100% Paediatric Unit failed to complete audit 100% X-Ray ODGH 100% X-Ray ODGH failed to complete audit 100% Labour Ward 100% 100% Labour Ward failed to complete audit 100% Max/Fax 100% Max/Fax failed to complete audit 100% Antenatal Ward 100% Antenatal Ward failed to complete audit 100% 11b 100% 100% 90% 100% 100% 10b (SSU) failed to complete audit 98% OPD S Port 90% 100% 100% 100% 100% 98% Dermatology % 90% 97% 14a 100% 90% 11b failed to complete audit 95% Ortho OPD S port 90% 100% Ortho OPD S port failed to complete audit 95% Prog Investigations 100% 100% 70% 100% 14b failed to complete audit 93% Postnatal Ward 90% 100% 90% 93% Theatre ODGH 80% 100% 90% 100% 90% E Ward (Gynae) % Treatment Centre failed to complete audit 90% 7a 100% 80% 80% 15b failed to complete audit 87% 9b 100% 70% 85% Acc and Emergency 90% 50% 90% 100% 83% G Ward (Ortho) 60% 70% 100% 100% 83% GUM Clinic 100% 100% 90% 60% 90% 60% 83% 15a % 70% 40% 100% 82% 9a 60% 100% 100% 80% Critical Care 70% 90% 80% Theatre S port 50% 90% 90% 80% Spinal Unit 100% 40% 70% 90% 100% 80% 80% Observation Ward 90% 80% 70% Observation Ward failed to complete audit 80% Medical Day Unit 80% 70% 80% 77% 14b % 40% 70% 70% 80% 77% EAU 100% 70% 60% 100% 20% 90% 73% Treatment Centre 90% 50% 80% 73% Ortho OPD ODGH 70% 50% 90% Ortho OPD ODGH failed to complete audit 73% 15b 50% 90% 70% 15a failed to complete audit 70% 10b 50% 100% 70% 60% 70% 70% 7b 10% 80% 100% 70% 40% 60% Endoscopy S port 50% Endoscopy failed to complete audit 50% Avg for completed audits 81% 94% 84% 82% 85% 79% 88% 85% % of Audits Completed % 45% 68% 46% % 44% Looking at the year overall, compliance across the Trust for Hand Hygiene using the WHO 5 Moments audit is 85%. Over the year only 44% of completed audits were actually submitted and four areas did not undertake any audit allocated to them during the year. Although on the face of it a number of areas averaged 100% for the year, many of these had only one audit performed and so no conclusions can be drawn with regard to an accurate estimation of compliance in these areas. Four areas averaged 70% or less for compliance for the year (15b, 10b, 7b and Endoscopy). In an attempt to increase the monthly returns we have changed the allocation system to give smaller clusters for each ward to monitor and we are to monitor this over the three months from December Areas who have not completed any Hand Hygiene Audit allocated to them in the year Southport and Formby DGH Ormskirk and District GH 11b, Ortho OPD Antenatal Ward, Ortho OPD Page 9

13 Commode Cleanliness A commode with visual faecal soiling is automatically classed as Contaminated. Pass grade is given to visually clean commodes with an RLU reading of less than 500 and Caution grades are given to visually clean commodes with RLU readings of between 500 and Week 03/12/ /12/ /12/ /12/2010 Ward W48 W49 W50 W51 10b Caution Pass Pass Pass 11b Pass Pass Contaminated Pass 14a Pass Pass Pass Pass 14b Pass Pass Pass Fail 15a Caution Pass Pass Pass 15b Pass Pass Pass Pass 7a Pass Contaminated Pass Fail 7b Pass Pass Pass Pass 9a Pass Pass Pass Caution 9b Pass Caution Contaminated Pass A Ward Pass Caution Pass Pass AED Pass Contaminated Pass Pass Critical Care Pass Pass Pass Pass G Ward was E Pass Pass Pass Pass EAU Pass Pass Fail Pass E Ward was H Pass Pass Pass Pass Obs Pass Pass Pass Fail PIU Fail Pass Pass Pass Spinal Pass Pass Pass Pass Over the past year commode cleanliness has been monitored on a weekly basis. Over the course of the year 7% of commodes overall were visually contaminated. Critical Care, G Ward (Ortho) and Spinal Injuries were the only areas to record no occasions where a visually contaminated commode was seen. The following chart indicates the percentage of commodes that were visually contaminated over the course of the year. Ward 9b recorded the highest percentage of contaminated commodes with almost one in five visual inspections noting the presence of contamination. % of Commodes visually contaminated 25% 20% 15% 10% 5% 0% 9b 15a 11b AED Obs 10b 14b 15b EAU 7b 9a PIU 14a 7a A Ward H Ward Critical Care E Ward Spinal Page 10

14 MRSA and C. difficile Pathway Compliance December 2010 Compliance is now RAG-rated 90% and over: 80%-89%: Green Amber Less than 80%: Red Ward MRSA Patients Pathways MRSA Pathway Compliance CDI Patients Pathways C. difficile Pathway Compliance 7a % 0 0 n/a 7b % % 9a % 0 0 n/a 9b % 0 0 n/a 10b % % 11b % % 14a % % 14b % 0 0 n/a 15a % % 15b % % SIU % 0 0 n/a A Ward % % Medicine % % Surgery % % Total % % Compliance has fallen again for the MRSA pathways in December Ward 14b has missed two MRSA pathways and 14a and 9b missed one MRSA pathway each. Page 11

15 Outbreaks and Incidents in December Period of Increased Incidence Ward 10b During the month of December a period of increased incidence for C. difficile infection was detected on ward 10b. A total of 5 cases were considered as being part of a cluster, including one case that was detected by tracking back cases attributed to the community. One urgent meeting was held in the IPC Team office on the 13 th to implement a range of measures including a ward deep clean. Unfortunately this clean was less than successfully implemented and following a mini-heat inspection a number of issues that had been outstanding since the HEAT inspection in April 2010 were noted. An immediate re-clean and plan for remedial works was implemented. A formal PII Meeting was held on the 23 rd December and the actions were ratified. The PCT and HPA were both informed and expressed satisfaction with the actions. Specimens were sent for Typing to Manchester and the results received some time later indicated the presence of at least three strains of C. difficile (Two cultures failed to grow in the reference lab). The last case was detected on the 13 th December and to the 6 th January no further cases have been noted. H1N1 Influenza December saw a large increase in the number of cases of H1N1 influenza which greatly challenged the Trust. 13 cases required critical care admission and three fatalities were recorded. Of the 115 specimens sent for testing to the end of December, 61 (53%) have been positive. There have also been a small number of Influenza B cases detected. The majority of cases on the wards were successfully managed in side-room facilities, however it was necessary to cohort within the Critical Care area (Coronary Care was temporarily moved onto Ward 7a and then into the HDU area to increase the capacity). A small number (3) of hospital-acquired cases was detected on ward 11b and this was felt to be related to an uncooperative patient who was continually roaming about the ward. Once this patient had been transferred to ITU no further cases were noted. A Flu contingency group was convened and the flu action plan implemented. Diarrhoea and Vomiting Two potential clusters of cases of Diarrhoea and Vomiting were noted during the month. One Bay was closed between the 1 st and 3 rd of the December on 7b with no organism detected and no staff involvement. On Ward 9b an outbreak of suspected norovirus began on the 29 th December with a number of patients and some staff being affected. Initially two bays were affected, however the ward were unable to contain the problem and the whole ward was subsequently closed a few days later. As at the 31 st December the outbreak was ongoing with no confirmed organism, although the clinical picture was that of a Norovirus outbreak. Flooding The Maternity and Facio-Maxillary Units at ODGH was affected by a flood caused by a failure of the air-conditioning unit on the 23 rd December. The Labour Ward was affected most severely. The incident was managed extremely well and the clean-up undertaken to a high standard. Theatre Temperature Due to the adverse weather conditions a burst pipe caused a temporary failure of the heating in the Southport site Operating Theatres. Patients requiring urgent surgery were risk-assessed and patient warming systems used to maintain body temperature during surgery. Page 12