Ayrshire and Arran NHS Board

Transcription

1 Paper 4 Ayrshire and Arran NHS Board Monday 31 ust Healthcare Associated Infection HAIRT Author: Bob Wilson, Infection Control Manager Babs Gemmell, Business Manager Sponsoring Director: Dr Alison Graham, Medical Director Date: 30 Recommendation NHS Board members are asked to review the full HAIRT report on Healthcare Associated Infections (HAI) with particular reference to performance against HEAT targets and infection prevention and control monitoring locally. The report topics are: Staphylococcus aureus bacteraemias (SABs) Clostridium difficile infections (CDI) Meticillin resistant Staphylococcus aureus (MRSA) Outbreak/incident update Alternate reporting to the NHS Board has been agreed and therefore an HAI exception report will be submitted to the next NHS Board meeting on 19 th ober. Summary HEAT Target Position 1 il 30 e To achieve a rate of no more than 0.32 cases per 1,000 occupied bed days for CDIs in the 15 and over age group by the year ending 31 ch To achieve a rate of no more than 0.24 cases per 1,000 acute occupied bed days for SABs by the year ending 31 ch NHS Ayrshire and Arran update Thirty-Eight (38) CDI cases placing the organisation 8 cases above the local trajectory level. Twenty-Two (22) SAB cases placing the organisation 1 case above the local trajectory level. An update on the current position against the HEAT targets is provided to NHS Board members in the following sections. 1 of 17

2 Glossary of Terms CDI CRA EQIA HAI HAIRT HEAT HPS IPCT KPI MRSA MSSA PCOIC PVC SAB SBAR SGHSCD UHA UHC Clostridium difficile Infection Clinical Risk Assessment Equality Impact Assessment Healthcare Associated Infection Healthcare Associated Infection Reporting Template Health, Efficiency, Access, Treatment Health Protection Scotland Infection Prevention & Control Team Key Performance Indicator Meticillin Resistant Staphylococcus aureus Meticillin Sensitive Staphylococcus aureus Prevention and Control of Infection Committee Peripheral vascular cannula Staphylococcus aureus bacteraemia Situation, Background, Assessment and Recommendation report Scottish Government Health and Social Care Directorates University Hospital Ayr University Hospital Crosshouse 2 of 17

3 1. SAB Update 1.1 HEAT Target To achieve a rate of no more than 0.24 cases per 1,000 acute occupied bed days for SABs by the year ending 31 ch (equates to no more than seven SABs per month). 1 il 30 e (Month 3) Total SABs 22 cases The HEAT target has been exceeded by 1 case at month Healthcare Acquisitions = 13 3 (Chart 1). Healthcare Associated = 5 Community Acquisitions = 4 Chart 1 SAB HEAT Target -16 monthly position Key actions to support SAB reductions A review of all SABs that occurred between uary and ch was tabled at the PCOIC in. It was agreed that: 1. All SAB SBARs should be issued to the Associate Medical Directors for inclusion in their respective Clinical Governance Groups to share wider organisational learning. 2. The completion of action plans are to be monitored by the IPCT. In the event of any delays in completing actions, escalation process to the relevant Clinical Governance Groups is to be put in place. 3. Quarterly summary reports of main themes from enhanced SAB investigations will be tabled at each PCOIC. 4. Monthly SAB data to be reported at daily Hospital Huddles to highlight specific areas for action. 5. The Peripheral Vascular Catheter clinical guideline will be finalised in ust and issued for consultation. Once this is agreed, a roll out campaign to raise awareness will be put in place. 3 of 17

4 A review of the current guideline for obtaining blood cultures is being taken forward via a short life working group with the view of reducing the risk of blood culture contamination and needlestick injuries. Trials of available products for taking a blood culture have taken place in both Emergency Departments. 2. CDI Update 2.1 HEAT Target To achieve a rate of no more than 0.32 cases per 1,000 occupied bed days for CDIs in the 15 and over age group by the year ending 31 ch 2016 (equates to no more than 10 cases per month). 1 il 30 e (Month 3) Total CDIs 38 cases The organisation 8 CDI cases above the trajectory levels set Acute Services = 5 cases (Chart 2). Community Hospitals = 6 cases Out of Hospital Cases = 27 cases Chart 2 CDI HEAT Target -16 monthly position Key actions to support CDI reductions The focus remains on reducing the overall levels of antimicrobial prescribing locally. There is active investigation on how electronic prescribing can be utilised to aid decision making by clinicians. The Hospital Empirical Prescribing Policy has been revised and issued for the new junior doctor intake. Monthly CDI data to be reported at Daily Hospital Huddles to promote awareness. 4 of 17

5 3. MRSA National Policy Clinical Risk Assessment Update There is a mandatory requirement for NHS Board s to achieve a minimum 90% compliance against the national MRSA Clinical Risk Assessment on all admissions to UHA and UHC (excluding day cases, paediatrics, obstetrics and acute psychiatry). Compliance increased further by 3% in Quarter 1 to 85% (Table 1). This is the highest compliance level reached since quarter 4 of 2013/14 activity year. Quarter Activity - Number of Clinical Areas Audited Total Nursing Notes Assessed Compliance Achieved Locally Q1 ( 14) % Q2 (Jul 14) % Q3 ( 14) % Q4 ( ch 15) % Q1 ( 15) % Table 1 MRSA KPI Quarterly Compliance The Business Manager is providing updates to Clinical Nurse Managers at both UHA and UHC on progress and agreeing actions required to improve compliance. The Business Manager is providing updates to Senior Charge Nurses at both UHA and UHC to provide ward data on individual compliance levels, discuss ward based approaches for improvement and offer support from the IPCT. Announcements at both the daily Hospital Huddles via Assistant Directors for Acute Services to prompt requirement for screening at appropriate intervals. Monthly audits are being undertaken in the medical and surgical receiving wards at UHA and UHC to increase feedback and allow earlier intervention if compliance levels fall and reporting results to the Senior Charge Nurses. A review of the process for recording and communicating the outcome CRAs completed at the Pre-operative Assessment Clinic is to be undertaken. 4. Outbreaks/Incidents Update 4.1 Norovirus Since the last Board report in e, there has been a further two room closures taking the total to 15 incidents (nine full ward closures and six room only closures). From the prompt identification and isolation of cases by clinical teams has resulted in fewer outbreaks, with room closures only rather than a full ward closed, where possible has allowed more flexible management thus reducing the impact on patient flow. 5 of 17

6 Monitoring Form Policy/Strategy Implications Workforce Implications Financial Implications Consultation (including Professional Committees) Risk Assessment Best Value - Vision and leadership - Effective partnerships - Governance and accountability - Use of resources - Performance management Compliance with Corporate Objectives Single Outcome Agreement (SOA) Not required. This update report has no policy/strategy implications. Not required. This update report has no workforce resource implications. The continual management and monitoring of HAIs in NHS Ayrshire and Arran in driving down infection rates as far as possible will ensure that costs per patient stay (ie treatments, length of stay, terminal ward cleaning etc) will not be impacted upon, ensuring that costs are minimised across the organisation. The HAI update is provided to agreed NHS Boards, Healthcare Governance Committees and to the Prevention & Control of Infection Committee at every meeting (4 times per year). Assessments are carried out on the HAI alert organisms by the Infection Control Nurse responsible for that particular clinical area to ensure that all necessary standard infection control precautions are initiated as appropriate in managing the patients care. Yes Yes Yes Patient Safety Not required. This is an update report to NHS Board members. Impact Assessment EQIA not required as this is an update report to NHS Board members. 6 of 17

7 Appendix 1 Healthcare Associated Infection Reporting Template (HAIRT) Section 1 Board Wide Issues This section of the HAIRT covers Board wide infection prevention and control activity and actions. For reports on individual hospitals, please refer to the Healthcare Associated Infection Report Cards in Section 2. A report card summarising Board wide statistics can be found at the end of section 1. Key Healthcare Associated Infection Headlines 22 SAB cases contributing to the HEAT target (1 case over the trajectory) 38 CDI cases contributing to the HEAT target (8 cases above trajectory). Staphylococcus aureus (including MRSA) Staphylococcus aureus is an organism which is responsible for a large number of healthcare associated infections, although it can also cause infections in people who have not had any recent contact with the healthcare system. The most common form of this is Meticillin Sensitive Staphylococcus Aureus (MSSA), but the more well known is MRSA (Meticillin Resistant Staphylococcus Aureus), which is a specific type of the organism which is resistant to certain antibiotics and is therefore more difficult to treat. More information on these organisms can be found at: Staphylococcus aureus : MRSA: NHS Boards carry out surveillance of Staphylococcus aureus blood stream infections, known as bacteraemias. These are a serious form of infection and there is a national target to reduce them. The number of patients with MSSA and MRSA bacteraemias for the Board can be found at the end of section 1 and for each hospital in section 2. Information on the national surveillance programme for Staphylococcus aureus bacteraemias can be found at: In this activity year, 22 SAB cases contributed towards the HEAT target. This is 1 above the trajectory. 7 of 17

8 Clostridium difficile Clostridium difficile is an organism which is responsible for a large number of healthcare associated infections, although it can also cause infections in people who have not had any recent contact with the healthcare system. More information can be found at: NHS Boards carry out surveillance of Clostridium difficile infections (CDI), and there is a national target to reduce these. The number of patients with CDI for the Board can be found at the end of section 1 and for each hospital in section 2. Information on the national surveillance programme for Clostridium difficile infections can be found at: In this activity year, 38 CDI cases contributed towards the HEAT target. Hand Hygiene Good hand hygiene by staff, patients and visitors is a key way to prevent the spread of infections. More information on the importance of good hand hygiene can be found at: NHS Boards monitor hand hygiene and ensure a zero tolerance approach to non compliance. The hand hygiene compliance score for the Board can be found at the end of section 1 and for each hospital in section 2. Information on national hand hygiene monitoring can be found at: The HAIRT contains hand hygiene compliance obtained through local hand hygiene auditing. 8 of 17

9 Cleaning and the Healthcare Environment Keeping the healthcare environment clean is essential to prevent the spread of infections. NHS Boards monitor the cleanliness of hospitals and there is a national target to maintain compliance with standards above 90%. The cleaning compliance score for the Board can be found at the end of section 1 and for each hospital in section 2. Information on national cleanliness compliance monitoring can be found at: Healthcare environment standards are also independently inspected by the Healthcare Environment Inspectorate. More details can be found at: The HAIRT contains cleaning and the healthcare environment compliance obtained through local auditing. Outbreaks -15 This section should give details on any outbreaks that have taken place in the Board since the last report, or a brief note confirming that none have taken place. Where there has been an outbreak then for most organisms as a minimum this section should state when it was declared, number of patients affected, number of deaths (if any), actions being taken to bring the outbreak under control and whether this was reported Outbreaks of Diarrhoea and/or Vomiting Number of Patients Affected Number of Staff Affected Length of Room/Ward closure (Days) Causative Organism Ward Hospital Month 2D Crosshouse Norovirus 5A Crosshouse Norovirus 9 of 17

10 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 of cases of Staphylococcus aureus blood stream infections (also broken 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) cases are 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: performance 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. 10 of 17

11 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) bacteraemia cases are 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. 11 of 17

12 NHS AYRSHIRE & ARRAN REPORT CARD Staphylococcus aureus bacteraemia monthly case numbers MRSA MSSA Total SABS Clostridium difficile infection monthly case numbers Ages Ages Ages Hand Hygiene Monitoring Compliance (%) AHP Ancillary Medical Nurse Board Total Cleaning Compliance (%) Board Total Estates Monitoring Compliance (%) Board Total of 17

13 UNIVERSITY HOSPITAL AYR REPORT CARD Staphylococcus aureus bacteraemia monthly case numbers MRSA MSSA Total SABS Clostridium difficile infection monthly case numbers Ages Ages Ages Cleaning Compliance (%) Ayr Estates Monitoring Compliance (%) Ayr of 17

14 UNIVERSITY HOSPITAL CROSSHOUSE REPORT CARD Staphylococcus aureus bacteraemia monthly case numbers MRSA MSSA Total SABS Clostridium difficile infection monthly case numbers Ages Ages Ages Cleaning Compliance (%) Crosshouse Estates Monitoring Compliance (%) Crosshouse of 17

15 AYRSHIRE CENTRAL HOSPITAL REPORT CARD Staphylococcus aureus bacteraemia monthly case numbers MRSA MSSA Total SABS Clostridium difficile infection monthly case numbers Ages Ages Ages Cleaning Compliance (%) ACH Estates Monitoring Compliance (%) ACH of 17

16 BIGGART HOSPITAL REPORT CARD Staphylococcus aureus bacteraemia monthly case numbers MRSA MSSA Total SABS Clostridium difficile infection monthly case numbers Ages Ages Ages Cleaning Compliance (%) Biggart Estates Monitoring Compliance (%) Biggart of 17

17 NHS COMMUNITY HOSPITALS REPORT CARD The community hospitals covered in this report card include: Ailsa Hospital Arran War Memorial Hospital Arrol Park Resource Centre East Ayrshire Community Hospital Girvan Community Hospital Kirklandside Hospital Lady garet Staphylococcus aureus bacteraemia monthly case numbers MRSA MSSA Total SABS Clostridium difficile infection monthly case numbers Ages Ages Ages NHS OUT OF HOSPITAL REPORT CARD Staphylococcus aureus bacteraemia monthly case numbers MRSA MSSA Total SABS Clostridium difficile infection monthly case numbers Ages Ages Ages of 17