Date of meeting: 29 September 2015 Subject Healthcare-associated infection report for August 2015

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1 Agenda item: SUMMARY REPORT Board of Directors Date of meeting: 9 September 5 Subject Healthcare-associated infection report for ust 5 Prepared by Approved by Presented by Name of meeting considered/approved by Richard Bellamy, Infection Control Doctor, JCUH David McCaffrey, Assistant Lead Nurse, Infection Prevention and Control Judith Connor, Assistant Director of Nursing Gill Hunt, Acting Director of Nursing / DIPC Richard Wight, Medical Director Purpose: To provide performance information in relation to healthcare-associated infections. Executive Summary Decision Approval Information Assurance This report summarises surveillance information on Clostridium difficile-associated diarrhoea, MRSA and MSSA bacteraemia, bacteraemia due to glycopeptide-resistant enterococci, ESBL-producing coliform infections and other important healthcare-associated infections for the month of ust 5. The C.difficile-associated diarrhoea target for 5/ is to have no more than 5 Trustapportioned cases of C.difficile among patients aged over years. There were trust-apportioned cases in ust 5. There have been 9 Trust-apportioned cases in the first 5 months of the financial year. There is no official MRSA bacteraemia target for 5/. There were Trust-assigned cases in ust 5. There has been Trust-assigned case in the first 5 months of the financial year. There is no official MSSA bacteraemia target for 5/. There were trust-apportioned cases in ust 5. There have been Trust-apportioned cases in the first 5 months of the financial year. Next Steps The Board of Directors are asked to note the current position in respect of HCAI and for their support for the actions being taken. Supports Trust Strategy Map in the following areas quality & patient safety business sustainability operational excellence organisational capability deliver integrated improved cost improved patient improved information care control flow forefront of clinical innovation increased productivity improved innovation processes continuous service improvement culture specialised services increased revenue & strong governance & workforce development market share risk management development service quality and enhanced services strong partnerships safety & engagement

2 HEALTHCARE ASSOCIATED INFECTION REPORT (DATA TO END OF AUGUST 5). SURVEILLANCE DATA. Clostridium difficile C diff /5 Sep Oct Nov Dec Jan 5 Feb 5 Mar 5 Apr 5 May 5 Jun 5 July 5 5 5/ to date Target for 5/ cases NA Not trust apportioned NA Trust apportioned - JCUH -FHN -Carters -Redcar -East Cl -Guis -Rutson -Friary -Lambert There were cases of C.difficile infection in ust 5, of which were classed as Trustapportioned. The annual target is to have no more than 5 Trust-apportioned cases. There have been 9 trust-apportioned cases in the first 5 months of the financial year. Deaths within days after C.difficile diagnosis: for July 5, / patients died during this period. Since April 9, /5 (9%) have died during the day follow-up period. Graph : Cumulative Trust-apportioned C.difficile cases - compared to 5/ trajectory Romanby AAU Ward Ward Ward Ward Ward Ward Ward Ward Ward Ward Ward 8 Ward 5 CITU Ward War d Ward Ward Friary Ward 8 Ward Romanby Lambert Lambert Gara Ward 5 Ward 5 Ward

3 Graph : number of C.difficile cases by month from st April to th ust 5. The table below shows the number of patients with CDI cared for in JCUH, FHN and our Primary Care Hospitals in the first 5 months of 5/. Trust Non Trust Toxin positive Toxin negative 5 55 The current position in respect of C.difficile remains a concern causing both a patient safety and reputational risk. Monitor enforcement action remains in place and the recovery plan being used to manage our performance is attached to this paper. Actions During ust 5 the following actions have been implemented: Gill Hunt has been appointed as acting Director of Infection Prevention and Control (DIPC) pending appointment of a future Director of Nursing. Judith Connor has been appointed as acting head of the infection prevention and control team. The root cause analysis process is being strengthened. In future the case review meetings will be organised by the infection prevention and control team and chaired by the DIPC. Attendance from senior medical and nursing staff will be essential to ensure that issues are adequately addressed. The times of the meetings have been altered to facilitate attendance by the infection control doctor. The use of chlorine wipes was rolled out across inpatient areas of the acute hospitals.

4 New doctors commencing work at South Tees Hospitals were educated about the trust s antimicrobial stewardship campaign, which is based on the principles of Start Smart, then Focus. This is one of the five components of the medical director s Right first and every time campaign. This strategy is supported by the SPARED/ERA campaign which is producing improvements in the ARED antimicrobial audit in most areas of the trust. The ARED audit was suspended for one month during ust to facilitate collection of data for a global antibiotic prevalence survey. This survey should hopefully provide us with national and international benchmarking data on our levels of antibiotic prescribing. The updated antibiotic guidelines booklet was distributed to the new doctors starting in ust. The HCAI Collaborative meetings continue to be well-attended by our major community and acute provider partners across Teesside. This is helping to share lessons learnt in different organisations and to increase the collaborative focus on infection control. Peer Hospital Visit Heather Lyle, C.difficile Project Nurse and Debbie Lockwood, Antibiotic Pharmacist accompanied by Judith Connor, Assistant Director of Nursing, visited Aintree University Hospital NHS Foundation Trust on the th ust to learn and share practice. Aintree were recommended by Monitor as a buddy Trust, recognising their improvements in recent years. Aintree University Hospital is based on one site with 5 beds (around wards). The specialities are trauma (the regional trauma centre is based here), critical care, renal, cardiology, elderly care and a ventilator inpatient centre. There are no paediatric, maternity, oncology, haematology, neurosciences, cardiothoracic or community services. Whilst there are differences between organisations in terms of infrastructure and technology there are some actions which have been added to the CDI recovery plan immediately and can be delivered with current resource, notably a side room database and an escalation process to ensure isolation standards are achieved consistently. A full report will be presented to the September meeting of IPAG and further actions debated and agreed. Concerns Inadequate bed cleaning between patients is a significant risk in terms of HCAI and all ward managers need to be able to provide assurance that beds are cleaned thoroughly by a trained and competent member of staff. Additional dedicated resource is being used on the acute admission units on the JCUH site at peak times to ensure standards are consistently achieved. Two new Band nurses have been recruited to the infection, prevention and control team and are due to start on the 9 th October 5. In the interim the team have had to prioritise duties to ensure that essential tasks in relation to prevention of C.difficile and other important infections are maintained. There will be a review of the team s capacity and future requirements by Gill Hunt and Judith Connor. Prevention of infection is also a key priority for the Clinical Matrons and they meet on a weekly basis with the Acting Director of Nursing / DIPC to ensure there is clear focus and actions are delivered. The lack of adequate isolation facilities remains a concern particularly on wards to. The infection prevention and control team are developing guidance on the best way to manage a patient in a side room which does not have full facilities. Cleaning standards remain a concern specifically at JCUH albeit progress has been made. Joint monitoring against the CC standards begins in September and a further independent audit is being undertaken by the British Institute of Cleaning Science (BICS). Weekly contract monitoring meetings are in place and the monthly Cleaning Standards meeting continues to ensure agreed actions are delivered. We continue to stress that any clinical staff who have concerns about the cleanliness of their

5 environment should contact the Carillion help desk and we are seeing a rise in the number of requests being made. Cleanliness is everyone s responsibility and we must raise our expectations and never accept poor standards.. MRSA bacteraemia MRSA /5 Sep Oct Nov Dec Jan 5 Feb 5 Mar 5 Apr 5 May 5 Ju n 5 July 5 5 5/ to date Target for 5/ cases 9 NA Not trust assigned Trust assigned 5 NA NA There was case of MRSA bacteraemia in ust 5. This case was classed as non-trust-assigned and was probably caused by a community-acquired pneumonia. The final assignation of the case which was detected at North Tees in July, but who had had previous interaction with our trust, has not yet been finalised. We have conducted an investigation of his care at South Tees and not identified any factors which contributed to the bacteraemia.. MSSA bacteraemia MSSA cases Not trust apportioned Trust apportioned /5 Sep Oct Nov Dec Jan 5 Feb 5 Mar 5 Apr 5 May 5 Jun 5 July 5 5 5/ to date NA NA NA Target for 5/ There were cases of MSSA bacteraemia in ust 5; of which were classed as Trustapportioned. Root cause analysis has been requested from the clinical team concerned and any lessons learnt will be discussed at directorate and centre meetings.. Surveillance for other healthcare-associated infections for ust 5 5/ /5 Bacteraemia due to glycopeptide-resistant enterococci 5 Bacteraemia due to E. coli 99 8 ESBL producing coliform infections 5 sample taken in community 85 5 sample taken in our trust bacteraemias Other alert organisms 5

6 . OUTBREAKS Diarrhoea & vomiting outbreaks number number of patients affected number of staff affected Annual total /5 Sep Oct Nov Dec Jan 5 Feb Mar 5 Apr 5 May 5 June 5 July 5 5 5/5 to date There were no significant outbreaks of diarrhoea and vomiting in ust 5.. OUTBREAK OF MULTI-DRUG-RESISTANT PSEUDOMONAS AERUGINOSA INFECTION IN ICU/, GHDU, WARD AND HDU The situation continues to be monitored. A further outbreak meeting will take place on the th ust 5. It appears that the outbreak is coming to an end and we are now in a post-outbreak monitoring situation.. LEGIONELLA In compliance with NHS guidance (HTM :- The Control of Legionella, hygiene safe hot and cold, drinking water systems) the Trust has a Water Management Policy which contains specific control actions associated with any infection control risk that may arise from Legionella, Pseudomonas aeruginosa or any other water contaminant. Such guidance requires routine screening for augmented care units for the present of Legionella and Pseudomonas aeruginosa. HTM :- recognises that Legionella can and does exist in many water systems at low levels or below detection thresholds. Routine testing in the absence of evidence of healthcare associated infections has not been considered as necessary by DH (it s complex and expensive) apart from those areas that are classified as augmented care units. Ward :- There has been further testing of designated water outlets which has only identified one colonised outlet to date which was located in the Supportive Care Bay (Room 9.C.) local control measures were implemented and this water outlet will be monitored routinely. Routine water sampling took place in the augmented care units at the Friarage hospital, which identified a number of Legionella counts in ITU and the Mowbray Unit. The Mowbray Unit was decanted to an alternative location and a few water outlets which were affected in ITU were taken out of service to be disinfected. All remedial actions were agreed in a Water Control Group meeting, which also included secondary assurance testing of the theatre block as it was a common hot water system with the Mowbray Unit. No patients have been affected.

7 5. MONITORING FOR MYCOBACTERIAL INFECTIONS ASSOCIATED WITH CARDIOTHORACIC HEATER-COOLER UNITS We are continuing to implement monitoring and disinfection practices in line with the Public Health England guidance. No patients have been affected in our trust.. HYDROGEN PEROXIDE FOGGING OF ULTRA-CLEAN THEATRES Following damage to the sealant holding HEPA filters in place at Friarage hospital, hydrogen peroxide fogging will not be performed in ultra-clean theatres at either acute hospital site.. INFECTION CONTROL NURSING TEAM SURVEILLENCE DATA Telephone calls Duty Nurse

8 Care Home data IPCN Training data 8

9 . RECOMMENDATIONS The Board of Directors are asked to note the current position in respect of HCAI and for their for the actions being taken. support A further report will be presented in October 5. Richard Bellamy David McCaffrey Judith Connor Gill Hunt Appendix C.difficile Recovery Plan 9