SOMERSET PARTNERSHIP NHS FOUNDATION TRUST INFECTION PREVENTION AND CONTROL ANNUAL REPORT 2015/16. Report to the Trust Board 28 June 2016

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1 SOMERSET PARTNERSHIP NHS FOUNDATION TRUST INFECTION PREVENTION AND CONTROL ANNUAL REPORT 2015/16 Report to the Trust Board 28 June 2016 Sponsoring Director: Author: Purpose of the report: Key Issues and Recommendations: Director of Nursing and Patient Safety. Head of Infection Prevention and Control/Decontamination Lead. To advise the Trust Board with regards to the Infection Prevention and Control activity for the year 2015/16 as per the requirements of the Health and Social Care Act. The Trust has robust systems and processes in place to manage the risk associated with the prevention and management of infections within our services. A Commissioner set trajectory of five cases of avoidable Clostridium difficile infections was attributed to the Trust for 2015/16. The out-turn figure reported as of 31 March, 2016, was eight cases of which zero were deemed as avoidable and therefore nil attributable to the Trust. The Trust had a trajectory of zero MRSA Blood Stream Infections (BSI). The out-turn figure for 2015/16 is reported as two cases, both of which were referred for arbitration. The NHS England Arbitration Panel subsequently agreed that both cases would be attributed to a third party - zero cases have therefore been reported, with the last attributable case being reported in 2009, pre-acquisition. There were six gastro-intestinal illness related outbreaks impacting on the Trust s inpatient activity. This is a reduction when compared to last year when there were 14 outbreaks. All affected wards were fully supported by the Infection Prevention and Control Team, and are to be commended for their robust management of the outbreaks June 2016 Public Board - 1 -

2 The increasing prevalence of antibiotic resistant microorganisms, especially those with multiple resistances, is causing international and local concern. The Trust has investigated two cases of blood stream infections associated with these organisms and learning has been disseminated trust wide. Audits of compliance with Trust policy to include hand hygiene, isolation, cleanliness and management of sharps have continued to be undertaken and the Trust Board can take a high level of assurance of compliance with CQC Outcome 8. A lack of interface between RiO and IC Net was identified at the close of 2014/15. This means that the IPCT are no longer automatically being notified of patients, with identified infections, being transferred to our inpatient wards. During 2016/16 BDO (Trust Internal Auditors) reviewed the Trust internal processes in place for managing infection prevention and control and for monitoring compliance with key regulations. The audit confirmed that the Trust had a robust infection internal audit plan that was in line with the Department of Health Code of Conduct. Amongst other areas of good practice - the Trust can be assured that actions identified were cascaded to the correct level of staff to enhance their learning; there was a robust training plan; and the Trust Clinical Governance Group adequately reviewed compliance and risk. Following the auditors recommendations - the Trust policy has been updated to ensure that all staff are aware of the escalation and governance process. It is also proposed that Board oversight is further strengthened through the new Quality and Performance committee. Actions required by the Board: The Board is asked to discuss and note the report. June 2016 Public Board - 2 -

3 INFECTION PREVENTION AND CONTROL ANNUAL REPORT 2015/16 SOMERSET PARTNERSHIP FOUNDATION TRUST INFECTION PREVENTION AND CONTROL ANNUAL REPORT 2015/16 CONTENTS Page CONTENTS 1 Introduction Surveillance Outbreaks Infection Prevention and Control Audit Activity Decontamination National Initiatives Training Legionella and Water Quality New Build Initiatives Compliance with CQC: Relevant CQC Standard Conclusion 33 APPENDICES APPENDIX A INFECTION PREVENTION AND CONTROL Team Work Programme 2015/ June 2016 Public Board - 3 -

4 INFECTION PREVENTION AND CONTROL ANNUAL REPORT 2015/16 1. INTRODUCTION 1.1 This report details Infection Prevention and Control activity from 1 April 2015 to 31 March 2016, with an assessment of performance against national targets for the year. The report provides assurance to the Board of Directors and the public on compliance with the Health and Social Care Act 2008 (updated July 2015): Code of Practice for the NHS on the prevention and control of healthcare associated infections and related guidance (commonly known as The Hygiene Code) and also in relation to National Institute for Health and Clinical Excellence (NICE) guidance. 1.2 This Annual Report is indicative of Somerset Partnership NHS Foundation Trust s continued pledge to deliver excellent community and mental health service to the population it serves by demonstrating ongoing commitment to reducing health care associated infections, and provides an overview of the progress made and the processes in place for the prevention and control of health care associated infections during the reporting period of 1 April 2015 to 31 March Infection Prevention and Control continues to be a fundamental component of the Quality and Patient Safety agenda. Despite the continued challenging financial climate during 2015/16, the Trust has continued to provide a service that meets the needs of our patients and service users. 1.4 Healthcare-associated infections are generally related to multiple factors. Prevention of these infections depends on daily vigilance and implementation Infection Prevention and Control practices. These practices are outlined in Trust infection prevention and control guidelines, policies, and procedures. 1.5 To reduce healthcare associated infections Somerset Partnership NHS Foundation Trust ensures that effective systems are in place for the prevention and control of infection. These systems incorporate national guidance and good practice, engage staff and make infection prevention and control everyone s business. All staff (clinical and nonclinical) employed by Somerset Partnership NHS Foundation Trust are responsible for understanding, maintaining and implementing these principles and practices within their respective service areas. 1.6 Microbiology and Infection Prevention and Control Medical support continues to be provided by the Taunton and Somerset NHS Foundation Trust s Consultant Microbiologist Team. The role of the June 2016 Public Board - 4 -

5 Somerset Partnership s Infection Prevention and Control Doctor is provided by Dr. Mike Smith. 1.7 The Somerset Partnership Infection Prevention and Control Team has maintained an effective service this year and has delivered on all of the Infection Prevention and Control activities outlined in the 2015/16 programmes of work across all services( for further details please refer to Appendix A). 2. SURVEILLANCE 2.1 Mandatory surveillance is carried out for all Meticillin Resistant Staphylococcus aureus bacteraemia (MRSA) (bloodstream infections), Meticillin Sensitive Staphylococcus aureus bacteraemia (MSSA) (bloodstream infections) and for all cases of Clostridium difficile notifications, using the national Healthcare Associated Infections Database system. Confirmed isolates are reported by the responsible laboratory, which for Somerset Partnership NHS Foundation Trust is via Taunton and Somerset NHS Foundation Trust. 2.2 Monthly isolate rates of Meticillin Resistant Staphylococcus aureus bacteraemia and Clostridium difficile are reported locally throughout the organisation via the Somerset Partnership NHS Foundation Trust local performance management structure. 2.3 Root cause analysis investigations are undertaken on all cases of Meticillin Resistant Staphylococcus aureus bacteraemia bloodstream infections and Toxin positive Clostridium difficile. This process is undertaken in collaboration with local care teams. The resulting actions plans are reviewed at strategic and operational level Infection Prevention and Control meetings, together with a review of routine surveillance data, to inform clinical practice. 2.4 In all appropriate clinical settings, the Somerset Partnership NHS Foundation Trust Infection Prevention and Control Team routinely collate, review and compare data on all alert organisms, conditions and infections in order to monitor infection rates and assess any increasing risks of infection. Data is fed back in a timely fashion, either routinely through the Infection Prevention and Control Implementation Group or locally when a problem occurs in order to ensure actions are taken. 2.5 IC Net is the database surveillance system used by both of the Somerset Acute NHS Foundation Trusts, Somerset Clinical Commissioning Group (in relation to primary care cases) and Somerset Partnership NHS Foundation Trust Infection Prevention and Control Teams. The system has been responsible for improving the June 2016 Public Board - 5 -

6 communication of patient details and clinical intervention between teams and healthcare settings across the county The system works by collating information in relation to patient admissions and discharges via the PAS and Cerner systems, linking them to the Acute Trust managed Laboratory interface. The information is then integrated into the system through pre-set filters to provide the Somerset Infection Prevention and Control Teams with relevant patient specific information A lack of interface between RiO and IC Net was identified at the close of 2014/15. Due to this lack of interface the Infection Prevention and Control Team are no longer automatically being notified of patients, with identified infections, being transferred to Somerset Partnership NHS Foundation Trust inpatient setting The main concerns regarding the lack of interface between IC Net/RIO/PAS and Cerner have been raised and highlighted via the Directorate and Trust Risk Register as; patients may not be isolated in a timely/robust manner resulting in the spread of infection within an inpatient area; patients may not commence timely/appropriate treatment due to staff being unaware of current infection status; incorrect figures may be reported to the Trust Board and via national reporting due to inaccuracies in the system The system is fully compliant with the Information Governance Toolkit The Infection Prevention and Control Team have continued to work with the Trust Information Management and Technology Team to endeavour to resolve all IC Net related issues, but as of the close of Quarter Four, 2015/16 the lack of interface between IC Net/RIO/PAS and Cerner continues to be problematic. 2.6 Immediate feedback to Locality/Service Managers and Matrons of hot spots or problem areas occurs as necessary. Routine and regular sharing of surveillance data is via the Somerset Clinical Commissioning Group Infection Prevention and Control Assurance Committee and Somerset Partnership NHS Foundation Trust Infection Prevention & Control Assurance Group. 2.7 Clostridium difficile Clostridium difficile infection (CDI) remains an unpleasant, and potentially severe or fatal infection that occurs mainly in elderly and June 2016 Public Board - 6 -

7 other vulnerable patient groups, especially those who have been exposed to antibiotic treatment. 17% of patients who are diagnosed with Clostridium difficile have died by day 30 after diagnosis. After controlling for risk of death in non-cdi patients (9%), the Clostridium difficile attributable death rate is 8% i.e. one in 12 patients, (Planche et al. Lancet Infect Dis, 2013) Reporting of all Clostridium difficile cases is part of the Mandatory Enhanced Surveillance System which is managed via Public Health England The NHS has made great strides in reducing the numbers of CDIs, however, the rate of improvement for CDI has slowed over recent years and some infections are a consequence of factors outside the control of the NHS organisation that detected the infection. Further improvement on the current position is likely to require a greater understanding of the individual causes of CDI cases, in order to understand if there were any lapses in the quality of care provided in each case, and if so, to take appropriate steps to address any problems identified For 2015/16, organisations have been encouraged to assess each CDI case to determine whether the case was linked with a lapse in the quality of care provided to patients Somerset Clinical Commissioning Group has considered the results of these assessments and exercise discretion in deciding whether any individual case of CDI affecting a patient under its contract should count towards the aggregate number of cases on the basis of which contractual sanctions are calculated As per the previous year, Commissioners have been advised by NHS England to apply exactly the same principles as outlined for infections identified as acute related infections to those identified from within the community, in order to encourage learning and improvement. This includes cases associated with community providers. Following identification of a sample positive for C. difficile obtained within 72 hours of admission to an acute setting or from a community setting or independent provider, providers are required to assess the care provided to determine if there were lapses in care. Any learning should support the development of an action plan and subsequent improvement in care as well as forming part of the relevant contract management processes As was the case in 2014/15, during 2015/16 there were no national CDI objectives attributed for community services providers, and no financial sanctions related to CDI mandated in the NHS Standard Contract for community services providers. June 2016 Public Board - 7 -

8 In an effort to continually drive healthcare improvement, Somerset Partnership NHS Foundation Trust was allocated a Commissioner set trajectory of five avoidable toxin positive CDI cases The out-turn figure for 2015/16 is eight toxin positive CDI cases, nil of which have been assessed as avoidable cases. Root Cause Analysis investigations were undertaken on all eight toxin positive cases, and all reviewed at the Somerset Partnership NHS Foundation Trust Infection Prevention and Control Assurance Group s bi-monthly meeting, the Somerset Microbiology and Infection Prevention and Control Lead s Meeting and the Somerset Clinical Commissioning Group Infection Prevention and Control Assurance Committee. All cases have been assessed in collaboration with the Somerset Clinical Commissioning Group Infection Prevention and Control Lead Nurse, and all assessed as non-avoidable The objectives for all organisations in 2016/17 are the same as for 2015/16 and Somerset Clinical Commissioning Group has set the 2016/17 Clostridium difficile infection objective trajectory at five avoidable cases Local guidance on management of patients identified with the organism is available via the Somerset Partnership NHS Foundation Trust Clostridium difficile Policy. This may be accessed via the Somerset Partnership NHS Foundation Trust Intranet site. 2.8 Meticillin Resistant Staphylococcus Aureus (MRSA) Staphylococcus aureus is a bacterium that is present on the skin and in the nose and throat of approximately 30% of the healthy population. On intact skin its presence is harmless. It is the most common cause of localised wound and skin infections Mandatory surveillance of blood stream infections due to Meticillin Resistant Staphylococcus aureus has continued during 2015/16. As of April, 2014, nil nationally set trajectories had been attributed to Somerset Partnership NHS Foundation Trust; therefore a Commissioner trajectory for 2015/16 was set at zero During 2015/16 all admissions to Somerset Partnership NHS Foundation Trust Community Services managed community hospitals, all high risk admissions to Mental Health inpatient units and all preoperative podiatric surgery patients have been routinely screened for Meticillin Resistant Staphylococcus aureus colonisation Mental Health Inpatient units screen the following high risk individuals only; those who have any indwelling device; June 2016 Public Board - 8 -

9 those who have a break in the skin, which would include acute, chronic and slow to heal wounds regardless of cause; history of admission (excluding A&E attendance) to any other hospital or residential setting within one month (a residential setting includes residential care/nursing care homes/ prison/young offenders institutions); history of surgery (including Minor and Day surgery) within one month Patients with Meticillin Resistant Staphylococcus aureus colonisation identified following admission screening are routinely decolonised to reduce the risk of Meticillin Resistant Staphylococcus aureus bacteraemia, as per local Policy During Quarter 2, 2015/16, a deteriorating patient residing at Frome Community Hospital was identified as suffering from an MRSA blood stream infection (BSI) the patient was subsequently transfered to the RUH, Bath. As per national policy, a Post Infection Review (PIR) was instigated. The investigation was unable to ascertain the source of the infection, and the probable source was therefore assessed as attributable to deep seated infection. The Trust Infection Control Doctor (Dr. Mike Smith) and Somerset CCG supported this view and arbitration via NHS England was therefore requested. The NHS England Arbitration Panel has supported this hypothesis and the case will therefore not be attributed to the Somerset Partnership inpatient period One case of MRSA Blood Stream Infection was reported via Somerset Clinical Commissioning Group (CCG) during Quarter 4, 2015/16. The patient involved was on the Somerset Partnership District Nurse caseload. An investigation into the patient s care pathway within Somerset Partnership NHS Foundation Trust was undertaken. From the evidence gathered by the Somerset Partnership IPC Team, there did not appear to be any identified breach in clinical practice which may have predisposed the patient to additional risk. This assessment was supported by the Trust infection Control Doctor, Dr Mike Smith. Following discussion with the Somerset CCG, it was agreed this case would be referred for arbitration (as per Guidance on the reporting and monitoring arrangements and post infection review process for MRSA bloodstream infections from April 2014 V2, Publications Gateway Reference 01559). This assessment was supported by the NHS England Arbitration panel, who agreed that the case would be attributed to a third party, June 2016 Public Board - 9 -

10 and therefore will not be reflected on the Somerset Partnership s baseline The out-turn figure reported by the Trust for 2015/16 therefore remains at zero cases Wessex House A period of increased incidence (MRSA colonisation) involving two patients residing at Wessex House was identified during Quarter Two, 2015/16. Dr David Hill (acting in the absence of the Trust Infection Control Doctor) confirmed a link between the two patients based on an identical and unusual sensitivity pattern and advised against ribotyping on this evidence. An RCA investigation was undertaken by the IPC Mental Health Lead, and key actions identified. These were shared with the Unit Manager and staff. Local training was also provided. 2.9 Meticillin Sensitive Staphylococcus Aureus (MSSA) Most strains of Staphylococcus aureus are sensitive to the more commonly used antibiotics, and infections can be effectively treated. Some Staphylococcus aureus bacteria are more resistant. Those resistant to the antibiotic meticillin are termed meticillin-resistant Staphylococcus aureus and often require different types of antibiotic to treat them. Those that are sensitive to meticillin are termed meticillinsensitive Staphylococcus aureus During 2015/16 there was no requirement for community care organisations to provide this as mandatory data. The Somerset Partnership Infection Prevention and Control team has continued to undertake root cause analysis investigations into any reported case of MSSA blood stream infection During Quarter 2, 2015/16 a patient residing at Dene Barton Community Hospital was identified as suffering from an MSSA blood stream infection (BSI). A root cause analysis investigation was undertaken and this case has been assessed by the Trust Infection Control Doctor (Dr. Mike Smith) who has advised that the case was not attributable to the Trust Gram Negative Organisms The increasing prevalence of antibiotic resistant micro-organisms, especially those with multiple resistances, is causing international concern. Antibiotic resistance makes infections difficult to treat. It may also increase the length of severity of illness, the period of infection, adverse reactions (due to the need to use less safe alternative drugs), length of hospital admission and overall costs. June 2016 Public Board

11 Many bacteria are normally found in the bowel. Not all are resistant to antibiotics and not all will cause serious illness. Species of bacteria commonly found include the Enterobacteriaceae (eg. Escherichia coli or E. coli, Klebsiella, Proteus and Enterobacter). These bacteria are also referred to as Gram-negative bacilli (thus called because of their appearance in the staining methodology used by the laboratory). Other clinically important Gram-negative bacilli include Pseudomonas and Acinetobacter These Gram-negative bacteria, under certain circumstances can become resistant to antibiotics and may require infection control management. These may be introduced into the gut via the faecal-oral route and establish in small numbers (colonisation). Problems can occur when the organism has the opportunity to migrate to areas such as the bladder (manifesting as a urinary tract infection), a wound (wound infection) or the blood stream (blood stream infection) Secondary spread in health care settings can readily occur via the hands of healthcare personnel. Endemic strains may persist in health care settings for years because of patient colonisation, environmental contamination, and hand transmission. Correct infection prevention and control practices are essential to prevent spread and outbreaks of Gram-negative bacteria There is nil national or local trajectory set for monitoring these organisms, and the Acute NHS Foundation Trusts do not currently undertake Root Cause Analysis investigations on such cases. Despite this, the Somerset Partnership Infection Prevention and Control team do undertake Root Cause Analysis investigations on all bloodstream infections, in an effort to identify any learning which may be disseminated During 2015/16 there have been two reported blood stream infections associated with Gram-negative bacteria; - Quarter Two: a patient residing at Wellington Community Hospital was identified as suffering from an E. coli blood stream infection. A root cause analysis investigation was undertaken and this case has been assessed by the Trust Infection Control Doctor, (Dr. Mike Smith), who has advised that the case was unavoidable; - Quarter Four: a patient was admitted to Burnham On Sea Community Hospital for rehabilitation from Weston General Hospital (noted that this patient also had a short admission at Southmead Hospital for clinical advice re: MRI findings) following an episode of left sided weakness and falls due to Meniere s June 2016 Public Board

12 disease. This case has been assessed by the Trust Infection Control Doctor (Dr Mike Smith) as an unavoidable blood stream infection secondary to a urinary tract infection Somerset Partnership NHS Foundation Trust Infection Prevention and Control Team have continued to provide training to clinically based staff on Gram-negative organism colonisations and provide regular advice when undertaking Infection Prevention and Control visits Public Health England has previously issued an Acute Trust-focused toolkit for the early detection, management and control of Carbapenemase Producing Enterobacteriaceae (CPE). This is a family of multi resistant Gram-negative bacteria that are no longer active against the carbapenem class of antibiotics, considered the "drug of last resort" for serious infections. There is national concern that CPE are the new "superbug". Death rates of up to 50% can be seen in patients with CPE sepsis, a rate much higher than other resistant infections such as MRSA or Clostridium difficile Public Health England Toolkit for managing Carbapenemaseproducing Enterobacteriaceae (CPE) in non-acute and community setting. This guidance was issued in June 2015, for non-acute healthcare settings. The Infection Prevention and Control Senior Nurse reviewed the document and completed a Briefing Paper which was shared with the Trust s Director of Nursing and Patient Safety. The toolkit is designed to inform practice in community and non-acute settings including Nursing and Residential Care Homes, Community Hospitals, Mental Health Units, EMI units, Prisons and those receiving domiciliary nursing care. The new guidance does not require significant changes in current Trust practice, however it may inform our approach to other resistant organisms, especially in relation to isolation management which could potentially be relaxed for those not symptomatic of active infection. 3. OUTBREAKS 3.1 Norovirus Norovirus is the most common cause of infectious gastroenteritis (diarrhoea and vomiting) in England. The Illness is generally mild and people usually recover fully within two to three days. Infections can occur at any age because immunity does not last. Historically known as 'winter vomiting disease', the disease is more prominent during the June 2016 Public Board

13 winter months, but can occur at any time of year. It is also known as small round structured virus (SRSV) or Norwalk-like virus Approximately 3,000 people a year are admitted to hospital with norovirus in England and the incidence in the community is thought to be about 16.5% of the 17 million cases of infectious intestinal disease in England per year, and there is evidence that this burden has increased over the past decade The symptoms usually start between hours after the initial norovirus infection, although they can start after as little as 12 hours. The first symptom is usually a sudden onset of nausea, which is followed by projectile vomiting and watery diarrhoea. Some people may also have: a mild fever; headaches; stomach cramps; aching limbs. Symptoms normally last between hours, although most people make a full recovery within one to two days Norovirus related outbreaks impacting on the Trust s inpatient activity may be viewed at Table National guidance in relation to norovirus outbreak management is based on a principle of minimising the disruption to important and essential services and maximising the ability of organisation to deliver appropriate care to patients safely and effectively. There has been a shift of focus towards a balance between the prevention of spread of infection and maintaining organisational activity. In effect, this means a move away from the traditional approach of complete ward closure and an adoption of a pragmatic, escalatory system of isolation using single rooms and cohort nursing without compromising patient care both for norovirus itself and other essential healthcare. This approach has been utilised across numerous Trust managed inpatient areas during the 2015/16 winter period, which has seen unprecedented pressures impacting on all health care services All affected areas were fully supported by the Infection Prevention and Control Team, and are all to be commended for their robust management of the outbreaks. June 2016 Public Board

14 3.1.7 A Norovirus Outbreak Review Meeting for 2014/15 has previously been held on Thursday 14 May 2015, where 14 outbreaks were reviewed, of which 11 had been confirmed as attributable to norovirus. At the close of Q4, 2016, of the six cases reported by the Trust, only one has been confirmed as attributable to norovirus. The 2015/16 Norovirus Outbreak Review Meeting will be convened in May, The Trust has previously participated in a national, multi-centred research trial which was attempting to ascertain if earlier identification of index cases involved in norovirus outbreaks could be achieved. The project was called WINCL ( when is norovirus control lost ). Reporting to the WINCL website commenced during Quarter Three of 2013/14 and was completed at the end of April, Background to study: Norovirus outbreaks have a significant impact on all care settings; little is known about the index cases from whom these outbreaks initiate. Aim of study: To identify and categorise norovirus outbreak index cases in care settings. Study results: Were published in January, 2016, in the Journal of Infection Prevention (The Where is Norovirus Control Lost (WINCL) Study: an enhanced surveillance project to identify norovirus index cases in care settings in the UK and Ireland, Curren et al). The conclusions reached were that the true index case is commonly not identified as the cause of a norovirus outbreak with at least 50% of index cases being misclassified. Unrecognised norovirus crosstransmission occurs frequently suggesting that either Standard Infection Control Precautions (SICPs) are being insufficiently well applied, and or SICPs are themselves are insufficient to prevent outbreaks. The above findings will be considered during the 2015/16 Norovirus Outbreak Review Meeting (May, 2016). June 2016 Public Board

15 Table 1: Trust-wide Norovirus Activity: 2015/16 INPATIENT AREA AFFECTED 1. Wincanton Community Hospital DATE OF RETRICTIONS NUMBER OF PATIENTS AFFECTED/ CAUSATIVE ORGANISM 28 March - 7 April, patients/ 2 staff; Organism not identified 2. Frome Community Hospital 8-16 December patients/ 5 staff; Organism not identified 3. Crewkerne Community Hospital 4. Bridgwater Community Hospital December patients/0 staff; Organism not identified 29 December January patients/ staff; Norovirus was identified 5. Chard Community Hospital 5-12th March, patients/5 staff; Organism not identified 6. South Petherton Community Hospital 3.2 Influenza 6th - 8th March, The Influenza Vaccination programme is a coordinated and evidence based approach to planning for the demands of Influenza across England. Each year the NHS prepares for the unpredictability of flu. For most healthy people, Influenza is an unpleasant but usually selflimiting disease with recovery generally within a week. However, the following people are at particular risk of severe illness if they catch Influenza: 7 patients /2 staff reported; Organism not identified older people; the very young; pregnant women; those with underlying disease, particularly chronic respiratory or cardiac disease; those who are immunosuppressed. June 2016 Public Board

16 3.2.2 All NHS healthcare workers have a duty of care to protect their patients and service users from infection. This includes getting vaccinated to provide protection against acquisition/cross infection of Influenza For the 2015/16 Influenza Vaccination Season, there was a national aspiration to vaccinate at least 75% of health care workers with direct patient contact. Despite this desire, there was nil mandated requirement for Trust to achieve this rate, and vaccination remains a voluntary decision The Trust Executive lead for the Programme was the Acting Director of Human Resources, with the Vaccination Programme being managed via the Work Team in collaboration with the Trust Occupational Health Service, Optima Vaccination sessions were available to frontline staff across a variety of inpatient settings, and delivered via Optima National, provisional data from the fifth monthly collection of influenza vaccine uptake by frontline healthcare workers (PHE Weekly National Influenza Report Summary of UK surveillance of influenza and other seasonal respiratory illnesses) show 50.8% of Healthcare staff were vaccinated by 29 February, 2016, from 96.6% of NHS Trusts, compared to 54.9% vaccinated in the previous season by 28 February The overall uptake for Somerset Partnership NHS Foundation Trust was 41.9% which is a 2% reduction on the 2014/15 figure. This downturn is reflected nationally, as is detailed above. Please see Table 2, for further details regarding Somerset Partnership s frontline staff uptake Public Health England (PHE) has previously reported that the 2014/15 influenza season in the UK was characterised by early circulation of Influenza A (H3N2). PHE have advised that that the seasonal Influenza vaccine delivered in 2014/15 provided low protection against the dominant circulating strain. This finding may have influenced staff s decision to be vaccinated during the 2015/16 season; therefore one hypothesis for the 2% reduction in staff uptake could be there was doubt in relation to the efficacy of the 2015/16 vaccine? June 2016 Public Board

17 3.2.8 Virus surveillance from the UK and elsewhere in Europe shows the strain A (H1N1) pdm09 is now the main seasonal flu virus, and the 2015/16 vaccine has been effective against this strain. Table 2: Uptake of Flu Vaccination: Data from 1 September December 2015 Trust Name Somerset Partnership 2015/16 Figures 2014/15 Figures No of Flu Vaccine No of Flu HCW doses uptake HCW doses involved given % involved given with with Direct Direct patient patient care care Vaccine uptake % 2,837 1, ,731 1, Respiratory Illness Outbreak Restrictions were placed on Meadow Ward, Williton Community Hospital between 27 October 2015 and 2 November 2015 due to an outbreak of respiratory symptoms (chesty coughs, expectorating, and pyrexia). Advice was given by the Trust Infection Control Doctor, Dr Mike Smith, and a Bristol based Consultant Virologist, based at the Southwest Regional Microbiology Laboratory. 3.4 Ebola No causative organism was identified from nasopharyngeal swabs despite local testing and further investigations were undertaken by the National Reference Laboratory. Ten patients were involved (two patients required acute trust intervention and one patient passed away [but was known to be receiving palliative care]). Restrictions were lifted on 2 November 2015 following post outbreak cleaning. Public Health England were advised of all actions taken and an outbreak review meeting was held on 28 October, The most widespread epidemic of Ebola virus disease in history began in 2013 and has continued for over two years, resulting in significant loss of life and social disruption across the region of West Africa. As of 2016, although the epidemic is no longer out of control, flare-ups of the disease are likely to continue for some time June 2016 Public Board

18 3.4.2 The outbreak began in Guinea in December, 2013, and then spread to Liberia and Sierra Leone, with minor outbreaks elsewhere. It has caused significant mortality, with reported case fatality rates of up to 70% and specifically 57 59% among hospitalized patients. Small outbreaks occurred in Nigeria and Mali, and isolated cases occurred in Senegal, the United Kingdom and Sardinia. Imported cases in the United States and Spain led to secondary infections of medical workers but did not spread further. As of 30 March 2016, the World Health Organization and respective governments have reported a total of 28,647 suspected cases and 11,322 deaths, though the WHO believes that this substantially understates the magnitude of the outbreak The WHO has warned that further small outbreaks of the disease may occur in the future, and vigilance should be maintained. A flare-up in January 2016 in Sierra Leone resulted in one death, one patient being treated, and over 100 people being quarantined. As of April 2016, the flare-up in Sierra Leone has been declared over, but new flare-ups have been reported in Guinea and Liberia Ebola is not new the virus was discovered nearly 40 years ago. Fruit bats, a delicacy for some West Africans, are thought to be the natural host, but various types of monkey can carry the virus too. There is currently no proven vaccine, or cure, but drug trials are being fast tracked and it is hoped that a vaccine will be available in the near future The Trust has not treated any patients, or returning healthcare staff, identified as being at high risk of having acquired the organism. The Viral Haemorrhagic Fever Policy can be accessed via Trust Internet site. 4. INFECTION PREVENTION AND CONTROL AUDIT ACTIVITY 2015/ Infection Prevention and Control audit enables the organisation to assess actual practice against defined standards as identified within the Code of Practice for the Prevention and Control of Health Care Associated Infections (2010); it should also permit reporting of noncompliance or issues of concern by either healthcare workers or the Infection Prevention and Control Team. 4.2 The Infection Prevention and Control audit programme promotes continual improvement as it enables a blame-free mechanism for changes in practice, if indicated. The results of audit, when provided back to staff, can turn defects into improvements after appropriate changes are completed. June 2016 Public Board

19 4.3 All audit results have been shared at the relevant Trust Best Practice Groups, the Trust Infection Prevention and Control Assurance Group, and are also reported quarterly via the Trust Clinical Governance Group. 4.4 A mixed methodology approach is applied by the Infection Prevention and Control Team when undertaking the audit programme, and includes; documentation review; staff interview; observational review. 4.5 Some fundamental requirements for preventing infection in healthcare environments are; cleanliness of hands and the environment; isolation of patients known or suspected of having easily transmissible or epidemiologically important pathogens; use of personal protective equipment (PPE); targeted screening (MRSA); management of sharps injuries. These are areas which have been subject to the Somerset Partnership Trust Infection Prevention and Control team undertaking audits of compliance and additionally the Team have audited; appropriate usage of Clinical Gloves. 4.6 Infection Prevention and Control Audit results have also been complimented by observational reviews undertaken via Patient Led Assessment of the Clinical Environment (PLACE). 4.7 Commercially led audits of compliance have also been undertaken during 2015/16 as follows; Daniels Healthcare: Review of sharps bin usage. 4.8 A member of the IPC Team has undertaken a Regulation Governance related audit to assess the Infection Prevention and Control Team s June 2016 Public Board

20 compliance with regards appropriate use of the county-wide Laboratory database system known as IC net. 4.9 A detailed Audit Report has been submitted to the Trust Clinical Effectiveness and Assurance Group and the Infection Prevention and Control Assurance Group Recommendations and resulting action plan, arising from the Infection Prevention and Control audits have been agreed and monitored by the following Trust Groups; Hand Hygiene/Cleanliness= Infection Prevention and Control Assurance Group; Community Infection Prevention Society Audit = Infection Prevention and Control Assurance Group; Environmental Cleanliness = Infection Prevention and Control Assurance Group, Facilities Management Governance Group; Isolation Audit = Infection Prevention and Control Assurance Group; MRSA Screening Audit = Infection Prevention and Control Assurance Group; Sharps Safety = Health and Safety Committee and Infection Prevention and Control Assurance Group; Medical Devices = Health and Safety Committee and Infection Prevention and Control Assurance Group; Internal Audit undertaken by BDO = Infection Control: Infection Prevention and Control Assurance Group; Environmental Cleanliness of the Prison Dental Healthcare facilities at; HMP Leyhill, Bristol, HMP Eastwood Park, Bristol, HMP Ashfield, Bristol, HMP Bristol = Infection Prevention and Control Assurance Group; HTM 01/05 compliance Prison Dental Healthcare facilities at; HMP Leyhill, Bristol, HMP Eastwood Park, Bristol, HMP Ashfield, Bristol, HMP Bristol = Infection Prevention and Control Assurance Group; June 2016 Public Board

21 Legionella: Compliance with flushing of little used outlets = Water Safety Group; Infection Prevention and Control Assurance Group Exceptions and actions taken: hand hygiene During Quarter Four 2015/16, the Trustwide hand decontamination rate has dropped to 91% (Trust compliance level has been set at 95%), although the March compliance level was assessed at 95.9% Further actions have been taken as follows; the Trust IPC Team have undertaken validation at the close of Q4, which is demonstrating compliance at 98%; a report was compiled to detail the earlier exceptions which have resulted in lower scores being reported locally and identified key actions to rectify any shortfalls, thus ensuring ongoing patient safety; the Trust IPC Mental Health has undertaken targeted training updates for Pyrland, Rydon, Willow and Wessex House. This training has been supported by the Ecolab Representative (Trust hand soap and gel Manufacturer); the IPC Leads for Bridgwater, South Petherton and West Mendip Community Hospitals have undertaken targeted training updates, again supported by the Ecolab representative; the IPC team are delivering an Infection Prevention and Control Study Day on May 5th, 2016, targeting the Trust IPC Link Practitioners. This day will be focused on the importance of the continued adherence to robust infection prevention and control standards, with a focus on hand decontamination; the January/February, 2016, results were discussed at the Trust IPC Assurance Group (held on March 8th, 2016). June 2016 Public Board

22 Table 4: Somerset Partnership Infection Prevention and Control Team Hand Hygiene Results 2015/16 Apr - 15 May - 15 Jun - 15 Jul - 15 Aug - 15 Sep - 15 Oct - 15 Nov - 15 Dec - 15 Jan - 16 Feb - 16 Mar - 16 Trustwide - Hand Hygiene Rates 97.9% 97.6% 98.8% 99.8% 99.3% 99.1% 99.1% 99.8% 99.2% 91.2% 87.5% 96.4% 97% Mental Health Hand Hygiene Audits Hospital Apr - 15 May - 15 Jun - 15 Jul - 15 Aug - 15 Sep - 15 Oct - 15 Nov - 15 Dec - 15 Jan - 16 Feb - 16 Mar - 16 Ash 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% Holford 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% Magnolia 100.0% 100.0% 96.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 90.0% 90.0% Pyrland % 100.0% 100.0% 100.0% 100.0% 100.0% 98.0% 100.0% 99.0% 100.0% 98.0% 100.0% Pyrland % 98.0% 78.0% Rowan 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% Rydon 100.0% 100.0% 98.0% 100.0% 96.0% 96.0% 96.0% 100.0% 100.0% 28.0% 58.0% 90.0% St Andrew's 88.0% 100.0% 100.0% 100.0% 94.0% 100.0% 100.0% 98.0% 98.0% 100.0% 100.0% 80.0% Willow 100.0% 100.0% 100.0% 100.0% 100.0% 90.0% 100.0% 100.0% 100.0% 80.0% 100.0% 100.0% Wessex House 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 84.0% 80.0% 70.0% 80.0% 97.6% 100.0% 99.3% 100.0% 98.9% 98.4% 99.3% 99.8% 97.9% 83.4% 91.4% 91.8% Community Hand Hygiene Audit Hospital Ward Apr - 15 May - 15 Jun - 15 Jul - 15 Aug - 15 Sep - 15 Oct - 15 Nov - 15 Dec - 15 Jan - 16 Feb - 16 Mar - 16 Bridgwater Waverly 100.0% 100.0% 100.0% 98.0% 94.0% 100.0% 100.0% 98.0% 100.0% 68.0% 86.0% 98.0% Burnham Ward 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% Chard Blue zone 100.0% 100.0% 100.0% 100.0% 100.0% 96.0% 100.0% 100.0% 100.0% 100.0% 98.0% 94.0% Crewkerne Ward 80.0% 100.0% 100.0% 100.0% 100.0% 100.0% 94.0% 100.0% 100.0% 100.0% 100.0% 100.0% Dene Barton Luke 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% Frome Marshfield Ward 90.0% 100.0% 96.0% 98.0% 100.0% 96.0% 90.0% 100.0% 100.0% 100.0% 98.0% 100.0% Minehead Exmoor Ward 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 98.0% 100.0% 100.0% 100.0% Shepton Mallet Fosse Ward 100.0% 100.0% 100.0% 100.0% 98.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% Stroke Unit 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% South PethertonMary Robertson Ward 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 68.0% 80.0% 100.0% Wellington Ward 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% West Mendip Cathedral 100.0% 70.0% 90.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 0.0% 100.0% Abbey 100.0% 70.0% 90.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 0.0% 100.0% Williton Meadow Ward 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% Wincanton Hadspen 100.0% 100.0% 100.0% 98.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% Athlone 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 98.1% 96.3% 98.5% 99.6% 99.5% 99.5% 99.0% 99.9% 99.9% 96.0% 85.1% 99.5% Table 5: Somerset Partnership Of Infection Prevention and Control Team Quarterly Hand Hygiene Validation Results 2015/16 QUARTER INPATIENT REPORTED VALIDATED SCORE SCORE Quarter 1 99% 98.8% Quarter 2 99% 99.69% Quarter 3 99% 97.2% Quarter 4 91% 98% June 2016 Public Board

23 Table 6: Somerset Partnership Cleanliness Results 2015/16 Apr - 15 May - 15 Jun - 15 Jul - 15 Aug - 15 Sep - 15 Oct - 15 Nov - 15 Dec - 15 Jan - 16 Feb - 16 Mar - 16 Trustwide - Cleanliness Rates 98.9% 99.1% 98.9% 98.3% 98.5% 98.5% 98.0% 98.7% 97.8% 98.6% 97.9% 98.1% Mental Health Cleanliness 2015/16 Hospital Apr - 15 May - 15 Jun - 15 Jul - 15 Aug - 15 Sep - 15 Oct - 15 Nov - 15 Dec - 15 Jan - 16 Feb - 16 Mar - 16 Ash 99.0% 99.0% 98.0% 98.0% 99.4% 99.0% 99.0% 99.0% 99.0% 99.0% 99.0% 98.0% Holford 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 92.0% 99.0% 95.0% 99.0% 98.0% 98.0% Magnolia 100.0% 100.0% 100.0% 99.0% 99.0% 98.0% 99.0% 99.0% 100.0% 100.0% 98.0% 100.0% Pyrland 100.0% 100.0% 100.0% 98.0% 97.0% 98.0% 98.0% 98.0% 99.0% 97.0% 99.0% 97.0% Rowan 100.0% 100.0% 100.0% 99.0% 99.0% 100.0% 100.0% 100.0% 94.0% 100.0% 98.0% 98.0% Rydon 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 99.0% 100.0% 100.0% 100.0% 99.5% 100.0% St Andrew's 99.5% 100.0% 100.0% 99.0% 99.5% 99.0% 99.0% 100.0% 96.0% 99.0% 98.0% 95.0% Willow 99.0% 99.0% 99.0% 97.0% 99.5% 99.0% 99.0% 99.0% 98.0% 99.0% 99.0% 99.0% Wessex House 99.0% 97.0% 98.7% 97.0% 98.3% 98.0% 99.0% 99.0% 99.0% 99.0% 98.0% 98.0% Mental Health Ward Total 99.6% 99.8% 99.6% 98.8% 99.2% 99.1% 98.1% 99.2% 97.6% 99.1% 98.6% 98.1% Community Health Cleanliness Audits 2015/2016 Hospital Apr - 15 May - 15 Jun - 15 Jul - 15 Aug - 15 Sep - 15 Oct - 15 Nov - 15 Dec - 15 Jan - 16 Feb - 16 Mar - 16 Bridgwater Overall) 99.0% 100.0% 98.0% 100.0% 99.0% 100.0% 98.5% 100.0% 99.3% 99.5% 99.0% 99.3% Mary Stanley Ward 100.0% 100.0% 99.0% 100.0% 97.0% 100.0% 96.0% 100.0% 99.0% 100.0% 98.0% 98.0% Waverly Ward 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 98.0% 100.0% 99.7% 99.0% 99.2% 99.2% Burnham (Overall) 100.0% 99.0% 99.0% 99.0% 100.0% 99.0% 99.0% 99.0% 96.5% 99.8% 98.0% 99.0% Wards 100.0% 99.0% 99.0% 99.0% 100.0% 99.0% 99.0% 99.0% 99.0% 99.8% 98.0% 99.0% Chard (Overall) 97.0% 98.0% 98.0% 99.0% 100.0% 99.0% 98.0% 99.0% 99.0% 98.0% 98.0% 100.0% Wards 96.0% 97.0% 97.0% 98.0% 100.0% 100.0% 98.5% 99.0% 98.5% 97.5% 98.0% 100.0% Crewkerne (Overall) 98.0% 99.0% 99.0% 98.0% 98.0% 98.0% 98.6% 98.0% 98.0% 98.5% 97.0% 98.0% Ward 97.0% 98.0% 99.0% 97.0% 98.0% 96.0% 100.0% 98.0% 98.0% 98.5% 97.0% 98.0% Dene Barton (Overall) 98.0% 99.0% 99.0% 98.0% 98.0% 98.0% 98.0% 97.2% 97.4% 99.0% 98.0% 97.9% Luke Ward 98.0% 99.0% 99.0% 98.0% 98.0% 98.0% 98.5% 97.3% 97.5% 98.0% 97.6% 98.0% Lydeard Ward Closed Closed 99.0% 98.0% 98.0% 99.0% 98.0% 97.8% 97.3% 100.0% 98.0% 98.5% Frome (Overall) 98.0% 100.0% 99.0% 96.0% 96.0% 96.0% 95.0% 97.5% 97.0% 97.0% 97.0% 96.5% Marshfield Ward 100.0% 100.0% 99.0% 96.0% 96.0% 96.0% 95.0% 96.0% 96.5% 95.0% 96.0% 96.0% Minehead Overall) 98.0% 99.0% 100.0% 99.0% 97.0% 97.0% 97.8% 98.0% 98.7% 100.0% 99.8% 99.0% Exmoor Ward 98.0% 99.0% 100.0% 100.0% 95.0% 97.0% 97.0% 98.0% 98.6% 100.0% 99.0% 99.0% Shepton Mallet (Overall) 98.0% 99.0% 96.0% 97.0% 99.0% 98.0% 97.5% 99.0% 97.0% 96.8% 96.0% 93.7% Fosse Ward 97.0% 99.0% 98.0% 99.0% 99.0% 99.0% 97.0% 97.0% 97.0% 97.0% 95.0% 92.5% Kearton Ward 96.0% 100.0% 96.0% 97.0% 98.0% 98.0% 97.0% 98.0% 98.0% 97.0% 97.0% 93.8% South Petherton (Overall) 99.0% 99.0% 99.0% 99.0% 99.0% 99.0% 99.0% 99.0% 99.0% 100.0% 99.5% 99.0% Mary Robertson Ward 99.0% 99.0% 100.0% 100.0% 100.0% 99.0% 99.5% 99.0% 100.0% 100.0% 99.5% 99.0% Wellington (Overall) 100.0% 98.0% 98.0% 98.0% 98.0% 98.0% 98.0% 98.0% 97.0% 97.0% 97.0% 98.0% Ward 100.0% 96.0% 96.0% 96.0% 96.0% 96.0% 96.0% 97.0% 95.0% 97.0% 97.0% 98.0% West Mendip (Overall) 99.0% 99.0% 99.0% 97.0% 98.0% 99.0% 99.0% 99.0% 98.0% 98.7% 98.0% 98.9% Cathedral Ward 99.0% 98.0% 98.0% 99.0% 99.0% 99.0% 99.0% 98.0% 98.0% 99.0% 98.0% 98.0% Abbey Ward 98.0% 99.0% 97.0% 97.0% 99.0% 98.0% 97.0% 99.0% 98.0% 98.0% 98.0% 98.0% Williton (Overall) 98.0% 99.0% 98.0% 98.0% 97.0% 98.0% 97.0% 97.5% 98.0% 97.0% 97.0% 97.5% Meadow Ward 96.0% 99.0% 98.0% 98.0% 98.0% 98.0% 97.5% 97.0% 97.5% 97.5% 97.0% 97.5% Wincanton (Overall) 98.0% 97.0% 97.0% 97.0% 97.0% 98.0% 97.5% 97.0% 96.0% 96.0% 92.5% 97.5% Hadspen Ward 97.0% 97.0% 96.0% 96.0% 97.0% 98.0% 98.0% 96.3% 96.0% 93.0% 96.0% 96.7% Athlone Ward 97.0% 97.0% 97.0% 99.0% 98.0% 98.0% 97.0% 97.3% 97.0% 99.0% 95.0% 98.3% Community Hospital Total 98.5% 98.8% 98.4% 98.1% 98.2% 98.2% 97.9% 98.3% 97.8% 98.3% 97.4% 98.0% 4.11 BDO ( Trust Internal Auditors): BDO were requested to review the Trust internal processes in place for managing infection prevention and control and for monitoring compliance with key regulations such as the Health and Care Social Act and to meet the standards of the Code of Practice Evidence of good practice was identified as follows: a robust infection audit plan that was in line with the Department of Health Code of Conduct. We also found that actions identified were cascaded to the correct level of staff to enhance their learning; June 2016 Public Board