REPORT SUMMARY SHEET

Transcription

1 Quality care for you, with you REPORT SUMMARY SHEET Meeting: Date: Title: Lead Director: Corporate Objective: Purpose: Trust Board June 2018 Infection Prevention and Control HCAI Report Medical Director Dr A Khan Safe, high quality care For assurance Summary of Key Issues for Trust Board Key issues: 1. C. difficile infections: 2017/18 48 cases (PHA target 31) 1 st April March (none linked) 2. MRSA bacteraemia: 2017/18 4 cases (2 preventable) 1 st April March cases 3. MSSA bacteraemia: 2017/18 48 cases 1 st April March cases (1 preventable) 4. Risk Register: Need for a redefinition and re-articulation of the risks associated with HCAI, and a need to review and strengthen the controls identified to manage this risk, following Trust Board workshop Key risks for discussion: Requirement to obtain organisational endorsement of a 3 year Strategic Plan for HCAI by end of July 2018, and commitment of all staff to meet the objectives of this plan Summary of SMT challenge/discussion: SMT is committed to progress and develop 3 years HCAI Strategic plan

2 TABLE OF CONTENTS 1 HCAI Performance 2018/19 (Year to Date May 2018) 3 2 Update on Infection Prevention & Control Issues IPC Independent Audit Activity... 9

3 1 HCAI Performance 2018/19 (Year to Date May 2018) HCAI PfA targets for 2018/19 have NOT yet been confirmed by the Public Health Agency [PHA] therefore we aim to adhere to the targets set for last year until these figures have been confirmed 4 MRSA bacteraemias & 31 C. difficile cases. Trust Board are asked to be mindful that patients presenting to hospital today are presenting with often very complex clinical needs, therefore - despite every effort to keep CDI and MRSA bacteraemia incidence low - an irreducible minimum will always be prevalent. Southern Trust Performance MRSA bacteraemia 2018/ /19 year to date (May 2018) there has been 0 MRSA Southern Trust MRSA Episodes Cumulative 1 st April 2018 March 2019

4 Southern Trust Performance Clostridium difficile 2018/ /19 year to date (May 2018) there have been 4 C. difficile cases. Southern Trust Clostridium difficile Episodes Cumulative 1 st April 2018 March 2018

5 Southern Trust Performance MSSA bacteraemia 2018/19 (Year to date May 2018) For 2018/19 surveillance of MSSA bacteraemias remains mandatory ONLY within the SHSCT. To facilitate on-going surveillance of MSSA bacteraemias during 2018/19; MSSA target data for 2017/18 is used as a comparison. Year to date (May 2018) there have been 8 MSSA cases. To date 1 has been identified as preventable. Southern Trust MSSA Episodes Cumulative 1 st April March 2019

6 2 Update on Infection Prevention & Control Issues Clostridium difficile infection (CDI) in SHSCT In 2017/18 there were 48 CDI cases in the SHSCT this exceeded PfA Target of 31 cases. From 1 st April 2018 to 18 th May 2018 there have been 4 cases of CDI across clinical areas in the SHSCT. Keeping CDI incidence low is a challenge for all Trusts at present, due to: The complex needs of today s patients, frequent hospital admissions, poor antimicrobial prescribing & stewardship and inappropriate anti-diarrhoeal prescribing in Primary care These challenges reinforce the need for continued collaborative working between IPCT, senior management and clinical staff as this is critical to help sustain good IPC practices across all clinical care. The Trust has recruited an antimicrobial pharmacist and the second microbiologist to replace existing vacancies is commencing in August The Trust has given commitment to investment in a third microbiologist and a second anti-microbial pharmacist. Ensuring appropriate use of antibiotics by clinical teams will be a key priority for the SHSCT The Trusts Root Cause Analysis (RCA) process will soon become known as a Post Infection Review (PIR). A tiered approach to completing each PIR will be taken to HCAI Strategic Forum in June 2018 for agreement and ratification. This will help streamline the number of PIRs to be completed and will enhance the learning. Norovirus & Influenza Update IPCT continue with proactive working providing information & knowledge relating to seasonal infections such as Norovirus and Influenza that have been present across our facilities over recent months and will continue to be a challenge. Regionally (as at 18 th May 2018) 4 D&V outbreaks in Private Nursing Homes across Northern Ireland One in each of the Trusts SHSCT, WHSCT, SEHSCT & BhSCT Trust Facilities (as at 18 th May 2018) Influenza We currently have no influenza outbreaks within the SHSCT.

7 was been an exceptional year for incidence of influenza across Northern Ireland. IPCT plan to engage with clinical and operational stakeholders for a reflective exercise and how we might address similar challenges in the future. Norovirus We currently have no Norovirus or D&V outbreaks within the SHSCT SHSCT /RQIA Augmented Care Audit Programme In SHSCT we are unique and have been highly commended by RQIA for establishing an Augmented Care Sister s forum. This work continues and is led by a Band 7 IPCN under the Direction of the Lead IPCN. Essentially this should be used as a joint platform for learning and our next meeting is due to be held 18 th June IPC Nursing (IPCN) Workforce, SHSCT Infection Prevention & Control [IPC] is a very highly specialised area of health & social care and to this regard recruiting and retaining staff is a constant challenge for the Lead IPCN particularly with increasing demands being placed on the service. A Position Paper on IPC Nursing workforce and support workers has been requested to ensure that the IPCN team continue to be able to provide this support. IPC Consultant Microbiologist, SHSCT SHSCT continue to provide a Medical Microbiology service with 1 full-time permanent consultant microbiologist who is supported by a locum consultant microbiologist. A second permanent consultant has been appointed and is due to take up post in August Community HALT Study September 2017 completed An action plan is now being created from the HALT Report that was circulated by the PHA. Point Prevalence Survey (PPS) Healthcare Associated Infections and Antimicrobial Use in Trust Hospitals in Northern Ireland A collective report from the Public Health Agency (PHA) is now in Draft format and will be taken to HCAI Strategic Forum once finalised by the PHA Water Safety The Trust Water Safety Committee was held in April 2018 and a focus was to involve operational staff more in the water safety and management hence membership now reflects clinical representation. Water safety must have ownership and accountability attached with clinical staff and in collaboration with Estates and Infection Prevention and Control colleagues together we can help promote and sustain water safety.

8 SHSCT Ebola Management Plan The SHSCT Viral Haemorrhagic Fever [VHF][ Management Plan requires to be revisited and refreshed. This plan is not complete and to do so will require involvement and inclusion of staff at all levels. SHSCT IPC Training/Education A blended learning approach is the focus now for all mandatory IPC training and this is well progressed within the SHSCT using a combination of e-learning, information leaflets and face to face training. Working with ELD colleagues in the Trust the SHSCT IPCT launched their mandatory training program on the 29 th June In that time approx staff has received their IPC mandatory training. Time spent training and refreshing staff in IPC practice is significant and the change and shift of acute care at home highlights increasing training needs for domiciliary care workers across the Southern Health & Social Care region. World Health Organisation [WHO] Hand hygiene day 5 th May 2018 In the SHSCT we celebrated WHO Hand Hygiene Day on Tuesday 8 th May IPCT met with the Chief Executive and members of senior management for a photoshoot and then set up workshop type booths across CAH, Lurgan & South Tyrone sites. This was a time to engage with the staff and public in regard to this very important practice and video clips have been running since on TV monitors across the Trust. SHSCT HCAI Strategic 3yr IPC Plan & IPC Action/Work Plan The Trust is currently developing an Infection Prevention and Control strategy This will include a detailed first year action plan designed to further embed best IPC practice from Board to ward. It will aim to eliminate preventable HCAIs from Trust facilities by providing a renewed focus on key areas such as antibiotic prescribing, hand hygiene, training and monitoring. It is planned that a first draft will be available for discussion with key stakeholders by the end of June

9 IPC Independent Audit Activity Hand Hygiene and Bare Below the Elbow Self Audit Scoring The Southern Trust promotes good hand hygiene at the point of care. The point of care represents the time and place at which there is the highest likelihood of transmission of infection via healthcare staff whose hands act as mediators in the transfer of microbes. One of the best ways to measure hand hygiene compliance is observation audit and the Trust had an on-going programme of hand hygiene audit. The compliance threshold for hand hygiene is 90% and areas that are non-compliant are required to reaudit daily until compliance is achieved. Being Bare below the Elbow is also an important factor for compliance with hand hygiene. The dress code policy requires staff to have sleeves short or rolled up to the elbow in order to allow access to the wrist for good hand hygiene technique and remove jewellery, such as watches. The policy also prohibits staff form wearing nail varnish, false nails or gel nails. Non-compliance is reported to the Trust Senior Management Team weekly and passed on to Operational Directors for corrective action to be taken. The IPCT independent audit results are fed back immediately to the ward manager and on a monthly basis to Operational Directors for corrective action. Hand Hygiene Compliance by Trust Location [Independent Audits] Compliance for the period on the Craigavon Area Hospital site exceeds the compliance threshold of 90%. On the Daisy Hill Hospital site, there has been no breach beneath the 90% compliance threshold since October 2013.

10 Compliance for the period on the Lurgan Hospital and South Tyrone Hospital sites exceeds the compliance threshold of 90%. Hand Hygiene Compliance by Staff Grouping A review of compliance by staff group indicates a dip in compliance by medical staff. The Medical Director wrote to all doctors to stress the importance of hand hygiene and supported this with face to face presentations (with the Consultant Microbiologist) at the Trust Morbidity and Mortality meetings.

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12 BBE Compliances Bare Below the Elbow / Nail Varnish-Extension Compliance

13 Bare Below the Elbow / Nail Varnish-Extension Compliance