δεφ Agenda Item: 11 PATIENT SAFETY AND INFECTION PREVENTION AND CONTROL REPORT Trust Board 20 th October 2010 PURPOSE: PREVIOUSLY CONSIDERED BY: To inform the Board of incidences regarding infection prevention & control performance Infection prevention and control data has been reported and considered at the Executive Committee, Risk and Quality Committee, Finance and Performance Committee and Trust Infection Control committee IMPLICATIONS: Objective(s) to which issue relates: To improve the quality of all aspects or our services Risk Issues: Failure to act upon outcomes may increase risk to patients and staff and place the Trust at risk breaching registration requirements set out in the Health & Social Care Act 2008 Reputation within the community Financial: HR: Healthcare/ National Policy: Legal Issues: Equality Issues: Loss of income due to not meeting contractual and CQUIN agreements Training capacity for mandatory training and developmental training including staff attending training provided Compliance with code of Practice and adult social care on the prevention and control of infections and related guidance Possible claims None RECOMMENDATIONS: The Board is asked to discuss the report and support the actions being taken DIRECTOR: Director of Nursing (DIPC)/Medical Director PRESENTED BY: Director of Nursing (DIPC)/Medical Director AUTHOR: Director of Nursing (DIPC) DATE: 20th October 2010 1
INFECTION PREVENTION AND CONTROL BOARD REPORT PURPOSE The purpose of this report is to inform the Board of the current and year to date (YTD) position for hospital acquired infections and broader infection prevention and control issues (appendix 1). The Board is asked to discuss the current performance and support the actions being taken. BACKGROUND The Trust has to ensure that patients do not acquire infections from poor environment or clinical practice. The information within this report has been drawn from the strategic health authority, from neighbouring organisations and from internal data gathering and monitoring processes. The position relating to patients that have acquired C.Difficille and MRSA is discussed at the Executive Committee, the Senior Infection Control Team, Risk and Quality Committee, Finance and Performance Committee and the Divisional Performance Reviews. Regional Position Across the East of England 6 other Trusts have breached the agreed trajectory for hospital acquired C Difficille (appendix 2) and 5 other Trusts have breached the agreed trajectory for hospital acquired MRSA (appendix 3) PERFORMANCE TO DATE mandatory surveillance Exceeding trajectory for C Difficille Year End Ceiling 63 (159 for 09/10) o YTD Trajectory end September 30 (80 YTD trajectory 09/10) o YTD Position end of September - 46 (38 YTD position 09/10) o September - 4 positive cases - in month trajectory 5 Exceeding trajectory for MRSA Year End Ceiling 3 (21 for 09/10) o YTD Trajectory end September 0 (11 YTD trajectory 09/10) o YTD Position end of September 2 (3 YTD position 09/10) o September 0 positive cases in month trajectory 0 MSSA The DoH is extending mandatory surveillance in 2011 to include MSSA and Escherichia coli bacteraemias. The Trust has been reporting MSSA for the last 2 years The infection prevention & control team are currently assessing the number of bacteraemias pre and post hours this would involve in both reporting and following up at clinical level. Genticimicin Resistant enterococci (GRE) No cases year to date No cases in 2009/10. Vancomycin Resistant enterococci (VRE) No cases year to date. No cases 2009/10 Key findings from C Difficillie and MRSA RCA s April to August The main issues arising from the 44 (April August) RCA s were: The need for constant review of antibiotic prescriptions to minimise prolonged and/or unnecessary courses Inappropriate sample sent to lab resulting in incidental findings Problems with timing of samples and isolation resulting in a third of the patients with a positive result would have been attributed to Pre 48 positive result reporting and would have been attributable to the community reporting data. 2
Lapses in compliance with some elements of standard infection prevention and control policies, guidance and precautions by staff as identified above ACTIONS TAKEN The following actions have been taken during September: Revised algorithms for stool specimens validated and circulated to all clinical areas. Microbiologist reviews all specimens sent to the laboratory for testing meet the criteria Infection Prevention and Control Nurses investigate at ward level with staff patients symptomatic with loose stools A&E, MAU, SSU and AAU to send stool specimens for all patients with a history of loose stools. All clinical wards that have had patients with a positive result are to be deep cleaned with Actichlor plus, all other clinical areas to have horizontal surfaces cleaned with Actichlor plus Top ten wards increased to weekly audit of compliance with High Impact Interventions Wards that score less than 95% accounting to the weekly Senior Infection Control Team chaired by the Director of Nursing DIPC. Chief Pharmacist reinforcing IV therapy visual triggers and 5 Day Stop policy with ward pharmacists Frequency of 5 Day Stop policy to be increased to monthly until 95% compliance achieved Teleconference held with the Head of Targeted Support at the Department of Health who advised that actions being taken were appropriate and unfortunately unable to come and undertake an external review at the current time. External peer review of clinical areas on the Lister and QE11 sites arranged by the Director of Nursing with the PCT and commenced 12 th October. 3 unannounced visits to take place before the end of October. NEXT STEPS Training needs analysis for doctors relating to antimicrobial stewardship to be complete and presented to TICC in October Guidance regarding Augmentin to be circulated and discussed at TICC Standard letter relating to non compliance with antibiotic prescribing to be introduced following rounds undertaken by microbiologist and antimicrobial pharmacist Clinical Director for Pathology to review microbiologist requirements. ICN to attend Patient Access meetings to ensure appropriate use of isolation facilities. Complete research regarding cleaning solutions for clinical area kitchens and make a decision by mid October External review of clinical areas to be arranged and completed by end November Weekly updates between DIPC and PCT Director of Nursing/ Deputy Director of Nursing To review the external report when received.. CONCLUSION The Trust remains off trajectory for C. Difficillie and MRSA bacteraemia however did remain within the monthly for September. No outbreaks of infections during the month of September. The Senior Infection Control Team to continue to monitor and reinforce actions to be taken and ensure accountability meetings continue. Sue Greenslade Director for Nursing, Infection Prevention and Control 13 th October 2010 3
APPENDIX 3 MRSA Performance Summary Report 2010-2011 August 2010 data Provider Annual target Year to date Year to date MRSA reports Status to annual Status to year to date Basildon And Thurrock University Hospitals NHS Foundation Trust 4 2 2 Below Reached 0 Bedford Hospital NHS Trust 3 1 2 Below Breached 0 Cambridge University Hospitals NHS Foundation Trust 10 4 4 Below Reached 1 Colchester Hospital University NHS Foundation Trust 6 3 1 Below Below 0 East And North Hertfordshire NHS Trust 3 0 2 Below Breached 1 Hinchingbrooke Health Care NHS Trust 2 0 2 Reached Breached 0 Ipswich Hospital NHS Trust 4 2 1 Below Below 1 James Paget University Hospitals NHS Foundation Trust 4 2 1 Below Below 0 Luton And Dunstable Hospital NHS Foundation Trust 3 1 1 Below Reached 0 Mid Essex Hospital Services NHS Trust 5 2 1 Below Below 0 Norfolk And Norwich University Hospital NHS Foundation Trust 7 4 5 Below Breached 2 Papworth Hospital NHS Foundation Trust 2 1 1 Below Reached 0 Peterborough And Stamford Hospitals NHS Foundation Trust 4 2 0 Below Below 0 The Princess Alexandra Hospital NHS Trust 2 1 0 Below Below 0 Southend University Hospital NHS Foundation Trust 3 1 0 Below Below 0 The Queen Elizabeth Hospital King's Lynn NHS Trust 3 0 0 Below Reached 0 West Hertfordshire Hospitals NHS Trust 5 2 3 Below Breached 1 West Suffolk Hospitals NHS Trust 4 2 0 Below Below 0 East of England 74 30 26 Below Below 6 MRSA reports this month Source: Health Protection Agency HCAI Data Capture System (Provisional data) Single report in month Multiple reports 4
APPENDIX 2 C Difficillie Summary Report 2010-2011 5