Betsi Cadwaladr University Health Board Committee Paper 05.04.12 Item QS12/37.5 Name of Committee: Subject: Summary or Issues of Significance National / Local Objectives Addressed: Legislation or Healthcare Standard: Evidence base or other relevant information to inform decision(s) Consultation with others: Consideration of legal issues Impact on Other Services: Consequences & Risks: Quality and Safety Committee Prevention and Control of Healthcare Acquired Infections performance to February 2012 The March meeting of the Prevention and Control of Infection Sub Committee met on the 20 th March 2012. Whilst the Health Board will achieve a 20% reduction of Clostridium Difficile 20/2012, the Health Board will fail to meet the reduction targets for Methycillin resistant Staph aureus (MRSA) bacteraemias. These are serious infections and cause for significant concern. BCUHB: A Strategic Direction 2009 2012; Transforming Care and 1,000 Lives initiatives; Annual Quality Framework for Wales (20); NHS Wales Delivery Framework for 20/2012; BCUHB: Infection Prevention and Control Strategy 20 2013; HCAI Framework of actions (20). Healthcare Standard for Wales (2005, revised 2009): 19 The Health Board has a duty of care to protect patients from unnecessary infection. Monthly performance data acquired from laboratory systems and submitted nationally. Discussed and agreed at the March 2012 meeting of the Prevention and Control of Infection Sub Committee (20.03.2012). Failure to prevent infection could lead to litigation and a breach in duty of care. All healthcare professionals to lead and direct evidence-based care towards reduction and zero-tolerance of Healthcare Associated Infections. Breach of duty of care by BCUHB to protect the public from harm. Harm to BCUHB reputation and risk of litigation. 1
Recommendations: That the Quality and Safety Committee receive the February Prevention and Control of Infection Sub Committee Performance Report and support the following recommendations: 1. CPGs to identify matrons to lead on the implementation of the initiatives related to aseptic non-touch technique (ANTT), urinary and peripheral catheter work; 2. Matrons to have rolled out the programs above by June 2012; 3. Root cause analysis of all staph aureus bactermias to be carried out by the medical team responsible for the patient; 4. All CPGs to adopt the specification for obtaining blood cultures to reduce the risk of cross contamination of specimens; 5. Ensure that all areas have in place appropriate hand decontamination audit programmes and that they are ensuring both good compliance with the audit process and achieving a greater than 90% compliance with hand decontamination; 6. All healthcare acquired infection to be reported on the IR1 / Datix system; 7. This SBAR to be presented at each Clinical Programme Group Quality and Safety Group and performance managed by the Clinical Programme Group.. Author(s) Presented by David Casey, Head of Nursing Infection Prevention and Control Jill Galvani, Director of Nursing, Midwifery & Patient Services Jill Galvani, Director of Nursing, Midwifery & Patient Services Date of report 26.03.12 Date of meeting 05.04.12 BCUHB Coversheet v3.0 2
BCUHB Staph Aureus Bloodstream Infections Situation The mandatory bloodstream surveillance and monitoring systems has identified that infections of the Staph aureus bacteraemias, including Methycillin resistant Staph aureus (MRSA) have increased in numbers from the 20-12 baseline. This is set against a background of a general rise in methicin sensitive staph aureus (MSSA) and a reduction in methicilin resistant Staph aureus (MRSA) in Wales. There has been a slow adoption and roll out of key initiatives related to interventions related to peripheral venous catheter care, urinary catheter care, Aseptic Non-Touch Technique (ANTT) and blood culture initiatives which, if implemented, will impact on this issue. Background Staph aureus bloodstream infections although small in numbers can represent serious infections. MSSA bloodstream infections generally tend to represent community acquisition with patients presenting on admission with clinical signs of infection. MRSA bloodstream infections generally represent healthcare associated infections. There are a percentage of the positive blood cultures that indicate that they have potentially been cross contaminated and do not represent infections. MRSA bacteraemias The tables below indicate the Health board is not achieving a reduction in these serious infections and the number of cases has increased compared to 20. In Wales, there has been a rise in MRSA bactermias over the last quarter; however prior to the last quarter, all other Health Boards were delivering a 20% reduction apart from BCUHB. Key measures that assist in reducing these infections; aseptic non-touch technique (ANTT), blood culture, Urinary and Peripheral vascular catheter care bundles have been developed and need to be fully implemented by the Clinical Programme Groups. The Associate Chiefs of Staff (Nursing), their Matrons and Ward Sisters will lead this work in partnership with other professional groups and supported by the Infection Control Team. Assessment There is significant work required to reduce staph aureus bactermias. Key to this will be ensuring the implementation of initiatives related to aseptic non-touch technique (ANTT), blood culture, urinary and peripheral catheter bundles. This should be combined with root cause analysis carried out by the Doctors caring for patients with staph aureus bactermias to ensure that they are both managed appropriately and identify trends or lessons learnt. As part of the All Wales Healthcare Acquired Infection Framework of actions (20), a zero tolerance of Healthcare acquired infections requires reporting through an IR1 report. 3
Recommendations 1. CPGs to identify matrons to lead on the implementation of the initiatives related to aseptic non-touch technique (ANTT), urinary and peripheral catheter work; 2. Matrons to have rolled out the programs above by June 2012; 3. Root cause analysis of all staph aureus bactermias to be carried out by the medical team responsible for the patient; 4. All CPGs to adopt the specification for obtaining blood cultures to reduce the risk of cross contamination of specimens; 5. Ensure that all areas have in place appropriate hand decontamination audit programmes and that they are ensuring both good compliance with the audit process and achieving a greater than 90% compliance with hand decontamination; 6. All healthcare acquired infection to be reported on the IR1 / Datix system; 7. This SBAR to be presented at each Clinical Programme Group Quality and Safety Group and performance managed by the Clinical Programme Group. BCUHB MRSA Bacteraemias 4
ALL Wales MRSA Bacteraemias 5
Monthly Improving Prevention and Control of Infection Report February 2012 Monthly Report: February 2012 Unvalidated Surveillance Data Orthopaedic % Compliance with mandatory Surveillance Orthopaedic SSI Infection No s C. Section Percentage of Compliance with Surveillance Data (Mandatory Targets of 95%) & Numbers of Infections (Un - validated Data) YMW YGC YG Combined BCUHB Inpatient Data 0% 0% 0% (Inpatient Figures) 0 0 0 0 40 57 41 0% 138 % Compliance with mandatory Surveillance 0% 45% 0% 82% C. Section SSI 0 0 0 0 Infection No s COMMENTS/ACTION YGC: Unexplained low compliance with the C/S SSI Audit this month. Notes requested for Drs to complete retrospectively. All forms will be fully completed by return of full audit to Cardiff. In-patient infections checked against discharge information given to the community. 6
Rate for Clostridium difficile - over 65s based on per 00 admissions and three Month Rolling Mean C. difficile Rolling Mean 70 60 50 40 30 20 0 M ar- Ap r- M ay- Ju n- J ul- Au g- Se p- Oc t- No v- De c- Ja n- Fe b- M ar- Ap r- M ay- Ju n- J ul- Au g- Se p- Oc t- No v- De c- Ja n- 12 Fe b- 12 YGC Mean YG Mean WMH Mean BCUHB Mean 7
C. difficile Deaths NUMBER OF CASES YMW YGC YG Primary Care Combined BCUHB 0 < 65 7 > 65 1 < 65 > 65 0 0 3 < 65 13 > 65 Primary 1 Secondary 0 4 < 65 31 > 65 Primary - 1 COMMENTS/ACTION BCUHB has achieved a greater than 20% reduction in the number of cases compared to last year. There has been a slight upward trend in the last 2 months that coincides with an increase in Norovirus. A reduction of 20% reduces the number of cases from 576 in 20 to 461 in 2012. MRSA / MSSA COMMENTS/ACTIONS 8
YMW YGC YG Primary Care MRSA Bacteraemia 3 2 1 (2 CAI, 1 HAI) CAI Combined BCUHB 6 MSSA Bacteraemia 2 (2 CAI) 3 5 CAI 1 unknown COMMENTS/ACTIONS: MRSA bactermias continue to exceed the number of cases identified in 20; this is set against a reducing trend across other Health boards in Wales. To address this issue it is necessary to implement these corrective actions: 1. CPGs to identify matrons to lead on the implementation of the initiatives related to Aseptic Non-Touch Technique (ANTT), urinary and peripheral catheter work. 2. Matrons to have rolled out the programs above by June 2012. 3. Root cause analysis of all staph aureus bactermias to be carried out by the medical team responsible for the patient. 4. All CPGs to adopt the specification for obtaining blood cultures to reduce the risk of cross contamination of specimens 5. Ensure that all areas have in place appropriate hand decontamination audit programmes and that they are ensuring both good compliance with the audit process and achieving a greater than 90% compliance with hand decontamination. YMW YGC YG Combined BCUHB Outbreaks 8 20 38 No of Patients affected 78 1 138 326 Lost bed days 56 136 163 355 COMMENTS/ACTIONS: Outbreaks of Norovirus have been affecting significant numbers of wards across all of BCUHB. There have also been significant outbreaks in nursing homes as well. Clearly the seasonal activity for Norovirus runs from December through till March and data from 2005-20 indicates the significant effect that it has on the organisation with no increase in bed capacity or reduction in activity to plan for the seasonal increase in outbreaks 9
COMMENTS/ACTION Over the last quarter there have been significant difficulties in accessing data for hand hygiene audits. Many CPGs are collecting and collating data on their share points. There is a requirement that the data is available via the nursing metrics dashboard to allow for scrutinising. Poor compliance with hand hygiene is directly correlated with infections and non compliances need to be addressed
Clean Hospitals Education and Training COMMENTS/ACTION YMW YGC YG Primary Care Combined BCUHB 82% 91% 94% 89% 219 staff 485 7 sessions 22 144 staff 6 sessions 122+ staff Some sessions no attendance info e.g. IV drug 9 sessions (3 cancelled due to lack of attendees 1 due to outbreaks) BCUHB YMW YGC Issues of Significance MRSA bacteraemia are continuing to rise with higher numbers than the previous year. There continues to be difficulties with obtaining the hand hygiene audit data resulting in some areas receiving a nil return. There has been a period of increased incidence of MRSA on a surgical ward at YMW (Feb / March). This is under investigation by the ICT. Hand hygiene audits have been increased and ward cleaning with Actichlor plus has been instituted. A meeting has been scheduled this week to review the situation in terms of audit findings and screening results. YG PRIMARY CARE