Quality care for you, with you REPORT SUMMARY SHEET Meeting: Date: Title: Lead Director: Corporate Objective: Purpose: High level context: Trust Board 29 th September 2016 Infection Prevention and Control HCAI Report Medical Director Safe, high quality care For assurance Summary of Key Issues for Trust Board HCAI Performance against last years, 2015/16 Priorities for Action (PfA) Targets for MRSA bacteraemia and Clostridium difficile infection (CDI) C. difficile infections Year to date, (21 st September 2016) 12 cases SHSCT target from PHA 2016/17 is 32 cases MRSA bacteraemia Year to date, (21 st September 2016) 4 cases 0 cases considered preventable SHSCT target from PHA 2016/17 is 5 cases. MSSA bacteraemia Year to date, (21 st September 2016) 24 cases 4 cases considered preventable PHA does not set a target for MSSA bacteraemia. Key issues/risks for discussion: Update on current in year HCAI information Internal/External engagement: HCAI Strategic Forum 2 nd November 2016 HCAI Clinical Forum 30 th September 2016
TABLE OF CONTENTS 1 HCAI Performance 2015/16 (Year to Date 16 th May 2016) 3 2 Update on Infection Prevention & Control Issues.....6 3 IPC Independent Audit Activity... 8
1 HCAI Performance 2016/17 (Year to Date 21 st September 2016) HCAI PfA targets for 2016/17 have been confirmed by the Public Health Agency [PHA] as 5 MRSA bacteraemias & 32 C. difficile cases. Southern Trust Performance MRSA 2016/17 2016/17 year to date (21 st September 2016) there have been 4 MRSA bacteraemia cases and none were considered to be preventable. Southern Trust MRSA Episodes Cumulative Total 1 st April 2015 21 st September 2016
Southern Trust Performance Clostridium difficile 2016/17 2016/17 year to date (21 st September 2016) there has been 12 C. difficile cases. Southern Trust Clostridium difficile Episodes Cumulative Total 1 st April 2015 21 st September 2016
Southern Trust Performance MSSA 2016/17 (Year to date 21 st September 2016) For 2016/17 surveillance of MSSA bacteraemias remains mandatory ONLY within the SHSCT. To facilitate on-going surveillance of MSSA bacteraemias during 2016/17; MSSA target data for 2009/10 is used as a comparison. Year to date (21 st September 2016) there have been 24 MSSA cases. To date 4 have been identified as preventable. Southern Trust MSSA Episodes Cumulative Total 1 st April 2015 21 st September 2016
2 Update on Infection Prevention & Control Issues Clostridium difficile infection (CDI) in SHSCT From 1 st April 2016 to 21 st September 2016 there have been 12 cases of CDI in the SHSCT. All cases of CDI are investigated fully by IPCT in collaboration with the clinical team on the day of diagnosis and all undergo a strict multidisciplinary Root Cause Analysis (RCA) with an aim of identifying and promoting shared learning for clinical staff as a result of a positive isolate. IPCT continue to work on a framework whereby trend analysis of CDI HCAI RCA outcomes can be used to identify and reduce problems in quality or care and patient safety. A briefing Paper on C.difficile RCA Outcome Themes Qtr. 2 2015- Qtr. 3 2016 [YTD 31 st August 2016] was presented to members of HCAI Strategic Forum on the 7 th September 2016. This paper gave an analysis of the top 3 sub themes emerging from CDI RCA s. The 3 sub themes are Acute Antimicrobial Prescribing, Non-compliant patient isolation as per Trust Guidelines and Documentation. Within the Briefing paper suggested High Level Actions were listed against each of the sub themes. Overall the paper was well received by those in attendance and outcomes to move the actions forward operationally were discussed and agreed. Our SHSCT bespoke CDI Trigger and surveillance system developed by the IPCT will in due course be shared to help promote co-ownership between clinical staff and IPCT now that the project is completed. Intelligence is gathered to this regard via SHSCT CDI Sub-Group who meets on a monthly basis to review and discuss SHSCT RCA findings that are completed for each CDI diagnosed following the robust RCA process.
SHSCT /RQIA Augmented Care Audit Programme Augmented care Sisters meetings continue. The first meeting was in May 2016 and IPCT continue to deliver on the request for monthly meetings until December 2016. Initially these meetings are for Hematology and Renal staff as this will allow IPC to focus on them and ensure they are adequately prepared for RQIA audit. In December 2016 the situation will be reviewed with an expectation to then engage with others in augmented care settings i.e. Delivery suites on both Acute sites. This collaborative working revolves around 3 RQIA audit tools: clinical audit tool governance audit tool and environmental audit tool While IPC will concentrate all its efforts on the clinical audit tool all areas need to be mindful of the governance audit tool also. Regular updates on the Trust IPC augmented care action plan and progress will continue to be given by IPCT at the SHSCT HCAI Clinical Forum (monthly) and HCAI Strategic Forum (every 2 months) as appropriate. Norovirus & Influenza Update Regionally IPCT continues to be notified daily of Norovirus (V&/or D) and Influenza (Flu A/B) incidence across Northern Ireland Care Homes. The Lead IPCN circulates this to the Operational Directors, Heads of Service and all other key stakeholders within the SHSCT for information and dissemination on a daily basis. The purpose of this is to be proactive in helping to prevent further outbreaks of infection within Trust facilities. At present in NI there no outbreaks of D &/or V in nursing /residential facilities There are no documented Influenza Outbreaks in Care Homes in NI at present. This is monitored very closely by the SHSCT IPCT on a daily basis. Trust Facilities Influenza We currently have no Flu Outbreaks within the SHSCT. Norovirus The Trust has had no further outbreaks of D &/or V across the facilities.
RCA - Community Engagement No further updates to report. Water Safety Funding is being sought within the Trust to fund input from an independent Water safety Consultant who will report with a view to maximising safety and cost effectiveness of water management in the SHSCT. Cutan Alcohol Hand Rub / Cutan Liquid soap Cutan is now well established within the acute, non-acute and community settings. IPC Community Master class will focus on Hand Hygiene on the 14 th September 2016 in Portadown Health Centre. Alcohol hand rub is freely available at all patient care areas and at the point of care. Regionally BSO Procurement are hosting a procurement group looking at the Regional contract for hand soaps, alcohol gels/foams and hand creams. The lead IPCN and Lead Occupational Health Nurse form the SHSCT are members of this panel. Progress will be reported via this platform but it is still embryonic at this stage. Ebola Management Plan The Trust Ebola Management Plan remains outstanding, as there are significant issues in locally managing laboratory investigations from patients being tested for Ebola. This will be discussed at the next meeting of the 5 Trust Medical Directors. SHSCT -Moving forward - Peripheral Line training in 2016 This was presented to HCAI Clinical Forum members and ANTT training sessions will recommence for Acute clinical staff from October 2016-December 2016 in the first instance. These sessions will be delivered by IPCNs and further phases of training have now been organised. 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 weekly hand hygiene auditing of staff. The compliance threshold for hand hygiene is 90% and areas that are non-compliant are required to re-audit daily until compliance is achieved. Being Bare below the Elbow is also an important factor for infection prevention and is included in the revised Trust Dress code policy. The policy requires staff to be free of clothing and jewellery such as watches while in the patient environment. The policy also prohibits staff to wear false nails. This is also audited weekly along with Hand Hygiene scoring.
Non-compliance is reported to the Trust Senior Management Team weekly and passed on to Operational Directors for corrective action to be taken. In accordance with the recommendations of the Independent Review of Pseudomonas the IPCT Audit Assistants are required to continue to complete independent audits of hand hygiene, commodes, and sluice and IV trolleys in augmented and non-augmented care settings. The IPCT have been completing IPC audit activity for some time now and this will continue now with our 2 Band 3 Audit Assistants. The 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. 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 of the compliance threshold since October 2013.
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.
Compliance % Compliance % Bare Below the Elbow / Nail Varnish-Extension Compliance 100 90 80 100 99 100 Bare Below The Elbow (Acute Directorate) Feb 16 - Jul 16 95 98 93 70 60 50 40 Craigavon Area Hospital Daisy Hill Hospital 30 20 10 0 100 99 100 100 99 99 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 100 90 Nail Varnish / Extension Compliance (Acute Directorate) Feb 16 - Jul 16 100 100 100 100 99 100 80 70 60 50 40 Craigavon Area Hospital Daisy Hill Hospital 30 20 10 0 100 100 100 100 100 100 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16
Compliance % Bare Below the Elbow / Nail Varnish-Extension Compliance 100 Bare Below The Elbow (OPPC Directorate) Feb 16 - Jul 16 90 80 70 60 50 40 Lurgan Hospital South Tyrone Hospital 30 20 10 0 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16