THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST HEALTHCARE ASSOCIATED INFECTIONS (HCAI) Agenda item A4(i) EXECUTIVE SUMMARY The paper highlights the increasingly challenging HCAI targets for the year 2013/14 and summarises the Trust s performance to date. During April, one MRSA bacteraemia has been reported and a further case is being investigated at the time of writing. With regard to C. difficile, nine cases were reported during April. The ongoing work to minimise the risk of HCAI is summarised in the paper, demonstrating significant activity. A reported case of measles and follow up action is also described. RECOMMENDATION To (i) note the content of this report (ii) comment accordingly. Helen Lamont Nursing & Patient Services Director Dr. Ashley Price Director of Infection Prevention and Control 14 th May 2013
THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST HEALTHCARE ASSOCIATED INFECTIONS 1. INTRODUCTION This paper reports the Trust s position as at the end of month 1 (2013/14), describing the progress against targets for the year (Appendix i). 2. INFECTION UPDATES a) MRSA Bacteraemia Current Position (Target = Zero Tolerance) One bacteraemia was reported in April 2013 (Ward 22 RVI). A Serious Case Review meeting took place to consider this. It was concluded that, with the exception of some poor documentation, practice was appropriate. A further case, reported in May (Ward 15 Freeman Hospital) is under review and it appears to have occurred in a frail, confused, elderly patient who had a high number of invasive devices inserted during his extended stay in hospital. A Serious Case Review meeting will be scheduled to consider this further. b) Clostridium Difficile Current Position (Target = 66) Nine hospital acquired cases were reported during the month of April. c) Norovirus There were two outbreaks of diarrhoea and vomiting in Care of the Elderly wards at FH in April; norovirus was identified from both outbreaks. A total of 27 patients and 4 staff were symptomatic. In total 99 bed days were lost. There have been no reported outbreaks in May, although surveillance data from PHE indicates norovirus is still circulating in the community. This information has been cascaded through Trust wide forums to ensure clinical staff remain vigilant to any potential cases. d) Measles The nationally reported outbreak continues, but is focused in South of Tyne. There has been one case reported in Children s Services in the Trust. The patient was asymptomatic when they attended the oncology day unit but later presented (often infectious for 24-48hrs prior to development of rash) with measles. They had contact with 20 patients before being diagnosed. A meeting was convened between clinicians, IPCN, infection control doctors, Public Health England and Occupational Health, and the following actions taken: All immunocompromised children have all received immunoglobulins. Staff have had Measles IgG checked or immunisation status confirmed. 1
Plan has been made for cohorting contacts when they receive further treatment in Oncology (up to 14 day incubation) Families have been made aware and parents who were in contact with index case have been advised to be vaccinated or to confirm vaccination status Plan for families coming with their children has been confirmed Information sheets have been made available for the parents/children. Guidance has been received from Public Health England, which highlights that there have been three confirmed cased of measles amongst healthcare workers in the North East (not this Trust) and Occupational Health are ensuring compliance with the guidance received. In line with trends across the country, the number of measles cases continues to rise in the North East, with the majority of cases being reported in Teesside 3. ONGOING ACTIONS WITHIN THE TRUST i) Ward Accreditation Scheme Delivery Suite remains unaccredited, and work is on-going to achieve the required standards. ii) Mandatory Training Current level 1 performance is at 75.2%, and level 2 at 71.9%. Efforts are being sustained to bring about improvements. iii) Improving Practice Non-ported safety cannula Trust wide roll out to commence this week (as part of this, all equipment and record sheets required for cannulation will be located together in one area on each ward) this will be the Cannulation Station Development of C. difficile patient cards in progress A review of how lessons learnt following RCA can be effectively disseminated to all clinical staff and become embedded in to clinical practice is underway. New guidelines introduced for daily Chlorhexidine washes in high risk patients New hand hygiene promotional campaign in progress due to launch in June 2013 Education sessions completed with hand hygiene auditors to reinforce best practice and consistent auditing across the Trust Norovirus still circulating, screensaver remains in situ and requests for ongoing vigilance via Trust-wide Forums CAUTI/UTI prevention of admissions project 12 month project working with Nursing and Residential Homes to improve patient care related to continence and IPC practices Discussion with CCGs to promote collaborative working and reestablishment of North of Tyne HCAI Reduction Group 2
IPC Link Staff (acute) Foundation Study Day to take place on 20 th May 2013 iv) Monitoring and Reporting CAT all IPC questions revised in April 2013, including a section for completion by medical staff relating to ANTT practice MRSA and Diarrhoea Care Pathway compliance audits in progress; results to be circulated May 2013 MRSA eradication therapy compliance audit complete, report to be table at IPC Operational Group 20 th May 2013 Directorate based education sessions on-going Revised RCA for deep spinal infections identified via national SSI Surveillance Programme v) Service Developments IV project nurse, 12 month secondment opportunity, recruitment in progress HPV (Hydrogen Peroxide Substitute) unit purchased; Hotel Services recruitment in progress. Rapid Response Cleaning teams established on both FH and RVI sites. Hand hygiene product trial complete, installation of GOJO sanitising gel, liquid soap and moisturiser to commence very soon. 4. SUMMARY Whilst the number of HCAIs reported in Month 1 is of concern, it is evident much work continues to ensure that minimising risk remains a high priority in order to protect patients and ensure the stringent targets are high on everyone s agenda. 5. RECOMMENDATION To (i) note the content of this report (ii) comment accordingly. Helen Lamont Nursing & Patient Services Director Dr. Ashley Price Director of Infection Prevention and Control 14 th May 2013 3