Item Number 7.1 BOARD24/ NHS Tayside Board 24 il HEALTHCARE ASSOCIATED INFECTION (HAI) CONTROL IN TAYSIDE FOR JANUARY AND FEBRUARY 1. SITUATION AND BACKGROUND Infections contracted while receiving healthcare are a significant cause of ill health. Members of the public reasonably expect that all practicable measures are being taken to reduce the opportunity for acquiring an infection as a result of their treatment and care. HAI is a priority patient safety issue for both the SGHD and NHS Tayside, being one of the most important events that can adversely impact on patients when they receive care Dr Gabby Phillips is the Lead Doctor Infection Control and Dawn Weir is the General Manager Infection Control. They are the lead officers for the HAI Strategy and annual programme of work. Professor D Nathwani is the lead for antimicrobial prescribing. Attached to this report is the summary position for uary and ruary. 2. ASSESSMENT To provide an update on progress with Healthcare Associated Infection (HAI) in Tayside using the standard reporting template as mandated by the Scottish Government Health Directorate (SGHD). NHS Tayside i.) ii.) is currently above the HEAT target for SABs. However, as almost half of episodes are community based, this is likely to show variable progress. is currently above CDI HEAT target though with the inclusion of those aged under 65 years of age in part contributing to this. Page 1 of 24
3. RECOMMENDATIONS For information 4. REPORT SIGN OFF Ms Lesley McLay, Chief Executive Dr G Phillips Lead Infection Control Doctor/ Director of Infection Control & Management Ms L McLay Chief Executive Professor D Nathwani Consultant Physician, Infection Unit/Lead Clinician for the AMT il Page 2 of 24
Healthcare Associated Infection Reporting Template (HAIRT) Section 1 Board Wide Issues This section of the HAIRT covers Board wide infection prevention and control activity and actions. For reports on individual hospitals, please refer to the Healthcare Associated Infection Report Cards in Section 2. A report card summarising Board wide statistics can be found at the end of section 1 Key Healthcare Associated Infection Headlines for uary and ruary CDI target breached. NHS Tayside is in line with the 3 antibiotic prescribing targets that support the CDI HEAT target, compliance with the target for surgical prophylaxis is showing a high level of reliability. SABs target remains breached but is trending down Staphylococcus aureus (including MRSA) Staphylococcus aureus is an organism which is responsible for a large number of healthcare associated infections, although it can also cause infections in people who have not had any recent contact with the healthcare system. The most common form of this is Meticillin Sensitive Staphylococcus Aureus (MSSA), but the more well known is MRSA (Meticillin Resistant Staphylococcus Aureus), which is a specific type of the organism which is resistant to certain antibiotics and is therefore more difficult to treat. More information on these organisms can be found at: Staphylococcus aureus : http://www.nhs24.com/content/default.asp?page=s5_4&articleid=346 MRSA:http://www.nhs24.com/content/default.asp?page=s5_4&articleID=252 NHS Boards carry out surveillance of Staphylococcus aureus blood stream infections, known as bacteraemias. These are a serious form of infection and there is a national target to reduce them. The number of patients with MSSA and MRSA bacteraemias for the Board can be found at the end of section 1 and for each hospital in section 2. Information on the national surveillance programme for Staphylococcus aureus bacteraemias can be found at: http://www.hps.scot.nhs.uk/haiic/sshaip/publicationsdetail.aspx?id=30248 Clostridium difficile Clostridium difficile is an organism which is responsible for a large number of healthcare associated infections, although it can also cause infections in people who have not had any recent contact with the healthcare system. More information can be found at: http://www.nhs.uk/conditions/clostridium-difficile/pages/introduction.aspx NHS Boards carry out surveillance of Clostridium difficile infections (CDI), and there is a national target to reduce these. The number of patients with CDI for the Board can be found at the end of section 1 and for each hospital in section 2. Information on the national surveillance programme for Clostridium difficile infections can be found at: http://www.hps.scot.nhs.uk/haiic/sshaip/ssdetail.aspx?id=277 Page 3 of 24
Hand Hygiene (HH) Good hand hygiene by staff, patients and visitors is a key way to prevent the spread of infections. More information on the importance of good hand hygiene can be found at: http://www.washyourhandsofthem.com/ NHS Boards monitor hand hygiene and ensure a zero tolerance approach to non compliance. The hand hygiene compliance score for the Board can be found at the end of section 1 and for each hospital in section 2. Information on national hand hygiene monitoring can be found at: http://www.hps.scot.nhs.uk/haiic/ic/nationalhandhygienecampaign.aspx HH Update uary and ruary National Hand Hygiene Reporting Expectations Now able to display the local HH data for both compliance with opportunity and technique. This will be displayed as a combined score for each of the four staff groups (Medical, Nursing, AHPs and Others). NHST will also display the compliance figures for the opportunities and technique separately to enable targeted interventions where needed. Quality Assurance process will be implemented by the IC team to provide some confidence around local data collection. A tool has been developed and agreed. Other Activities: HH Co-ordinator: Providing training and support to areas around their auditing processes in acute services Continue to work with garet Tannahill in Care Inspectorate to provide training for Home Care staff in P&K as part of the Care Home Educational Package work with Social Care & Social Work Improvement Scotland Skin Health The HH Co-ordinator continues to provide significant support to OHSAS (Occupational Health & Health and Safety). Cleaning and the Healthcare Environment Keeping the healthcare environment clean is essential to prevent the spread of infections. NHS Boards monitor the cleanliness of hospitals and there is a national target to maintain compliance with standards above 90%.The cleaning compliance score for the Board can be found at the end of section 1 and for each hospital in section 2. Information on national cleanliness compliance monitoring can be found at: http://www.hfs.scot.nhs.uk/online-services/publications/hai/ Healthcare environment standards are also independently inspected by the Healthcare Environment Inspectorate. More details can be found at: http://www.nhshealthquality.org/nhsqis/6710.140.1366.html Page 4 of 24
Outbreaks This section should give details on any outbreaks that have taken place in the Board since the last report, or a brief note confirming that none have taken place. Where there has been an outbreak then for most organisms as a minimum this section should state when it was declared, number of patients affected, number of deaths (if any), actions being taken to bring the outbreak under control and whether this was reported to the Scottish Government. For outbreaks of norovirus a more general outline of the outbreak may be more appropriate. No outbreaks recorded, though VRE activity was high in the Surgical Unit at Ninewells as reported in the last Board report. Planned clean is being progressed. Other HAI Related Activity See Appendices as below Page(s) Appendix 1 MRSA 12 Appendix 2 Vancomycin-resistant Enterococcus (VRE) 13 Appendix 3 SABs & CDI Data 13-14 Appendix 4 Hand Hygiene Compliance for Stracathro and CHPs 15 Appendix 5 ESBLs ly data set 16 Appendix 6 Antimicrobial Prescribing data 16-19 Appendix 7 Surgical Site Infection (SSI) data 20 Appendix 8 Hot Topics / Horizon Scanning 20 Appendix 9 HAI and Medical Certificate of Death 21 Appendix 10 Status of HEI Action Plans 22 Appendix 11 Glossary 23 Page 5 of 24
Healthcare Associated Infection Reporting Template (HAIRT) Section 2 Healthcare Associated Infection Report Cards The following section is a series of Report Cards that provide information, for each acute hospital and key community hospitals in the Board, on the number of cases of Staphylococcus aureus blood stream infections (also broken down into MSSA and MRSA) and Clostridium difficile infections, as well as hand hygiene and cleaning compliance. In addition, there is a single report card which covers all community hospitals [which do not have individual cards], and a report which covers infections identified as having been contracted from outwith hospital. The information in the report cards is provisional local data, and may differ from the national surveillance reports carried out by Health Protection Scotland and Health Facilities Scotland. The national reports are official statistics which undergo rigorous validation, which means final national figures may differ from those reported here. However, these reports aim to provide more detailed and up to date information on HAI activities at local level than is possible to provide through the national statistics. Understanding the Report Cards Infection Case Numbers Clostridium difficile infections (CDI) and Staphylococcus aureus bacteraemia (SAB) cases are presented for each hospital, broken down by month. Staphylococcus aureus bacteraemia (SAB) cases are further broken down into Meticillin Sensitive Staphylococcus aureus (MSSA) and Meticillin Resistant Staphylococcus aureus (MRSA). More information on these organisms can be found on the NHS24 website: Clostridium difficile :http://www.nhs24.com/content/default.asp?page=s5_4&articleid=2139§ionid=1 Staphylococcus aureus :http://www.nhs24.com/content/default.asp?page=s5_4&articleid=346 MRSA:http://www.nhs24.com/content/default.asp?page=s5_4&articleID=252§ionID=1 For each hospital the total number of cases for each month are those which have been reported as positive from a laboratory report on samples taken more than 48 hours after admission. For the purposes of these reports, positive samples taken from patients within 48 hours of admission will be considered to be confirmation that the infection was contracted prior to hospital admission and will be shown in the out of hospital report card. Targets There are national targets associated with reductions in C.diff and SABs. More information on these can be found on the Scotland Performs website: http://www.scotland.gov.uk/about/performance/scotperforms/partnerstories/nhsscotlandperformance Understanding the Report Cards Hand Hygiene Compliance Hospitals carry out regular audits of how well their staff are complying with hand hygiene. Each hospital report card presents the combined percentage of hand hygiene compliance with both opportunity taken and technique used broken down by staff group. Understanding the Report Cards Cleaning Compliance Hospitals strive to keep the care environment as clean as possible. This is monitored through cleaning and estates compliance audits. More information on how hospitals carry out these audits can be found on the Health Facilities Scotland website: http://www.hfs.scot.nhs.uk/online-services/publications/hai/ Understanding the Report Cards Out of Hospital Infections Clostridium difficile infections and Staphylococcus aureus (including MRSA) bacteraemiacases are all associated with being treated in hospitals. However, this is not the only place a patient may contract an infection. This total will also include infection from community sources such as GP surgeries and care homes and. The final Report Card report in this section covers Out of Hospital Infections and reports on SAB and CDI cases reported to a Health Board which are not attributable to a hospital. Page 6 of 24
NHS TAYSIDE BOARD REPORT CARD Staphylococcus aureus bacteraemia monthly case numbers MRSA 2 2 2 1 1 1 0 0 1 3 1 1 MSSA 11 13 15 10 8 10 6 15 7 8 10 8 Total SABS 13 15 17 11 9 11 6 15 8 11 11 9 Clostridium difficile infection monthly case numbers Ages 15-64 2 6 1 4 6 4 12 6 3* 2 1 2 Ages 65 plus 12 10 6 11 14 12 15 13 9 8 10* 6 Ages 15 plus 14 16 7 15 20 16 27 19 12 10 11 8 * 1 case indeterminate as to which hospital to allocate against, counted in Tayside total only. See Appendix 3, pages 13-15 for related SAB/CDI information Hand Hygiene Monitoring Compliance (%) see below* AHP Ancillary Medical Nurse Opportunity 99 99 99 98 98 99 98 99 99 99 99 99 Technique 97 99 98 98 98 98 97 98 99 99 99 99 Board Total * Staff Group compliance rates have not previously been captured electronically and so this breakdown is not available to populate the tables. E-Health are currently exploring the best software solution to have this information made available. Cleaning Compliance (%) Board Total 95.4 93.95 94.26 94.56 94.81 94.76 95.14 94.39 94.62 94.80 94.50 94.40 Estates Monitoring Compliance (%) Board Total 98.64 99.3 99.14 99.03 98.77 98.97 98.29 98.34 98.19 98.35 98.64 98.55 Page 7 of 24
NHS TAYSIDE NINEWELLS HOSPITAL REPORT CARD Staphylococcus aureus bacteraemia monthly case numbers MRSA 0 2 1 0 1 0 0 0 0 0 0 1 MSSA 4 5 5 4 4 4 4 2 4 2 5 4 Total SABS 4 7 6 4 5 4 4 2 4 2 5 5 Clostridium difficile infection monthly case numbers Ages 15-64 1 2 1 3 5 1 2 4 0 1 0 1 Ages 65 plus 1 2 1 4 6 2 7 4 2 3 1 2 Ages 15 plus 2 4 2 7 11 3 9 8 2 4 1 3 See Appendix 3, pages 13-15 for related SAB/CDI information Hand Hygiene Monitoring Compliance (%) AHP Ancillary Medical Nurse Opportunity 96 96 98 96 97 96 95 97 96 96 97 96 Technique 96 97 97 96 97 96 94 98 98 99 98 99 Board Total Cleaning Compliance (%) Board Total 94.06 92.89 93.57 93.54 93.94 93.98 94.07 93.79 93.46 93.60 93.56 93.70 Estates Monitoring Compliance (%) Board Total 99.83 99.74 99.77 99.95 99.32 99.51 99.16 99.21 99.05 99.46 99.55 98.90 Page 8 of 24
NHS HOSPITAL PERTH ROYAL INFIRMARY REPORT CARD Staphylococcus aureus bacteraemia monthly case numbers MRSA 0 0 0 1 0 0 0 0 0 1 0 0 MSSA 0 1 0 1 1 1 1 2 0 1 1 0 Total SABS 0 1 0 2 1 1 1 2 0 2 1 0 Clostridium difficile infection monthly case numbers Ages 15-64 0 0 0 0 0 0 0 2 0 0 0 0 Ages 65 plus 6 2 1 1 2 2 3 0 1 0 2 1 Ages 15 plus 6 2 1 1 2 2 3 2 0 0 2 1 See Appendix 3, pages 13-15 for related SAB/CDI information Hand Hygiene Monitoring Compliance (%) AHP Ancillary Medical Nurse Opportunity 99 97 99 97 98 99 99 99 98 98 99 98 Technique 99 98 98 98 98 97 98 100 99 98 97 98 Board Total Cleaning Compliance (%) Board Total 94.11 95.5 94.33 93.37 94.20 95.57 93.44 94.95 94.76 93.80 95.60 94.05 Estates Monitoring Compliance (%) Board Total 98.7 99.34 98.88 98.99 99.12 98.75 97.93 98.86 99.23 99.10 98.56 98.78 Page 9 of 24
NHS HOSPITAL ROYAL VICTORIA HOSPITAL REPORT CARD Staphylococcus aureus bacteraemia monthly case numbers MRSA 0 0 0 0 0 0 0 0 0 0 0 0 MSSA 1 0 0 0 0 0 0 0 0 0 0 0 Total SABS 1 0 0 0 0 0 0 0 0 0 0 0 Clostridium difficile infection monthly case numbers Ages 15-64 0 0 0 0 0 0 0 0 0 0 0 0 Ages 65 plus 0 0 0 0 0 1 0 0 1 0 0 0 Ages 15 plus 0 0 0 0 0 1 0 0 1 0 0 0 See Appendix 3, pages 13-15 for related SAB/CDI information Hand Hygiene Monitoring Compliance (%) AHP Ancillary Medical Nurse Opportunity 100 100 100 99 100 100 99 100 100 100 100 100 Technique 100 99 100 100 100 99 99 100 99 100 99 99 Board Total Cleaning Compliance (%) Board Total 94.19 95.68 94.62 95.95 95.41 96.03 93.42 96.46 96.37 95.79 95.78 94.98 Estates Monitoring Compliance (%) Board Total 100 100 99.87 99.94 100 99.92 100 100 100 99.90 99.82 100 Page 10 of 24
NHS HOSPITAL STRACATHRO HOSPITAL REPORT CARD Staphylococcus aureus bacteraemia monthly case numbers MRSA 0 0 0 0 0 0 0 0 0 0 0 0 MSSA 0 0 0 0 0 0 0 0 0 0 0 0 Total SABS 0 0 0 0 0 0 0 0 0 0 0 0 Clostridium difficile infection monthly case numbers Ages 15-64 0 0 0 0 0 0 0 0 0 0 0 0 Ages 65 plus 0 0 0 0 0 0 0 0 0 0 0 0 Ages 15 plus 0 0 0 0 0 0 0 0 0 0 0 0 See Appendix 3, pages 13-15 for related SAB/CDI information Hand Hygiene Monitoring Compliance (%) AHP Ancillary Medical Nurse Opportunity 99 99 96 100 100 98 100 96 100 99 99 100 Technique 94 99 99 100 100 99 95 96 100 99 100 100 Board Total Cleaning Compliance (%) Board Total 95.66 96.97 94.2 96.92 94.48 95.53 95.25 96.34 96.43 96.18 94.23 94.05 Estates Monitoring Compliance (%) Board Total 97.98 97.45 98.86 98.81 98.62 97.35 97.21 92.63 97.54 95.94 94.89 96.0 Page 11 of 24
NHS TAYSIDE COMMUNITY HOSPITALS REPORT CARD The community hospitals covered in this report card include: Royal Dundee Liff Hospital Strathmartine Hospital Dudhope Young Persons Unit Arbroath Infirmary Aberfeldy Community Hospital Blairgowrie Community Hospital Murray Royal Hospital St garets Hospital, Auchterarder Brechin Infirmary Little Cairnie Montrose Royal Infirmary Crieff Community Hospital Carseview Centre Whitehills Health & Community Care Centre Pitlochry Community Hospital Staphylococcus aureus bacteraemia monthly case numbers MRSA 0 0 0 0 0 0 0 0 0 0 0 0 MSSA 0 0 1 0 0 0 0 1 0 1 0 0 Total SABS 0 0 1 0 0 0 0 1 0 1 0 0 Clostridium difficile infection monthly case numbers Ages 15-64 0 0 0 0 0 0 0 0 0 0 0 0 Ages 65 plus 1 0 0 1 0 2 1 1 2 0 1 1 Total CDI 1 0 0 1 0 2 1 1 2 0 1 1 See Appendix 3, pages 13-15 for related SAB/CDI information NHS OUT OF HOSPITAL REPORT CARD Staphylococcus aureus bacteraemia monthly case numbers MRSA 2 0 1 0 0 1 0 0 1 2 1 0 MSSA 6 7 9 5 3 5 1 10 3 4 4 4 Total SABS 8 7 10 5 3 6 1 10 4 6 5 4 Clostridium difficile infection monthly case numbers Ages 15-64 1 3 0 1 1 2 10 3 2 1 1 1 Ages 65 plus 4 6 4 5 6 5 4 5 3 5 5 2 Total CDI 5 9 4 6 7 7 14 8 5 6 6 3 Page 12 of 24
MRSA Appendix 1 MRSA KPIs During the third quarter of - 1st ober to 31st ember - a figure of 87% was recorded in relation to compliance with the application of the Clinical Risk Assessment (CRA).The target is 90%. Remedial educational sessions continue to be delivered by the infection control team staff. MRSA Reduction in control limits due to continued low numbers of hospital acquisitions. 16 c-chart for Number of New MRSA Acquired in Ninewells Hospital uary 2011 - ruary No. of New MRSA 14 Mean UCL UWL 12 LWL 6 per. Mov. Avg. (No. of New MRSA) 10 8 6 4 2 0-11 -12-13 e y -14 No. of NewMRSA Mean and Limits recalculated at e 8 c-chart for Number of New MRSA Acquired in Perth Royal Infirmary uary 2011 - ruary No. of New MRSA 7 Mean UCL 6 UWL 6 per. Mov. Avg. (No. of New MRSA) 5 4 3 2 1 0-11 -12-13 e y -14 No. of NewMRSA Feg 2 c-chart for Number of New MRSA Acquired in Royal Victoria Hospital uary 2011 - ruary No. of New MRSA Mean UCL UWL 6 per. Mov. Avg. (No. of New MRSA) No. of NewMRSA 1 0-11 -12-13 e y -14 Page 13 of 24
Vancomycin-resistant Enterococcus (VRE) Appendix 2 There has been an increase in detection in VRE in surgical unit. Pinpointing place of acquisition is difficult. The situation is being monitored, additional cleaning is being put into the surgical unit and opportunity will be taken to do a terminal clean of key wards in surgical unit as a precautionary measure. Slight reduction in new cases in uary. 25 No. of New VRE New VRE Positive Patients and VRE Blood Cultures taken in NHS Tayside (All Sites - Including Community) uary 2012 onwards No. Positive VRE Blood Cultures 20 Number of Positive VRE 15 10 5 0-12 - 13-14 Staph aureus bacteraemias (SABs). HEAT target is 24 episodes per 100 000 Acute Occupied Bed Days Appendix 3 No change. 0.38 Number of S. aureus Bacteraemias/1000 AOBD taken in NHS Tayside (NOT all Hospital Acquired) Annual Rolling Total in Line with HEAT Target 0.36 0.34 0.32 Rate/1000 AOBD 0.30 0.28 Rolling total HEAT Target 0.26 0.24 0.22 0.20-12 -13-14 -15 Page 14 of 24
C.difficile Infection (CDI) HEAT target is 32 over the age of 15 years per 100 000 Occupied Bed Days. NHS Tayside Data Due to the revision of HPS denominator data the CDI HEAT Target chart is currently under review and the graph below demonstrates the total number of cases over the age of 15 years. NHS Tayside is above the target but progressing downwards NHS Tayside CDI Positive Samples 30 25 No. of C.Diff Episodes 20 15 10 5 0-12 -13-14 Page 15 of 24
Hand Hygiene Compliance for Stracathro and CHPs Appendix 4 100 Hand Hygiene Opportunity Results for Stracathro, Dundee, Angus and Perth and Kinross CHP 2012 onwards 99 98 97 %Compliance 96 95 94 Stracathro Dundee CHP Angus CHP P & K CHP 93 92 91 90-12 -12-12 -12-12 -12-12 -12-12 -12-13 -13-13 -13-13 -13-13 -13-13 -13-13 -13-14 -14 Hand Hygiene Technique Results Charts 100 Hand Hygiene Technique Results for Ninewells, PRI and RVH 2012 onwards 96 %Compliance 92 88 Ninewells PRI RVH 84 80-12 -12-12 -12-12 -12-12 -12-12 -12-13 -13-13 -13-13 -13-13 -13-13 -13-13 -13-14 -14 Hand Hygiene Technique Results for Stracathro, Dundee, Angus and Perth and Kinross CHP 2012 onwards 100 96 %Compliance 92 88 84 80-12 -12-12 -12-12 -12-12 -12-12 -12-13 -13-13 -13-13 -13-13 -13-13 -13-13 -13-14 -14 Stracathro Dundee CHP Angus CHP P & K CHP Page 16 of 24
ESBLs Appendix 5 No significant change or triggers breached in any single ward, though there continues to be small numbers of new cases detected allocating place of acquisition is difficult. There is a mixture of hospital and community acquired cases. The place of detection is not necessarily the place of acquisition. 35 Number of New ESBL Patients per uary 2012 onwards 30 25 Number of Patients 20 15 All Angus CHP P & K CHP Dundee CHP STX PRI NW 10 5 0-12 -13 e y t -14 Antimicrobial Prescribing Appendix 6 The government HEAT targets require that health boards collect compliance data for surgical prophylaxis within Colorectal surgery. This has been highlighted as a high burden surgical area and compliance data must be reported on a monthly basis. Within Tayside the Antimicrobial Management Team are working alongside the SPSP team to do work around the surgical checklist within theatres to capture this data. Compliance with these data has been good and these data are presented below. In line with national steer we plan to address timely appropriate prophylaxis with other key surgical procedures Page 17 of 24
Our compliance with other HEAT related prescribing targets: empiric prescribing and quinolone prescribing in primary care is also consistently good, see figures 3 and 4 below. The new primary care target aimed at reducing total antibiotic prescribing is likely to prove to be challenging and Tayside is preparing for this with primary care colleagues. Overlong duration of treatment remains a key driver of resistance. Recent audit work has shown a significant proportion of patients receiving antibiotics for more than 7 days inappropriately. In future, downstream wards will be audited to review appropriateness of both antibiotic choice and antibiotic duration for compliance with local guidance. Patients admitted to these wards with UTIs or pneumonia will be targeted, the aim is to have antibiotic course length specified at point of prescribing. The purpose of this will be to ensure appropriate course lengths are prescribed for patients and to reduce overall antibiotic use. The inappropriate and excessive use prescribing carbapenem antibiotics has been recognised nationally as a serious thereat to our ability to treat multi-resistant pathogens. To address this wardbased pharmacy staff identify patients prescribed meropenem and alert the antibiotic pharmacy team of these patients. Patients prescribed meropenem are then reviewed by microbiologists or the infectious diseases medical staff to ensure use is appropriate. Meropenem use is reviewed at each AMG meeting. The sepsis bundle continues to be used to optimise the treatment of sepsis from a range of community acquire and HAI s. Implementation of the sepsis bundles remains challenging in some areas and improvement work is being undertaken. SAB management continues to optimised by use of a national algorithm and prompt specialist clinical review. Figure 1: Combined % Compliance with antibiotic policy before and after pharmacist intervention for NW & PRI admissions units, RVH, Stracathro, and Arbroath Page 18 of 24
Figure 2: Change in Prescribing Practice Medicine, Surgery, and Medicine for Elderly wards. Antibacterials Usage in NHS Tayside Hospitals 50000 45000 40000 35000 No of DDDs / Restricted / Promoted 30000 25000 20000 No of DDDs Restricted Promoted 15000 10000 5000 0 10 / 112008 12 / 2008 01 / / 2008 02 / / 2009 03 / / 2009 04 / / 2009 05 / / 2009 06 / / 2009 07 / / 2009 08 / / 2009 09 / / 2009 10 / / 2009 11 / / 2009 12 / / 2009 01 / / 2009 02 / / 2010 03 / 2010 / 04 / / 2010 / 05 / 2010 06 / / 2010 07 / / 2010 08 / / 2010 09 / / 2010 / / 2010 / 11 / 2010 12 / / 2010 / / 2010 02 / 2011 / 03 / 2011 / 04 / / 2011 05 / / 2011 06 / / 2011 07 / / 2011 08 / / 2011 09 / / 2011 10 / / 2011 / 2011 / 12 / / 2011 / / 2011 02 / 2012 / 03 / 2012 / 04 / / 2012 05 / / 2012 06 / / 2012 07 / / 2012 08 / / 2012 09 / / 2012 10 / 2012 / 11 / 2012 / / / 2012 / / 2012 02 / / 03 / / 04 / / 05 / / 06 / / 07 / / 08 / / 09 / / 10 / / 11 / / / / / / JANUARY FEBRUARY MARCH APRIL MAY JUNE JULY AUGUST SEPTEMBER OCTOBER NOVEMBER DECEMBER JANUARY FEBRUARY MARCH APRIL MAY JUNE JULY AUGUST SEPTEMBER OCTOBER NOVEMBER DECEMBER JANUARY FEBRUARY MARCH APRIL MAY JUNE JULY AUGUST SEPTEMBER OCTOBER NOVEMBER DECEMBER JANUARY FEBRUARY MARCH APRIL MAY JUNE JULY AUGUST SEPTEMBER OCTOBER NOVEMBER DECEMBER JANUARY FEBRUARY MARCH APRIL MAY JUNE JULY AUGUST SEPTEMBER OCTOBER NOVEMBER DECEMBER JANUARY FEBRUARY Financial / Financial Year / Financial Name Figure 3: NHS Tayside and Scotland: - Quinolone DDDs per 1000 patients during the period: - ober 2012 ember. Page 19 of 24
Figure 4: Each HB in Scotland: - Quinolone seasonal variation for the period il 2012 - ch. Fluoroquinolone seasonal variation, il 2012 - ch 15.00% 10.00% 5.00% 0.00% -5.00% -10.00% -15.00% -20.00% -25.00% -30.00% NHS A&A NHS Borders NHS D&G NHS Fife NHS Forth Valley NHS Grampian NHS GG&C NHS Highland NHS Lanarkshire NHS Lothian NHS Orkney NHS Shetland NHS Tayside NHS Western Isles Scotland National HEAT targets were implemented to support reduction in Clostridium difficile infection. In primary care, seasonal variation in quinolone use (summer months vs. winter months) should be < 5%, and NHS Tayside has successfully met this target for 10-11, 11-12 and 12-13. The HEAT target for quinolone seasonal variation ceased in il but is still monitored at Board level. This data is only updated annually when data to ch is available therefore it is important to consider recent quinolone prescribing trends in conjunction with seasonal variation data. Page 20 of 24
Surgical Site Infection Surveillance (SSI) Appendix 7 Surveillance continues as per National requirements. Local surveillance figures including 30 day post discharge figures where appropriate. NOF = neck of femur Hip = Total hip replacement Knee = total knee replacement TAH = Total abdominal hysterectomy Vascular = selected vascular procedures Breast no. (% infection) C section no. (% infection) NOF no. (% infection) Hip no. (% infection) Knee no. (% infection) TAH No. (% infection) Vasc no. (% infection) Colorectal no. (% infection) 12 34 (0) 101(9) 61 (2) 51 (2) 41 (0) 12 (17) 25 (8) 39 (0) 82 (1) 63 (0) 54 (4) 44 (0) 11 (0) 19 (0) 11 (0) 107 (6) 65 (2) 53 (0) 62 (2) 15 (0) 37 (0) 10 (0) 88 (2) 52 (0) 54 (2) 50 (4) 14 (0) 18 (11) 8 (13) 117 (11) 57 (2) 52 (4) 52 (0) 11 (0) 19 (11) 7 (0) 83 (2) 55 (2) 54 (2) 52 (2) 12 (8) 21 (9) 13 (8) 85 (4) 51 (2) 69 (0) 44 (0) 18 (6) 18 (6) 7 (0) 107 (5) 54 (2) 67 (0) 50 (0) 12 (8) 21 (10) 10 (0) 81 (6) 59 (0) 62 (2) 69 (3) 14 (0) 22 (14) 7 (0) 90 (2) 60 (0) 61 (0) 54 (0) 10 (0) 26 (0) 9 (0) 99 (3) 52 (2) 59 (2) 51 (0) 15 (0) 26 (0) 20 (10) 9 (0) 92 (3) 70 (3) 49 (2) 47 (2) 16 (6) 28 (4) 16 (19) 13 12 (0) 85 (6) 62 (5) 63 (5) 50 (2) 13 (0) 24 (8) 27 (7) 12 (0) 84 (6) 40 (0) 73 (4) 50 (2) 16 (6) 24 (0) 26 (4) ch 12 (0) 94 (5) 44 (0) 65 (2) 55 (2) 11 (0) 30 (3) 27 (7) il 21 (0) 107 (9) 53 (0) 60 (0) 50 (0) 7 (18) 23 (0) 22 (18) 21 (0) 88 (1) 61 (0) 56 (4) 63 (2) 12 (0) 27 (0) 15 (13) e 14 (0) 89 (2) 54 (2) 57 (4) 60 (0) 10 (0) 18 (0) 25 (8) y 16 (0) 115 (0) 51 (0) 37 (0) 67 (1) 13 (0) 35 (6) 21 (5) 16 (0) 102 (5) 63 (3) 37 (0) 53 (4) 15 (7) 16 (12.5) 30 (10) t 15 (0) 108 (1) 52 (0) 42 (2) 76 (7) 15 (0) 27 (7) 31 (6) 14 (0) 79 (1) 59 (2) 59 (2) 44 (2) 16 (6) 25 (8) 30 (13) 10 (0) 121 (4) 52 (0) 54 (6) 54 (0) 11 (0) 11 (0) 30 (7) 8 (0) 114 (2) 73 (0) 46 (2) 57 (2) 13 (0) 15 (7) 33 (3) 15 (0) 117 (4) 64 (0) 49 (6) 39 (0) 9 (0) 16 (12.5) NB: From ch 2012, Breast Surveillance only in PRI, NW surveillance has been discontinued. Hot Topics/ Horizon Scanning Appendix 8 Single room provision: to be discussed and entered as a risk for the organisation PVL and community staphylococcal infections Increase in negative pressure rooms required in level 2/3 areas. To be discussed and entered as a risk for the organisation Multi-resistant gram-negative bacteria for which antibiotic treatment is severely restricted. We are seeing a small increase in the number of these bacteria being identified in the laboratory. Staff awareness on the need to screen for these in high risk groups is increasing Page 21 of 24
HAI and Medical Certification of Death: MRSA and CDI Appendix 9 5 4 Number of HAI Deaths (for C. Diff) Recorded on any line on the MCCD for NHS Tayside per 2010 - ruary NB: Deaths on chart include: - 1. Patients dying in NHST, but resident in other Health Boards and NHST residents dying elsewhere 2. Both underlying cause and contributory factors (ie any mention) 3. The infection may not have been acquired in the Board of Residence 4.All deaths in NHST (hospital and community recorded) Number 3 2010 2011 2012 2 1 0 3 Number of HAI Deaths (for MRSA) Recorded on any line on the MCCD for NHS Tayside per 2010 - ruary NB: Deaths on chart include: - 1. Patients dying in NHST, but resident in other Health Boards and NHST residents dying elsewhere 2. Both underlying cause and contributory factors (ie any mention) 3. The infection may not have been acquired in the Board of Residence 4.All deaths in NHST (hospital and community recorded) 2 Number 2010 2011 2012 1 0 Page 22 of 24
HEI Inspections Appendix 10 Update uary Perth Royal Infirmary, ember This unannounced inspection resulted in 4 requirements and one recommendation. The requirements relate to: limited access to ward specific HAI information when the Senior Charge Nurse is not available, non closure of temporary closure mechanism on sharps boxes held in clinical areas, documentation related to PVC bundles and cleaning of equipment. The report acknowledges that NHS Tayside has undertaken significant work to put an effective water management system in place to demonstrate compliance with Chief Executive Letter (CEL) 08(). However, there is a recommendation that further education is provided to relevant staff in relation Pseudomonas aeruginosa. Previous Inspections to NHS Tayside by HEI:- Announced Unannounced Ninewells Hospital - ember 2009 (Complete) Perth Royal Infirmary - 2010 (Complete) Stracathro Hospital 2012 (Complete) Ninewells Hospital ember 2010 (Complete) Ninewells Hospital il 2011 Stracathro Hospital 2011 (Complete) Ninewells Hospital ember 2011 (Complete) Perth Royal Infirmary ruary 2012 Ninewells Hospital ober 2012 (Complete) Stracathro il (Complete) Perth Royal Infirmary ember Ninewells, il 2011-11 Requirements and 3 Recommendations. One requirement is outstanding:- NHS Tayside does not fully meet the requirements of HDL (2005)8 and HDL (2001)10 in relation to the role of the ICM which requires the ICM to have full accountability for domestic services and decontamination. This is the same for other Boards in Scotland and is one of the reasons that the HDLs are currently being reviewed nationally. The timescale for completion of this review has been delayed. Perth Royal Infirmary, ruary 2012-2 Requirements and 3 Recommendations. Only one requirement remains outstanding relating to improved completion of PVC bundles. This remains a challenging area in which to achieve sustained compliance. Page 23 of 24
AOBD Acute Occupied Bed Days 'Alert' organisms- The microbiology department supply the clinical groups with daily reports of alert organisms that are likely to cause outbreaks of infection and /or are multi drug resistant. Antimicrobials- An antimicrobial is a substance that kills or inhibits the growth of microbes such as bacteria (antibacterial activity), fungi (antifungal activity), viruses (antiviral activity), or parasites (anti-parasitic activity). Bacteraemia- Bacteraemia is the presence of bacteria in the blood. It is the principal means by which local infections spread to distant organs. Carbapenamase Producing Enterobacteriacae (CPE). Coliforms (bowel bacteria) producing enzymes that break down a wide range of antibiotics. National guidelines for screening and isolation. Found mainly outwith Scotland at this time in certain parts of the UK but is more common in Asia, Southern Europe and other parts of the world. Considered to have the potential to be one of the most significant threats to public health C difficile- Clostridium difficile is a species of bacteria called Clostridium, which are anaerobic spore-forming rods. It causes a range of symptoms from diarrhoea through to a severe inflammation of the large bowel pseudomembranous colitis. Although part of the normal gut flora in about 5% of the adult population, infection can occur after normal gut flora is altered by the use of antibiotics. Treatment is by stopping antibiotics and commencing specific anti-clostridial antibiotics, e.g. metronidazole. CDI is short for Clostridium difficile Infection. Cohorting. The grouping together of patients with the same infection/symptoms to reduce risk of spread to unaffected individuals: so for instance there may be a bay of patients with symptoms of diarrhoea and a separate bay where patients are not symptomatic. It can be done by bay (or rarely by ward). It would be started when the capacity to care for such affected patients exceeds the number of single rooms. It preferably should include dedicated facilities for positive (affected) or negative (not affected) cohort patients and may or may not be managed with cohort nursing staff. DDD. Defined daily dose. The DDD is the assumed average maintenance dose per day for a drug used in its main indication in adults. ESBLs. Extended spectrum beta-lactamase enzyme producers. These are bacteria like E coli which cause a range of infections such as urinary tract infections or blood poisoning and have acquired the ability to produce the ESBL enzymes. This means these germs are able to destroy all antibiotics in the penicillin and cephalosporin classes. Often these bacteria are resistant to other types of antibiotic and this leaves a very restricted choice for treatment and often the patient needs intravenous treatment. Mostly seen in community settings at the moment. HEAT- HEAT targets are a core set of Ministerial objectives, targets and measures for the NHS. HEAT targets are set for a 3-year period and progress towards them is measured through the Local Delivery Plan process. MRSA - Meticillin-resistant Staphylococcus aureus, (MRSA) is a specific strain of the Staphylococcus aureus bacterium that has developed antibiotic resistance, first to penicillin since 1947, and later to meticillin and related anti-staphylococcal drugs (such as flucloxacillin). Popularly termed a "superbug", it was first discovered in Britain in 1961 and is now widespread throughout the UK. There are still antibiotics left that can deal with this infection. More often than not it colonises (i.e. lives as part of the normal flora of the individual) rather than infects, but if the normal defence systems are breached for instance following an operation or if a line is put into a vein, infection can result. Norovirus - A group of related viruses, including Norwalk and Norwalk-like viruses that can cause stomach pain, diarrhoea, and vomiting in humans. PVL - Panton Valentine Leucocidin. A potent toxin (poison) produced by staphylococci (MRSA and MSSA) which attacks white blood cells. Most frequently seen in community isolates and often in children. It can cause a range of effects from simple but recurrent abscess through to a serious infection like pneumonia. Quinolone antibiotics- The quinolones are a family of broad-spectrum antibiotics. Surgical prophylaxis- Surgical prophylaxis is the use of antibiotics usually a singe dose at the time of the operation to prevent infections at the surgical site. Vancomycin resistant enterococci. Enterococci are a normal part of human bowel flora. They rarely cause infection and if they do tend to be UTIs. Can cause bacteraemia in at risk patients. The ALERT antibiotic sensitivity pattern (vancomycin resistance) is readily traceable. These usually colonise rather than infect. Other antibiotic choices are available if treatment is required. Page 24 of 24