NHS GRAMPIAN
Infection Control Committee
Minutes from meeting held on 10th November 2010
The Board Room, ARI
11.00 – 13.00
Present:
Pamela Harrison,Infection & Prevention Control Manager
Dr Maria Rossi, CHPM, Public Health(attended on behalf of Helen Howie)
Tommy Ovens, Public Forum Representative
Jenny Ingram,SPSP Lead for NHSG
Gillian McCartney, Specialist Antibiotic Pharmacist
Dr Elizabeth Murphy, Consultant in Occupational Health, NHSG
Dr Alexander McKenzie,Consultant
Stewart Rogerson, Head of Decontamination, NHSG(deputising for Gary Mortimer)
Roy Browning, Infection Control Senior Nurse
Elinor Smith, Nurse Director, NHSG
Karen Wares, Local Health Board Co-ordinator
Eunice Chisholm, Lead Nurse
Jenny Ingram, SPSP Lead for NHSG
Vince Shields,Divisional General Manager (deputising for Dr Pauline Strachan)
Elizabeth Kemp, Development Pharmacist
Anneke Street, PA to Infection Control Manager(Minute taker)
1 / Introduction and Apologies /
PEH opened the meeting. Apologies were received from :
Heather Kelman Andrew Fowlie / Sandy Thomson
Roelf Dijkhuizen Anne Marie Karcher
John Brett Jenny Gibb
Pamela Molyneux
2 / Minutes of last meeting 9th September 2010 /
Minutes from the meeting 9th September 2010 were ratified with the following amendments
AMK asked for various changes to the wording under the headings Staph aureusbacteraemias and Measles.
AS to amend / AS
3 / Matters Arising /
- PEH reported that most of the matters arising were actions and were updated in the NHSG Infection Control Action Plan
Item / Subject / Action to be taken and Key Points raised in discussion / Action
4 / Standing Items / 4.1Surveillance Report (HAI-RT)
- The HAI-RT was submitted.
Staph auerus bacteraemias
PEH reported a significant breakthrough with Dr Gray’s and Woodend, having had no SABS cases in the last two months. On a less positive note, NHSG did not meet the HEAT target for 2010 and faces significant challenges for meeting the new target for April. The proposed new target for beyond 2011 will be 0.26 cases per 1000 bed days.
Initiatives include more work being done around PVC/device insertion. Progress has been made in A&E regarding PVC insertion and blood culture packs are being developed in ITU. Once good feedback is obtained,this will be rolled out to other areas. NHSG are being supported, on this, by HPS. Jackie Ley and Peter Christie will be coming up to NHSG to hold workshops and a web/video-conference is set up to be held on the 30th November to discuss various issues; organised by NES.
ES queried what was being discussed regarding urinary catheters, as this is one of the key nursing quality indicators. PEH replied that a bundle has been developed at Woodend and that the Continence Service were taking the lead on this.
PEH to provide updated information on developments regarding Urinary Catheters for the next meeting.
EC fedback that the policy “Guidelines and Procedures for the Management of Venous Access Devices” was close to being ratified. Justine Collie is leading on this.
The setting up of a SABS Short Life Working Group is under discussion to ensure NHSG is more organised andto make decisions on clinical issues.
JI, PEH and AMK will discuss this and arrange for a Group to be assembled.
ES suggested that nursing clinical leadership could be provided.
Clostridium difficile
PEH reported that NHSG are on trajectory to meet the 30% reduction currently stipulated and the 50% reduction that is to come. Work is ongoing with regards to embedding the Antimicrobial Guidelines and GM fedback that they would be uploaded onto the Intranet next week to coincide with the rollout of the posters.
PEH also informed the Group that more C-diff cases were now being identified in the Community rather than in healthcare settings
Hand Hygiene
NHSG is well above the target of 90% and at present is showing 96% compliance. There are new moves towards measuring compliance with hand washing techniques and PEH fedback that this had been discussed at the last ICM networking meeting.
VS suggested that this was the opportunity to make changes around compliance of technique before our scores fall.
KDW replied that she is confident that NHSG’s compliance percentage will not drop as technique has always been audited within Grampian and sits at scores around the 80% mark.
KDW also fedback that at, at present, there is no data for August onwards being shown on BOXI due to data cleansing problems. BOXI will also be moving to a new version shortly.
KDW also raised the subject of Dress Code and the Uniform Policy and insisted that this must be made a priority as these are the points that currently affect compliance with technique.
JI suggested an SBAR and will forward NHS Lanarkshire’s for information.
JI/PEH/AMK
JI
Item / Subject / Action to be taken and Key Points raised in discussion / Action
4 / Standing Items cont… /
Cleaning
NHSG’s compliance is still well above 94% but more robust measuring tools are required for Woodend as scores are lower here.
SR reported that monitoring system rates dropped and an action plan has been put in place. Scores must be higher by the next quarter at WoodendHospital.
Healthcare Environment
This section relates to the HEI visit to RACH. Please see section 6.1 for details.
Outbreaks
There have be no significant outbreaks since the last report.
Antimicrobial Prescribing
GM reported compliance with guidelines is being measure in AMAU and Ward 15, WGH. Figures up to May have dropped slightly and in September data collection was commenced at Dr Gray’s Hospital.
MR queried the graphs suggesting that the layout could be confusing.
SM agreed that they would feedback on the graph layout to the design team.
Report Card
The graphs show an overall reduction, Grampian wide, in C-diff, MRSA and MSSA .
ARI shows that there is a decrease in MRSA/MSSA infections and an increase in cleaning compliance since the last report.
Dr Gray’s and Woodend’s graphs show that there have been no SABs/C-diff cases for two months but cleaning compliance has dropped slightly.
The Community Hospitals graphs show no CDI’s or MRSA cases and only 1 MSSA.
The Healthcare Associated Infection Reporting Template is due to be reviewed by the Scottish Government soon.
4.2 Infection Control Work Plan
- The NHSG Infection Control Work Plan was submitted
PEH reminded the Committee that the Work Plan had been reviewed at the last meeting and unless anyone had anything specific they wished to discuss she would move onto the Risk Control Plan.
No issues were raised.
- The NHSG Rick Control Plan was submitted
This document was last reviewed in July and therefore PEH concentrated on the Very Highs and the Highs.
Item / Subject / Action to be taken and Key Points raised in discussion / Action
4 / Standing Items cont… /
- Very Highs
Systems in place for identifying cleaned equipment - SR admitted that this issue remained unresolved and that work was ongoing to establish a system to be implemented, that ensures clean and dirty equipment
can be identified easily. The protocol has been devised but must be implemented further. During the recent visit to RACH the HEI picked up on problems with a piece of equipment not being decontaminated according to policy.
ES remarked that Eleanor Murray was still working on this with others.
VS suggested that the risks were split into
(i) Systems in place for identifying clean equipment
(ii)Instructions for cleaning of patient equipment
PEH to split the risks in the report
PEH and SR to meet with regard to the risks surrounding equipment decontamination.
Highs
Workload of IPCT –Streamlining of workloads has been ongoing and although the pressures of H1N1 no longer exist, pressure continues due to understaffing in the department.
RAB feels that with Norovirus season approaching, this is not the best time to downgrade this risk.
VS asked whether anything could be done to alleviate this risk. If not, perhaps it should be accepted and noted that no resolution can be made.
ES asked what the gaps were in the Actions and suggested the problem be escalated.
PEH replied that a new Work Plan would be developed, shortly, for 2011~12 and she would add this information to the actions.
Risk Assessment and patient admission –A pilot had been undertaken, at Dr Grays, on the risk assessment tool and education is continuing.
VS replied that he did not consider it a good idea to lower this risk.
ES suggested that an update is required on how the pilot is progressing.
PEH to obtain feedback.
Risk assessment of maintenance projects – has this action been implemented ?
It was understood by all that this action requires the ward Sister to sign of all works documentation for their area.
SR explained that this relates to HAI Scribe, there was nothing in place when the HEI visited.
ES suggested that an “owner” be assigned to each risk on the register to ensure responsibility and gain feedback for the Committee. PEH to look into.
This risk was closed as completed.
Cleaning
SR fedback that work is ongoing on this issue.
Education
PEH informed the Committee that the HAI Education Group are leading on this. Mandatory training has been decided and the Action Plan has been split between implementation and completion. PEH enquired as to whether the Committee felt that the Risk Control Plan actions should also be separated. This was agreed.
PEH to complete.
PEH/SR
PEH
PEH
PEH
PEH
Item / Subject / Action to be taken and Key Points raised in discussion / Action
4 / Standing Items cont… / MR fedback that she felt that “Low” risks should be removed from the Risk Control Plan.
PEH reported that the Risk Control Module of DATIX was being used but not to its full potential.
4.4Outbreaks
- Measles
The Measles SBAR was submitted
MR explained the SBAR to the Committee, noting that figures had changed slightly since the last report – 67 patients were risk assessed from Ward 45 – ENT and the Infection Unit; of these 58 had had significant exposure and 25 staff had been excluded from work.
Good communication between OHS, Labs and Infection Prevention and Control ensured staff returned to work timeously, although service was disrupted in these wards.
Issues have to be addressed for the future and one of the recommendations made was that Primary Care needs a more robust policy on Risk Assessment.
EM expressed concern with the wording of the recommendations, stressing that immunity checks and immunisation was the responsibility of Management and not OHS. All “new starts” are offered the MMR vaccine on commencement of work within NHSG but not all take up the offer. This is a personal choice and GP Practices are often where the poor uptake occurs.
VS replied that clarification and action were needed and this should be assessed by Clinical Leads and GAPF.
VS to organise a meeting between Senior Management and Dr Pauline Strachan to discuss.
MR to amend some wording within the document and when completed, forward to AS.
MR
5 / Reporting to Clinical Governance and Board /
- PEH will provide covering paper for the HAI Report when it is submitted to the Board.
6 / AOCB /
6.1 HEI Inspection of RACH
- The Action Plan and Inspection Report were submitted
There were some recurring themes within the Action Plan including Cleaning and the compliance with the HDL regarding the role of the ICM.The Report reads well but the recommendations/actions within the Action Plan are disappointing.
RSD has suggested that members from the RACH HEI group attend the next ICC meeting to update the Committee.
PEH to invite Ken McLay to the next meeting.
ES felt it was a repetitive Action Plan and was disappointed with the 11 requirements that need to be implemented.
PEH fedback that the issue of stock rotation had been picked up on again. PEH and Joanne Grant – ICN had specifically visited RACH to check stock but on the day, HEI found out of date stock.
SR replied that a stock reset has been implemented since the visit.
SM queried requirement 5 surrounding Infection Control accountability and demonstrating clear links to the Antimicrobial Management Team.
Item / Subject / Action to be taken and Key Points raised in discussion / Action
6 / AOCB cont… /
PEH replied that this relates to the HDL and the HEI’s interpretation of the role of the ICM. HEI understands the role of ICM to be more of a General Manager – accountable for antibiotic prescribing and the Infection Control Doctor. This is not the case within NHSG and in many other Health Boards also.
JI enquired as to who was taking the Grampian actions forward.
PEH will discuss this with RSD but leads were identified in the Action Plan supplied.
- Flu Vaccinations
EM fedback that, so far, 1200 staff have registered and 700 staff have been vaccinated.
She asked for managers to continue encouraging staff to attend the sessions. - Wedding Rings in Theatre
ES produced a paper from HPS that had been discussed in a meeting with NHS Dumfries & Galloway. The paper surrounded the wearing of wedding rings by surgical scrub teams and the proposed discontinuation of this practice.
AS to circulate this paper to the members of the Committee
AS
7 / Date of next meeting /
- 19th January 2011, 11.00 – 13.00 – The Board Room, ARI
1