NHS GRAMPIAN
Infection Control Committee
Minutes from meeting held on 19th January 2011
The Board Room, ARI
11.00 – 13.00
Present:
Pamela Harrison,Infection & Prevention Control Manager
Tommy Ovens, Public Forum Representative
Gillian McCartney, Specialist Antibiotic Pharmacist
Stewart Rogerson, Head of Decontamination, NHSG(attending for Gary Mortimer)
Roy Browning, Infection Control Senior Nurse
Karen Wares, Local Health Board Co-ordinator
Caroline Hind, Development Pharmacist
Dr Anne Marie Karcher, Medical Microbiologist / Infection Prevention & Control Doctor
John Brett, Head of Health & Safety for NHSG
Laura Standaloft, Dental Nurse Team Leader (deputising for Lynn Young)
Ken McLay, Clinical Director, Children’s Services
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 Vince Shields
Jenny Gibb Helen Robbins/Jenny Ingram
Pamela Molyneaux Helen Howie
Elinor Smith Alexander MacKenzie
2 / Minutes of last meeting 10th November 2010 /
Minutes from the meeting 10th November 2010 were ratified with no amendments
PEH opened the meeting by welcoming Ken McLay, Clinical Director for Children’s Services who attended in place of Alan Pilkington.
It is envisaged that this will ensure better linkage between the Infection Control Committee and Children’s Services.
3 / Matters Arising /
- PEH informed the Committee that the Measles SBAR was not attached as planned.
Maria Rossi did reissue the document but there are still some points requiring clarification with OHS and therefore it was decided to postpone this until the next Committee meeting.
VS has been taking various issues forward with the Senior Management Team also and an update will be provided at the next meeting.
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 (including MRSA)
There were no cases of MRSA in November although MSSA cases rose in October and November; none of these were attributed at Dr Gray’s Hospital.
NHSG has exceeded the expected rates but this is no different to any other Health Board who seem to be experiencing the same problems. Blood culture packs and device insertion has been concentrated on within 5 key areas with RSD and ES writing to Senior Management offering advice or support.
Current HEAT Status
PEH is to amend the MSSA data which shows incorrect figures.
Clostridium difficile
NHSG is still on trajectory to meet initial and revised targets for patients over 65 years.
Hand Hygiene
NHSG is showing good results. The compliance rate published is 96% but the recent embargoed report shows 98%. NHSG are joint second with NHS Fife at present.
Cleaning
Previously there was an issue with Woodend Hospital showing less than 90% and an action plan has been put in place.
SR fedback that there have been staffing problems at Woodend but monitoring is now more accurate and consistant than previously. Options include moving staff to other areas to cover but Woodend will remain “amber” at present although stringent monitoring is now present. RoyalCornhillHospital is also showing “amber” and this is being looked into.
AMK felt that perhaps this should be come a high priority on the Risk Control Plan as the press have picked up on the failings.
PEH to add to the Risk Control Plan and assess risk.
Outbreaks
There had been no high impact outbreaks to discuss although Norovirus is present across NHSG with 6 wards being closed during November.
Scorecards
The NHS GrampianHand Hygiene graph shows lower figures than the National Targets but this can be attributed to the fact that different wards are targeted for National and local data. This graph shows all wards across NHSG.
KDW requested that zeros are not shown as this would indicate that there was no compliance, which is not the case. KDW to check BOXI for these figures and PEH to amend the graph.
PEH went through the remaining graphs commenting on each one at each location.
With regard to the Community Hospitals C-diff graph, this shows erratic figures but the drop in cases since
PEH
KDW / PEH
Item / Subject / Action to be taken and Key Points raised in discussion / Action
4 / Standing Items cont… /
July could be attributed to the Antibiotic Prescribing guidelines being rolled out to GPs.
Out of Hospital Infections continue to remain high and the figures include diagnoses by GPs within 48 hours of admission, where the source cannot always determined.
NHSG’s cleaning compliance is still well above 94%.
Antimicrobial Prescribing
PEH to include Antimicrobial prescribing data into the report before it is submitted to the Board.
GM reported that, within ARI, the trend usage of the 4 Cs is now static(figures have dropped since April 2009). The third graph shows a progressive reduction of the 4 Cs, as a percentage of all antibiotics and the number of CDI cases, as do the graphs for Dr Gray’s Hospital. The WoodendHospital graph also shows a dramatic reduction since the 4 Cs were removed from wards. Community hospitals do not show as dramatic reductions due the Primary Care Guidelines being developed later than the secondary care ones but reduction is present. The RoyalCornhillHospital graph shows the most significant drop overall in usage.
Ken McLay raised the possibility of run charts showing unacceptable and out of range figures for areas and AMK raised her concerns regarding the upper and lower control limits attached to data. She feels that Clinicians are still happy if figures are within the lower limits but should be pressing for a nil data return.
4.2 Infection Control Work Plan
- The NHSG Infection Control Work Plan was submitted
PEH fedback to the Committee that the bulk of the Work Plan has been completed. Some tasks are taking slightly longer, due parameters having been moved.
Each unfinished task was looked at - - Seek feedback on provision of surveillance data
Various forms of feedback have been received from the HEI, individual wards and from RACH. The opinion meters were unavailable during Infection Prevention week so this was not achieved
The timescale on this was not achievable and this task will be carried forward to the 2011 Work Plan. - Implement a poster for each ward area stating who is in charge on that day
There has been no feedback on this.
PEH will contact members for an update. - Audit HAI Clinical Risk assessment in clinical areas
This is not easy to implement. A pilot is ongoing within Dr Gray’s where inpatient admissions to Surgical and Medical areas are asked 2 questions. This still requires to be piloted in ARI. This task will be carried forward. - Implement SPSP spread plan to reduce HAIs
This is ongoing.
PEH will ask JI to update the Committee at the next meeting
PEH
PEH/JI
Item / Subject / Action to be taken and Key Points raised in discussion / Action
4 / Standing Items cont… /
- Develop and implement mandatory HAI training programme
This is ongoing. The issue is still getting staff to attend training sessions.
The Articulate package for Hand Hygiene training is almost ready for staff testing. When this is completed a SICPs one will be commenced.KDW fedback that she was meeting with Anne Duffy that afternoon. Rollout is anticipated on 1st April.
JB commented that Senior Managers must take the responsibility for cascading the training programmes down to staff. When JB spoke to the GAPF Chairman he was assured that NHSG are dedicated to encouraging staff to attend all relevant training available. - Design educational programme relating to risk assessment. Complete rollout.
Risk assessment training will be incorporated into Clinical induction training - Managers of all training providers/training departments must have an objective in KSF outline
This is still ongoing as not all managers have access to AT Learning as yet.
JB asked for an update at the next meeting. - Risk Control Plan
- The NHSG Rick Control Plan was submitted
- QIS 3a.3, 3a.6.
RSD received agreement from HEI that although this does not meet the HDL no further action will be taken.
PEH suggested this risk was closed. The Committee agreed. - QIS 3a.3, 3a.6
The Senior Charge Nurse Review was to be completed by April. PEH asked ES to confirm that this has been finalised. ES confirmed this. Risk to be closed. - HSE 3.2.5
When this risk was raised there was no ICM in place, H1N1 was causing a great deal of work and staff shortages were present.
Work has been completed regarding working practices and the risk was reduced in May.
PEH does not want to close this risk due to the uncertainty of the MRSA and Hand Hygiene projects but would like to consider reducing the impact from major to moderate.
JB suggested amending the narrative in the controls section.
PEH to reword and change the impact to moderate - QIS 3b.1
There is still work to do around this but there is now better consistency with regard to information at ward level. National Audits regarding Hand Hygiene technique have not yet been implemented and a CNO letter is expected therefore “scores on doors” is premature.
PEH to amend wording.
PEH
Item / Subject / Action to be taken and Key Points raised in discussion / Action
4 / Standing Items cont… /
- QIS 4a.1
This is complete. PEH asked the Committee to move to close this risk.
The Committee agreed.
- QIS 3a.1 (x 3)
This is complete. PEH asked the Committee to move to close this risk.
The Committee agreed.
- QIS 1a.7,2 – Communication and Information Strategy
This has been reviewed and is in place. PEH asked for the risk to be closed.
The Committee agreed.
- QIS 1a.7,2 – NHSG Effective Communication Flows
JB raised the issue that not all departments have team meetings. Is the information getting to front line
staff ?Issues have been raised regarding Team Brief and Global email not reaching all employees. JG considered the risk still to be present and although a strategy is in place there is still work to be done surrounding this.
PEH to rewrite “gaps in controls” column.
- QIS 2b
PEH considered that there was now a robust framework in place with documentation available and asked the Committee to close the risk.
The Committee agreed.
- QIS 5b
Mandatory training is in place. And work is ongoing with regard to delivery.
PEH requested this risk to be closed
The Committee agreed. - Outbreaks
- No major outbreaks have occurred although Norovirus is present across NHSG.
This has been a quieter season than normal within ARI but Dr Gray’s has seen a substantial number of cases; thought to be caused by patient movement.
AMK fedback that the outbreak over Christmas was due to poor communication. Decisions were made to move affected patients from several wards to 1 ward but inadvertently this was transmitting infection
(the domino effect). Wards were not closed and advice was not sought from the Microbiologist on call at the time. This is worrying and better communication is needed.
AMK is to address this at the Moray Infection Control Committee meeting next week - Chickenpox
There has been a similar incident to the Measles one recently although it didn’t require a PAG meeting.
The issue seems to be that Managers do not know the immunity status of their staff and confidentiality of staff details delays the process.
Item / Subject / Action to be taken and Key Points raised in discussion / Action
5 / Reporting to Clinical Governance and Board /
- PEH will submit the HAI-RT to the Board and the Clinical Governance Committee
6 / AOCB /
6.1 HEI Inspection of RACH
Ken McLay attended the meeting to give his feedback on the recent RACH HEI visit.
The report must be signed off by 27th January 2011.
PEH reported that the main themes of the visit were surrounding accountability and structure within RACH.
Ken McLay replied that the HEI had problems understanding how RACH sat within the City CHP and that it was not assigned to the Acute sector.
One recommendation was that each hospital should have its own HEI Group and that they were all represented at this Committee. This is impractical as there would then be too many members present at the meetings. A solution would be that PEH become a member of all these individual Groups.
The issues regarding Cleaning have now been progressed but a previous visit to Dr Gray’s highlighted the lack of knowledge regarding colour coding, on this occasion with regard to mops.
The HEI also felt that Domestic staff at RACH had no knowledge of the colour coding system or the cleaning schedules for patient equipment. Work is ongoing on this, with extra training being provided.
Kevin Freeman suggested that NHSG contact HPS for support and advice on this and PEH, Stewart Rogerson and Eleanor Murray attended a teleconference last week with HPS and HFS contacts. Actions were brought from this meeting and advice will be taken forward.
Ken McLay raised the issue of auditing SSIs feeling that there would be difficulty in defining where these were contracted. He felt that this should be done Nationally and clarification is required on what needs to be audited. A short life working group will be established to take this forward.
AMK considered that the HEI is geared more to adult services and not children’s and she and Ken McLay agreed that the same standards cannot be applied to children’s services.
PEH reiterated that there were inconsistencies between inspectors and raised this after compiling an audit on other hospital’s HEI visits but this was not upheld by the HEI.
- vCJD
A CMO letter was received stating that all surgical impatient admissions must be asked the pertinent questions and that all, high risk, surgical procedures Ophthalmology, Neurology etc. need to be covered.
HPS has also now produced a document due to patients still “slipping through the net”. ES is reviewing this.
AMK suggested this be added to the Risk Control plan as a “very high” risk and that a more robust consent form is required.
SR replied that extra precautions have been put in place surrounding decontamination on endoscopy equipment due to an increase in incidents but feels that there is still not enough clarity on who should be asking the pre admission screening questions.
AMK reported that the latest figures from Blood Transfusion Service were worrying regarding positive vCJD carriers.
Ken McLay asked whether RSD or Richard Carey had brought this to the Clinical Advisory Group.
AMK and Henry Watson to meet with RSD to discuss.
PEH to add this risk to the Risk Control Plan.
PEH
AMK/Henry Watson/RSD
PEH
Item / Subject / Action to be taken and Key Points raised in discussion / Action
7 / Date of next meeting /
- 9th March 2011, 11.00 – 13.00 The Board Room, ARI
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