Healthcare Associated Infection Bimonthly Report

July 2014

Section 1– Board Wide Issues

Key Healthcare Associated Infection Headlines

NHS Grampian

  • Monthly ward hand hygiene audit results for May and June 2014 show that compliance remained at or over 95% across NHS Grampian.
  • Cleaning monitoring compliance scores were 93% in May and 94% in June.
  • Estatesmonitoring compliance scores were 96% in Mayand June.
  • Clostridium difficile infection (CDI) case numbers for May and June were 13 and 9 respectively.
  • There were 17Staphylococcus aureus bacteraemias (SABs) in May and 8 in June.

Aberdeen Royal Infirmary

  • Cleaning and estates monitoring compliance remains above the 90% target.
  • The number of CDI cases numbered 5 in May and 3 in June.
  • There were 4 SABs in May and 2 in June.

Dr Gray’s Hospital

  • Cleaning and estates monitoring compliance remains above the 90% target.
  • The number of CDI cases numbered 1 in May and 0 in June.
  • There was 1 SAB in May and 0 in June.

WoodendHospital

  • Cleaning and estates monitoring compliance remains above the 90% target.
  • The number of CDI cases numbered 1 in May and 0 in June.
  • There were 0 SABs in May and 0 in June.

Other Hospitals

  • Due to the size of these hospitals and the number of SABs and CDIs, AberdeenMaternityHospital, RoyalCornhillHospital, Royal Aberdeen Children's Hospital, Roxburgh House and all Community Hospitals figures are included in this scorecard.
  • There were 0 cases of CDI in May and June.
  • There was 1 case of SAB in May but 0 in June,

Out of Hospital

  • There were 6 cases of CDI in May and 6 in June diagnosed out with or within 48 hours of being admitted to hospital.
  • SABs numbered 11 in May and 6 in June.

Staphylococcus aureus (including MRSA)

Staphylococcus aureus Bacteraemia Surveillance

Health Protection Scotland published their quarterly reports on the surveillance of Staphylococcus aureus bacteraemia (SAB) in Scotland, January - March 2014 on 2 July 2014.

The following table and graphs demonstrate NHS Grampian’s rates of SABs compared with all other Boards in Scotland. In summary, NHS Grampian has the 3rd highest acute in-patient activity of all Boards in Scotland but continues to have below average rates of S aureus bacteraemias.

Funnel plot of S. aureus bacteraemia rates for all NHS boards in Scotland against acute occupied bed days (x100 000), 1 January 2014 to 31 March 2014

Funnel plot of MRSA bacteraemia rates for all NHS boards in Scotland against acute occupied bed days (x100 000), 1 January 2014 to 31 March 2014

Funnel plot of MSSA bacteraemia rates for all NHS boards in Scotland against acute occupied bed days (x100 000), 1 January 2014 to 31 March 2014

Clostridium difficile

Clostridium difficile Infection Surveillance

Health Protection Scotland also published their quarterly reports on the surveillance of Clostridium difficile infections (CDIs) in Scotland, January to March 2014 on 2 July 2014.

The following tables and graphs demonstrate NHS Grampian’s rates of CDI compared with all other Boards in Scotland, with data broken down for age groups 65 years and 15-64 years.

In summary, NHS Grampian’s total in-patient activity (including Community Hospitals) is the 4th highest for patients aged 65 and over and 3rd highest for patients aged 15-64. In both age groups, NHS Grampian’s rate of CDI is below the average for the whole of Scotland.

CDI cases, bed days and incidence rates by NHS board in patients aged ≥65 years in the period January to March 2014 compared to the annual incidence rate for the year ending December 2013

Funnel plot of CDI incidence rates in patients aged ≥65 years for all NHS boards in Scotland

CDI cases, bed days and incidence rates by NHS board in patients aged 15-64 years in the period January to March 2014 compared to the annual incidence rate for the year ending December 2013

Funnel plot of CDI incidence rates in patients aged 15-64 years for all NHS boards in Scotland

Hand Hygiene

The NHS Hand Hygiene Campaign came to a close in August 2013. NHS Boards are now required to publish locally collected quality assured data and these are contained within the scorecards towards the end of this report.

Cleaning and the Healthcare Environment

The Healthcare Environment Inspectorate visited AberdeenMaternityHospital again on 30 June and 1 July 2014.

Once again the inspectors found evidence that the standard of cleanliness had been sustained from the improvements first seen in October 2013 and further improvements made. The report will be published on 26 August 2014.

All HEI inspection reports for NHS Grampian are available at:

Incidents and Outbreaks

Norovirus Prevalence

Monday Point Prevalence Surveillance figures are reported to Health Protection Scotland. These capture the significant outbreaks of Norovirus in NHS Grampian and the prevalence of Norovirus activity in close to real time. They are not, and should not be interpreted as data for benchmarking or judgement. The data can be used for the assessment of risk, Norovirus outbreak preparedness and an indication of impact on service delivery only.

During the months of May and June 2014 no wards or bays were closed due to norovirus.

Data on the numbers of wards closed due to confirmed or suspected norovirus is available from HPS on a weekly basis at:

Other HAI Related Activity

Surgical Site Infection (SSI) Surveillance

NHS Grampian participates in the Surgical Site Infection (SSI) surveillanceprogramme that is mandatory in all NHS boards in Scotland. All NHS boards are required to undertake surveillance for hip and knee arthroplasty and caesarean section procedures as per the mandatory requirements of HDL (2006) 38 and CEL (11) 2009. In addition NHS Grampian carries out surveillance for in-patient breast surgery.

Readmission surveillance is carried out using prospective readmission data on orthopaedic and breast procedure categories under inpatient surveillance up to 30 days post operatively. Post discharge surveillance until day 10 post operation is also carried out for all caesarean sections performed.

Last available quarter (01/01/14 – 31/03/14)

Category of Procedure / Number of operations / Number of Infections / NHS Grampian SSI rate (%) / National dataset SSI rate (%)
Breast Surgery / 169 / 0 / 0.0 / 0.0
Caesarean section / 429 / 4 / 0.9 / 1.5
Hip arthroplasty / 171 / 1 / 0.6 / 0.8
Knee arthroplasty / 144 / 0 / 0.0 / 0.0

At the time of writing Health Protection Scotland are due to publish their Annual Report on Surgical Site Infection across NHS Scotland. One of the aims of this report is to describe the variation in SSI incidences between NHS boards and highlight boards with higher than expected incidences.

It is anticipated that the report will demonstrate lower than average incidences of SSI following Caesarean section and hip arthroplasty in NHS Grampian during 2013.

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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 ofcases of Staphylococcus aureusblood stream infections (alsobroken 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) casesare 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:

Staphylococcus aureus:

MRSA:

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:

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:

Understanding the Report Cards – ‘Out of Hospital Infections’

Clostridium difficile infections and Staphylococcus aureus (including MRSA) bacteraemiacasesare 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.

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NHS BOARD REPORT CARD – NHS Grampian

Staphylococcus aureus bacteraemia monthly case numbers

Jul
2013 / Aug
2013 / Sept
2013 / Oct 2013 / Nov 2013 / Dec 2013 / Jan 2014 / Feb
2014 / Mar 2014 / Apr 2014 / May 2014 / June 2014
MRSA / 0 / 2 / 0 / 1 / 1 / 2 / 2 / 0 / 1 / 0 / 0 / 0
MSSA / 18 / 9 / 6 / 13 / 15 / 7 / 11 / 8 / 10 / 12 / 17 / 8
Total SABS / 18 / 11 / 6 / 14 / 16 / 9 / 13 / 8 / 11 / 12 / 17 / 8

Clostridium difficile infection monthly case numbers

Jul
2013 / Aug
2013 / Sept
2013 / Oct 2013 / Nov 2013 / Dec 2013 / Jan
2014 / Feb
2014 / Mar 2014 / Apr 2014 / May 2014 / June 2014
Ages 15-64 / 1 / 2 / 3 / 4 / 1 / 0 / 1 / 1 / 4 / 0 / 2 / 1
Ages 65 plus / 5 / 4 / 8 / 6 / 4 / 3 / 8 / 3 / 11 / 9 / 11 / 8
Ages 15 plus / 6 / 6 / 11 / 10 / 5 / 3 / 9 / 4 / 15 / 9 / 13 / 9

Hand Hygiene Monitoring Compliance (%)

Jul
2013 / Aug
2013 / Sept
2013 / Oct 2013 / Nov 2013 / Dec 2013 / Jan
2014 / Feb
2014 / Mar 2014 / Apr 2014 / May 2014 / June 2014
AHP / 99 / 99 / 95 / 99 / 98 / 97 / 98 / 98 / 98 / 99 / 98 / 99
Ancillary / 97 / 98 / 98 / 96 / 95 / 96 / 95 / 97 / 93 / 96 / 95 / 98
Medical / 93 / 92 / 98 / 95 / 93 / 94 / 95 / 95 / 96 / 94 / 94 / 96
Nurse / 99 / 99 / 98 / 99 / 98 / 96 / 97 / 98 / 97 / 99 / 99 / 98
Board Total / 97 / 97 / 98 / 98 / 97 / 96 / 97 / 98 / 97 / 98 / 96 / 98

Cleaning Compliance (%)

Jul
2013 / Aug
2013 / Sept
2013 / Oct 2013 / Nov 2013 / Dec 2013 / Jan
2014 / Feb
2014 / Mar 2014 / Apr 2014 / May 2014 / June 2014
Board Total / 95 / 96 / 95 / 95 / 89 / 93 / 94 / 94 / 94 / 93 / 93 / 94

Estates Monitoring Compliance (%)

Jul
2013 / Aug
2013 / Sept
2013 / Oct 2013 / Nov 2013 / Dec 2013 / Jan
2014 / Feb
2014 / Mar 2014 / Apr 2014 / May 2014 / June 2014
Board Total / 96 / 96 / 96 / 96 / 93 / 96 / 95 / 96 / 96 / 96 / 96 / 96

NHS HOSPITAL A REPORT CARD – Aberdeen Royal Infirmary

Staphylococcus aureus bacteraemia monthly case numbers

Jul
2013 / Aug
2013 / Sept
2013 / Oct 2013 / Nov 2013 / Dec 2013 / Jan
2014 / Feb
2014 / Mar 2014 / Apr 2014 / May 2014 / June 2014
MRSA / 0 / 0 / 0 / 1 / 0 / 0 / 1 / 0 / 0 / 0 / 0 / 0
MSSA / 7 / 3 / 2 / 1 / 3 / 0 / 5 / 2 / 4 / 5 / 4 / 2
Total SABS / 7 / 3 / 2 / 2 / 3 / 0 / 6 / 2 / 4 / 5 / 4 / 2

Clostridium difficile infection monthly case numbers

Jul
2013 / Aug
2013 / Sept
2013 / Oct 2013 / Nov 2013 / Dec 2013 / Jan
2014 / Feb 2014 / Mar 2014 / Apr 2014 / May 2014 / June 2014
Ages 15-64 / 0 / 1 / 0 / 1 / 1 / 1 / 0 / 0 / 2 / 0 / 1 / 0
Ages 65 plus / 2 / 2 / 1 / 2 / 1 / 0 / 6 / 1 / 3 / 2 / 4 / 3
Ages 15 plus / 2 / 3 / 1 / 3 / 2 / 1 / 6 / 1 / 5 / 2 / 5 / 3

Cleaning Compliance (%)

Jul
2013 / Aug
2013 / Sept
2013 / Oct 2013 / Nov 2013 / Dec 2013 / Jan
2014 / Feb 2014 / Mar 2014 / Apr 2014 / May 2014 / June 2014
Hospital Total / 95 / 95 / 95 / 95 / 82 / 89 / 92 / 93 / 94 / 93 / 93 / 94

Estates Monitoring Compliance (%)

Jul
2013 / Aug
2013 / Sept
2013 / Oct 2013 / Nov 2013 / Dec 2013 / Jan
2014 / Feb 2014 / Mar 2014 / Apr 2014 / May 2014 / June 2014
Hospital Total / 97 / 96 / 97 / 97 / 95 / 96 / 96 / 97 / 96 / 97 / 96 / 98

NHS HOSPITAL B REPORT CARD – Dr Gray’s Hospital

Staphylococcus aureus bacteraemia monthly case numbers

Jul
2013 / Aug
2013 / Sept
2013 / Oct 2013 / Nov 2013 / Dec 2013 / Jan
2014 / Feb
2014 / Mar 2014 / Apr 2014 / May 2014 / June 2014
MRSA / 0 / 0 / 0 / 0 / 0 / 0 / 1 / 0 / 0 / 0 / 0 / 0
MSSA / 1 / 0 / 0 / 0 / 0 / 0 / 1 / 0 / 0 / 0 / 1 / 0
Total SABS / 1 / 0 / 0 / 0 / 0 / 0 / 2 / 0 / 0 / 0 / 1 / 0

Clostridium difficile infection monthly case numbers

Jul
2013 / Aug
2013 / Sept
2013 / Oct 2013 / Nov 2013 / Dec 2013 / Jan
2014 / Feb
2014 / Mar 2014 / Apr 2014 / May 2014 / June 2014
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 / 1 / 0
Ages 15 plus / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 1 / 0

Cleaning Compliance (%)

Jul
2013 / Aug
2013 / Sept
2013 / Oct 2013 / Nov 2013 / Dec 2013 / Jan
2014 / Feb
2014 / Mar 2014 / Apr 2014 / May 2014 / June 2014
Hospital Total / 95 / 95 / 94 / 94 / 95 / 95 / 95 / 93 / 94 / 94 / 94 / 94

Estates Monitoring Compliance (%)

Jul
2013 / Aug
2013 / Sept
2013 / Oct 2013 / Nov 2013 / Dec 2013 / Jan
2014 / Feb
2014 / Mar 2014 / Apr 2014 / May 2014 / June 2014
Hospital Total / 97 / 97 / 97 / 98 / 98 / 97 / 98 / 98 / 98 / 98 / 98 / 98

NHS HOSPITAL B REPORT CARD – Woodend Hospital

Staphylococcus aureus bacteraemia monthly case numbers

Jul
2013 / Aug
2013 / Sept
2013 / Oct 2013 / Nov 2013 / Dec 2013 / Jan
2014 / Feb
2014 / Mar 2014 / Apr 2014 / May 2014 / June 2014
MRSA / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0
MSSA / 0 / 0 / 0 / 1 / 1 / 0 / 0 / 0 / 0 / 0 / 0 / 0
Total SABS / 0 / 0 / 0 / 1 / 1 / 0 / 0 / 0 / 0 / 0 / 0 / 0

Clostridium difficile infection monthly case numbers

Jul
2013 / Aug
2013 / Sept
2013 / Oct 2013 / Nov 2013 / Dec 2013 / Jan
2014 / Feb
2014 / Mar 2014 / Apr 2014 / May 2014 / June 2014
Ages 15-64 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 1 / 0 / 0 / 0
Ages 65 plus / 0 / 0 / 0 / 0 / 1 / 0 / 0 / 0 / 1 / 2 / 1 / 0
Ages 15 plus / 0 / 0 / 0 / 0 / 1 / 0 / 0 / 0 / 2 / 2 / 1 / 0

Cleaning Compliance (%)

Jul
2013 / Aug
2013 / Sept
2013 / Oct 2013 / Nov 2013 / Dec 2013 / Jan
2014 / Feb
2014 / Mar 2014 / Apr 2014 / May 2014 / June 2014
Hospital Total / 94 / 94 / 94 / 95 / 95 / 95 / 93 / 95 / 93 / 94 / 94 / 94

Estates Monitoring Compliance (%)

Jul
2013 / Aug
2013 / Sept
2013 / Oct 2013 / Nov 2013 / Dec 2013 / Jan
2014 / Feb
2014 / Mar 2014 / Apr 2014 / May 2014 / June 2014
Hospital Total / 93 / 88 / 91 / 93 / 90 / 93 / 90 / 91 / 90 / 88 / 90 / 92

OTHERNHS HOSPITALS REPORT CARD

The other hospitals covered in this report card include:

Aberdeen Maternity Hospital

Royal Cornhill Hospital

Royal Aberdeen Children's Hospital

Roxburgh House

All Community Hospitals

Staphylococcus aureus bacteraemia monthly case numbers

Jul
2013 / Aug
2013 / Sept
2013 / Oct 2013 / Nov 2013 / Dec 2013 / Jan
2014 / Feb
2014 / Mar 2014 / Apr 2014 / May 2014 / June 2014
MRSA / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0
MSSA / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 2 / 1 / 0 / 1 / 0
Total SABS / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 2 / 1 / 0 / 1 / 0

Clostridium difficile infection monthly case numbers

Jul
2013 / Aug
2013 / Sept
2013 / Oct 2013 / Nov 2013 / Dec 2013 / Jan
2014 / Feb
2014 / Mar 2014 / Apr 2014 / May 2014 / June 2014
Ages 15-64 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0
Ages 65 plus / 0 / 2 / 0 / 3 / 1 / 0 / 0 / 1 / 1 / 1 / 0 / 0
Ages 15 plus / 0 / 2 / 0 / 3 / 1 / 0 / 0 / 1 / 1 / 1 / 0 / 0

NHS OUT OF HOSPITAL REPORT CARD

Staphylococcus aureus bacteraemia monthly case numbers

Jul
2013 / Aug
2013 / Sept
2013 / Oct 2013 / Nov 2013 / Dec 2013 / Jan
2014 / Feb
2014 / Mar 2014 / Apr 2014 / May 2014 / June 2014
MRSA / 0 / 2 / 0 / 0 / 1 / 2 / 0 / 0 / 1 / 0 / 0 / 0
MSSA / 10 / 6 / 4 / 11 / 11 / 7 / 5 / 4 / 5 / 7 / 11 / 6
Total SABS / 10 / 8 / 4 / 11 / 12 / 9 / 5 / 4 / 6 / 7 / 11 / 6

Clostridium difficile infection monthly case numbers

Jul
2013 / Aug
2013 / Sept
2013 / Oct 2013 / Nov 2013 / Dec 2013 / Jan
2014 / Feb
2014 / Mar 2014 / Apr 2014 / May 2014 / June 2014
Ages 15-64 / 1 / 1 / 7 / 3 / 0 / 2 / 1 / 1 / 1 / 0 / 1 / 1
Ages 65 plus / 3 / 0 / 3 / 1 / 1 / 0 / 2 / 1 / 6 / 4 / 5 / 5
Ages 15 plus / 4 / 1 / 10 / 4 / 1 / 2 / 3 / 2 / 7 / 4 / 6 / 6

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