Healthcare Associated Infection Bimonthly Report

March 2013

Section 1– Board Wide Issues

Key Healthcare Associated Infection Headlines

NHS Grampian

  • Monthly ward hand hygiene audit results for December and January show that compliance above the national 90% across NHS Grampian.
  • Cleaning and estates monitoring compliance remains stable and above the 90% target.
  • Clostridium difficile infection (CDI) case numbers for December and January were 9 and 10 respectively.
  • There were 12 Staphylococcus aureus bacteraemias (SABs) in December and 11 in January.

Aberdeen Royal Infirmary

  • Monthly ward hand hygiene audits show that compliance remained above national 90% target during December and January.
  • Cleaning and estates monitoring compliance remains above the 90% target.
  • CDI cases numbered 2 in both December and January
  • There was 1 SAB in December and 6 in January, all of which were MSSA bacteraemias

Dr Gray’s Hospital

  • Monthly ward hand hygiene audit results for December and January show that compliance remained above 95% in Dr Gray's Hospital.
  • Cleaning and estates monitoring results are comfortably above the 90% target.
  • There was a single case of CDI in December.
  • There were no cases of Staph aureus bacteraemia in December or January.

WoodendHospital

  • Hand hygiene compliance remains above the national 90% compliance target.
  • Cleaning monitoring compliance remains stable and estates monitoring compliance is now comfortably above the 90% target.
  • There were no cases of CDI in WoodendHospital in December and January only a single case of S aureus bacteraemia in January. There have been no cases of MRSA bacteraemia in the 12 months up to the end of January.

Community Hospitals

  • Due to the size of these hospitals and the number of SABs and CDIs, AberdeenMaternityHospital, RoyalCornhillHospital, Royal Aberdeen Children's Hospital and Roxburgh House figures are included in this scorecard.
  • There were 3 cases of CDI in December and 0 SABs during this reporting period.

Out of Hospital

  • There were 6 cases of CDI in December and 8 in January diagnosed out with or within 48 hours of being admitted to hospital.
  • SABs numbered 8 in December and 4 in January.

Staphylococcus aureus (including MRSA)

Staphylococcus aureus Bacteraemia Surveillance

The Health Protection Scotland(HPS) quarterly report on the surveillance of Staphylococcus aureus bacteraemias which was published on 9 January 2013showed that between 1 July and 30 September 2012 the reported SAB rate in NHS Grampian was 0.248 episodes per 1000 acute occupied bed days (AOBDs) compared with 0.293 for NHS Scotland as a whole.

For MRSA bacteraemia the rate was 0.015 episodes per 1000 AOBDs compared with 0.026 in NHS Scotland. For MSSA bacteraemia the rate was 0.233 cases per 1000 AOBDscompared with 0.267 in NHS Scotland.

Current HEAT Status

Health Protection Scotland’s report also demonstrated that, for this target period (April 2011 to March 2013), NHS Grampian’s quarterly rolling year SAB rate was once again on trajectory at 0.28 cases per 1000 acute occupied bed days over the 12 months 1 July 2011 to 30 June 2012.

Clostridium difficile

Clostridium difficile Infection Surveillance

The HPS quarterly report on the surveillance of CDIwhich wasalsopublished on 9 January 2013 showed that between 1 July and 30 September 2012 the reported CDI rate in patients over 65 years old in NHS Grampian was 0.304 episodes per 1000 total occupied bed days (TOBDs) compared with 0.319 for NHS Scotland as a whole.

Hand Hygiene

The NHS Hand Hygiene Campaign 23rdBi-monthly Audit Report which was published on 30 January 2013 confirmed that NHS Grampian achieved a compliance figure of 88%.

It had been 4 years since we had seen similar performance against the national 90% target.

Recent bi-monthly audit results (using the same methodology and auditors) had demonstrated good compliance (95-99%).

On this occasion, one ward’s 30% compliance score was key in determining the overall non-compliant score. This ward had not displayed issues before. Without this ward’s score, compliance would have been 95%. Following intensive support, this ward’s hand hygiene practice is now compliant.

It has been identified that there is a discrepancy between the self audit data and the nationally collected snapshot data for the same period. The known difference in data collection (opportunity v opportunity + technique) does not account for this.

Actions have included introducing more objectivity around ward level hand hygiene audits, a review of support to persistently non-compliant areas and a more robust escalation and action procedure following non-compliant audits.

The 24th bimonthly audit took place at the end of January. Unpublished data indicates that hand hygiene compliance across 15 selected areas has improved and is now 92%.

Cleaning and the Healthcare Environment

Cleaning and Estates Monitoring

The Health Facilities Scotland (HFS) National Cleaning Compliance Report Quarters 1-3 results were published in March and cover the period April to December 2012.

The report shows that NHS Grampian achieved 96% compliance with the NHSScotland National Cleaning Services Specification across all hospital sites.

In relation to estates monitoring compliance, overall NHS Grampian is compliant. However, WoodendHospital is 87.9% compliant between October and December. HFS acknowledged that it is clear from the detailed responses and the Senior Management oversight of WoodendHospital that NHS Grampian is robustly managing the situation. Older buildings present particular problems for cleaning the fabric of the Estate. Local, more recent data suggests a significant improvement from the beginning of 2013 onwards.

The full report can be found 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 and Norovirus outbreak preparedness only.

During December and January 2013the following instances of Norovirus were submitted:

On Monday 3 December, 0 hospitals in NHS Grampian had wards or bays closed.

On Monday10December, 1 hospital in NHS Grampian had 1 ward and no bays closed with 8 patients and 6 staff members affected.

On Monday 17 December, 0 hospitals in NHS Grampian had wards or bays closed.

On Monday 7 January, 1 hospital in NHS Grampian had 1 ward and no bays closed with 1 patient and 2 staff members affected.

On Monday 14 January, 0 hospitals in NHS Grampian had wards or bays closed.

On Monday 21 January, 0 hospitals in NHS Grampian had wards or bays closed.

On Monday 28 January, 0 hospitals in NHS Grampian had wards or bays closed.

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

Pertussis

In February 2 members of staff and one patient at Royal Aberdeen Children’s Hospital and AberdeenMaternityHospital were diagnosed with Pertussis (Whooping Cough).

Extensive contact tracing was undertaken of patients, parents/guardians and visitors to assess their need for prophylaxis and symptom status -with testing as appropriate to symptoms and history.

As at 21 March no further cases have been identified.

Influenza A

There have been 2 outbreaks of Influenza A at WoodendHospital in February and March 2013.

In one ward there were 10 symptomatic patients who were positive for influenza A (H3) (7 of whom were vaccinated). There were 10 staff symptomatic with an influenza like illness (ILI). The ward was closed on 25/2/13 and reopened on 5/3/13. Symptoms were generally very mild.

In the other ward (which is separated by 2 sets of double doors) 4 patients were been confirmed with influenza A (H3) of whom 2 were vaccinated. Two additional patients (who were vaccinated) were readmitted to ARI following discharge with respiratory illness (pneumonia) and treated for influenza. (Making a total of 6). Five members of staff had symptoms.

All appropriate control measures were put in place. It was agreed that the incidents in these wards were most likely to be related given the closeness in geography, time and people and both being H3. Of note there is still a significant amount of influenza circulating in the community at the present time and the outbreak in the second ward could have been started through an initial community case (ie a member of staff and/or visitor).

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 (1 October to 31 December 2012)

Category of Procedure / Number of operations / Number of Infections / NHS Grampian SSI rate (%) / National dataset SSI rate (%)
Breast Surgery / 168 / 0 / 0.0 / 0.0
Caesarean section / 387 / 6 / 1.6 / 1.8
Hip arthroplasty / 174 / 0 / 0.0 / 0.5
Knee arthroplasty / 173 / 0 / 0 / 0.1

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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 ofStaphylococcus aureusblood stream infections (alsobroken down into MSSA and MRSA) and Clostridium difficileinfections, as well as hand hygiene, cleaning and estates monitoring 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 difficileinfections (CDI)and Staphylococcus aureusbacteraemia(SAB) cases are presented for each hospital, broken down by month. Staphylococcus aureusbacteraemia(SAB) casesare further broken down into Meticillin SensitiveStaphylococcus aureus (MSSA) and Meticillin Resistant Staphylococcus aureus (MRSA). Data are presented as both a graph and a table giving case numbers. 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.

Understanding the Report Cards – Hand Hygiene Compliance

Good hand hygiene is crucial for infection prevention and control. More information can be found from the Health Protection Scotland’s national hand hygiene campaign website:

Hospitals carry out regular audits of how well their staff are complying with hand hygiene. The first page of each hospital report card presents the percentage of hand hygiene compliance for all staff inboth graph and table form.

Understanding the Report Cards – Cleaning Compliance

Hospitals strive to keep the care environment as clean as possible. This is monitored through cleaning compliance audits. More information on how hospitals carry out these audits can be found on the Health Facilities Scotland website:

The first page of each hospital Report Card gives the hospitals cleaning compliance percentage in both graph and table form.

Understanding the Report Cards – ‘Out of Hospital Infections’

Clostridium difficileinfectionsand 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. Given the complex variety of sources for these infections it is not possible to break this data down in any more detail.

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