5.9 infection control report - nhs highland · 2013-01-28 · guidelines, review with microbiology...

Highland NHS Board5 February 2013

Item 5.9

INFECTION PREVENTION & CONTROL REPORT

Report by Liz McClurg, Infection Control Manager and Dr Emma Watson, ConsultantMicrobiologist on behalf of Heidi May, Board Nurse Director & Executive Lead for InfectionControl

The Board is asked to:

Note the performance position for the Board. Note the progress to keep infection under control.

1 Aim

The purpose of this paper is to update Board members of the current status of HealthcareAssociated Infections (HAI) and infection control measures in NHS Highland.

2 Contribution to Board Objectives

One of the Board key objectives is “to reduce to an absolute minimum the chance of acquiring aninfection whilst receiving healthcare and to ensure our hospitals are clean”. This report presents acomprehensive view of HAI data and activities for scrutiny and feedback from the Board.

3 Scaling factor used in reporting incidence rates

To ensure consistency with wider UK and European Centre Disease Prevention & Control (ECDC)reporting and in light of decreases in the observed rates, Health Protection Scotland (HPS) havechanged the scaling factor used in reporting incidence rates to ‘per 100,000 bed days’ instead ofthe previously used ‘per 1000 bed days’. The Clostridium difficile target for example, now showsas 39 rather than 0.39.

It should be noted that NHS Highland figures for Staphylococcus aureus bacteraemia (SAB) andClostridium difficile are provisional until validated by Health Protection Scotland (HPS) on aquarterly basis.

Summary

Table 1 NHS Highland infection prevention & control targets and performance data

Group Target NHS Scotland NHS HighlandClostridiumdifficile

Age 65 andover

39.0(100,000OBDs)

31.9For period July– Sept 12

21.1For period July– Sept 12.

Green

Staphylococcusaureusbacteraemia

Age 15 andover

26.0(100,000)OBDs

29.3For period July– Sept 12

12.8For period July– Sept12.

Green

Hand Hygiene 95% 95% 98% Green

2

Cleaning 90% 96% Green

Estates 90% 97% Green

Antibacterialprescribing

Hospital-basedEmpiricprescribing

95% AMAU -96%

Green

Ward 4A –95%

Green

Surgicalantibioticprophylaxis

Compliant Yes Green

Primary Careempiricalprescribing

Compliant Yes Green

Source: - Health Protection Scotland/ISD/Local data.

4 Achievements Surgical Site Infections (SSI) for orthopaedic procedures remains low. It has been 110

days since last Total Hip Replacement SSI and 249 days since last fractured neck of femurSSI up to 30/11/2012.

ICNet Infection Control Electronic Surveillance System is now live in North Highland. .

5 Challenges To deliver Infection Prevention & Control support and HAI education in care homes and

adult social care settings. To involve all clinical staff in hospitals and in the community to put in place initiatives to

reduce device/healthcare related infections. To resource appropriate pan Highland infection prevention doctor time

6 Risks This season is tipped to be one of the worst for norovirus cases, many wards have been

closed across Scotland. NHS Highland has had some ward closures and there is a risk offurther closures given that norovirus is prevalent in the community.

7 Forecast The Harm Reduction Work stream within the Highland Quality Approach will include

infection control; this will enable a coordinated response to reducing HAI. An education sub group of the Infection Control Improvement Group is being convened in

January 2013 to standardise HAI education and training across NHS Highland.

Emma Watson – Consultant Microbiologist

Liz McClurg – Infection Control Manager

25 January 2013

3

NHS Highland Healthcare Associated Infection Report –November 2012

Section 1 – NHS Highland Board Wide Issues

1. Staphylococcus aureus (including MRSA)

1.1 TrendsNational data published by Health Protection Scotland identifies that NHS ScotlandStaphylococcus aureus bacteraemia rate July – September 2012 was 29.3 per 100,000 acuteoccupied bed days (AOBDs).

NHS Highland’s rate was 12.8 per 100,000 AOBDs (8 SABs), this is a decrease on the previousquarters, (January – March 2012, 23.4 (15 SABs), April – June 2012, 30.3 (19 SABs).

October – December 2012 (not yet validated by HPS) 21.04 per 100,000 AOBDs (13 SABs).

The annual rate (not yet validated by HPS) for NHS Highland, January – December 2012 is 21.8per 100,000 AOBDs (National target March 2013, 26 per 100,000 AOBDs)

A report prepared by Dr Adam Brown, Consultant Microbiologist for the December 2012 InfectionControl Improvement Group indicates there is no ongoing upward trend in SABs in quarters 2 - 4 line-related SABs constitute a small but significant and potentially preventable proportion of all

SABs (19%, 6 SABs) Of the 6 line related SABs, 4 are associated with Peripherally Inserted Central Catheters (PICC

lines) One third of all SABs for Q2 – Q4 were community-associated with no prior healthcare

involvement.

1.2 Current InitiativesA group will meet in January 2013 to lead on the reliable implementation of the Central LineInsertion and Maintenance Bundle and the reliable implementation of a PICC Maintenance Bundleand to understand more around Midlines and Hickman lines and validate results around PVCinsertion and maintenance. The Infection Control Improvement Group will monitor progress.

Staphylococcus aureus is an organism which is responsible for a large number ofhealthcare associated infections, although it can also cause infections in people who havenot had any recent contact with the healthcare system. The most common form of this isMeticillin Sensitive Staphylococcus Aureus (MSSA), but the more well known is MRSA(Meticillin Resistant Staphylococcus Aureus), which is a specific type of the organism whichis resistant to certain antibiotics and is therefore more difficult to treat. More information onthese 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 nationaltarget to reduce them. The number of patients with MSSA and MRSA bacteraemias for theBoard can be found at the end of Section 1 and for each hospital in Section 2. Informationon the national surveillance programme for Staphylococcus aureus bacteraemias can befound at:

http://www.hps.scot.nhs.uk/haiic/sshaip/publicationsdetail.aspx?id=30248

4

Figure 1 Staphylococcus aureus bacteraemia (MRSA and MSSA) cases per 100,000 occupied beddays, all ages, with 95% confidence interval (vertical lines), linear trend (Black line) and target (Redline) = 26, CI = Confidence Interval

Figure 1 shows that SAB rates have remained stable at low levels since January 2010.

Figure 2 Funnel Plot of SAB rates for all NHS Boards against acute occupied bed days 01/07/2012– 30/09/2012

HG = Highland

Figure 2 shows that in the current reported quarter ending September 2012 that the Highland SABrate was significantly lower than that of other Scottish Boards.

1.3 MRSA ScreeningNo change from last report.

5

2 Clostridium difficile

Clostridium difficile is an organism which is responsible for a large number of healthcareassociated infections, although it can also cause infections in people who have not had anyrecent contact with the healthcare system. More information can be found at:www.nhs.uk/conditions/Clostridium-difficile/Pages/Introduction.aspxNHS Boards carry out surveillance of Clostridium difficile infections (CDI), and there is anational target to reduce these. The number of patients with CDI for the Board can be foundat the end of section 1 and for each hospital in section 2. Information on the nationalsurveillance programme for Clostridium difficile infections can be found at:www.hps.scot.nhs.uk/haiic/sshaip/ssdetail.aspx?id=277

2.1 TrendsClostridium difficile in patients aged 65 and over

National data published by Health Protection Scotland identifies that NHS Scotland Clostridiumdifficile rate July – September 2012 was 31.9 per 100,000 occupied bed days (OBDs).

NHS Highland’s rate was 21.1 per 100,000 OBDs (10 cases), this is a decrease on the previousquarters, January – March 2012, 44.0 (23 cases), April – June 2012, 32.8 (16 cases).

October – December 2012 (not yet validated by HPS) 18.99 per 100,000 OBDs (9 cases).

The annual rate (not yet validated by HPS) for NHS Highland, January – December 2012 is 29.2per 100,000 OBDs (National target March 2013, 39 cases per 100,000 OBDs) which means theBoard is well on track to meet the National HEAT Target.

Please note that the numbers for Clostridium difficile in patients age 65 and over in the HAIRTdiffer from HPS July – September 2012 quarterly report. The reason being, that the HPS protocolfor surveillance takes the number from the assigned laboratory which, in this quarter, was 1 fromthe Southern General and 2 from Inverclyde Hospitals. These are, however, included in the out ofhospital infections report for Argyll & Bute CHP.

Figure 3 Clostridium difficile cases per 100,000 occupied bed days, 65 years and over, with 95%confidence interval, linear trend and target = 39.

The graph shows that NHS Highland has achieved a sustained downward trend in Clostridiumdifficile rates despite some variation quarterly. The Board is well on track to meet the HEAT target.

6

Figure 4 Funnel Plot of CDI incidence rates in patients aged 65 and over for all NHS Boards inScotland, July – September2012.

HG = Highland

Clostridium difficile in patients aged 15 – 64 years

National data published by Health Protection Scotland identifies that NHS Scotland Clostridiumdifficile rate July – September 2012 was 41.6 per 100,000 occupied acute bed days (AOBDs).

NHS Highland’s rate was 60.8 per 100,000 AOBDs (10 cases), January – March 2012, 40.0 (7cases), April – June 2012, 66.4 (12 cases).October – December 2012 (not yet validated by HPS) 60.8 per 100,000 AOBDs (10 cases).The annual rate (not yet validated by HPS) for NHS Highland, January – December 2012 is 57.1per 100,000 AOBDs.

There is no national HEAT target for Clostridium difficile in patients aged 15 – 64 years. DespiteNHS Highland having a slightly higher rate from the national average, the rate remains well withinexpected levels as demonstrated in Figure 6.Figure 6 Funnel Plot of CDI incidence rates in patients aged 15 – 64 years for all NHS Boards inScotland, July – September 2012

HG = Highland

7

2.3 Anti Microbial Prescribing

Audits of Antimicrobial Prescribing

Audits conducted in Raigmore Hospital, General Surgical and Orthopaedics wards showimprovements in prescribing in accordance with guidelines. The Dental Clinical GovernanceGroup in conjunction with the Antimicrobial Management Team are reviewing issues highlighted byan audit of antibiotic prescribing in the Dental Out of Hours and Emergency Dental Centre, aroundthe completion of documentation of the indication for antibiotic use.

European Antibiotic Awareness Day, November 2012

This year, the focus for prescribers was to “Start Smart and Then Focus” using local prescribingguidelines, review with microbiology results and the clinical progress of the patient. Publicity forthis event included an article in Public Health News, an “all users” email and intranetannouncement and a presentation in the Raigmore canteen. Information for the public in the formof posters and leaflets was distributed to all GP surgeries, community pharmacies, acute andcommunity hospitals and NHS Highland Care Homes.

Table 2 shows NHS Highland progress against the 3 national indicators.

Antimicrobial Indicator NHS Highland progress

Hospital-based empirical prescribingIn acute admission areas, antibioticprescriptions are compliant with the localantimicrobial policy and the rationale fortreatment is recorded in the clinical case notein above 95% of sampled cases.

Ward AMAU - CompliantData from April 2011 to November 2012shows prescribers in AMAU have achievedthe target as median compliance withantibiotic prescribing guidelines stands at96%.Ward 4A - CompliantData from April 2011 to November 2012shows that, although still below the target,median compliance has increased to 93.5%,Data from April 2012 to December 2012shows median compliance at 95%.

Surgical antibiotic prophylaxisDuration of surgical antibiotic prophylaxis isless than 24 hours and compliant with localantimicrobial prescribing policy in above 95%of sampled elective colorectal surgical cases.

Compliant.A review of prescribing in October 2012showed continuing compliance with guidelinerecommendations for elective colorectalsurgery.Preliminary data collection for urologicalsurgery commenced in December 2012.Further reports will follow.

Primary care empirical prescribingSeasonal variation in Quinolone use(summer months vs. winter months) is lessthan 5%.

Compliant.Data to the end of March 2012 indicatescontinuing compliance with this measure.NHS Highland is one of only two Boards inScotland to demonstrate compliance with thisquality indicator for every year since it wasfirst measured in 2008/09.

8

3 Hand Hygiene

Good hand hygiene by staff, patients and visitors is a key way to prevent the spread ofinfections. 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 noncompliance. The hand hygiene compliance score for the Board can be found at the end ofsection 1 and for each hospital in section 2. Information on national hand hygiene monitoringcan be found at:http://www.hps.scot.nhs.uk/haiic/ic/nationalhandhygienecampaign.aspx

3.1 TrendsNHS Highland Hand Hygiene Rolling Monthly Audit Programme continues across all clinical areassustaining an average of 98% compliance for November and December 2012.

The November 2012 National Hand Hygiene Audit report shows NHS Highland compliance as98%, National compliance was 95%.

3.2 InitiativesHand hygiene audits continue to be undertaken monthly by all clinical areas, the results displayedand any non compliance addressed.

4 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 maintaincompliance with standards above 90%. The cleaning compliance score for the Board can befound at the end of section 1 and for each hospital in section 2. Information on nationalcleanliness 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 HealthcareEnvironment Inspectorate. More details can be found at:http://www.nhshealthquality.org/nhsqis/6710.140.1366.html

4.1 Current RatesDomestic Service teams continue to carry out monthly cleaning and estates audits as per NHSScotland National Cleaning Services Specification sustaining an average of 96% compliance inNovember and December 2012 for Domestic monitoring; the average Estates compliance was96% in November and 97% in December 2012

4.2 Current initiativesTwo hospitals were below the target of 90% for Estates monitoring in November 2012, CountyCommunity Hospital Invergordon 88.6% and Mid Argyll Hospital Lochgilphead 89.1%. Local actionplans were implemented resulting in 96.1% and 98.5% respectively in December 2012.

In December 2012 one hospital was below target for Domestic monitoring, St Vincent’s HospitalKingussie 89.7% and one for Estates monitoring in Argyll & Bute Hospital 89.1%.Local action planshave been implemented.

4.3 HEI InspectionsAn unannounced HEI inspection to Raigmore Hospital was undertaken on Wednesday 21November 2012 following the receipt of the updated 16-week action plan. They found evidencethat NHS Highland has implemented a number of changes and taken positive action to address the

9

requirements made following the last inspection in June 2012. The final report and action plan willbe published on Monday 28 January 2013.

5 Outbreaks/Incidents

NorovirusNorovirus is prevalent in the community therefore there is a high risk of transmission to hospitals.In comparison with national figures since 2009, NHS Highland ward closures are low. The HealthProtection Team informs the Infection Prevention & Control Team of community outbreaks inhotels, care homes, ships etc. Between 01/09/2012 – 31/12/2012, there have been outbreaks in 9care homes, 4 hotels and 1 small cruise ship.

Hospital Staff are now familiar with following the norovirus protocols and are supported by theInfection Prevention & Control Team. Since the last report there has been one ward closure.Ward 3A Raigmore hospital reported the first case on 28/11/2012. The ward was reopenedfollowing extensive cleaning on 17/12/2012. A total of 9 patients and 21 staff were affected. Byclosing the ward to admissions and minimising movement of staff spread was prevented to otherwards. Currently the samples to test for norovirus are sent out with Highland. We are investigatinghow this can be achieved locally in the future.

Figure 7 shows the number of hospitals in Scotland with wards closed due to Norovirus from09/01/2012 – 31/12/2012.

Health & Safety Executive Visit

The main education programme based on NES Preventing Infection in Care is being piloted in twoCare Homes now managed by NHS Highland as a result of integration and will be progressed in allother homes following evaluation. The first quarterly update day for Infection Control Key Workerswas held in December 2012.

All Care Homes are developing action plans. Integration and governance arrangements are beingprogressed with appropriate representation in the Control of infection Committee structure.

The HSE confirmed in December 2012 that NHS Highland have complied fully with theImprovement notice in respect to infection control in the community.

10

6 Surgical Site Infections (SSI)

Colorectal Surgical Site InfectionColorectal surveillance shows that the overall the rate (18%) of elective colorectal surgical siteinfections has not changed since surveillance commenced in June 2011. A detailed report will besubmitted to the Infection Control Improvement Group in February 2013.

Orthopaedic Surgical Site InfectionsOrthopaedic surgical site infection rates remain low. January – November 2012, the Total Hipreplacement SSI rate was 1.2% and the Fractured Neck of Femur SSI rate was 1%.

Caesarean Section InfectionsThe number of Caesarean section surgical site infections remains low (no elective SSIs and 1emergency SSI in October/ November 2012; the measures outlined in the action plan continue tobe implemented. It will be at least 6 months before it can be determined if the practice of leavingthe abdominal wound dressing in situ for 7 days post operatively is lowering the infection ratealthough initial findings are favourable.

7 Infection Prevention & Control Education

A uniform approach to infection prevention & control training and the recording of training is beingtaken across Highland. An education sub group of the Infection Control Improvement Group isbeing convened in January 2013 to ensure patient safety is achieved in relation to infectionprevention & control by standardising HAI education and training, targeted at different staff groupsacross NHS Highland in hospitals, community, care homes, Adult Day Care Centres, LearningDisability and Bank and Social Care staff.

8 Highland Quality Approach

To ensure that there is a co-ordinated approach to harm reduction; Infection Prevention & ControlTeam will participate in the Harm Reduction work stream within the Highland Quality Approach andthe Scottish Patient Safety Programme.

9 ICNet Infection Control Electronic Surveillance System

The ICNet Infection Control Electronic Surveillance System which will improve our ability tointerrogate data and understand trends went live in North Highland in January 2013.

Because Argyll & Bute CHP interface with laboratories in NHS Greater Glasgow & Clyde, ICNetwill not be live until later this year.

11

Healthcare Associated Infection Reporting Template (HAIRT)Section 2 – Healthcare Associated Infection Report Cards

The following section is a series of ‘Report Cards’ which provide information for each acutehospital (Raigmore, Caithness General, Belford and Lorn & Islands), and the community hospitalswithin each Operational Unit/CHP. The information includes the number of cases ofStaphylococcus aureus blood stream infections (also broken down into MSSA and MRSA) andClostridium difficile infections as well as hand hygiene and cleaning and estates compliance.

The out-of-hospital infections report card identifies infections as having been contracted fromoutwith hospital.

The information in the report cards is provisional local data, and may differ from the nationalsurveillance reports carried out by Health Protection Scotland and Health Facilities Scotland. Thenational reports are official statistics which undergo rigorous validation, which means final nationalfigures may differ from those reported here. However, these reports aim to provide more detailedand up-to-date information on HAI activities at local level than is possible to provide through thenational statistics.

Understanding the Report Cards – Infection Case Numbers

Clostridium difficile infections (CDI) and Staphylococcus aureus bacteraemia (SAB) cases arepresented for each hospital and the community hospitals within each CHP broken down by month.Staphylococcus aureus bacteraemia (SAB) cases are further broken down into Meticillin SensitiveStaphylococcus aureus (MSSA) and Meticillin Resistant Staphylococcus aureus (MRSA). Data ispresented as both a graph and a table giving case numbers. More information on these organismscan be found on the NHS24 website:

Clostridium difficile :http://www.nhs24.com/content/default.asp?page=s5_4&articleID=2139&sectionID=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&sectionID=1

For each acute hospital and community hospitals in each CHP, the total cases for each month arethose which have been reported as positive from a laboratory report on samples taken more than48 hours after admission. For the purposes of these reports, positive samples taken from patientswithin 48 hours of admission will be considered to be confirmation that the infection was contractedprior 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 foundfrom the Health Protection Scotland’s national hand hygiene campaign website:http://www.washyourhandsofthem.com/

Hospitals carry out regular audits of how well their staff are complying with hand hygiene. The firstpage of each hospital/CHP report card presents the percentage of hand hygiene compliance for allstaff in table form.

Understanding the Report Cards – Cleaning Compliance

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

12

http://www.hfs.scot.nhs.uk/online-services/publications/hai/

The Report Cards show the hospitals’ cleaning compliance percentage in table form.

Understanding the Report Cards – ‘Out of Hospital Infections’

Clostridium difficile infections and Staphylococcus aureus (including MRSA) bacteraemia casesare all associated with being treated in hospitals. However, this is not the only place a patient maycontract an infection. This total will also include infection from community sources such as GPsurgeries, care homes and the community itself. 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 whichare not attributable to a hospital. Given the complex variety of sources for these infections it is notpossible to break this data down in any more detail.

13

Abbreviations

ADTC Area Drugs & Therapeutics Committee

AMT Antimicrobial Prescribing Team

AMAU Acute Medical Admissions Unit

CHP Community Health Partnership

CDI Clostridium difficile Infection

CNO Chief Nursing Officer

CVC Central Venous Catheter

ECDC European Centre for Disease Prevention & Control

GDP General Dental Practitioner

HAI Healthcare Associated Infection

HAIRT Healthcare Associated Infection Reporting Template

HEAT Health Improvement, Efficiency, Access, Treatment

Hemi arthroplasty

HPSHSE

An operation used to treat fractured hip similar to a total hip replacement, butinvolves only half of the hip.Health Protection ScotlandHealth & Safety Executive

ICU Intensive Care Unit

JAG Joint Advisory Group

MSSA Meticillin Sensitive Staphylococcus Aureus

MRSA Meticillin Resistant Staphylococcus Aureus

PICC Peripherally Inserted Central Catheter

PPI Proton Pump Inhibitor

PVC Peripheral Venous Catheter

QUAD Quality Assurance Document

RIDDOR Reporting of Injuries, Diseases and Dangerous Occupational Regulations 1995

SAB Staphylococcus aureus Bacteraemia

SHPN Scottish Health Planning note

SHTM 64 Scottish Health Technical Memoranda – Sanitary assemblies.

SPC Statistical Process Chart

SAPG Scottish Antimicrobial Prescribing Group

SICPs Standard Infection Control Precautions

SPSP Scottish Patient Safety Programme

VAP Ventilator Associated Pneumonia

14

Staphylococcus Aureus Bacteraemia (SAB) criteria

Contaminated bloodculture

Staphylococcus aureus isolated from blood, and

SAB diagnosis incompatible with clinical picture, i.e. no orminimal clinical signs and symptoms indicating SAB.

Hospital acquiredinfection

Staphylococcus aureus isolated from blood cultures taken 48hours after admission or within 48 hours of discharge, and,

The presence of clinical signs and symptoms indicating SAB

Community onset-healthcareassociated infection

Staphylococcus aureus isolated from blood cultures taken <48hours after admission, and

The presence of clinical signs and symptoms indicating SAB, and

At least one of the following within the past 12 months:Hospitalisation or invasive device management as an outpatient /community patient, or dialysis as an outpatient / communitypatient.

Truecommunity infection

Staphylococcus aureus isolated from blood, and

No hospitalisation within the past 12 months

No dialysis within the past 12 months

No community or outpatient healthcare for invasive devicemanagement in the past 12 months

Quarterly rolling year Clostridium difficile Infection Cases per 1000 total occupied bed days for HEAT Target Measurement

0.00

0.05

0.10

0.15

0.20

0.25

0.30

0.35

0.40

0.45

Apr 10 -Mar 11

Jul 10 -Jun 11

Oct 10 -Sept 11

Jan 11 -Dec 11

Apr 11 -Mar 12

Jul 11 -Jun 12

Oct 11 -Sept 12

Jan 12 -Dec 12

Apr 12 -Mar 13

0.34 0.26 0.26 0.22 0.28 0.30 0.29

0.39 0.39 0.39 0.39 0.39 0.39 0.39 0.39 0.39

0.21 0.21 0.21 0.21 0.20 0.24 0.23

Actual Performance

Target

Actual Performance

Jul 11 -

Jun 12

Apr 11 -

Mar 12

Jan 12 -

Dec 12

Apr 12 -

Mar 13

Apr 10 -

Mar 11

Jul 10 -

Jun 11

Jan 11 -

Dec 11

Oct 10 -

Sept 11

Jul 10 -

Jun 11

Oct 10 -

Sept 11

Quarterly rolling year Staphylococcus aureus Bacteraemia Rates per 1000 Acute Occupied Bed Days for HEAT Target Measurement

Apr 10 -

Mar 11

Jan 11 -

Dec 11

Apr 11 -

Mar 12

Jul 11 -

Jun 12

Oct 11 -

Sept 12

Apr 12 -

Mar 13

Jan 12 -

Dec 12

Oct 11 -

Sept 12

0.00

0.05

0.10

0.15

0.20

0.25

0.30

Apr 10 -Mar 11

Jul 10 -Jun 11

Oct 10 -Sept 11

Jan 11 -Dec 11

Apr 11 -Mar 12

Jul 11 -Jun 12

Oct 11 -Sept 12

Jan 12 -Dec 12

Apr 12 -Mar 13

.

0.21 0.21 0.21 0.21 0.20 0.24 0.23

0.26 0.26 0.26 0.26 0.26 0.26 0.26 0.26 0.26Target

Actual Performance

Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12

8 3 4 4 7 7 3 3 4 2 5 6


97 97 97 97 97 97 98 98 98 99 98 98

Pan Highland Total Staphylococcus aureus Bacteraemia Cases (all ages)

MRSA Bacteraemia Cases (all ages)

Hand Hygiene Monitoring Compliance (%)

10

12

0

2

4

6

8

10

12



94 94 93 95 95 92 96 96 96 96 96 96


95 96 95 96 96 95 97 97 96 97 96 97


3 1 1 1 1 1 0 0 0 0 1 2

Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12

MSSA Bacteraemia Cases (all ages)Clostridium difficile Cases (ages 15 and over)

Cleaning Compliance (%)

Estates Monitoring Compliance (%) 0

2

4

6

8

10


0

2

4

6

8

10

12

14

16

18


0

2

4

6

8

10

12



15 8 5 13 11 5 9 9 5 6 5 8 5 2 3 6 4 6 3 3 4 2 4 4


1 1 1 0 1 2 2 1 1 0 1 1


96 95 96 96 97 97 98 96 99 95 99 99

Raigmore Hospital Total Staphylococcus aureus Bacteraemia Cases (all ages)

MRSA Bacteraemia Cases - (All Ages)


12

0

2

4

6

8

10

12



93 93 93 95 93 95 93 94 93 94 96 96


95 95 97 96 94 95 98 98 96 96 97 97


0 0 0 0 0 1 0 0 0 0 0 0


9 3 1 3 1 1 5 0 2 4 2 3 1 1 1 0 1 2 2 1 1 0 1 1



Estates Monitoring Compliance (%)0

2

4

6

8

10


0

20

40

60

80

100

Jan-12 Feb-12

0

2

4

6

8

10

12

14

16

18


2

4

6

8

10

12



0 0 0 0 0 0 0 0 0 0 0 0


99 98 98 99 100 99 100 100 98 100 99 99

Total Staphylococcus aureus Bacteraemia Cases (all ages)

MRSA Bacteraemia Cases - (All Ages)

Caithness General Hospital


Cleaning Compliance (%) 10

12

0

2

4

6

8

10

12



95 95 90 95 99 94 96 99 96 95 96 95


97 98 98 96 99 98 96 98 96 97 97 97

Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Npv-12 Dec-12

0 0 0 0 0 0 0 0 0 0 0 0




2

4

6

8

10

Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Npv-12 Dec-12

0

2

4

6

8

10

12

14

16

18


0

2

4

6

8

10

12



0 1 1 1 2 1 0 1 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0


1 0 0 0 0 0 0 0 1 0 0 0


97 92 99 100 100 98 96 99 100 98 100 98 MRSA Bacteraemia Cases - (All Ages)

Total Staphylococcus aureus Bacteraemia Cases (all ages)Belford Hospital



12

0

2

4

6

8

10

12



90 96 93 95 96 90 94 97 97 97 98 99


99 99 97 98 97 95 100 98 96 96 96 98


0 0 0 0 0 0 0 0 0 0 0 0




2

4

6

8

10


0

2

4

6

8

10

12

14

16

18


2

4

6

8

10

12



0 0 1 2 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0


0 0 0 0 0 0 0 0 0 0 0 0


96 100 99 99 99 100 100 98 98 100 99 100

Total Staphylococcus aureus Bacteraemia Cases (all ages)


Lorn & Islands Hospital


Cleaning Compliance (%)8

10

12

0

2

4

6

8

10

12



97 97 96 95 96 93 98 96 97 99 96 97


94 95 94 93 95 93 96 95 92 98 97 98


0 0 0 0 0 0 0 0 0 0 0 0



2

4

6

8


0

2

4

6

8

10

12

14

16

18


0

2

4

6

8

10

12



0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0



0 0 0 0 0 0 0 0 0 0 0 0


97 94 95 95 94 96 97 98 97 98 97 97

Argyll & Bute CHP Community Hospitals Total Staphylococcus aureus Bacteraemia Cases (all ages)




Argyll & Bute Community Hospitals include Argyll & Bute Hospital, Lochgilphead,Campbeltown Hospital, Cowal Community Hospital Dunoon, Dunaros CommunityHospital, Isle of Mull, Islay Hospital, Mid Argyll Community Hospital & IntegratedCare Centre Lochgilphead, Victoria Hospital & Annex Rothesay

10

12

0

2

4

6

8

10

12



94 95 95 95 95 93 96 97 97 97 95 95


95 96 94 97 96 96 97 95 98 96 95 96


0 0 0 0 0 0 0 0 0 0 0 0




2

4

6

8

10


0

20

40

60

80

100

Jan-12 Feb-12 Mar-12 Apr-12

0

2

4

6

8

10

12

14

16

18


0

2

4

6

8

10

12



0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

.

Out of Hospital Infections Clostridium difficile Infection Cases

0

2

4

6

8

10

12



6 3 2 6 7 3 4 8 2 2 2 2

MSSA Bacteraemia Cases MRSA Bacteraemia Cases

0

2

4

6

8

10

12


0

2

4

6

8

10

12




3 1 2 6 3 4 1 2 2 2 3 3 3 1 1 1 1 0 0 0 0 0 1 2

Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13

0 0 0 0 0 0 0 0 0


97 96 98 99 99 99 99 97 100

NW Operational Unit Total Staphylococcus aureus Bacteraemia Cases (all ages)

The North West Operational Unit comprises Dunbar Hospital, Thurso; Town &County Wick; Lawson Memorial Hospital, Golspie; Migdale Hospital, Bonar Bridge,Ross Memorial Hospital Dingwall, County Community Hospital Invergordon,MacKinnon memorial Hospital, Broadford & Portree Hospital Isle of Skye.




12

0

2

4

6

8

10

12



97 95 91 97 95 95 96


98 97 98 96 96 97 98


0 0 0 0 0 0 0 0 0

Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13

0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0

Clostridium difficile Cases (ages 15 and over) MSSA Bacteraemia Cases (all ages)



2

4

6

8


0

20

40

60

80

100

Jan-00

0

2

4

6

8

10

12


0

2

4

6

8

10

12



0 0 0 0 0 0 0 0 0


97 95 93 96 95 98 98 98 97

South Mid Operational Unit Total Staphylococcus aureus Bacteraemia Cases (all ages)

The South Mid Operational Unit comprises Ross Memorial Hospital Dingwall,County Community Hospital Invergordon, RNI Community Hospital Inverness,Town & County Hospital Nairn, Ian Charles Community Hospital Grantown onSpey, St. Vincents Hospital Kingussie. For the purposes of monitoring New CraigsPsychiatric Hospital is included in this report card.




12

0

2

4

6

8

10

12



96 96 92 96 95 96 96


97 94 92 95 96 96 97


0 0 0 0 0 0 0 0 0

Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13

1 1 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0

Clostridium difficile Cases (ages 15 and over) MSSA Bacteraemia Cases (all ages)



2

4

6

8


0

20

40

60

80

100

Jan-00

0

2

4

6

8

10

12


0

2

4

6

8

10

12


5.9 infection control report - nhs highland · 2013-01-28 · guidelines, review with microbiology...

Documents