annual report on healthcare associated infection …...annual report on healthcare associated...

Annual Report on

Healthcare Associated Infection

2015/16

Prodine Kubalalika, Lead Nurse for Infection Prevention and Control, CWHHE CCGs

Jane Beckford, Assistant Director for Quality Improvement and Clinical Assurance, Hounslow CCG

July 2016

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Contents Page no.

1. Executive Summary 3

2. MRSA Blood-Stream Infections 5

3. Clostridium Difficile Infections 9

4. Outbreaks and Infection-Related Serious Incidents 12

5. Antimicrobial Stewardship 14

6. Infection Prevention Indicators for Quality Schedules 14

7. Infection Prevention Activity in CWHHE 15

8. Conclusion: Priorities for 2016/17 17

Appendices

1. Detail of MRSA Post Infection Reviews – TRUST CASES 18

2. Detail of MRSA Post Infection Reviews – CCG CASES 22

3. Clostridium Difficile Case Review – TRUST CASES 27

4. Outbreaks and Infection-Related Serious Incidents 38

Report received by CCG Quality and Patient Safety Committees Date

Hammersmith and Fulham CCG 23.08.16

Ealing CCG 17.08.16

Central London CCG 24.08.16

West London CCG 23.08.16

Hounslow CCG 27.09.16

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1. Executive Summary

This annual report provides a summary position on healthcare associated infection in 2015/16 across

CWHHE. This was the second full year in which the CCGs had a dedicated infection prevention and control

(IPC) resource, which has enabled greater scrutiny of Trust systems for infection prevention, as well as in-

depth review of significant infections, Serious Incidents and outbreaks.

All Trusts and CCGs have a zero tolerance target for MRSA blood-stream infections. The Post Infection

Review (PIR) process has helped to clarify issues of attribution for cases of MRSA sepsis and to identify the

most likely source or contributory factor for the infection, to inform prevention strategies going forward. The

trend this year has been a reduction in Trust-attributed MRSAs, but an increase in CCG cases. These have

been in patients in the community with multiple co-morbidities. Actions to prevent MRSA blood-stream

infections are incorporated into the CCG infection prevention work programme for 2016/17, and include:

close working with provider IPC teams on improving the management of invasive devices; following up Trust

PIR action plans to ensure any lapses in care are addressed to prevent recurrence of infections; and raising

any actions required with other providers (including GPs and district nurses) or other commissioners (such as

Brent, Harrow and Hillingdon CCGs) to ensure any lapses in clinical practice identified in neighbouring Trusts

are addressed.

MRSA is just one potential cause of sepsis – there are many others. Trusts have been monitored on their

implementation of the UK Sepsis Trust Clinical Toolkits in 2015/16, which will continue in 2016/17.

Trusts and CCGs have nationally-set objectives for reducing Clostridium difficile (C diff) infections and there is

a requirement for joint provider-commissioner review of cases to determine which may be due to a lapse in

care. Imperial reported many more C diff infections (73 – a rate of 2.1 per 10,000 bed days) than Chelsea and

Westminster and West Middlesex combined (18 – a rate of 0.7 per 10,000 bed days). However, detailed case

review, although identifying areas for improvement, did not reveal significant lapses in care at Imperial and

further work will be carried out in 2016/17 to explore the thresholds for sending stool specimens, which

appear to vary between Trusts.

A summary is provided in the report on infection-related Serious Incidents (SIs), of which there were 19 in

2015/6, including 10 outbreaks or clusters of infection, 1 MRSA-related death, 1 C diff-related death, 3

incidents of linked cases of C diff and 4 other incidents. All Root Cause Analyses were scrutinised by the Lead

Nurse for Infection Prevention and Control and action plans are monitored with Trust IPC teams.

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Seven of the outbreaks or clusters of infection were caused by carbapenemase-producing

Enterobacteriaceae (CPE) at Imperial – these are organisms that are highly resistant to antibiotics. One

outbreak in particular affected 40 patients, although only 9 patients had clinical infections. This outbreak

prompted focused work with the Trust, including regular teleconference meetings and two clinical visits to

affected wards. Imperial, and all Trusts commissioned by CWHHE CCGs, will be monitored on their

implementation of the CPE toolkits in 2016/17, as a Quality Schedule indicator.

The annual report provides a summary of the work of the Infection Clinical Network which aims to detect

risks and trends in healthcare associated infection and to pool the resources of CCG and Trust Infection

Prevention and Control (IPC) Leads and Public Health England (PHE) to jointly work on solutions.

On 01 April 2016, Jane Beckford, formerly Lead Nurse for Infection Prevention and Control, moved to a new

role as Assistant Director for Quality Improvement and Clinical Assurance in Hounslow CCG. Prodine

Kubalalika was appointed as the new Lead Nurse for IPC for CWHHE and commenced in post on 16 May

2016.

This report may be made available to the public only after removal of the appendices, from which it may

be possible to identify individual patients.

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2. MRSA Blood-Stream Infections

MRSA Blood-Stream Infections by Trust and CCG in 2015/16 – Zero Tolerance Target

Trust Trust-attributed CCG-attributed Third party-attributed

Imperial 409228 (Brent) 423652 (Leicester) 427376 (H&F) 433969 (Hounslow) 433957 (Wandsworth) 454887 (Mid Essex) 463638 (H&F)

407351 (Islington) 411429 (Ealing) 429318 (Hillingdon) 457712 (H&F) 460767 (West)

415130 (Hounslow) 426323 (Hounslow) 430961 (West) 463334 (West) 463325 (H&F) 473742 (Brent)

C&W 0 406809 (Lewisham) 429806 (West)

0

West Mid 463434 (Hounslow) 417567 (Hounslow) 421969 (Hounslow) 428164 (Hounslow) 458981 (Hounslow) 462601 (Hounslow) 474451 (Hounslow) 469838 (Hounslow)

458775 (Hounslow)

CCG Trust-attributed CCG-attributed Third party-attributed

Central 0 0 418794 (Guys St Thomas’s)

West 0 429806 (C&W) 460767 (Imperial)

430961 (Imperial) 463334 (Imperial)

H&F 427376 (Imperial) 463638 (Imperial)

457712 (Imperial) 463325 (Imperial)

Ealing 412274 (LNWHT) 408556 (LNWHT) 434351 (LNWHT) 455209 (LNWHT) 461713 (Hillingdon) 471400 (LNWHT)

411429 (Imperial) 464723 (LNWHT) 476581 (LNWHT)

470286 (LNWHT)

Hounslow 433969 (Imperial) 463434 (West Mid)

417567 (West Mid) 421969 (West Mid) 428164 (West Mid) 458981 (West Mid) 462601 (West Mid) 474451 (West Mid) 469838 (West Mid)

415130 (Imperial) 426323 (Imperial) 458775 (West Mid)

Please see Appendices 1 and 2 for details of Trust- and CCG-attributed cases.

Cases in blue occurred in Q4, so have not previously been reported to committee.

Cases in non-bold font are attributed to CCGs outside of CWHHE (but were treated by acute services

commissioned by CWHHE). They were not reviewed and are not included in the Appendices.

Cases in italics are the second episode of sepsis in the same patient (426323 and 415130 relate to the same

patient; 408556 and 471400 are also the same patient).

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There was an additional case of note (421221 – not listed above), attributed to Brent CCG, but with learning

for Willesden Community Hospital (LNWHT community services) around urinary catheter management,

screening and decolonisation for MRSA and antibiotic review. The action plan was fully implemented by the

LNWHT Community Infection Prevention Team.

Summary Table showing Number of MRSA Cases by Trust and CCG in 2015/16

Compared with Previous Two Years

Trust Trust attributed

cases

CCG attributed

cases

Third party attributed

cases

Total 2015/16 (Trust

attributable)


attributable)


attributable)

Imperial 7 5 6 18 (7) 13 (8) 25 (13)

C&W 0 2 0 2 (0) 0 (0) 7 (5)

WMUH 1 7 1 9 (1) 8 (3) 8 (5)

CCG Trust attributed

cases

CCG attributed

cases

Third party attributed

cases

Total 2015/16 (CCG

attributable)

Total 2014/15 (CCG

attributable)

Total 2013/14 (CCG

attributable)

Central 0 0 1 1 (0) 3 (1) 1 (1)

West 0 2 2 4 (2) 2 (0) 12 (6)

H&F 2 1 1 4 (1) 2 (0) 5 (0)

Ealing 6 3 1 10 (3) 7 (1) 7 (2)

Hounslow 2 7 3 12 (7) 5 (3) 6 (3)

Thematic Analysis of MRSA Cases

For all Trusts and CCGs, the MRSA objective is “zero tolerance”. Since April 2013, all cases of MRSA blood-

stream infection have been subject to a Post Infection Review (PIR) process.

During 2015/16, all 20 CWHHE CCG-attributed cases of MRSA were investigated by the Lead Nurse for

Infection Prevention. The Post Infection Reviews of 15 Trust-attributed cases were also reviewed (this

includes 6 cases attributed to LNWHT/Hillingdon). Cases are attributed to CCG or Trust based on whether

they are diagnosed pre- or post-48 hours of admission. Some cases were referred to NHS England for

arbitration and 8 of these (one Trust and 7 CCG cases) were then attributed to Third Party. These are cases

that are either deemed to have been acquired at another Trust or in a care home, or are deemed to be

Intractable - this denotes a case where there are patient factors (such as immunosuppression or delay in

seeking treatment) rather than healthcare factors, which contributed to acquisition of the infection.

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Many of the MRSA cases were in complex patients with multiple co-morbidities. Some of these patients had

reached the last phase of their life when they succumbed to MRSA sepsis. There were six patients who died;

in only two of these patients was MRSA deemed to have contributed to their death. In one case, this was

logged as a Serious Incident and investigated accordingly. In the other case, discussion took place with the

care home the patient was admitted from, who reviewed their policy for care of the deteriorating patient

with the patient’s GP.

The priority in Post Infection Review is to establish whether any acts or omissions by healthcare providers

contributed to the acquisition of an MRSA blood-stream infection and to ensure any necessary actions are

identified and implemented to prevent a recurrence. There was often a need to work across several

providers, including GPs, to ensure integrated care and appropriate discharge planning for patients. For the

CCG-attributed cases, many of the patients required their care package to be enhanced following their

admission with MRSA, for example to include more frequent visits by their personal care provider, or to be

referred for district nursing support with their urinary catheter. In three patients (411429, 457712, 464723) a

safeguarding alert was raised following the Post Infection Review, which led to some specific issues

impacting on patient safety being identified and addressed by multi-disciplinary teams.

The graph below shows the factors which were deemed the most likely source or contributory factor for

each MRSA blood-stream infection. When feedback from the Trust (as in five cases) indicated that the

infection originated in one of two possible sites (e.g. the chest or the urinary tract), in order to avoid a large

number of cases listed as “unknown”, these cases have been allocated as 0.5 of a case to each of the two

suggested factors.

The graph shows that the majority of the Trust-attributed cases were linked to invasive devices or wounds,

whereas the CCG-attributed cases originated from chest, wound or urinary infections, mainly in elderly

patients. Two cases that arose in renal dialysis satellite units were originally attributed to CCGs, despite the

patient’s shunt or line being exclusively managed by the acute Trust. However when CCG-attribution was

contested, NHS England attributed both cases to Third Party, rather than to the acute provider. The four

cases linked to prosthesis / graft relate to the two patients who each had two episodes of sepsis, where their

prosthesis was the site of a deep-seated, recurrent infection.

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Graph showing the Most Likely Source or Contributory Factor for MRSA Blood-Stream Infections in CWHHE

in 2015/16

Actions to prevent MRSA blood-stream infections are incorporated into the CCG infection prevention work

programme for 2016/17, and include:

Close working with acute provider IPC teams on improving the management of invasive devices.

A continued focus with all Trusts, especially at the acute-community interface, on the management (and

ideally avoidance) of urinary catheters – this includes monitoring the effective use of catheter passports

for patients in whom a urinary catheter cannot be avoided and monitoring of Trusts’ Safety

Thermometer data on catheter-associated urinary tract infections.

Following up with Trusts on their action plans from Post Infection Reviews, to ensure that any lapses in

care are addressed to prevent recurrence of infections, and raising any actions required with other

providers, such as general practice or district nursing.

Close working with Brent, Harrow and Hillingdon (BHH) CCGs to ensure that lapses in clinical practice

identified in LNWH Trust are addressed and that BHH quarterly healthcare associated infection reports

are presented at Ealing CCG’s Quality and Patient Safety Committee, to provide assurance of this.

0

1

2

3

4

5

6

7

Trust attributed

CCG attributed

Third Party attributed

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3. Clostridium Difficile Infections

The Lead Nurse for Infection Prevention and Control met quarterly with Trust IPC Leads throughout 2015/16

to review Clostridium difficile cases, in order to determine which may have resulted from a lapse in care and

to ensure all necessary remedial actions were taken.

Quarterly and Year-End Position on C diff Performance and Summary of Lapse in Care Decisions

Trust Q1 Q2 Q3 Q4 Total No. due to lapse in care

% due to lapse in care

2015/16 Objective

2016/17 Objective

Imperial 23 9 25 16 73 5 6.8% 69 69

C&W 1 2 3 2 8 0 0% 7 16*

WMUH 1 4 1 4 10 4 40% 9

*Combined C diff target following merger

See Appendix 3 for a more detailed summary of cases and how lapse in care decisions were reached for

each Trust.

The main issue of note was that in Quarter 4, there were three cases identified as possibly resulting from

lapses in care at West Middlesex. In each case, this was due to non-compliance with the Trust’s

Antimicrobial Prescribing Policy. Post-merger, the Trust is harmonising its policies, with the aim of having a

single Antimicrobial Prescribing Policy for the whole Trust. The introduction of an antimicrobial dashboard

and monthly audit at Chelsea and Westminster, to measure adherence to local antimicrobial prescribing

standards on all inpatient wards, has seen improved compliance. This quality improvement initiative will now

be implemented at the West Middlesex site as part of the Trust’s engagement in the 2016/17 Antimicrobial

Resistance (AMR) CQUIN.

Imperial continues to report higher numbers of C diff infections than Chelsea and Westminster and West

Middlesex, however Imperial’s numbers are comparable with many other London Trusts and the number of

cases this year (73) has reduced from 2014/15 (81). The Trust carries out robust C diff case review and

undertakes quarterly surveillance of antimicrobial usage as part of its antimicrobial stewardship programme.

Further work to explore the thresholds for sending stool specimens across CWHHE CCGs commissioned

providers, which appear to vary between Trusts, will be undertaken by the CCG Lead Nurse for Infection

Prevention and Control and the findings will be reported through quarterly reports to Quality and Patient

Safety Committees in 2016/17.

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Dedicated pharmacist support for C diff case review is being identified from within the CCG Medicines

Management team. This expertise will help ensure all necessary steps are taken to control and monitor

prescribing to reduce the risk of C diff, as well as multidrug-resistant organisms.

The charts below show the rates of C diff infection per 10,000 bed days. The calculation of a rate of C diff

infection allows a more meaningful comparison between Trusts than the number of cases alone. Direct

comparison of numbers of cases should be avoided as Trusts vary considerably in their size and the

healthcare activities they provide.

Annual rates 2014/15 and 2015/16 Quarterly rates in 2015/16 *C&W rates are combined with West Mid

Graphs showing Acute Trust Rates of C diff Infection per 10,000 Bed Days

0

0.5

1

1.5

2

2.5

3

3.5

Q1 Q2 Q3 Q4

Imperial

C&W

0

0.5

1

1.5

2

2.5

3

Imperial C&W

2014/15

2015/16

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Clostridium Difficile Infections – Summary Position by Trust and CCG in 2015/16

Acute Trust Trust-attributed cases

Annual Objective Non Trust-attributed cases

Total cases 2014/15 Performance

2016/17 Objective

Imperial 73 69 78 151 81 69

C&W 8 7 18*

36* 8 16*

West Mid 10 9 8

CCG Trust-attributed cases

Non Trust-attributed cases

Total CCG-attributed cases

Annual Objective

2014/15 Performance

2016/17 Objective

Central 12 17 29 40 39 40

West 29 42 71 51 57 51

H&F 12 16 28 35 34 35

Ealing 34 42 76 67 72 67

Hounslow 15 24 39 37 42 37

Community/Mental Health Trust**

Trust-attributed cases

Annual Objective (locally-agreed)

Non Trust-attributed cases

Total cases 2014/15 Performance

2016/17 Objectives were not locally-agreed as this was not deemed a useful measure due to very low number of cases and complexity of attribution

CLCH 2 4 0 2 1

WLMHT 0 2 0 0 0

LNWHT 1 None 3 4 6

*Combined figures/targets following Trust merger.

** Community and mental health providers - this includes cases in bedded units which are within CWHHE CCGs (therefore HRCH is not included as its bedded unit is in Richmond CCG). These providers do not have a nationally-set objective, but any cases are monitored and reviewed quarterly.

Red shading indicates a breached objective

Green shading indicates an achieved objective

Grey shading indicates cases that do not count towards objective but provide an overall picture of the source and burden of disease

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4. Outbreaks and Infection-Related Serious Incidents

A total of 19 outbreaks / other Serious Incidents (SIs) related to infection were reported by Imperial (18) and

Central London Community Healthcare (1) in 2015/16. This compares with 30 SIs reported by six different

organisations in 2014/15. It should be noted that the Serious Incident Framework was updated in March

2015 and is less prescriptive than the previous version was on defining what constitutes an infection-related

SI. This may account for the reduction in SIs reported in 2015/16.

All Root Cause Analyses (RCAs) were reviewed by the Lead Nurse for Infection Prevention and Control and

further queries raised with Trusts where necessary. The implementation of RCA action plans is monitored

with Trusts at quarterly IPC visits. Further detail on all infection-related SIs reported in 2015/16 is included

in Appendix 4.

Summary of Serious Incidents related to Infection by Trust in 2015/16

Trust Outbreaks (not C diff)

MRSA-related death

C diff-related death

Linked C diff cases

Other Trust Total

Imperial 9* 1 1 3 4** 18

Central London Community Healthcare 1 0 0 0 0 1

Total Incident Type 10 1 1 3 4 19

Comparison with 2014/15 data 14 4 5 5 2 30

*7 of which were CPE-related incidents – ward closures / clusters of infection – see below.

** The 4 “Other” incidents were:

Hepatitis C transmission

Wound infection possibly linked to bypass equipment

Pertussis in a healthcare worker

Hospital-acquired legionella infection.

CPE Outbreaks at Imperial

The most significant infection event in 2015/16 was an outbreak of Carbapenemase-producing

Enterobacteriaceae (CPE) (NDM-producing Klebsiella pneumoniae) at Imperial, which appeared to be the

first CPE outbreak of this scale in London.

The outbreak was reported in Quarter 1, continued in Quarter 2 across renal and vascular wards at Imperial,

and resolved during Quarter 3. A total of 40 cases were identified between July 2014 and October 2015,

although 31 were cases of colonisation (rather than clinical infection) identified by enhanced screening.

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Thirteen patients who tested positive to CPE sadly died - this included all nine patients with positive clinical

samples. An investigation found that CPE was not a significant factor in these deaths, but that it could not be

ruled out as a contributory factor in seven deaths. All the deaths were in patients with significant co-

morbidities. The Mortality Review was received by the Clinical Quality Group on 25 February 2016, along

with the Trust’s End of Outbreak Report, which provided full details of the outbreak and the action plan.

Three Serious Incident reports were submitted during the outbreak, relating to separate ward closures,

which totalled 34 days of ward closure. A separate ward closure of 7 days was not reported on STEIS. A later

SI report (January 2016) related to transmission between four patients of an identical strain of CPE (NDM-KP).

Control measures included the isolation of affected patients in side-rooms and cohort bays, enhanced

infection control, cleaning and decontamination procedures. A screening programme across all 10 Trust

haemodialysis units led to 1293 patients being screened: 98 (7%) refused; 21 (1.6%) were found to carry CPE,

of which 8 (0.6%) were newly detected and none of whom had the outbreak strain.

A letter was sent on 28 October 2015 to the Trust Medical Director from the Director of Quality, Nursing &

Patient Safety, Hammersmith and Fulham CCG, and the Deputy Clinical Quality Director, Trust Development

Authority, to express concerns regarding the Trust’s management of the outbreak. A follow-up clinical visit

by the CCG Lead Nurse for Infection Prevention and Control and the Assistant Director for Quality

Improvement and Clinical Assurance, with the TDA Head of Infection Prevention, took place on 16

November, revealing some improvements on the wards, but also some on-going causes for concern. A report

was sent to the Trust, the recommendations from which were incorporated into the Trust’s End of Outbreak

Report and action plan.

A second outbreak caused by an unrelated strain of CPE (GES-5-producing Klebsiella oxytoca) was reported

by the Trust on 6 October 2015. This affected a haematology / oncology ward at Hammersmith Hospital and

led to the ward being closed on two occasions. There appeared to have been transmission from an index

case to 11 other patients. One patient died and the death was reviewed as part of the overall Mortality

Review described above. For this patient, CPE was isolated along with other organisms from blood cultures.

However, this was against a clinical picture of severe neutropaenic sepsis and immunosuppression,

associated with aggressive leukaemia, which was deemed to be the cause of death, rather than the CPE.

Public Health England was involved and the second outbreak was reported as a Serious Incident. A robust

RCA was received and the incident was closed.

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5. Antimicrobial Stewardship

Antimicrobial resistance (AMR) presents a significant threat to public health, through the development of

micro-organisms that cannot be treated with commonly available antibiotics, for example CPE. In addition,

the use of antibiotics alters the normal gut flora, predisposing patients to C diff infection. Good antimicrobial

stewardship is therefore crucial to the prevention and control of healthcare associated infections.

The Lead Nurse for Infection Prevention and Control will continue to work with Trusts to ensure that

antimicrobial stewardship is embedded in their annual programmes of work, with continuous monitoring of

adherence to local policies as required by the Hygiene Code. Dedicated pharmacist support is being

identified from within the CCG Medicines Management team, to provide a point of contact to work with the

Lead Nurse for IPC on implementing local strategies to address antimicrobial resistance.

All acute Trusts were required to report to Clinical Quality Groups on their antimicrobial audit as a Quality

Schedule requirement throughout 2015/16, and this will continue in 2016/17.

In 2015/16, CCGs were issued a Quality Premium with specific performance indicators for antimicrobial

prescribing in primary care, and for secondary care, a requirement to carry out a data validation exercise.

This exercise informed the development of a National AMR CQUIN for 2016/17. All acute Trusts are

encouraged to participate in the aim of reducing antibiotic consumption, encouraging focus on antimicrobial

stewardship, and ensuring antibiotic review within 72 hours.

6. Infection Prevention Indicators for Quality Schedules

Quality Schedules for 2015/16 included quality indicators which aimed to ensure Trusts had robust systems

in place for infection prevention and were implementing new national guidance. A refreshed set of infection

prevention quality indicators was developed for the 2016/17 Quality Schedules, which are summarised

below. Trusts are expected to report on their performance against these indicators in their quarterly IPC

reports to Clinical Quality Groups; a template has been provided to guide Trusts on the level of detail

required.

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Indicator Acute Trusts Community Trusts

Mental Health Trusts

Hygiene Code compliance, including policies for invasive device management

√ √ √

Implementation of Sepsis Clinical Toolkits √ √ √

Antimicrobial Audit √

Implementation of CPE Toolkit √

7. Infection Prevention Activity in CWHHE

7.1 Trust Clinical Visits

Trust visits to meet with IPC teams took place quarterly throughout the year, to discuss cases and outbreaks

of infection, as well as team priorities, risks identified and responses to national directives.

Trust Development Authority (TDA) visit to London North West Healthcare NHS Trust (LNWHT)

The Lead Nurse for IPC accompanied the TDA Head of Infection Prevention and Control on his visit to LNWHT

on 30 September 2015. Acute wards and community units across many sites were visited by two inspection

teams during the day and showed varying standards of IPC practice. Feedback was provided to the Trust

Director of Infection Prevention and Control (DIPC) and the Infection Control Doctor on the day and a joint

TDA/CCG report was sent to the Trust. Most of the recommended actions for improvement related to acute

services, so were followed up by BHH CCGs as the lead commissioner for LNWHT.

7.2 Infection Prevention and Control Policy for Primary Care

The above policy was developed by the CCG Lead Nurse for Infection Prevention and Control in response to a

number of requests from practices, in order to support them in safe working practice and preparing for CQC

visits. The policy was circulated to all CWHHE general practices in February 2016 and covers the following

areas:

• Standard Infection Control Precautions

• Hand Hygiene

• Protective Clothing

• Safe Use and Disposal of Sharps

• Spillage of Blood or Body Fluids

• Safe Management of Laundry

• Packaging, Handling and Delivery of Laboratory Specimens

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• Single Use Medical Devices

• Safe Management of Clinical Waste.

Members of the Infection Clinical Network, local Microbiologists and Practice staff are thanked for their

comments on earlier drafts of the policy.

7.3 Infection Clinical Network

The Infection Clinical Network is a professional forum which all CWHHE Trusts are invited to attend. In

addition, there is representation from Public Health England (NW London Health Protection Team). The

meetings are coordinated by the CCG Lead Nurse for IPC. The membership is multi-disciplinary, including

Infection Prevention and Control Nurses, Antimicrobial Pharmacists, Microbiologists and Directors of

Infection Prevention and Control (DIPCs). Average attendance across the quarterly meetings was 12

members (a slight increase from 10 the previous year), with the majority of Trusts represented at all

meetings.

The issues discussed included:

Trust year-end C diff reports for 2014/15 and updating members on the national conference on new

developments in C diff prevention and treatment.

MRSA – learning from the reviews of cases in 2014/15.

Antimicrobial updates from primary and secondary care and the patient safety alert on antimicrobial

stewardship.

Presentation on implementation of the CPE toolkit (Dr Bharat Patel, Consultant Medical Microbiologist,

AMR & HCAI Lead for Public Health Laboratory London).

Presentation on the launch of a new MSc course in Advanced Practice in Infection Prevention and

Control at the University of West London in October 2015 (Dr Jennie Wilson, Reader, Healthcare

Epidemiology).

Review of Terms of Reference, membership and effectiveness of the Network.

Presentation on the implementation of a water safety plan in a community Trust.

Updates for members from the NHSE-led IPC Commissioning Network.

The new HCAI database – discussion on challenges in its implementation and possible solutions.

Public Health England updates, including Zika virus.

Presentation from Imperial on learning from the CPE outbreak.

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The Network has continued to provide an effective forum for lively discussion and debate on infection

prevention and control issues in NW London and has provided IPC teams with an opportunity to keep

updated on national initiatives and local developments. Members have already been invited to lecture on

the MSc course at the University of West London, so their expertise can be shared with those newer to the

field of infection prevention and control. The Network agreed that in 2016/17, membership will be extended

across NW London, to include the Lead Nurse for IPC in Brent, Harrow and Hillingdon (BHH) CCGs and

representatives from Trusts for whom BHH CCGs are the lead commissioner.

8. Conclusion: Priorities for 2016/17

Joint working with Trust IPC teams and the analysis of data, cases and outbreaks of healthcare associated

infection in 2015/16 has enabled the following priorities to be established for 2016/17:

Focusing on Trust systems for preventing infections associated with invasive device use, for example

intravenous lines and urinary catheters.

Monitoring Trusts’ implementation of the UK Sepsis Trust Clinical Toolkits for the prompt recognition

and management of sepsis.

Exploring the thresholds for sending stool specimens for C diff testing, which appear to vary between

Trusts.

Monitoring Trusts’ implementation of the toolkit for managing CPE – this will now include community

and mental health Trusts, since the launch of the non-acute CPE toolkit in June 2015.

Establishing effective working with Medicines Management on C diff case review and antimicrobial

stewardship in secondary care.

Close working with Brent, Harrow and Hillingdon (BHH) CCGs to ensure that lapses in clinical practice

identified in LNWH Trust are addressed and that BHH quarterly healthcare associated infection reports

are presented at Ealing CCG’s Quality and Patient Safety Committee, to provide assurance of this.

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