Quality care – for you, with you

REPORT SUMMARY SHEET

Meeting: Date:

Trust Board 25th May 2017

Title:

Infection Prevention and Control HCAI Report

Lead Director: Medical Director

Corporate Objective: Safe, high quality care

Purpose:

For assurance

Summary of Key Issues for Trust Board

Key issues:

The below data details the HCAI Performance against 2016/17 Priorities for Action targets: C. difficile infections – 2016/17: 34 cases against a PHA target of 32 cases So far in 2017/18, we have had 7 cases, not linked MRSA bacteraemia – 2016/17: 6 cases against a PHA target of 5 cases. It should be noted that none of these 6 cases were considered preventable So far in 2017/18, we have had 1 case, which was considered preventable MSSA bacteraemia – 2016/17: 58 cases – 10 cases considered preventable So far in 2017/18, we have had 7 cases, 1 of which was considered preventable

Key risks for discussion:

Continued engagement of key stakeholders in relation to Point Prevalence Survey in June 2017

Ongoing staffing pressures within the IPC Nursing Team and the Medical Microbiology workforce

Summary of SMT challenge/discussion: It was agreed that SHSCT would be active participants in regional programme to deal with increasing HCAI/AMR across the province, including workstreams to engage with key staff.

TABLE OF CONTENTS

1 HCAI Performance 2016/17 …… ........................................ 3

2 Update on Infection Prevention & Control Issues .......... …..6

3 IPC Independent Audit Activity ........................................... 10

1 HCAI Performance 2016/17 (Year to Date 31st

March 2017)

The SHSCT performed very well against HCAI PfA targets for 2016/17 – but there is always room for improvement.

PfA HCAI Targets for 2017/18 have not yet been discussed with PHA.

We must be mindful that patients presenting to hospital today appear to be presenting with often very complex clinical needs therefore despite every effort to keep CDI and MRSA bacteraemia incidence low an irreducible minimum will always be prevalent in healthcare.

Southern Trust Performance MRSA bacteraemia 2016/17

2016/17 year to date (31st March 2017) there have been 6 MRSA bacteraemia cases and none were considered to be preventable.

Southern Trust MRSA Episodes Cumulative

Total – 1st

April 2016 – 31st

March 2017

Southern Trust Performance Clostridium difficile 2016/17

2016/17 year to date (31st March 2017) there have been 34C. difficile cases.

Southern Trust Clostridium difficile Episodes Cumulative

Total – 1st

April 2016 – 31st

March 2017

Southern Trust Performance MSSA bacteraemia 2016/17 (Year to date 31st

March 2017)

For 2016/17 surveillance of MSSA bacteraemias remains mandatory ONLY within the SHSCT.

To facilitate on-going surveillance of MSSA bacteraemias during 2016/17; MSSA target data for 2009/10 is used as a comparison.

Year to date (31st March 2017) there have been 58 MSSA cases.

To date 10 have been identified as preventable.

Southern Trust MSSA Episodes Cumulative

Total – 1st

April 2016 – 31st

March 2017

2 Update on Infection Prevention & Control Issues

Clostridium difficile infection (CDI) in SHSCT

From 1st

April 2016 to 31st

March 2017 there have been 34 cases of CDI in the SHSCT.

All cases of CDI diagnosed within the Trust are investigated fully by IPCT in collaboration with the clinical

team on the day of diagnosis [or the next available working day] and all undergo a strict multidisciplinary

Root Cause Analysis (RCA) with an aim of identifying, implementing, promoting and sustaining shared

learning for all clinical staff across the Trust. IPCT facilitate the RCA and it is expected that learning

outcomes are shared via appropriate forums and platforms that may be unique to each Directorate.

IPCT continue to work on a framework whereby trend analysis of CDI HCAI RCA outcomes can be used

to identify and reduce problems in quality of care and patient safety. IPCT utilise learning intelligence from

RCAs to help illustrate and support recommended IPC practice and to help inform IPC training packages

that are delivered at various training opportunities across the Trust.

Outcomes from RCAs are taken on a regular basis to the 2 key IPC Forums, HCAI Clinical and HCAI

Strategic Forum and IPCT and these are used as shared platforms to help inform key operational

stakeholders regarding the RCA process outcomes & expected actions

PROPOSAL THAT HAS ACHIEVED HCAI STRATEGIC and HCAI CLINICAL FORUM ENDORSEMENT

The IPCT believe the adoption and implementation of this framework will enable the Trust to

continually review patterns and trends in CDI HCAI RCA to yield actionable findings at the hospital

and Trust level that can be monitored longitudinally.

The IPCT propose that the outputs from this framework should be a standing item for:

HCAI Strategic Forum

HCAI Clinical Forum

Medical Director Trust Board Report

M&M Meetings

Unfortunately due to increasing work pressures on the IPCT this work has not progressed.

SHSCT /RQIA Augmented Care Audit Programme

Augmented care Sisters meetings that were reinstated in May 2016 continued to delivered and facilitated by the IPCNs on a monthly basis until December 2016. Unfortunately since January 2017 the proactive planned regular meetings with augmented care Sisters remain ‘stepped down’. This is temporary until IPC nursing workforce has been able to recruit the correct skill mix to sustain such meetings. Individual IPCNs continue to work directly with Sisters from augmented care areas particularly focusing on Adult Haematology and Renal.

Regular updates on the Trust IPC augmented care action plan and progress were to be given by IPCT at the SHSCT HCAI Clinical Forum (monthly) and HCAI Strategic Forum (every 3 months), this will be reinstated when monthly meetings recommence.

IPC Nursing Workforce, SHSCT

Infection Prevention & Control [IPC] is a very highly specialised area of health & social care and to this regard recruiting and maintaining staff is a constant challenge. It is with regret that we have recently lost 2 senior IPCNs other jobs within the Trust which has given them opportunity for promotion.

The Medical Director and Assistant Director have been fully briefed with regard to IPCN workforce issues by the Lead IPCN and much support has been offered to recruit. 3 x Band 6 and 1 Band 7 IPCNs have been recruited all on a full-time permanent basis. Plans to appoint a second full-time permanent Band 7 is in place.

It will take time now to enhance IPC knowledge base of new individual staff and time will be needed to help create and enhance individual skill mix.

Ultimately the IPC Nursing workforce for the SHSCT will comprise of:

Lead IPCN x 1

Band 7 IPCN x 5 WTE

Band 6 IPC x 3 WTE

Band 3 x 3 WTE [IPC Independent Auditors]

.

Norovirus & Influenza Update

Regionally

IPCT continues to be notified daily of Norovirus (V&/or D) and Influenza (Flu A/B) incidence across Northern Ireland Care Homes. Data to this regard is e-mailed from PHA to the Lead IPCN, SHSCT and to the Operational Directors, Heads of Service and all other key stakeholders within the SHSCT for information and dissemination on a daily basis. The purpose of this is to be proactive in helping to prevent further outbreaks of infection within Trust facilities.

At present in Northern Ireland (NI) there 4 outbreaks of D &/or V in nursing /residential facilities and 2 outbreaks of influenza.

Trust Facilities

Influenza

We currently have no Influenza outbreaks within the SHSCT.

Norovirus

We currently have no Norovirus or suspected Norovirus outbreaks within the SHSCT.

RCA - Community Engagement

No further updates to report. Promoting opportunity for IPC engagement with Primary care colleagues is a top priority issue for IPC.

Water Safety

The Independent Water safety Consultant Dr Lee has now completed her overview of water safety across the SHSCT. This report is out for consultation at present and hosts 97 recommendations. A final copy will be tabled at HCAI Strategic Forum and a copy will be given to all Operational Directors for dissemination to clinical staff.

Cutan Alcohol Hand Rub / Cutan Liquid soap

Cutan is now well established within the acute, non-acute and community settings.

Alcohol hand rub is freely available at all patient care areas and at the point of care.

Regionally BSO Procurement is presently hosting a procurement group tasked with a review of the Regional contract for hand soaps, alcohol gels/foams and hand creams. The lead IPCN and Head of Occupational Health from the SHSCT are members of this panel. Work continues within the CAG group.

No further issues to report.

Ebola Management Plan

The Trust ‘Ebola Management Plan’ remains outstanding. Agreement with laboratory issues and testing samples to be agreed.

SHSCT IPC Mandatory Training

A ‘blended’ learning approach is the focus for mandatory IPC training with information leaflets, e-learning and face to face teaching methods. This has extended into a Regional piece of work of which the SHSCT are fulfilling a very active role.

IPC e-learning packages already exist within the Trust for:

Non-Clinical staff

Medical Staff

This is a complex piece of work that has progressed and it is now almost complete. An e-learning package has been created for Clinical staff and is presently under trial. Health & social care staff from many disciplines fall in to this group and a Training Needs Analysis [TNA] has been created. This gives rise to a 2 tier approach for IPC mandatory training. The Trust plans to launch the complete IPC Training package and all details on TNA in June 2017.

Northern Ireland Pont Prevalence Survey (PPS) 2017

As indicated by deputy CNO, the Public Health Agency (PHA) is co-ordinating the Point Prevalence Survey (PPS) of Healthcare Associated Infections and antimicrobial use in acute hospitals in Northern Ireland (NI) 2017. The PPS study will be undertaken in May/June 2017 in NI. The last PPS measuring HCAI prevalence and antimicrobial use in acute settings in NI was undertaken in 2012. The European Centre for Disease Control (ECDC) is co-ordinating the survey. All UK Administrations, the Republic of Ireland and other EU countries are participating in the PPS.

The PPS will be co-ordinated by the PHA and the SHSCT PPS nominated co-ordinator is the Lead IPCN for the Trust. This survey requires meticulous planning and collaborative working between IPCT and clinical staff. CAH & DHH will be taking part and data will be collected 1st, 2nd, 5th & 7th June 2017.In SHSCT we have assembled a small PPS Team comprised of member(s) of infection prevention & control (IPC), and antimicrobial pharmacist, member(s) of nursing staff at ward level and administrative support provided by IPC. ALL inpatient wards in CAH & DHH will be taking part in the survey.

1. To estimate the burden (prevalence) of HAI & antimicrobial use

2. To describe patients, invasive procedures, infections (sites, microorganisms including markers of antimicrobial resistance) and antimicrobials prescribed

3. To describe key strictures and processes for the prevention of HAIs and antimicrobial resistance at the hospital and ward level in hospitals

4. To disseminate results to those who need to know at local, regional, national and EU level

Raise awareness

Train and reinforce surveillance structures and skills

Identify common EU problems and set up priorities accordingly

Evaluate the effect of strategies and guide policies

5. To provide standardised tool for hospitals to identify targets for quality improvement

The Lead IPCN and Trust co-ordinator will brief Trust Board regarding outcomes via this report as progress is made

IPC Independent Audit Activity

Hand Hygiene and Bare Below the Elbow Self Audit Scoring

The Southern Trust promotes good hand hygiene at the ‘point of care’. The point of care represents the time and place at which there is the highest likelihood of transmission of infection via healthcare staff whose hands act as mediators in the transfer of microbes. One of the best ways to measure hand hygiene compliance is observation audit and the Trust had an on-going programme of hand hygiene audit.

The compliance threshold for hand hygiene is 90% and areas that are non-compliant are required to re-audit daily until compliance is achieved.

Being ‘Bare below the Elbow’ is also an important factor for compliance with hand hygiene.

The dress code policy requires staff to have sleeves short or rolled up to the elbow in order to allow access to the wrist for good hand hygiene technique and remove jewellery, such as watches. The policy also prohibits staff form wearing nail varnish, false nails or gel nails.

Non-compliance is reported to the Trust Senior Management Team weekly and passed on to Operational Directors for corrective action to be taken.

The IPCT independent audit results are fed back immediately to the ward manager and on a monthly basis to Operational Directors for corrective action.

Hand Hygiene Compliance by Trust Location [Independent Audits]

Compliance for the period on the Craigavon Area Hospital site exceeds the compliance threshold of 90%. On the Daisy Hill Hospital site, there has been no breach of the compliance threshold since October 2013.

Compliance for the period on the Lurgan Hospital and South Tyrone Hospital sites exceeds the compliance threshold of 90%.

Hand Hygiene Compliance by Staff Grouping

A review of compliance by staff group indicates a dip in compliance by medical staff. The Medical Director wrote to all doctors to stress the importance of hand hygiene and supported this with face to face presentations [with the Consultant Microbiologist] at the Trust Morbidity and Mortality meetings.

BBE Compliances

Bare Below the Elbow / Nail Varnish-Extension Compliance

Bare Below the Elbow / Nail Varnish-Extension Compliance