highland nhs board 29 january 2019 item 4 · bacteraemia (sab) including mrsa. for nhs highland...

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Highland NHS Board29 January 2019

Item 4.6

INFECTION PREVENTION & CONTROL REPORT

Report by Catherine Stokoe, Infection Control Manager and Dr Vanda Plecko, Consultant Microbiologist/Infection Control Doctor, on behalf of Heidi May, Board Nurse Director & Executive Lead for Infection Control

The Board is asked to: • Note the position for the Board.• Note the update on the current status of Healthcare Associated Infections (HAI) and

Infection Control measures in NHS Highland.• Note that we will not achieve the Staphylococcus aureus bacteraemia (SAB) target.• Note that we are over the Clostridium difficile target trajectory but may still meet this

target.

Contribution to Board Objectives

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

1. Background and summaryThe table below shows NHS Highland Infection Prevention and Control targets andperformance data.

Group Target NHS Highland HEAT rate

Clostridium difficile

Age 15 and over

HEAT rate of 32.0 cases per 100,000 OBDs to be achieved by year ending 03/19

29

Oct-Dec Q4 2018

Green (NHSH data)

Staphylococcus aureus bacteraemia

HEAT rate of 24.0 cases per 100,000 AOBDs to be achieved by year ending 03/19

26

Oct-Dec Q4 2018

Red (NHSH data)

Hand Hygiene 95% Oct-Nov 2018 performance 96%

Green

Cleaning 92% Oct-Nov 2018 performance 96%

Green

Estates 95% Oct-Nov 2018 performance 96%

Green

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

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Achievements • An awareness day highlighting the importance in the insertion and management of

peripheral vascular catheters was held in Raigmore. This was in response to an observed increase in device related Staphylococcus aureus bacteraemia cases. The event was well attended and will become a regular event.

• Over the period of October to December sporadic cases of norovirus and flu have been identified in both hospital and community settings. Due to the vigilance undertaken by all involved the impact on services has so far been minimal.

Challenges • The Board need to note we are above the predicted trajectory for Clostridium difficile at

week 40 by two cases. This position remains changeable and it is still possible that we can achieve the target.

• The Board needs to note that we have not met the Staphylococcus aureus bacteraemia (SAB) including MRSA target. See section 1 for further detail.

• During the winter month’s norovirus and flu viruses become more prevalent in our community. The focus of the Infection Prevention and Control Team will be on prevention and outbreak management over the forthcoming months. See section 4.3 for further detail.

• The Infection Prevention and Control Nurse covering the west (of the North & West Division) is on sick leave till the end of January 2019; they are also due to retire in May 2019, and enter in to a phased retirement from February onwards. Cover is being provided primarily by the Infection Prevention and Control Nurse from the North Division, with additional assistance being provided by the Infection Prevention and Control Nurse from the South and Mid Division. As and when required additional assistance is being provided by the Infection Control Manager.

• Dr J Mills Consultant Microbiologist will be resigning from his position in NHS Highland at the end of January 2019. The appointment to the future vacant position is currently being advertised.

Catherine Stokoe – Infection Control Manager Vanda Plecko – Consultant Microbiologist & Lead Infection Control Doctor, January 2019

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NHS Highland Healthcare Associated Infection Report 1. Staphylococcus aureus (including MRSA)

1.1 Staphylococcus aureus bacteraemia target The target for 2018/2019 for NHS Highland is 24 cases or less per 100,000 acute occupied bed days for Staphylococcus aureus bacteraemia (SAB) including MRSA. For NHS Highland this means no more than approximately 60 cases by 31st March 2019. The local delivery plan HEAT targets for 2018/2019 are yet to be agreed by NHS Scotland, so we continue to currently report against previous local delivery plan arrangements. At time of writing (9th January 2019) we are reporting 60 cases, yet to be internally verified. Therefore the Board need to note we have not met this target. Local data identifies our internally verified position as of the 30th November 2018 as 55 cases, against a target of approximately 60 cases.

1.2 Trends NHS Highlands position showing actual verified case numbers as of 30th of November 2018 (data not yet validated by HPS) is tabled below. 1st April 2018 – 30th November 2018

MSSA = 55 MRSA = 0 Total SABs = 55 Cases

Preventable = 13 including 2 Contaminant Not preventable = 30 Unknown = 10 Under Investigation = 2 Hospital Acquired Cases = 19 Community Acquired Cases = 19 Healthcare Associated Cases = 17 Undergoing Investigation = 0 For definitions of above classifications please see section 2 page 16

Since April 2018 13 cases have been assessed as being preventable (including 2 contaminants; 3 PVC; 3 PICC; 2 urinary catheter; 1 Central line, 1 associated with skin and the management of leg ulcers and 1 relating to buttonhole fistula). All cases continue to be reviewed. Following the identification of a rise in the number of cases potentially associated with invasive devices in October 2018 the Infection Prevention and Control Team within Raigmore hospital worked in conjunction with the Clinical teams to review and raise the awareness of the care of invasive vascular devices. The formation of a Short life working vascular group has been established. In addition to the focus on vascular devices, the Infection Prevention and Control Doctor and nursing team are also working with tissue viability and the wider teams to prevent infections relating to wound and skin conditions.

Staphylococcus aureus is an organism which is responsible for a large number of healthcare associated infections, although it can also cause infections in people who have not had any recent contact with the healthcare system. The most common form of this is meticillin Sensitive Staphylococcus Aureus (MSSA), but the more well known is MRSA (meticillin Resistant Staphylococcus Aureus), which is a specific type of the organism which is resistant to certain antibiotics and is therefore more difficult to treat. More information on these organisms can be found at:

http://www.nhs.uk/conditions/staphylococcal-infections/Pages/Introduction.aspx

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 national target to reduce them. Information on the national surveillance programme for Staphylococcus aureus bacteraemias can be found at:

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

http://www.nhs.uk/conditions/staphylococcal-infections/Pages/Introduction.aspx

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

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Health Protection Scotland were informed of the position and were assured by the actions undertaken by the Board. At the time of writing (9th January 2019) the last device related SAB was identified on the 27th of November 2018. Figure 1: NHS Highland Staphylococcus aureus bacteraemia Cumulative Case numbers year on year since 2014, based on NHS Highland case number data.

Figure 2: Healthcare associated Staphylococcus aureus bacteraemia (SAB) incidence infection rates (per 100,000 total occupied bed days) for all NHS boards in Scotland in Q3 2018. Created and published by Health Protection Scotland. NHS Ayrshire & Arran, and NHS Tayside overlap.

HG- NHS Highland

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Figure 3: Community associated Staphylococcus aureus bacteraemia (SAB) incidence infection rates (per 100,000 population) for all NHS boards in Scotland in Q3 2018. Created and published by Health Protection Scotland. NHS Orkney and NHS Shetland overlap, as do NHS Borders and NHS Dumfries & Galloway.

HG- NHS Highland

1.3 Current Initiatives The combined CDI/SAB action plan developed to implement actions to reduce staphylococcus aureus bacteraemia is in place and progress is monitored monthly and presented to the Control of Infection Committee.

2. Clostridium difficile

2.1 Clostridium difficile HEAT Target

The target for 2018/2019 for NHS Highland is 32 cases or less in patients aged 15 and over per 100,000 total occupied bed days. For NHS Highland this means no more than approximately 78 cases by 31st March 2019. The local delivery plan HEAT targets for 2018/2019 are yet to be agreed by NHS Scotland, so we continue to currently report against previous local delivery plan arrangements. At the time of writing (9th January 2019) we are reporting 60 cases, yet to be internally verified, and the Board need to note we are above the predicted trajectory for Clostridium difficile by 2 cases at week 40. This position remains changeable and it is still possible that we can achieve the target.

Clostridium difficile is an organism which is responsible for a large number of healthcare associated infections, although it can also cause infections in people who have not had any recent contact with the healthcare system. More information can be found at:

http://www.nhs.uk/conditions/Clostridium-difficile/Pages/Introduction.aspx

NHS Boards carry out surveillance of Clostridium difficile infections (CDI), and there is a national target to reduce these. Information on the national surveillance programme for Clostridium difficile infections can be found at:

http://www.hps.scot.nhs.uk/haiic/sshaip/ssdetail.aspx?id=277

http://www.nhs.uk/conditions/Clostridium-difficile/Pages/Introduction.aspx

http://www.hps.scot.nhs.uk/haiic/sshaip/ssdetail.aspx?id=277

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Local data identifies our verified position as of the 30th November 2018 as 53 cases, against a target of approximately 78 cases. 2.2 Trends

NHS Highlands position showing actual case numbers as of 30th November 2018 (data not yet validated by HPS) is tabled below. 1st April 2018 to 30th November 2018

Total CDI Cases aged 15 and over = 53

Aged 15-64 = 16 Aged 65+ = 37

Healthcare Associated = 33 Community Acquired = 15 Unknown = 4 Under Investigation = 1 For definitions of above classifications please see section 2, page 17

Figure 4: NHS Highland Clostridium difficile Infection age 15 and over, case numbers year on year since 2014, based on NHS Highland case number data

Figure 5: Healthcare associated Clostridium difficile Infection (CDI) incidence infection rates (per 100,000 total occupied bed days (TOBD) for all NHS boards in Scotland in Q3 2018. Created and published by Health Protection Scotland. NHS National Waiting Times Centre, NHS Shetlands and NHS Western Isles overlap.

HG- NHS Highland

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NHS Highland Cumulative Toxin Positive Cdifficile age 15 and over

2014-2015 2015-2016 2016-2017 2017-2018 2018-19 Heat Target to 31-3-19

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Figure 6: Community associated Clostridium difficile Infection (CDI) incidence infection rates in community associated cases (per 100,000 total occupied bed days (TOBD) for all NHS boards in Scotland in Q3 2018. Created and published by Health Protection Scotland.

2.4 Antimicrobial Management A number of national antimicrobial quality prescribing indicators have been developed for boards and progress within NHS Highland is detailed below. Acute Hospital Antibiotic Prescribing Measures Downstream ward audit results at the end of November 2018: The audit is conducted in wards 7A, 6C and 6A in Raigmore. The medical notes and drug chart are reviewed to assess compliance with measures 1 to 4. The drug chart should have all doses of antibiotics administered (i.e.no omissions) or a code written to explain the reason for omission. The medical notes should have the indication for antibiotics clearly recorded and the reason for choosing an alternative antibiotic rather than the guideline recommendations is documented. If the patient is on intravenous antibiotics (by injection) this therapy should be reviewed within 72 hours to assess if injection therapy is still required or if the antibiotics can be changed to an oral tablet. If the patient is on oral antibiotics, the total number of days of therapy should be recorded either on the drug chart or in the medical notes (e.g. for 5 days) so the intended stop date is clear.

Data for 7C, 6C and 4C/4A is the median from July 2017 to November 2018

Current target Ward 7A Ward 6C Ward 4A

1. All prescribed doses administered or a reason documented if not 95% 100% 98% 96%

2. Indication documented in Medical Notes 95% 100% 100% 96% 3. Choice compliant with Formulary or reason

for deviation documented in medical notes 95% 96% 96% 96%

4. Oral duration or IV review documented on drug chart or in

medical notes Oral

95% (from

October 2018)

78% 88% 76% 86% 70% 86%

Note the change in target for measure 4 to 95% from October 2018. Robust processes for recording the duration on the drug chart for all patients on oral antibiotics continues to rely on the memory of the person prescribing. The introduction of electronic prescribing will improve this. A recent report discussed by Scottish Antimicrobial Prescribing Group noted board performance was mixed with NHS Highland similar to many other boards. Teams are recommended to use quality improvement methodology to test process measures and find

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solutions to improve reliability. These audits are no longer required to be reported nationally and are to be used locally for quality improvement purposes. An example of such is detailed in the ‘Antibiotic Audits in Caithness General’ section below. National quality prescribing indicators for antibiotic use in both primary and secondary care have not yet been approved by Scottish Government but are likely to focus on reducing total antibiotic use, not increasing the use of antibiotic injections and increasing the use of World Health Organisation approved list antibiotics (generally first line, preferred antibiotics). The introduction of Hospital Electronic Prescribing and Administration system (HEPMA) will greatly enhance the likelihood of achieving the latter two measures and is eagerly awaited. Antibiotic Audits in Caithness General At the most recent Antimicrobial Management Team meeting, a junior doctor presented the results of two antibiotic audit cycles conducted in both the admissions and step down wards in Caithness General. Compliance with all measures was just below target but improved during the second cycle, especially the oral duration recording. Changes made included taking the drug charts to the board round for review, keeping patients on antibiotics as shared responsibility between medical and rehabilitation teams and highlighting the need to record the duration of oral therapy on the drug chart. After the second cycle, improvements in recording the reasons for varying from guidelines and for continuing intravenous treatment were noted. A significant barrier to demonstrating a reliable process for all measures is the number of permanent staff and high numbers of locum staff who may be less familiar with local processes and not fully engaged with existing quality improvement projects as they may only be there for a short time. A review of staffing is ongoing. Primary Care Key Performance Indicator A national report on antibiotic prescribing in primary care was recently published by the Scottish Antimicrobial Prescribing Group. Since 2013, GP practices have been asked to reduce their prescribing to the rate of the lowest 25% of practices in Scotland or make an acceptable reduction. Boards are deemed to have achieved the quality indicator if 50% of practices meet this standard. In this report, prescribing in January to March 2018 was compared to the same months in 2016, the new baseline period. NHS Highland was the top performing board with 70.4% of practices achieving the quality indicator which is fantastic. A further 8 boards met the standard with the national figure being 57.5%. Prescribers in primary care are to be highly commended for acting on the messages to reduce antibiotic use and change their prescribing practice throughout the board. This information will be shared and celebrated with prescribers through the Pink One publication. Management of Infection Guidelines Updates The most recent sections of guidance to be updated are dental infections and urinary tract infections (UTI). 3 Hand Hygiene Reporting

3.1 Current Hand Hygiene Compliance Rates NHS Highland Hand Hygiene Rolling Monthly Audit Programme continues across all clinical areas, and compliance rates are being sustained above the 95% target.

Good hand hygiene by staff, patients and visitors is a key way to prevent the spread of infections. More information on the importance of good hand hygiene can be found at:

http://www.washyourhandsofthem.com./ http://www.washyourhandsofthem.com./documents/hand-hygiene-and-nhs-scotland/your-5-moments-for-hand-hygiene/5-moments-credit-card.aspx Each Board is responsible for monitoring and reporting hand hygiene compliance data.

http://www.washyourhandsofthem.com./

http://www.washyourhandsofthem.com./documents/hand-hygiene-and-nhs-scotland/your-5-moments-for-hand-hygiene/5-moments-credit-card.aspx

http://www.washyourhandsofthem.com./documents/hand-hygiene-and-nhs-scotland/your-5-moments-for-hand-hygiene/5-moments-credit-card.aspx

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Compliance data for Oct to Nov 2018 identifies an average of 96% for hand hygiene compliance across NHS Highland. Any areas identified during the audits, as requiring action, are reported immediately to the relevant person for actioning. 4. Cleaning and the Healthcare Environment

4.1 Cleaning and Estates audit data The monthly cleaning and estates audits, conducted as per the National Cleaning Services Specification and through the use of Synbiotix© (the Facilities Management Scotland web based audit tool), demonstrate compliance rates are being sustained above the locally defined targets (92% domestic monitoring and 95% estates monitoring). The data for Oct to Nov 2018 identifies an average compliance of 96% for domestic monitoring, and 96% for estates across NHS Highland. Any areas identified during the audits, as requiring action are reported immediately to the relevant person. A series of unannounced independent Public Peer Review audits is in progress; these occur across all hospital sites in NHS Highland. 4.2 Healthcare Environment Inspections (HEI) The report for the announced HEI Inspection that occurred across three sites in Argyll and Bute in July 2018, was published on the 26th September 2018. (Campbeltown Hospital, Mid Argyll Community Hospital and Cowal Community Hospital), and the subsequent 18 week follow up report has been submitted. This was a positive report in relation to the cleanliness of the environment and patient care. Some areas requiring focus were already underway within the Board. 8 requirements were received, and all have been met with the exception of:

• Requirement 1, align line management of the Infection Prevention and Control Nursing team to the Infection Control Manager, as per Vale of Leven recommendation. This action is in progress and due to be completed by March 2019.

• Requirement 2, ensure a reliable system is in place to monitor compliance with infection prevention and control mandatory training. This action is in progress and due to be completed by March 2019.

Benchmarking continues against all the national HEI inspection reports published, in order to ensure learning is disseminated. 4.3 Outbreaks/ clusters and multidrug resistant isolates associated with NHS Highland

There have been two outbreaks reported since the last report. Ward 6C Raigmore Hospital, was closed on 13th December 2018 due to confirmed norovirus, and reopened on the 22nd December 2018. Ward 7C Raigmore is currently closed at time of writing this report due to confirmed norovirus, on the 4th January 2019.

Keeping the healthcare environment clean is essential to prevent the spread of infections. Information on national cleanliness 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 Healthcare Environment Inspectorate. More details can be found at:

http://www.nhshealthquality.org/nhsqis/6710.140.1366.html

Each Board is responsible for monitoring and reporting the cleanliness of hospitals.

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

http://www.nhshealthquality.org/nhsqis/6710.140.1366.html

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Sporadic cases of norovirus and influenza are being reported across the NHS Highland area.

The Divisional Units have ensured winter preparedness plans are in place and flu vaccination opportunities provided to all staff. The chart below (taken from the 2018 Staff Flu uptake report week 51) shows a comparison with 2017/18 uptake.

5. Surveillance 5.1 MRSA Clinical Risk Assessment (CRA) Screening Audit

Staff are required to complete a Clinical risk assessment on all acute patient admissions as per the Health Protection Scotland definition defined criteria. The MRSA clinical risk assessment and screening process are embedded into the common admission document and monitoring of compliance occurs by the Infection Prevention and Control Nurses across NHS Highland. The past five quarters show sustained compliance within NHS Highland.

MRSA Key Performance Indicator Compliance %

2016 April – June Q1

2016 July – Sept Q2

2016 Oct –Dec Q3

2017 Jan – March Q4

2017 Apr – June Q1


2017 Sept – Dec Q3

2018 Jan –March Q4

2018 April – June Q1


2018 Oct – Dec Q3

NHS Highland

84% 86% 86% 77% 67% 94% 94% 94% 95% 98% awaited

NHS Scotland

82% 84% 82% 79% 85% 90% 88% 83% 84% 84% awaited

6. Escherichia coli (E.Coli) Bacteraemia surveillance

As of 1st April 2016 the surveillance of Escherichia coli (E. Coli) Bacteraemia became a mandatory requirement for all NHS Boards to undertake. Data is collected by the Infection Prevention and Control Team in conjunction with the relevant clinical teams, and cases discussed to identify learning. The data collected and presented below highlights the local case numbers.

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NHS Highland Staff Flu Vaccination Uptake: current year (2018/19) vs. trajectory year (2017/18)

Current Year (2018/19)

Trajectory Year (2017/18)

1 Based on the date of input into the Public Health Staff Flu Vaccine Database

In 2010 Health Protection Scotland provided a Clinical Risk assessment tool comprising of three questions, to NHS Boards in order to ensure a consistent risk-based approach to mandatory MRSA swab screening is undertaken. As part of the national mandatory MRSA screening programme quarterly compliance data is submitted by NHS Boards to provide assurance that Clinical Risk Assessment (CRA) compliance is at or above 90%.

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NHS Highlands position showing actual case numbers as of 30th November 2018 (data not yet validated by HPS) is tabled below. 1st April 2018 to 30th November 2018

Total Cases = 131 Hospital Acquired = 18 Healthcare Associated = 28 Community Associated = 84 Not Known = 0 Under Investigation = 1

Figure 7: Healthcare associated Escherichia coli bacteraemia (ECB) incidence infection rates (per 100,000 total occupied bed days) for all NHS boards in Scotland Q3 2018. Created and published by Health Protection Scotland. NHS Orkney and NHS Shetland overlap.

HG- NHS Highland

Figure 8: Community associated Escherichia coli bacteraemia (ECB) infection incidence rates cases (per 100,000 population for all NHS boards in Scotland in Q3 2018. Created and published by Health Protection Scotland. NHS Forth Valley and NHS Highland overlap

HG- NHS Highland

The Board should note that discussions are underway between Health Protection Scotland and National Services Scotland around the formation of a target for the reduction of E.Coli bacteraemia over a period of time. A formal announcement to NHS Boards will be issued at some point.

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6.1 Surgical Site Infections (SSI)

NHS Highland continues to monitor SSI rates through mandatory surveillance. The clinical teams alongside the Infection Prevention & Control Surveillance team and the Scottish Patient Safety Programme team (Acute adult workstream: SSI) are working jointly to review incidents of infection, and ensure that care practices are evidence based and maintained. RAIGMORE 30 DAYS READMISSION ELECTIVE COLORECTAL SSI

There have been 4 colorectal Surgical Site infections reported, from 137 procedures performed between January 2018 to end of October 2018, giving an SSI rate of 2.9%. Figure 9: Monthly SSI rate in elective colorectal surgery, Jan 2015 to October 2018

RAIGMORE 30 DAYS READMISSION ORTHOPAEDIC SSI Total Hip replacement (THR) There was 1 THR infection in August giving an SSI rate of 0.3% for 2018. Figure 10: NHSH Monthly SSI Rate for Total Hip Replacement January 2015 –Oct 2018

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Hemi-arthroplasty There has been 1 hemi - arthroplasty surgical site infections reported, from 147 procedures performed between January 2018 to end of October 2018, giving an SSI rate of 0.7%. Figure 11: Monthly SSI rate for Hemi arthroplasty surgery Jan 2015 to October 2018

NHSH 10 DAYS POST DISCHARGE CAESAREAN SECTION SSI ELECTIVE C-SECTION Elective C-Section There have been 5 C-section Surgical site infections reported, from 293 procedures performed between January 2018 to end of October 2018, giving an SSI rate of 1.7%. Figure 12: Monthly SSI rate for elective C Sections, Jan 2015 to October 2018.

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EMERGENCY C-SECTIONS Emergency C-Section There have been 9 C-Section Surgical site infections reported, from 286 procedures performed between January 2018 to end of October 2018, giving an SSI rate of 3.1%. Figure 13: Monthly SSI rate for emergency C Section, Jan 2015 to October 2018

A meeting with the Raigmore obstetricians has occurred and Dr Darren Thomas has agreed to lead on the C-section SSI improvement group which will review all relevant cases and ensuring learning is disseminated. Figure 14: shows the funnel plot of caesarean section (elective and emergency combined) SSI incidence (per 100 procedures) in inpatients and post discharge surveillance to day 10 of all NHS Boards in Scotland in Q3 2018. Created and published by Health Protection Scotland. NHS Borders and NHS Dumfries & Galloway overlap, as do NHS Orkney, NHS Shetland and NHS Western Isles

HG- NHS Highland

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RAIGMORE 30 DAYS READMISSION ELECTIVE VASCULAR SSI Vascular Surveillance became a mandatory requirement from Health Protection Scotland starting 1st April 2017. Only elective procedures are included in this standard surveillance which incorporates those who have undergone planned surgery, and those who are readmitted due to their previous surgery. Patients are monitored 30 days after their operation for infection as part of this mandatory surveillance. This type of surgery includes patients undergoing amputation due to limb ischaemia, and those undergoing surgery on arteries or veins. There have been 3 surgical site infections reported, from 104 procedures performed between January 2018 to end of October 2018, giving an SSI rate of 2.9%. Figure 15: SSI Rate following Vascular Surgery, April 2017 – October 2018

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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 of cases of Staphylococcus aureus blood stream infections and Clostridium difficile infections, as well as hand hygiene and cleaning compliance. In addition, there is a single report card which covers all community hospitals [which do not have individual cards], and a report which covers infections identified as having been contracted from outwith hospital. Understanding the Report Cards – Infection Case Numbers Clostridium difficile infections (CDI) and Staphylococcus aureus bacteraemia (SAB) cases are presented for each hospital, broken down by month. SAB cases are further broken down into Meticillin Sensitive Staphylococcus aureus (MSSA) and Meticillin Resistant Staphylococcus aureus (MRSA). For each hospital the total number of cases for each month, been reported as positive from a laboratory report, on samples taken more than 48 hours after admission. Understanding the Report Cards – Hand Hygiene Compliance Hospitals carry out regular audits of how well their staff are complying with hand hygiene. Each hospital report card presents the combined percentage of hand hygiene compliance with both opportunity taken and technique used broken down by staff group. Understanding the Report Cards – Cleaning Compliance Hospitals strive to keep the care environment as clean as possible. This is monitored through cleaning and estates compliance audits. Understanding the Report Cards – ‘Out of Hospital Infections’ CDI and SAB (including MRSA) bacteraemia cases are presented as ‘‘Out of Hospital Infections’ and are not attributable to a hospital. This section identifies those infections from community sources such as GP surgeries and care homes, and those from positive samples taken from patients within 48 hours. Abbreviations

SAB Definitions Definitions: Hospital acquired infection (HAI): Positive blood culture obtained from a patient who has been hospitalised for ≥48 hours. OR patient was transferred from another hospital, the duration of in-patient stay is calculated from the date of the first hospital admission. OR If the patient was a neonate/baby who has never left hospital since being born. OR The patient was discharged from hospital in the 48hr prior to the positive blood culture being taken. OR A patient who receives regular haemodialysis as an out-patient. OR Contaminant if the blood aspirated in hospital Healthcare associated infection (HCAI): Positive blood culture obtained from a patient within 48 hours of admission to hospital and fulfils one or more of the following criteria: 1. Was hospitalised overnight in the 30 days prior to the positive blood culture being taken. 2. Resides in a nursing, long term care facility or residential home. 3. IV, or intra-articular medication in the 30 days prior to the positive blood culture being taken, but excluding IV illicit drug use. 4. Regular user of a registered medical device e.g. intermittent self-catheterisation, home CPD or PEG tube with or without the direct involvement of a healthcare worker (excludes haemodialysis lines see HAI). 5. Underwent any medical procedure which broke mucous or skin barrier i.e. biopsies or dental extraction in the 30 days prior to the positive blood culture being taken. 6. Underwent care for a medical condition by a healthcare worker in the community which involved contact with non-intact skin, mucous membranes or the use of an invasive device in the 30 days prior to the positive blood culture being taken e.g. podiatry or dressing of chronic ulcers, catheter change or insertion. Community infection: Positive blood culture obtained from a patient within 48 hours of admission to hospital who does not fulfil any of the criteria for healthcare associated bloodstream infection. Not known: Only to be used if the SAB is not an HAI, and unable to determine if Community or HCAI.

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CDI definitions Definitions: Healthcare-associated CDI: a case with onset of symptoms on day three or later, following admission to a healthcare facility on day one, OR in the community within four weeks of discharge from any healthcare facility. This may apply to the current hospital or a previous stay in another healthcare facility, e.g. in another hospital, a long-term care facility or other healthcare facilities (e.g. outpatient departments etc.) Community-associated CDI: a case with [onset outside of healthcare facilities, AND without discharge from a healthcare facility within the previous 12 weeks] OR [onset on the day of admission to a healthcare facility or on the following day AND not resident in a healthcare facility within the previous 12 weeks] Unknown association: a case who was discharged from a healthcare facility 4–12 weeks before symptom onset

ADTC Area Drugs & Therapeutics Committee AMT Antimicrobial Prescribing Team

AMAU Acute Medical Admissions Unit CHP Community Health Partnership

CDI Clostridium difficile Infection CMO Chief Medical Officer

CNO Chief Nursing Officer CVC Central Venous Catheter

HEAT Health Improvement, Efficiency, Access, Treatment ECDC European Centre for Disease Prevention & Control

GDP General Dental Practitioner HAI Healthcare Associated Infection

HAI QIF Healthcare Associated Infection

Quality Improvement Facilitator

HAIRT Healthcare Associated Infection

Reporting Template

HPS Health Protection Scotland HSE Health and Safety Executive

JAG Joint Advisory Group HFS Health Facilities Scotland

CPE Carbapenemase-producing Enterobacteriaceae MRSA Meticillin Resistant Staphylococcus Aureus

PICC Peripherally Inserted Central Catheter MSSA Meticillin Sensitive Staphylococcus Aureus

PVC Peripheral Venous Catheter SAB Staphylococcus aureus Bacteraemia

PPI Proton Pump Inhibitor SPC Statistical Process Chart

RIDDOR Reporting of Injuries, Diseases & Dangerous Occurrences

Regulations 1995

Hemiarthroplasty: Operation to treat fractured hip (only involves half

of hip)

SHPN Scottish Health Planning Note SHTM Scottish Health Technical Memoranda

SICPs Standard Infection Control Precautions SAPG Scottish Antimicrobial Prescribing Group

IPCT Infection prevention & control team SPSP Scottish Patient Safety Programme

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NHS HIGHLAND REPORT CARD NHS Highland Staphylococcus aureus bacteraemia (SABs) monthly case

numbers

Dec 2017

Jan 2018

Feb 2018

March 2018

April 2018

May 2018

June 2018

July 2018

August 2018

Sept 2018

Oct 2018

Nov 2018

MRSA 0 0 1 0 0 0 0 0 0 0 0 0 MSSA 2 4 6 5 9 6 7 3 6 9 7 8 Total SABS

2 4 7 5 9 6 7 3 6 9 7 8

NHS Highland Clostridium difficile infection monthly case numbers

Dec

2017 Jan 2018

Feb 2018

March 2018

April 2018

May 2018

June 2018

July 2018

August 2018

Sept 2018

Oct 2018

Nov 2018

Ages 15-64

1 3 2 3 2 0 5 5 2 1 0 1

Ages 65 plus

8 6 7 7 9 8 4 2 5 1 6 3

Ages 15 plus

9 9 9 10 11 8 9 7 7 2 6 4

Hand Hygiene Monitoring Compliance (%)

-4

1

6

11

16

SAB's NHS Highland

MRSA MSSA Total SABS

-4

1

6

11

16C.difficile NHS Highland

Ages 15-64 Ages 65 plus Ages 15 plus

19

Dec 2017

Jan 2018

Feb 2018

March 2018

April 2018

May 2018

June 2018

July 2018

August 2018

Sept 2018

Oct 2018

Nov 2018

Board Total

93

99

96

96

97

96

99

96

97

96

97

95

AHP 97 92 99 97 99 97 99 99 99 94 96 98 Ancillary 87 94 90 93 96 95 99 94 96 97 98 98 Medical 90 93 95 95 93 92 97 96 92 94 94 87 Nurse 99 99 98 99 98 98 99 95 99 99 99 98 Cleaning Compliance (%)

Dec 2017

Jan 2018

Feb 2018

March 2018

April 2018

May 2018

June 2018

July 2018

August 2018

Sept 2018

Oct 2018

Nov 2018

Board Total

97

96

96

96

96

96

97

96

96

96

96

96

Estates Monitoring Compliance (%)

Dec

2017 Jan 2018

Feb 2018

March 2018

April 2018

May 2018

June 2018

July 2018

August 2018

Sept 2018

Oct 2018

Nov 2018

Board Total

98

97

97

96

98

97

97

96

96

96

96

96

20

NHS HIGHLAND RAIGMORE HOSPITAL REPORT CARD

Staphylococcus aureus bacteraemia (SABs) monthly case numbers

Dec 2017

Jan 2018

Feb 2018

March 2018

April 2018

May 2018

June 2018

July 2018

August 2018

Sept 2018

Oct 2018

Nov 2018


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

Clostridium difficile infection monthly case numbers

Dec 2017

Jan 2018

Feb 2018

March 2018

April 2018

May 2018

June 2018

July 2018

August 2018

Sept 2018

Oct 2018

Nov 2018

Ages 15-64

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

Ages 65 plus

5 2 3 1 2 1 0 2 1 0 2 1

Ages 15 plus

5 3 3 1 2 1 0 2 1 0 2 1


Dec 2017

Jan 2018

Feb 2018

March 2018

April 2018

May 2018

June 2018

July 2018

August 2018

Sept 2018

Oct 2018

Nov 2018

Total 95 93 93 92 95 98 96 97 87 93 95 95 AHP 94 80 95 89 94 100 95 100 93 90 89 97 Ancillary 96 89 89 86 87 96 95 97 90 90 98 92 Medical 91 93 91 90 88 94 95 93 67 93 96 93 Nurse 98 100 97 98 97 98 99 97 99 99 98 97 Cleaning Compliance (%)

Dec 2017

Jan 2018

Feb 2018

March 2018

April 2018

May 2018

June 2018

July 2018

August 2018

Sept 2018

Oct 2018

Nov 2018

94 95 95 94 94 95 94 95 94 94 94 95 Estates Monitoring Compliance (%)

Dec

2017 Jan 2018

Feb 2018

March 2018

April 2018

May 2018

June 2018

July 2018

August 2018

Sept 2018

Oct 2018

Nov 2018

Total 96 96 97 98 97 97 97 96 96 96 96 96

21

NHS HIGHLAND CAITHNESS GENERAL HOSPITAL REPORT CARD


Dec 2017

Jan 2018

Feb 2018

March 2018

April 2018

May 2018

June 2018

July 2018

August 2018

Sept 2018

Oct 2018

Nov 2018


0 0 0 0 2 0 0 0 0 0 0 0


Dec 2017

Jan 2018

Feb 2018

March 2018

April 2018

May 2018

June 2018

July 2018

August 2018

Sept 2018

Oct 2018

Nov 2018

Ages 15-64

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

Ages 65 plus

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

Ages 15 plus

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


Dec 2017

Jan 2018

Feb 2018

March 2018

April 2018

May 2018

June 2018

July 2018

August 2018

Sept 2018

Oct 2018

Nov 2018

Total 98 100 99 96 98 100 100 89 98 96 97 99

AHP 100 100 100 100 100 100 100 100 100 91 100 100 Ancillary 100 100 100 100 100 100 100 60 100 100 100 100 Medical 92 100 100 85 90 100 100 94 91 95 90 95 Nurse 100 100 96 100 100 100 99 100 100 97 97 100

Cleaning Compliance (%)

Dec 2017

Jan 2018

Feb 2018

March 2018

April 2018

May 2018

June 2018

July 2018

August 2018

Sept 2018

Oct 2018

Nov 2018

Total 94 96 95 95 97 94 95 94 95 94 95 95 Estates Monitoring Compliance (%)

Dec 2017

Jan 2018

Feb 2018

March 2018

April 2018

May 2018

June 2018

July 2018

August 2018

Sept 2018

Oct 2018

Nov 2018

Total 93 95 95 96 95 95 94 95 96 91 93 93

22

NHS HIGHLAND BELFORD HOSPITAL REPORT CARD


Dec 2017

Jan 2018

Feb 2018

March 2018

April 2018

May 2018

June 2018

July 2018

August 2018

Sept 2018

Oct 2018

Nov 2018


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


Dec 2017

Jan 2018

Feb 2018

March 2018

April 2018

May 2018

June 2018

July 2018

August 2018

Sept 2018

Oct 2018

Nov 2018

Ages 15-64

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

Ages 65 plus

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

Ages 15 plus

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


Dec 2017

Jan 2018

Feb 2018

March 2018

April 2018

May 2018

June 2018

July 2018

August 2018

Sept 2018

Oct 2018

Nov 2018


Dec

2017 Jan 2018

Feb 2018

March 2018

April 2018

May 2018

June 2018

July 2018

August 2018

Sept 2018

Oct 2018

Nov 2018


Dec 2017

Jan 2018

Feb 2018

March 2018

April 2018

May 2018

June 2018

July 2018

August 2018

Sept 2018

Oct 2018

Nov 2018

Total 99 99 99 99 97 100 99 98 99 98 97 100

23

NHS HIGHLAND LORN & ISLANDS HOSPITAL REPORT CARD


Dec 2017

Jan 2018

Feb 2018

March 2018

April 2018

May 2018

June 2018

July 2018

August 2018

Sept 2018

Oct 2018

Nov 2018


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


Dec 2017

Jan 2018

Feb 2018

March 2018

April 2018

May 2018

June 2018

July 2018

August 2018

Sept 2018

Oct 2018

Nov 2018

Ages 15-64

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

Ages 65 plus

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

Ages 15 plus

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


Dec

2017 Jan 2018

Feb 2018

March 2018

April 2018

May 2018

June 2018

July 2018

August 2018

Sept 2018

Oct 2018

Nov 2018

Total 100 100 98 100 100 97 97 100 96 98 94 98 AHP 100 100 100 100 100 100 100 100 97 100 100 94 Ancillary 100 100 100 100 100 88 100 100 100 100 91 100 Medical 100 100 90 100 100 100 88 100 88 94 90 100 Nurse 100 100 100 100 100 100 99 100 100 98 99 98


Dec 2017

Jan 2018

Feb 2018

March 2018

April 2018

May 2018

June 2018

July 2018

August 2018

Sept 2018

Oct 2018

Nov 2018


Dec

2017 Jan 2018

Feb 2018

March 2018

April 2018

May 2018

June 2018

July 2018

August 2018

Sept 2018

Oct 2018

Nov 2018

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

24

NHS HIGHLAND NORTH & WEST DIVISION COMMUNITY HOSPITALS REPORT CARD

The community hospitals covered in this report card include: • Dunbar Hospital, Thurso • Town & County Hospital, Wick • Lawson Memorial Hospital Golspie • Migdale Hospital, Bonar Bridge • MacKinnon Memorial Hospital, Broadford • Portree Hospital, Isle of Skye

Staphylococcus aureus bacteraemia monthly case numbers Dec

2017 Jan 2018

Feb 2018

March 2018

April 2018

May 2018

June 2018

July 2018

August 2018

Sept 2018

Oct 2018

Nov 2018


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

0 Clostridium difficile infection monthly case numbers Dec

2017 Jan 2018

Feb 2018

March 2018

April 2018

May 2018

June 2018

July 2018

August 2018

Sept 2018

Oct 2018

Nov 2018

Ages 15-64

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

Ages 65 plus

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

Ages 15 plus

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


Dec 2017

Jan 2018

Feb 2018

March 2018

April 2018

May 2018

June 2018

July 2018

August 2018

Sept 2018

Oct 2018

Nov 2018



Dec

2017 Jan 2018

Feb 2018

March 2018

April 2018

May 2018

June 2018

July 2018

August 2018

Sept 2018

Oct 2018

Nov 2018


Dec 2017

Jan 2018

Feb 2018

March 2018

April 2018

May 2018

June 2018

July 2018

August 2018

Sept 2018

Oct 2018

Nov 2018

Total 98 97 97 97 99 64 96 97 97 96 96 95

25

NHS HIGHLAND SOUTH & MID DIVISION COMMUNITY HOSPITALS REPORT CARD

The community hospitals covered in this report card include: • Ross Memorial Hospital, Dingwall • County Community Hospital, Invergordon • Royal Northern Infirmary Community Hospital, Inverness • Town & County Hospital, Nairn • Ian Charles Hospital, Grantown on Spey • St Vincent’s Hospital, Kingussie • For the purposes of monitoring New Craigs Psychiatric Hospital is included in this

report card. Staphylococcus aureus bacteraemia (SABs) monthly case numbers Dec

2017 Jan 2018

Feb 2018

March 2018

April 2018

May 2018

June 2018

July 2018

August 2018

Sept 2018

Oct 2018

Nov 2018


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

Clostridium difficile infection monthly case numbers Dec

2017 Jan 2018

Feb 2018

March 2018

April 2018

May 2018

June 2018

July 2018

August 2018

Sept 2018

Oct 2018

Nov 2018

Ages 15-64

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

Ages 65 plus

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

Ages 15 plus

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


Dec 2017

Jan 2018

Feb 2018

March 2018

April 2018

May 2018

June 2018

July 2018

August 2018

Sept 2018

Oct 2018

Nov 2018



Dec 2017

Jan 2018

Feb 2018

March 2018

April 2018

May 2018

June 2018

July 2018

August 2018

Sept 2018

Oct 2018

Nov 2018


Dec 2017

Jan 2018

Feb 2018

March 2018

April 2018

May 2018

June 2018

July 2018

August 2018

Sept 2018

Oct 2018

Nov 2018

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

26

NHS HIGHLAND ARGYLL & BUTE IJB COMMUNITY HOSPITALS REPORT CARD

The community hospitals covered in this report card include: • Argyll & Bute Hospital Lochgilphead • Campbeltown Hospital • Cowal Community Hospital, Dunoon, • Dunaros Community Hospital, Isle of Mull • Islay Hospital • Mid Argyll Community Hospital & Integrated Care Centre, Lochgilphead • Victoria Hospital, Rothesay

Staphylococcus aureus bacteraemia (SABs) monthly case numbers Dec

2017 Jan 2018

Feb 2018

March 2018

April 2018

May 2018

June 2018

July 2018

August 2018

Sept 2018

Oct 2018

Nov 2018


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


2017 Jan 2018

Feb 2018

March 2018

April 2018

May 2018

June 2018

July 2018

August 2018

Sept 2018

Oct 2018

Nov 2018

Ages 15-64

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

Ages 65 plus

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

Ages 15 plus

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


Dec 2017

Jan 2018

Feb 2018

March 2018

April 2018

May 2018

June 2018

July 2018

August 2018

Sept 2018

Oct 2018

Nov 2018


Dec 2017

Jan 2018

Feb 2018

March 2018

April 2018

May 2018

June 2018

July 2018

August 2018

Sept 2018

Oct 2018

Nov 2018


Dec 2017

Jan 2018

Feb 2018

March 2018

April 2018

May 2018

June 2018

July 2018

August 2018

Sept 2018

Oct 2018

Nov 2018

Total 98 96 97 96 95 75 96 97 96 96 96 96

27

NHS HIGHLAND OUT OF HOSPITAL REPORT CARD Staphylococcus aureus bacteraemia monthly case numbers Dec

2017 Jan 2018

Feb 2018

March 2018

April 2018

May 2018

June 2018

July 2018

August 2018

Sept 2018

Oct 2018

Nov 2018


2 3 6 4 7 6 5 1 4 6 5 6


2017 Jan 2018

Feb 2018

March 2018

April 2018

May 2018

June 2018

July 2018

August 2018

Sept 2018

Oct 2018

Nov 2018

Ages 15-64

1 2 2

3 1 0 4 5 2 1 0 1

Ages 65 plus

3 4 3 5 5 3 4 0 3 0 3 2

Ages 15 plus

4 6 5 8 6 3 8 5 5 1 3 3

highland nhs board 29 january 2019 item 4 · bacteraemia (sab) including mrsa. for nhs highland...

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