Quality care – for you, with you

REPORT SUMMARY SHEET

Meeting: Date:

Trust Board 31st August 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

High level context: C. difficile infections: 2016/17 34 cases 2017/18 target from PHA 31 cases 1st April-18th August 2017 16 cases (none linked) MRSA bacteraemia: 2016/17 6 cases (0 preventable) 2017/18 target from PHA 4 cases 1st April-18th August 2017 1 case (1 preventable) MSSA bacteraemia: 2016/17 58 cases PHA does not set a target for MSSA bacteraemia, 1st April-18th August 2017 17 cases (1 preventable)

Summary of SMT challenge/discussion:

Need for sustainable solutions to medical workforce issues – consideration for cross-

Trust working, and provision of clinical scientist

Constant challenge of C. Diff given increasingly elderly population – need for

increased anti-microbial surveillance activities

Water Safety report and recommendations have now been completed – need to

ensure prioritised recommendations are completed

Internal/External engagement: HCAI Strategic Forum met on 5th July 2017. Next meeting due to be held 4th October 2017 HCAI Clinical Forum next due to meet 30th August 2017

TABLE OF CONTENTS

1 HCAI Performance 2016/17 (Year to Date August 2017) ……3

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

3 IPC Independent Audit Activity ............................................. 9

1 HCAI Performance 2016/17 (Year to Date August 2017)

HCAI PfA targets for 2016/17 have been confirmed by the Public Health Agency [PHA] as:

4 MRSA bacteraemias &

31 C. difficile cases.

Trust Board are asked to 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.

Southern Trust Performance MRSA bacteraemia 2017/18

2017/18 year to date (August 2017) there has been 1 MRSA bacteraemia - considered to be preventable.

Southern Trust MRSA Episodes Cumulative

Total – 1st

April 2017 – 18th

August 2017

Southern Trust Performance Clostridium difficile 2017/18

2017/18 year to date (August 2017) there have been 16 C. difficile cases.

Southern Trust Clostridium difficile Episodes Cumulative

Total – 1st

April 2017 – 14th

August 2017

Southern Trust Performance MSSA bacteraemia 2017/18 (Year to date August 2017)

For 2017/18 surveillance of MSSA bacteraemias remains mandatory ONLY within the SHSCT.

To facilitate on-going surveillance of MSSA bacteraemias during 2017/18; MSSA target data for 2017/18 is used as a comparison.

Year to date (August 2017) there have been 17 MSSA cases.

To date 1 has been identified as preventable.

Southern Trust MSSA Episodes Cumulative

Total – 1st

April 2017 – 14th

August 2017

2 Update on Infection Prevention & Control Issues

Clostridium difficile infection (CDI) in SHSCT

From 1st

April to 18th

August there have been 16 cases of CDI in the SHSCT.

The number of CDI cases in the first 5 months is unusually high with 16 cases of CDI and to this regard

the IPCT continue to work very closely with the clinical staff across the Trust. In June 2017 we had 4 cases

and following a thorough investigation there would appear to be no link between the cases. Diligent pro-

active guidance, support and energy continue to be offered to clinical staff from the IPCT.

The complex needs of patients today make CDI incidence a challenge for Trusts; however, in the SHSCT

we continue to perform well within the UK. Continued collaborative working between IPCT, Senior

Management and clinical staff is critical to help sustain good IPC practices.

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 CDI cases 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.

It should also be recognised that as well as CDI cases being diagnosed some clinical areas across the

Trust have had several months ‘CDI Free’. Some wards are more likely to have patients diagnosed with

CDI and others are less likely. However, in some cases we have had wards who have had no CDI cases

for 20 months. Celebrating success in relation to this is important.

SHSCT /RQIA Augmented Care Audit Programme

A revised model of working now exists between augmented care ward sisters and charge nurses and the

IPCNs. Each IPCN works with their identified augmented care area to help progress, support and nurture

standards as they relate to IPC.

In addition to working with individual areas quarterly meetings will now be scheduled to meet collectively

for the purpose of supporting each other and promoting shared learning.

Regular updates on the Trust IPC augmented care action plan and progress will be given by IPCT at the

SHSCT HCAI Clinical Forum (monthly) and HCAI Strategic Forum (every 3 months). The lead IPCN will

also give regular feedback on progress to the Medical Director as required.

Presently Delivery Suites and SCBU are listed as augmented care areas. No other Trust have identified

these areas as augmented care and it has been requested by IPCT for senior management to agree to no

longer include Delivery suites & SCBU as augmented care. This will be ratified and agreed at the next

HCAI Strategic Forum on the 4th October 2017.

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.

Following a successful recruitment drive, the IPC nursing workforce issues have now been resolved in that we now have a Lead IPCN plus 8 IPCNs (Band 6 & 7) which equates to 7.4 WTE and this does not include 0.6 WTE IPCN presently on a career break. Given that the team has a number of new recruits it is important to recognise that time, opportunity and resource needs to be identified to ensure the team are trained and mentored to meet the challenges of working within this team. Available courses and training are limited in NI. The senior IPCNs will continue to train, educate and develop junior nurses but seeking opportunity to equip new recruits with the necessary knowledge and skills to do the job is essential.

IPC Consultant Microbiologist, SHSCT

SHSCT continue to provide a service with 1 full-time permanent consultant microbiologist who is

supported by a locum consultant microbiologist. Workload is significant and the Medical Director is fully

briefed as to the challenges this brings to the team.

Norovirus & Influenza Update

Regionally

One outbreak presently in private nursing home D & V [? Norovirus]

No Influenza outbreaks regionally at present

Trust Facilities

Influenza

We currently have no Influenza outbreaks within the SHSCT.

Norovirus

We currently have no Norovirus outbreaks within the SHSCT

Community ‘HALT’ Study 2017

The SHSCT will be taking part in a major European study facilitated by the Public Health Agency (PHA).

IPCT will lead on this and it is called the “HALT 2017” - Point Prevalence Survey of Healthcare Associated

Infections and Antimicrobial use in Long Term Care facilities. A similar survey was completed in 2013 and

involves the residential care homes within the Trust. This is taking place in mid-September 2017 and a

report will become available in due course following completion.

Point Prevalence Survey (PPS) 2017 - Healthcare Associated Infections and

Antimicrobial Use in Trust Hospitals in Northern Ireland

As indicated by Deputy CMO, the Public Health Agency is co-ordinating the Point Prevalence Survey

(PPS) of Healthcare Associated Infections and antimicrobial use in acute hospitals in Northern Ireland

during 2017.The SHSCT has taken part in this major European study in June 2017 facilitated by the PHA.

This was completed as a result of fabulous collaborative working between the IPCT, clinical staff and the

PHA.

A report will be available in due course.

Water Safety

The Independent Water Safety Consultant Dr Lee is now complete. There are a significant number of

recommendations that are required to be considered, discussed, prioritised and implemented. Members of

the SHSCT Water Safety Group will lead on this and update accordingly.

Ebola Management Plan

Following recent agreement on outstanding issues, the Trust Ebola Management Plan is scheduled for

completion by the end of September, with a walk through to test this plan scheduled for December 2017.

SHSCT IPC Training/Education

A ‘blended’ learning approach is the focus for mandatory IPC training with information leaflets, e-learning

and face to face teaching methods. IPC mandatory training has not been revisited or refreshed for 10

years and IPCNs within the SHSCT have worked closely regionally with colleagues to help create the

blended IPC training matrix. This involved 18 months of collaborative working with colleagues in other

Trusts and ELD. The IPC training matrix was launched in SHSCT on the 29th June 2017 and has been

implemented across the Trust. We are leading the way with this initiative and have forwarded an

application for poster presentation at the Trusts Quality Awards 2017.

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 beneath the 90% 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