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  • Healthcare Associated Infection Bimonthly Report May 2015

    Section 1 Board Wide Issues

    Key Healthcare Associated Infection Headlines The Infection Prevention and Control Team are nearing the end of the first year of a an NHS

    Grampian wide programme of supported environmental audits. This programme was set up to support Senior Charge Nurses and Clinical Departmental Managers to carry out their environmental audits with support around applying consistent levels of scrutiny of cleaning and measuring compliance with standard infection control precautions (SICPs). Feedback to date has been extremely positive and an evaluation is planned prior to reviewing the audit tool (in light of the publication of the new HAI standards) and commencing the new audit cycle.

    230 NHS Grampian staff have registered for the 7th annual Infection Prevention and Control conference - Champions Challenged to be held at the Aberdeen Exhibition and Conference Centre on 23 June. Several international speakers have agreed to present including Professor Hugo Sax, Martin Kiernan and David Tucker alongside our locally respected Professor Rona Patey and our Lead Infection Prevention and Control Doctor, Anne Marie Karcher. More details can be found at www.eventsforce.net/championschallenged2015

    Work is nearing completion on the implementation of a surgical site infection (SSI) surveillance module of the current Infection Prevention and Control clinical management system (ICNet). This should increase automation of data collection of wound infections following Caesarian section, and hip and knee replacements (arthroplasties) and therefore increase capacity to carry out SSI surveillance for other surgical procedures.

    NHS Grampian has been asked to participate in an information gathering exercise around the

    time and resources to clean the bed space between patients by the national Equipment and Environment Decontamination Steering Expert Advisory Group. The group is particularly interested in the work done locally to pilot a bed response team and the challenges faced with implementing this.

    NHS Grampian are well represented on the national CPE Screening Working Group whose

    remit it is to support Boards with the implementation of a national CPE Screening Programme in line with Scottish Government Interim Guidance. This group has met twice and so far collected information on what Boards have in place now and also produced information leaflets for patients and healthcare workers.

    The Woodend Hospital HAI Group have established a robust system for reporting HAI risks and

    good practice from wards to the Board, via the Infection Control and Clinical Governance Committees.

    Another successful HAI awareness raising day was held in Mental Health and Learning Disability Services, organise by the MHLD HAI Group and supported by the Infection Prevention and Control Team, with fun activities for staff designed to maximise engagement in the infection control agenda.

    Actichlor Plus training sessions (how to clean with chlorine-releasing agent) continue and have proven to be very popular.

    This section of the HAIRT covers Board wide infection prevention and control activity and actions. For reports on individual hospitals, please refer to the Healthcare Associated Infection Report Cards in Section 2. A report card summarising Board wide statistics can be found at the end of section 1

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  • Staphylococcus aureus (including MRSA)

    Staphylococcus aureus Bacteraemia Surveillance Health Protection Scotland published their quarterly reports on the surveillance of Staphylococcus aureus bacteraemia (SAB) in Scotland, October - December 2014 on 7 April 2015. The following table and graphs demonstrate NHS Grampians rate of SABs compared with all other Boards in Scotland. NHS Grampian experienced average rates of S aureus bacteraemia in the most recent quarter and the fourth lowest rate of the mainland health boards. MRSA bacteraemia rates continue to be below the national average and MSSA bacteraemia rates slightly above. Each new case continues to be discussed at a weekly multidisciplinary team meeting involving Infection Prevention and Control Doctor(s), Infection Prevention and Control Nurses, Surveillance Nurse, Antimicrobial Pharmacist, Infection Unit Nurse and a microbiology registrar. If any issues are identified, a meeting is held with staff from the area concerned, and an SBAR is produced. A graph showing surveillance data from June 2005 (when this surveillance programme commenced) demonstrates a reduction in the rate of MRSA bacteraemia, no reduction in MSSA bacteraemias and therefore a The following measures have been put in place: Testing of a new system for providing feedback to clinical teams has commenced. Work has commenced on standardising paperwork for recording insertion and maintenance of

    peripheral vascular catheters (PVCs) across NHS Grampian.

    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:

    Staphylococcus aureus : http://www.nhs24.com/content/default.asp?page=s5_4&articleID=346

    MRSA: http://www.nhs24.com/content/default.asp?page=s5_4&articleID=252

    NHS Boards carry out surveillance of Staphylococcus aureus blood stream infections, known as bacteraemias. These are a serious form of infection and there is a national target to reduce them. The number of patients with MSSA and MRSA bacteraemias for the Board can be found at the end of section 1 and for each hospital in section 2. 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

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    http://www.nhs24.com/content/default.asp?page=s5_4&articleID=346http://www.nhs24.com/content/default.asp?page=s5_4&articleID=252http://www.hps.scot.nhs.uk/haiic/sshaip/publicationsdetail.aspx?id=30248

  • S aureus bacteraemia cases and incidence rates (per 100 000 Acute Occupied Bed Days): Q3 2014 (July to September 2014) compared to Q4 2014 (October to December 2014)

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  • S aureus bacteraemia cases and incidence rates (per 100 000 Acute Occupied Bed Days): 2013 compared to 2014

    The bold outline denotes statistically significant change from previous year.

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  • Funnel plot of SAB rates (per 100 000 AOBDs) for all NHS Boards in Scotland in Q4 2014

    Funnel plot of MRSA bacteraemia rates (per 100 000 AOBDs) for all NHS Boards in Scotland in Q4 2014

    Funnel plot of MSSA bacteraemia rates (per 100 000 AOBDs) for all NHS Boards in Scotland in Q4 2014

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    70 S aureus bacteraemia rates (per 100 000 acute occupied bed days)NHS Grampian

    mrsa_rate mrsa_lower_CI mrsa_upper_CImssa_rate mssa_lower_CI mssa_upper_CIsab_rate sab_lower_CI sab_upper_CI

    Clostridium difficile

    Clostridium difficile Infection Surveillance Health Protection Scotland also published their quarterly reports on the surveillance of Clostridium difficile infections (CDIs) in Scotland, October - December 2014 on 7 April 2015. The following tables and graphs demonstrate NHS Grampians rates of CDI compared with all other Boards in Scotland, with data broken down for age groups >65 years and 15-64 years. NHS Grampians total in-patient activity (including Community Hospitals) is the 4th highest in Scotland. In patients aged over 65 years, NHS Grampians rate of CDI has returned to below the average for the whole of Scotland following 2 quarters or being above average. NHS Grampians rate for 2014 has shown a statistically significant increase. In patients aged 15-64 years, the rate is considerably below average for both the Q4 and the year 2014. In Q4 NHS Grampian has the lowest rate of the all the mainland health boards and the second lowest for 2014. Graphs showing surveillance data from 2006 (patients over 65 years old) and 2009 (15-64 years old) demonstrate the downward trend in CDI rates over both age groups over time. As with S aureus bacteraemias, each new case is discussed at a weekly multidisciplinary team meeting involving Infection Prevention and Control Doctor(s), Infection Prevention and Control Nurses, Surveillance Nurse, Antimicrobial Pharmacist, and a microbiology registrar the Infection Unit Nurse is not present for the CDI case discussions. By close investigation of each case and typing of the organisms when indicated the Infection Prevention and Control Team is assured that the recent increase in infections is not due to any outbreaks.

    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. The number of pa

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