THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST
Board Paper - Cover Sheet
Report Title
Healthcare Associated Infections
(HCAI)
Lead Director
Nursing & Patient Services Director
Report
Author
Classification
Helen Lamont, Nursing and Patient Services Director
Ashley Price, Director of Infection Prevention and Control (DIPC)
NHS Unclassified
Purpose (Tick
one only)
Approval
Links to
Strategic
Objectives

Links to CQC
Fundamental
Standard(s)
Identified
Risk? (If yes,
risk
reference)

Decision
Agenda Item A5(i)
Information

To put patients and carers at the centre of all we do and to
provide care of the highest standard in terms of both safety
and quality
 To continue to be recognised as a first-class teaching
hospital, counted amongst the top 10 in the country, which
promotes a culture of excellence, in all that we do
Regulation 12, 15, 20
Yes, specified in Risk Register.
 Breaches of target
 Significant outbreaks have financial, reputational and
patient safety implications
Resource
Implications
Legal
implications
and equality
and diversity
assessment
Benefit to
patients and
the public
No additional resource implications
Report
History
This is a regular monthly update to the Board on Healthcare
Associated Infections (HCAI)
Next steps
To read, discuss and approve this paper
Failure to effectively control infections may lead to patient harm,
litigation against the Trust and loss of reputation.
There are no specific equality and diversity implications from this
paper.
Infection Prevention & Control is fundamental to providence and
safe, clean environment for patients, staff and visitors.
Agenda item A5(i)
THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST
HEALTHCARE ASSOCIATED INFECTIONS (HCAI)
EXECUTIVE SUMMARY
This paper summarises the Trust’s position in relation to HCAI and the external
targets at the end of December 2015, Month 9 2015/16.
There were eight C. difficile cases in December, bringing the total to date to 72
against a year-end target for 2015/16 of 77. 11 cases have been successfully
appealed and ten more are being considered. This significantly mitigates the
current position.
No further cases of MRSA bacteraemia were reported during December 2015.
One case from October has now been assigned as Third Party following
arbitration. This means that five MRSA cases are currently attributed to the Trust
so far in 2015/16 (7 reported minus 2 Third Party).
The staff seasonal flu vaccination campaign continues, with uptake of the vaccine
among frontline staff at a lower level compared with last year, at 52% this year
against 59% last year.
A significant amount of work continues to ensure that risks of HCAI are minimised
for the benefit of the patients and the Trust including Ward refurbishments on both
sites.
RECOMMENDATION
To (i) note the content of this report (ii) comment accordingly.
Mrs Helen Lamont
Nursing & Patient Services Director
Dr Ashley Price
Director of Infection Prevention and Control
14th January 2016
THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST
HEALTHCARE ASSOCIATED INFECTIONS (HCAI)
1.
INTRODUCTION
This paper provides the monthly report to the Board in relation to Healthcare
Associated Infections (HCAI) describing the progress against targets for the year,
and reporting the Trust’s position for the end of Month 9 (2015/16). The performance
is summarised in the Healthcare Associated Infection report at Appendix i.
2.
INFECTION UPDATE
(i)
MRSA Bacteraemia – (Target = Zero Tolerance)
No further cases of MRSA were reported during December 2015; the year to date
total is seven. One case from October has now been assigned as Third Party
following arbitration. This means that five MRSA cases are currently attributed to the
Trust so far in 2015/16 (7 reported minus 2 Third Party).
This year’s figure of five cases attributed to the Trust compares with three cases to
the end of December 2014. A new action plan to support reduction of
Staphylococcal infections is in development by the IPC Team.
(ii)
Clostridium difficile – (Target = 77)
The Board is aware that the Trust’s target has been set at 77 cases for the current
financial year.
In December, eight cases were identified, bringing the year-to-date total to 72 cases,
against a cumulative target of no more than 57.8 cases. However, taking into
account the 11 appeals, this means 61 cases for the year to date.
The graph below demonstrates this year’s performance when compared with the
number of cases last year, i.e. in 2014/15 taking into account the successful appeals
(65 as a year-end figure in 2014/15, rather than 89). At the same time last year, the
Trust had reported 46 cases of C. difficile by the end of December 2014, compared to
61 cases by the end of December 2015. Lessons learned from every case of C.
difficile are circulated to clinical staff via the Quarterly HCAI Reports and monthly
from the Serious Infection Review Meetings. A renewed focus on antibiotic
stewardship is also being led among the medical staff by a Consultant Microbiologist.
A new Take Five audit has now been implemented, requiring that five patients have
their antibiotics audited on every Ward each month. The IPC Operational Group is
reviewing the C. difficile Action Plan.
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C. diff 2014/15 & 2015/16 (minus succesful appeals)
90
80
70
60
50
40
30
20
10
0
(iii)
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
C. difficile 2014/15
5
9
13
17
21
27
36
40
46
54
64
Mar
73
Trajectory 2015/16
6.4
12.8
19.3
25.7
32.1
38.5
44.9
51.4
57.8
64.2
70.6
77.0
C. difficile 2015/16
2
4
8
15
23
29
38
53
61
MSSA
In November 2015 there were nine MSSA bacteraemias attributed to the Trust,
bringing the year-to-date total to 51 cases. This compares with 44 cases at the
same point in 2014/15.
In December 2015 there were eight MSSA bacteraemia attributed to the Trust,
bringing the year-to-date total to 59 cases. This is compared with 50 cases at the
same point in 2014/15.
There are currently no national targets for MSSA but the Trust continues to
monitor and report the numbers of MSSA bacteraemia. Root Cause Analysis
(RCA) is undertaken in cases where a Consultant Microbiologist feels there are
lessons to learn.
MSSA was a significant focus at the December 2015 IPC Operational Group
meeting and additional work and actions were agreed. A new Action Plan
identifies initiatives that have already been implemented over the last year and
also outlines future proposed actions. These include changes to the MSSA RCA
process. A revised RCA is awaiting approval and, once approved, will be
completed in all cases of Trust-acquired MSSA (defined as being identified more
than 48 hours after admission). .
(iv) E. coli
In November there were 20 E. coli bacteraemia attributed to the Trust, bringing the
year-to-date total to 112 cases. This is compared with 95 cases at the same point
in 2014/15. The numbers will continue to be monitored monthly by IPCC.
In December there were 17 E. coli bacteraemia attributed to the Trust, bringing the
year-to-date total to 129 cases. This is compared with 101 cases at the same
point in 2014/15. The numbers will continue to be monitored monthly by IPCC,
who are aware that the number of E. coli cases this year has increased when
compared with 2014/15.
2
A working group involving the Continence Team, IPC and staff from
Neurosciences and Musculoskeletal Directorates have developed a new document
to promote urinary catheter removal. This incorporates the urinary catheter care
plan and the HOUDINI framework (this is a protocol which allows the earliest
removal of a urinary catheter by Nurses). It is an acronym which reminds Nurses
why they should not remove a catheter. This has been approved by The Clinical
Records Advisory Committee (CRAC) and Trust-wide rollout is imminent.
As with MSSA, there are currently no national targets for E. coli but the Trust
continues to monitor and report their numbers. The primary source of each E. coli
bacteraemia is recorded by the Microbiology lab for information.
3.
ONGOING WORK
(i) Communication
Mandatory Training
In November, the IPC Mandatory Training figure was 87% and in December was
84.58% (this is subject to change as training data is currently being migrated
between systems and validation is not yet complete). There has been an overall
improvement in this figure since April 2015, when the figure was 69%.
(ii) Outbreaks
There were three outbreaks of diarrhoea and vomiting during December, one at
Freeman Hospital and two at the RVI. Norovirus was isolated from samples from one
of the Wards at the RVI, but in the other two Wards no causative organism was
identified.
There were three C. difficile periods of increased incidence (PIIs) in December,
involving two patients being positive on each of the three Wards. Meetings to
discuss these cases will take place and ribotyping will identify whether the cases
were linked.
Patient Services and the IPC Team were involved in managing these outbreaks,
which are now closed.
(iii) Flu Vaccination Campaign
This year’s flu campaign has now ended. It was delivered in partnership with Lloyds
Pharmacy.
At 24th December 2015, the vaccination uptake was 52% for frontline staff and 45%
for all staff, meaning that 4,350 vaccines have been administered to frontline staff so
far, and 6,619 in total. At the end of last year’s campaign, the uptake was higher, at
59% for frontline staff but was lower overall at 41%, with 5,184 vaccines delivered to
frontline staff and 6,352 in total.
3
The campaign has been successful in the following ways:







(iv)
Improved and greater accuracy in recording of flu vaccination statistics
Good coverage of clinics across the campaign – using the same location for dropin clinics gave a clearer message
More vaccines delivered than in previous years
Less impact on Newcastle OHS, in terms of nurse cover / phone calls and emails
into the department
Good marketing campaign simple and consistent message
Regular emails as to flu dates and location increased uptake
The use of lanyards for Peer vaccinators was positively praised by staff and
managers. It allowed staff to easily identify the peer vaccinators.
Flu Admissions
The Trust is beginning to see a rise in the number of admissions from flu, with eight
cases during the last week of December. Point of care testing is being undertaken in
Assessment Suite, which yields faster results than sending routine full respiratory
samples to the lab. A graph of Trust admissions for flu is below.
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4.
RISKS AND RISK MITIGATION
Risks relating to Infection Prevention and Control are monitored and managed on an
ongoing basis at the monthly Infection Prevention and Control Committee (IPCC) and
the IPC Operational Group, which now meets monthly. As well as the high-profile
work to minimise MRSA and C. difficile infections, the IPC Team works hard to
ensure that the Trust protects its patients from the threats posed by emerging
infections. A renewed focus on MSSA bacteraemia is now underway within the
Trust. All key infection risks are recorded on the Trust’s Risk Register, with the
person responsible being clearly identified, and the Register being regularly reported
at IPCC.
5.
SUMMARY
The current MRSA bacteraemia and C. difficile position continues to be a high priority
in relation to patient safety and the potential financial and reputational risks to the
Trust.
A significant amount of high profile Trust-wide work continues across all aspects of
IPC to protect the patients in the care of the Trust.
6.
RECOMMENDATION
To (i) note the content of this report (ii) comment accordingly.
Mrs Helen Lamont
Nursing & Patient Services Director
Dr Ashley Price
Director of Infection Prevention and Control
14th January 2016
5