MEETING
NHS CUMBRIA TRUST BOARD
DATE
5 October 2011
AGENDA ITEM
10.1
TITLE OF REPORT
INFECTION PREVENTION & CONTROL REPORT
BOARD ACTION
REQUESTED
FOR INFORMATION
EXECUTIVE SUMMARY
The prevention of healthcare associated infections continues to be a challenge and it
is therefore important to keep up the momentum and continue to reduce the levels of
infection. Particular areas of work include;


Reducing rates of Clostridium difficile associated diarrhoea. The Infection
Prevention Team is supporting primary care in reducing the prescribing of
antibiotics.
Training for care home and care agency staff. The Infection Prevention Team is
supporting both Cumbria Care and Care Sector Alliance Cumbria in developing
and delivering training programmes for care staff.
Currently NHS Cumbria performance in the prevention of health care associated
infection is good. NHS Cumbria is below the trajectory set by the SHA for both MRSA
bacteraemia and Clostridium difficile associated diarrhoea.
What are the implications for the following:Financial
Management of infection control is integral to current working
implications
practices
Risk
assessment
and mitigation
Need to replace the surveillance system.
(include risk
register reference
if appropriate)
Legal
There are legal duties to the PCT (both as commissioner and
provider) under the Health Act (2008)
Workforce
Equality and
Diversity
Infection Prevention and Control is part of all Cumbria PCT staff
job descriptions.
There should be sufficient training to overcome any cultural and
communication barriers.
Public
engagement
This paper is presented to the Board in a Public meeting for
Information.
Partnership
Partnership working must be supported across the whole Health
NHS CUMBRIA INFECTION PREVENTION REPORT SEPTEMBER 2011
1
Economy in Cumbria and close links between commissioners,
providers and the Health Protection Agency must be fostered
Communication This report will be publicised on the PCTs website
State where this paper has been discussed or agreed prior to the Trust Board
i.e. committees etc
This paper has been prepared by PCT and Acute Trust staff.
What are the next steps?
The recommendations in this paper will be taken forward through Cumbria Infection
Prevention Steering Group
Public Engagement Matrix
Level
Evidence
Please Tick
() as
appropriate
Information
Giving
Sharing of
information
in order to
increase
awareness
Consultation
People’s views
and/or
experience
sought and
taken into
account
Community
Involvement
Mechanisms
in place in
order to
secure lay
participation

Capacity
Building
Skills/knowledge/
resources being
transferred to
support
community or
condition groups
etc
Empowerment
Partnership or
other
agreement with
accountability
transfer

Which Cumbria PCT objective does
this paper support?
Insert
Tick
()
To work with others to improve health
for the people of Cumbria

To make best use of all available
resources

To achieve core standards and targets

Reference or Standard number,
eg, Standards for Better Health
Core Standard – Infection Control
(if appropriate)
Core standard – infection control
Director Sponsor
Prof John Ashton, Director of Public Health
Presented By
Dr Nigel Calvert, Associate Director of Public
Health
Dr Nigel Calvert nigel.calvert@cumbriapct.nhs.uk
Contact Details
NHS CUMBRIA INFECTION PREVENTION REPORT SEPTEMBER 2011
2
Infection
Report
Prevention
and
Control
September 2011
NHS CUMBRIA INFECTION PREVENTION REPORT SEPTEMBER 2011
3
Introduction
This report aims to inform NHS Cumbria Board of current issues in infection prevention and
control and to report on progress for the period June – August 2011.
NHS Cumbria has a key role in implementing and monitoring improvements in infection
prevention and control across Cumbria as its role is to:


Commission services from healthcare providers for its local population.
Commission general medical services: including General Practices, NHS Dentists,
Optometrists and Community Pharmacists.
This report covers services commissioned by the PCT.
HEALTH PROTECTION – INFECTION PREVENTION & CONTROL TEAM
NHS Cumbria Infection Prevention and Control function sits within Health Protection in Public
Health. The Government’s publication Healthy Lives, Healthy People: our strategy for public
health in England sets out the transfer of public health to Local Authorities, as it stands this
includes the local Health Protection Team incorporating infection prevention and control.
The Team is as follows:

Associate Director of Public Health – Health Protection

0.8 Senior Health Protection Nurse

0.8 Health Protection Nurse
Intelligence
Surveillance
Clostridium difficile associated diarrhoea (CDAD)
NHS Cumbria is below the trajectory set by the Strategic Health Authority (SHA) for the
number of cases of CDAD. However, in June 31 patients were reported as suffering CDAD.
This caused concern as we would need to go back to March 2010 to see more cases reported
in a one month period.
The cases in June were broken down as follows:




7 apportioned to UHMBT (Cumbria residents);
7 apportioned to NCUHT;
1 apportioned Blackpool (Cumbria resident)
16 apportioned as GP/pre 48 hour (1Cumb Partnership)
NHS CUMBRIA INFECTION PREVENTION REPORT SEPTEMBER 2011
4
The following information is a summary of the issues & the actions that have been put in
place.
GP/pre 48 hour cases
The data collected following each report showed that patients had either had a recent stay in
hospital or had been prescribed antibiotics appropriately. 2 patients were seen by the same
GP; however, one of these patients was not prescribed antibiotics. The Associate Director of
Public Health – Health Protection and a Consultant Microbiologist visited this GP to discuss
antibiotic prescribing. 4 other practices have been visited by the same professionals to
discuss antibiotic prescribing. Training has also been arranged to take place during practices
Protected Learning Time. The increase in community cases may be linked to the periods of
increased incidence * at the acute trusts as detailed below.
University Hospital of Morecambe Bay NHS Trust (UHMBT)
A Norovirus outbreak (OB) at Furness General Hospital (FGH) UHMBT during June resulted
in some increased testing, but this did not explain all of the increased in case numbers.
There were 6 reports of CDAD at FGH and 1 case at Westmorland General Hospital (WGH).
No new emerging themes were found from the collection of data. A period of increased
incidence* investigation was undertaken at FGH. A ward that has increased isolation
occupancy is available to care for patients suffering CDAD at FGH.
North Cumbria University Hospitals NHS Trust (NUCHT)
Periods of increased incidence* were declared on 3 wards on the Carlisle site. Actions
included: a deep clean of the affected wards and a major redesign on one ward which is
ongoing to remedy some of the issues identified.
*A period of increased incidence (PII) of CDAD: two or more new cases (occurring more
than 48 hours post admission, not relapses) in a 28-day period on a ward. (DH 2009
clostridium difficile infection: How to deal with the problem)
The number of patients reported as suffering the infection in July fell to 16.
MRSA Bacteraemia
The SHA trajectory for Cumbria for 2011 – 2012 is 12. Up to the end of July 4 patients have
been reported as suffering a MRSA bacteraemia. Root cause analyses have been conducted.
All of these patients’ infections with the exception of one were apportioned to care in the
community. Two patients received community nursing care in their own home and one patient
lived in a care home. The fourth patient’s report was apportioned to UHMBT but following a
root cause analysis was agreed to be as a result of a contaminated sample in that the patient
was not suffering MRSA bacteraemia.
Extension of surveillance
As from January 2011 there is a mandatory requirement for all NHS acute trusts to report
Meticillin Sensitive Staphylococcus aureus (MSSA) bacteraemia. Mandatory surveillance was
also extended to E. coli bloodstream infections from 1 June 2011. This extension reflects the
zero tolerance approach that the Government have made clear that the NHS should adopt for
NHS CUMBRIA INFECTION PREVENTION REPORT SEPTEMBER 2011
5
all Healthcare Associated Infections (HCAIs), while recognising that not all MSSA
bacteraemia are HCAIs.
In terms of expectations over the remainder of 2011-12, with MSSA and E.coli bloodstream
infections, the Department of Health requests that commissioners, providers and those
involved in performance management, focus initially on ensuring comprehensive compliance
with this extension of mandatory surveillance. Once the mandatory data reporting has been
embedded and there is a robust baseline established on those E. coli infections and MSSAs
that are healthcare associated, the Department of Health have stated that organisations will
wish to consider what additional interventions could be introduced to minimise these
infections.
Wider Measures
Cumbria Infection Prevention Steering Group
The first meeting of the Cumbria Infection Prevention Steering Group took place in June. The
aim of this Group is to ensure that sustained, reduced rates of Health-care associated
infection (HCAI) are evident across the whole health economy by implementing measures
that are known to be effective. The objectives of the Group include:




Strategic direction
Advice & support
Overview of HCAIs
Work projects
Those with roles in Infection Prevention including: Directors if Infection prevention and
Control; specialist nurses, microbiologists and pharmacists from the three Cumbria NHS
Trusts are members of the Group, along side GPs, representatives from the Health Protection
Agency and Cumbria County Council Adult Social Care. The Care Quality Commission (CQC)
also has a role in this Group and CQC representatives will be attending the next meeting.
Care homes and care agencies
The Team continues to link with Cumbria County Council by way of both Cumbria Care (CC)
and Care Sector Alliance Cumbria (CSAC) with regard to training and support. CSAC
arranged 4 half day infection prevention training sessions across the county. The Infection
Prevention Team delivered the training. 38 organisations were represented and 78 carers
attended.
We will be delivering training sessions with Cumbria Care for that organisation’s Infection
Prevention Link Workers in the autumn. .
A self assessment audit tool was distributed to all care homes in Cumbria. The aim of this
audit was to assist Nursing and Residential Care Home establishments to identify good,
acceptable and poor aspects of their environment and practice in the context of infection
prevention and control. A further aim was to inform future training and resource needs for
their organisation and also to form part of their overall clinical governance. The closing date
for return has passed but audits continue to be submitted. A response rate of more than 60%
has been achieved so far. Results are being analysed and will be reported at a later date.
NHS CUMBRIA INFECTION PREVENTION REPORT SEPTEMBER 2011
6
Current Picture of Healthcare-Associated Infection in
Cumbria
The graphs below show the number of MRSA bacteraemia infections and the number of
Clostridium difficile infections that have been reported by North Cumbria University Trust
(NCUHT) and University of Morecambe Bay NHS Trust (UHMBT). The last two graphs show
total figures for MRSA bacteraemia and Clostridium difficile for the residents of Cumbria.
North Cumbria University Hospitals NHS Trust (NCUHT)
MRSA bacteraemia
No MRSA bacteraemias have been apportioned to NCUHT.
Clostridium difficile
The graph below shows the number of cases apportioned to NCUHT
CDiff Cases NCUHT
25
20
15
Actuals
Trajectory
10
5
0
Apr-11
May-11
Jun-11
Jul-11
University Hospitals of Morecambe Bay NHS Trust (UHMBT)
MRSA bacteraemia
The graph below shows infections that have been reported by UHMBT laboratory. The graph
shows the cases apportioned to the acute trust and also cases apportioned as non-acute, that
is care they received in the community.
(The figures below include patients resident in North Lancashire).
NHS CUMBRIA INFECTION PREVENTION REPORT SEPTEMBER 2011
7
MRSA Cases Reported by UHMBT
3
2
1
0
Apr-10
May-10
Jun-10
Jul-10
Acute
0
2
0
0
Non-Acute
1
0
0
0
Aug-10
Sep-10
Oct-10
Nov-10
Dec-10
Jan-11
Feb-11
Mar-11
Clostridium difficile
CDiff Case Reported by UHMBT (Cumulative)
25
20
15
Actuals
Trajectory
10
5
0
Apr-11
May-11
Jun-11
Jul-11
NHS Cumbria
The SHA trajectory for Cumbria for 2011 – 2012 is 12. Up to the end of July 4 patients have
been reported as suffering a MRSA bacteraemia.
All of these patients’ infections with the exception of one were apportioned to care in the
community.
NHS CUMBRIA INFECTION PREVENTION REPORT SEPTEMBER 2011
8
MRSA bacteraemia
NHS Cumbria Commissioner MRSA
3
2
1
0
CPCT
Apr-10
May-10
Jun-10
Jul-10
2
1
0
1
Aug-10
Sep-10
Oct-10
Nov-10
Dec-10
Jan-11
Feb-11
Mar-11
Clostridium difficile
(The figs below include residents of Cumbria who suffered the infection out of the area of
Cumbria i.e. in another PCT area). The trajectory set by the SHA for April 2012 – March 2013
is 243.
PCO CDiff Infections Breakdown (Cumulative)
100
Not Set
Other
80
Not Know n
Penal Establishment
60
GP/Pre 48 Hour
Residential Home
40
Nursing Home
Private Hospital
20
CPFT (PCT Hospital)
Acute Hospital
0
Apr-11
May-11
Jun-11
Jul-11
Conclusion
This report has described the current situation with regard to healthcare associated infections
up to the beginning of August. The report also describes work that is underway with the
independent sector to facilitate a sustained reduction in infections.
NHS CUMBRIA INFECTION PREVENTION REPORT SEPTEMBER 2011
9
As stated earlier, NHS Cumbria performance is good. NHS Cumbria is below the trajectory
set by the SHA for both MRSA bacteraemia and Clostridium difficile associated diarrhoea.
NHS CUMBRIA INFECTION PREVENTION REPORT SEPTEMBER 2011
10
TRUST BOARD
5 OCTOBER 2011
AGENDA ITEM: 10.1
Contact details:
Name: Nigel Calvert
Address: PCT HQ
Tel: 07920467372
Email: nigel.calvert@cumbriapct.nhs.uk
Web:
11
NHS Cumbria