Agenda item 7(ii)
THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST
COUNCIL OF GOVERNORS
HEALTHCARE ASSOCIATED INFECTIONS (HCAI)
EXECUTIVE SUMMARY
This paper summarises the Trust’s position in relation to the HCAI targets for the
year 2014/15 and also presents performance at the end of May 2015, Month 2
2015/16.
A final 10 C. difficile cases from 2014/15 were discussed at the Appeals Panel at
the beginning of June but a decision has not yet been made. These decisions will
have an impact on the total number of cases counted against the 2014/15 target.
There were three cases of C. difficile reported in May, against a year-end target for
2015/16 of 77.
Two cases of MRSA bacteraemia were reported during May, both of which were
attributed to the Trust.
A significant amount of work continues to ensure that risks of HCAI are minimised
for the benefit of the patients and the Trust.
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
10th July 2015
THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST
COUNCIL OF GOVERNORS
HEALTHCARE ASSOCIATED INFECTIONS (HCAI)
1.
INTRODUCTION
This paper is based upon 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 2 (2015/16). The performance
is summarised in the Healthcare Associated Infection report at Appendix i.
2.
INFECTION UPDATE
(i)
MRSA Bacteraemia – (Target = Zero Tolerance)
Two cases of MRSA were reported during May 2015, both of which were attributed to
the Trust. One case was from the RVI and the other from Freeman Hospital.
In the first case, the patient was screened as routine for MRSA on admission and
was found to be positive in carriage sites, topical eradication therapy was
appropriately commenced. The Rapid Review and Post Infection Review (PIR) have
revealed good Aseptic Non-Touch Technique (ANTT) practice when accessing lines.
Some minor issues were identified with documentation, antibiotic prescribing, posttreatment screening and transfer communication between wards. Further discussion
will take place at the Serious Infection Review meeting in late June.
The second patient tested positive from a sample taken on 31st May and therefore
investigations did not begin until the result was confirmed on 3rd June. At the time of
writing, there is insufficient information to draw any conclusions about the lessons
that can be learned from this case. A Serious Infection Review Meeting has been
scheduled for July.
(ii)
Clostridium difficile – (Target = 77)
Governors are aware that with the Trust’s target has been set at 77 cases for the
year ahead.
In May, only three cases were identified, bringing the year-to-date total to eight cases
against a cumulative target of no more than 12.8 cases.
The graph below demonstrates this year’s performance against the number of cases
last year, i.e. in 2014/15 before taking into account the successful appeals (89 as a
year-end figure in 2014/15, rather than 73).
1
C. diff 2014/15 & 2015/16
100
90
80
70
60
50
40
30
20
10
0
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
C. difficile 2014/15
6
13
20
27
33
40
50
55
62
70
80
Mar
89
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
5
8
 C. difficile Appeals
As previously noted, a total of 16 C. difficile cases have been upheld on appeal for
2014/15. A final 10 C. difficile cases from 2014/15 were discussed at the Appeals
Panel at the beginning of June but no decisions have been made yet, pending
further information which the Trust is providing. These decisions will have an
impact on the total number of cases counted against the 2014/15 target. One
case is being considered for appeal from the 2015/16 financial year so far.
3.
ONGOING WORK
(i) Communication
Mandatory Training
In April, compliance with IPC Mandatory Training was 69% for Level 1 and 70% for
Level 2. In both cases this is a reduction on previous months but part of this may be
because the system used to monitor training compliance is changing. IPC Mandatory
Training continues to be a priority for the Trust and compliance levels are monitored
on an ongoing basis. The need to improve IPC Mandatory Training compliance was
discussed in detail June’s IPCC, and will again be formally raised in the Clinical
Policy Group to ensure Clinical Directors are actively leading work to ensure
compliance.
(ii) Ebola Preparedness
Although the risk of receiving patients into the Trust has diminished considerably,
planning continues in order to ensure a legacy is left following all the work that has
been undertaken to assure ongoing preparedness.
Newcastle Hospitals will remain one of the centres to care for patients with Viral
Haemorrhagic Fevers and other Hazard Group 4 biological agents (these are
organisms which cause the most severe illnesses in humans, as defined by the
Health & Safety Executive). NHS England is currently undertaking a review of what
is required in England and Wales to maintain preparedness for these types of
infections.
2
4.
RISKS AND RISK MITIGATION
During April there was one outbreak of diarrhoea and vomiting at the RVI and one
Ward at Freeman which reported an increased incidence of diarrhoea and vomiting.
In both cases, Norovirus identified as the causative organism. Both Infection
Prevention & Control and Patient Services were actively involved in managing these
outbreaks.
5.
SUMMARY
The current MRSA bacteraemia and C. difficile situation 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
10th July 2015
3