Summary for Submission of
Paper to the Trust Board
Paper No: NHST(13)022
Subject: Infection control report 1/1/2013 to date
Purpose:
The control of healthcare associated infections is of major public concern and is a top
priority for the Trust.
Summary: This report summarises the Trust performance since 1st January 2013.
Financial Implications:
Stakeholders: Patients, the public, staff and commissioners.
Recommendation(s): It is recommended that the Board note this report.
Review Date: June 2013
Author : Karen D Allen
Presenting Manager: Karen D Allen, Director of Infection Prevention & Control
Trust Board date: 27 March 2013
Infection Control update
27 March 2013
1. MRSA bacteraemia
1.1 Trajectory
The target for 2012-2013 is 3 cases or fewer. We have had 10 hospital-acquired
cases.
1.2 Root cause analysis (RCA)
Root cause analyses are undertaken for all hospital-acquired cases of MRSA
bacteraemia and these are reviewed at the Executive Team RCA Review meetings.
As part of the RCA, ward teams undertake action planning to address any issues
identified.
Sex Age Ward Source
RCA
Prior
MRSA
1
m
85
5B
Chronic wound
Failure to screen chronic wound on
No
admission. Staffing levels.
2
f
61
1D
IV line infection Line care issues. Staffing levels.
Yes
3
f
81
4C
4
5
f
f
91
39
5A
1B
6
f
84
3D
Post op chest
infection
IV line infection
Infected skin
lesions
Psoas abscess
7
f
76
1B
Cellulitis
8
m
58
3D
9
f
81
3C
83
1A
10 m
No pre-op MRSA suppression.
Yes
Yes
No
Chest infection
Line care issues. Staffing levels.
Failure to swab infected dermatitis on
admission.
Care plan did not address risk of
MRSA bacteraemia.
Inappropriate empirical Rx in known
carrier.
Blood culture contaminant.
Surgical wound
infection
Chest infection
Inappropriate empirical Rx in known
carrier.
Chest infection.
Yes
Yes
Yes
Yes
No
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Trust-wide actions have been taken to address all issues identified by RCA.
1.3 Current actions (in progress or recently completed)
1.3.1 ANTT (Aseptic non-touch technique) competency assessments for all clinical
staff: 58% recorded on ESR (Electronic staff record) (11/3/13). Some records have
not been submitted to ESR yet, so the competency rate is likely to be much higher.
1.3.2 ANTT nurse specialist (short term contract) is to be appointed (closing date
15/3/13).
1.3.3 NHS Institutes Sustainability Tool scores in 70s (must be over 55 for
sustainability). Lowest scoring areas addressed. Highest risk to sustainability is
staffing levels.
1.3.4 MRSA decolonisation treatment commenced promptly & appropriately for both
previously MRSA positive patients on admission as well as newly diagnosed MRSA
patients.
1.3.5 Interactive Antibiotic Policy is available on intranet. Working on production of
app for smartphones.
1.3.6 There are clear responsibilities for housekeeping duties in the absence of the
housekeeper.
1.3.7 Communication of cleaning provision out of hours. Audit of awareness
undertaken: 99% of 83 staff aware of procedures. A booklet for staff has been
produced by Medirest.
1.3.8 Medical staff engagement with appraisals to include infection control. Evidence
required.
1.3.9 Assurance on staffing levels.
1.3.10 Governance review.
1.3.11 Sharing of practice with well-performing Trusts.
1.3.12 Covert hand hygiene audits have continued on a monthly basis and there has
been an improvement in the rates of compliance.
1.3.13 Global health economy working.
2. CDT diarrhoea
The target for 2012-2013 is 37 cases or fewer. In 11 months there have been 31
cases.
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Root cause analyses are undertaken for all hospital-acquired cases of CDI and these
are reviewed at the Executive Team RCA Review meetings. The infection control
ward dashboard report is also reviewed at the meeting.
An audit of the use of proton pump inhibitors is in progress.
3. MSSA (methicillin-sensitive Staphylococcus aureus) bacteraemia
Jan-March 2012: 7 cases
Jan-Mar 2013: 3 cases (up to 14/3/13)
There has been a reduction in the number of cases compared with the same time
period last year.
Root cause analyses are undertaken for all hospital-acquired cases of MSSA
bacteraemia and these are reviewed at the Executive Team RCA Review meetings.
4. E coli
The numbers are similar to those for last year.
5. SSI
January-September 2012
Whiston rate National rate
(Infected/Total)
Hip replacement 1/213 (0.5%)
1.2%
Knee
4/249 (1.6%)
1.6%
replacement
6. Outbreaks
January
5C– MRSA – January 2013
5 patients
2 staff
Typing results: 4 patients plus 1 staff had same strain
2E- MRSA – January 2013
4 patients (babies).
2 parents: The father of index case and mother of the 3rd case were
colonised.
2 staff (unrelated strains)
The patient and parent strains were PVL (Panton Valentine Leukocidin) positive. This
strain circulates in the community (some association with Asian ethnicity or travel to
Asia) and seems usually to cause superficial, milder infections rather than severe or
invasive disease. A point source from the community and then onward transmission
is the most likely cause.
February
1A- MRSA – February 2013
2 patients
5 staff
Typing results: 1 patient and 3 staff with same strain.
1D- MRSA – February 2013
2 patients (different antibiograms)
2 staff
Typing results: 1 patient and 1 staff with same strain.
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7. Best practice technical guidance: Water sources and potential
Pseudomonas aeruginosa contamination of taps and water systems. DOH 31
March 2012.
Measures such as replacement taps, removing flow straighteners, guidance on
avoidance of contamination of the taps, daily flushing of taps and provision of sterile
water where indicated by risk assessment have been undertaken. The use of
halogen based biocide system is proposed for a trial period of 3 months. Two other
Trusts have had success with long-term eradication of Pseudomonas from water
supplies using this system.
Karen D Allen
Director of Infection Prevention & Control
14 March 2013
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