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 September 2015, Month 6 2015/16.
There were seven C. difficile cases in September, bringing the total to date to 40
against a year-end target for 2015/16 of 77. Seven cases have been successfully
appealed and four more are being considered.
Two further cases of MRSA bacteraemia were reported during September, which
were attributed to the Trust. This means that five MRSA cases are currently
attributed to the Trust so far in 2015/16.
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
19th October 2015
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 6 (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 further cases of MRSA were reported during September 2015, both of which
were attributed to the Trust. This means that five cases are attributed to the Trust so
far in 2015/16.
The CCG-attributed case of MRSA from August has now been assigned as ‘Third
Party’ following review by NHS England (North). The Third Party category is used in
cases where the MRSA bacteraemia cannot legitimately be assigned to either the
CCG or the Trust.
In relation to the first of September’s Trust-acquired bacteraemia, a Post-Infection
Review meeting has taken place and this has been followed up with a Serious
Infection Review Meeting, which identified some learning needs in relation to
antibiotics, and that the patient was not always compliant with advice.
The second case of MRSA bacteraemia in September was identified in a different
area. As the case was identified at the end of the month, investigations are still
ongoing. The patient regularly attends as both an inpatient and day case at Freeman
Hospital along with other hospitals in the region. Initial investigations have
highlighted the patient has a history of MRSA colonisation.
(ii)
Clostridium difficile – (Target = 77)
The Board is aware that with the Trust’s target has been set at 77 cases for the year
ahead.
In September, 7 cases were identified, bringing the year-to-date total to 40 cases,
against a cumulative target of no more than 38.5 cases. Taking into account the 7
appeals, this means 33 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 before taking into account the successful
appeals (89 as a year-end figure in 2014/15, rather than 65). At the same time last
year, the Trust was in the same position as it had reported 40 cases of C. difficile by
September 2014.
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C. diff 2014/15 & 2015/16
100
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
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
14
23
33
40
C. difficile Appeals
Of the 40 cases reported so far in 2015/16, 7 cases have been successfully
appealed, with a further 4 being considered for appeal. This brings the total
counted against the target to 33 cases.
MSSA
In September there were again 9 MSSA bacteraemia attributed to the Trust,
bringing the year-to-date total to 39 cases. This is compared with 32 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.
(iv) E. coli
In September there were 14 E. coli bacteraemia attributed to the Trust, bringing
the year-to-date total to 75 cases. This is compared with 75 cases at the same
points in 2014/15. The numbers will continue to be monitored monthly by IPCC.
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 September, compliance with IPC Mandatory Training was 80%. There are now
seven bespoke programmes to cater for the needs of different staff groups and each
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staff member is allocated their appropriate programme; the above compliance rate
reflects the combined scored for all seven.
IPC Mandatory Training continues to be a priority for the Trust and compliance levels
are monitored on an ongoing basis.
(ii) Outbreaks
During September there was one outbreak of diarrhoea and vomiting at the RVI. The
ward was temporarily closed to admissions resulting in 43 bed days lost, norovirus
was identified as the causative organism.
(iii) Flu Vaccination Campaign
The ‘flu campaign’ was launched on Monday 28th September. The delivery of the
campaign is in partnership with Lloyds Pharmacy.
Over the first week approximately 900 vaccines have been administered by Lloyds
and Trust Peer vaccinators via sessions on pre-determined Wards or at defined dropin clinics.
The service has been well received. Daily debrief meetings between key members of
the Trust’s flu team and the Lloyds contractors means that the Trust is continuing to
deliver an improved and efficient service. Vaccination uptake rates will be reported to
Board starting in November.
(iv) C. difficile Campaign
Throughout September the IPCNs have visited wards with interactive activities to
raise awareness and promote the new eRecord C. difficile documentation, as part of
the planned C. difficile Campaign. The roadshows have been Ward-based to
encourage clinical staff attendance. To enhance staff participation, the campaign
has been extended for an additional month and will continue throughout October.
Within Care of the Elderly there is some focused work with link staff to promote best
practice in relation to diarrhoea management to support staff in identifying risk factors
to prevent occurrence of C. difficile.
(v) MERS-CoV
MERS-CoV (Middle East Respiratory Syndrome Coronavirus) is an emerging
international threat with recent outbreaks occurring in Middle East countries and
South Korea.
National guidance is currently available on the assessment and management of
MERS-CoV and the Trust management flow chart can be found on the intranet.
More detailed Trust guidance for the management of this and other highly pathogenic
respiratory organisms is in development.
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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 IPCC and the IPC Operational Group, which meets
twice a month. 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. 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
19th October 2015
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