Item 11 – Infection control HCAI update - East and North Herts NHS ...

Agenda item: 11Trust BoardHCAI performance reportJune 25, 2008Noel ScanlonDirector of Infection prevention & Control / Director of NursingHelen O’ConnorNurse consultant / Asst. Director of Infection prevention & ControlJames QuinnMedical DirectorLorane FitchLead Doctor, Infection controlKevin HazelwoodAntimicrobial pharmacist

MRSA target & performance 2008/9MRSA bacteraemia incidence* v. target100No. of M RSA bacteraem ias90807060504030201002001 / 02 2002 / 03 2003 / 04 2004 / 05 2005 / 06 2006 / 07 YTD 2007/8 target 2008/9Target 0 0 56 48 39 31 22 21Actual 72 86 56 50 56 53 33 9YearTargetActualInfectionsin year todate Jun 2,2008UNVALIDATED2MRSA/HCAI report to Board

Monthly performance vs Recovery trajectory 2008/9Cases M RS A Bacteraem ia876543210Incidence v recovery trajectory MRSA BacteraemiaE&N Herts NHS Trust 2008/9Apr May June July Aug Sept Oct Nov Dec Jan Feb MarMonthPost 48 hourPre 48 hourPost 48 hour Pre 48 hour Trajectory 2008/93MRSA/HCAI report to Board

MRSA bacteraemia rates v cumulative trajectoryCumulative incidence v Cum. trajectory MRSA Bacteraemia E&N Herts NHS Trust 2007/82520Cases MRSA Bacteraemia151050Apr May June July Aug Sept Oct Nov Dec Jan Feb MarCum Post 48h specimens 2 6Cum Specimens (all) 2 9Cum Trajectory 2 4 6 8 10 12 14 16 18 19 20 21Month4Source: Unvalidated HPA Mandatory enhanced surveillance scheme MESS data Dec 3, 2007MRSA/HCAI report to Board

MRSA Monthly 2006 / 2007 and 2007/8No of Patients1086420MRSA Bacteraemia2006 20072008 % reduction800%700%600%500%400%300%200%100%0%-100%-200%Jan Feb M ar Apr M ay Jun Jul Aug Sep Oct Nov Dec2006 6 3 8 3 2 4 4 3 1 4 7 92007 4 4 8 5 2 5 2 1 1 3 4 32008 0 2 5 2 7% reduction 100.0% 50.0% 0.0% -66.7% 0.0% -25.0% 50.0% 66.7% 0.0% 25.0% 42.9% 66.7%% Reduction from 20065Source: HPA Mandatory Bacteraemia Surveillance Scheme and PCT Local Delivery Plans PROVISIONAL UNVALIDATED DATA*MRSA/HCAI report to Board

MRSA Bacteraemias April – May, 2008Incidence & PrevalenceMRSA Bacteraemia 2007-8Not Set3%Trauma &orthopaedics6%Nephrology12%ICU9%Geriatric medicine15%HDU6%Cardiology6% Colorectal surgery6%Gastroenterology3%General surgery9%General medicine25%No. MRSA +ve Blood cultures876543210MRSA Bacteraemia by speciality Apr-May 2008Nephrology, 2AprilA&E QEII, prev.Lister 8BBarley x2Stanborough,10BNKnebworth,5AMonthUrology, 1Geriatricmedicine, 4Generalmedicine, 2May6MRSA/HCAI report to Board

Clostridium difficile incidence 2004/5 to date*v targets 2007/8 and 2008/9700600563 574500400300200356414183C DiffincidenceTrack linetargetNew track line2008/9 targetLinear (Trackline target)10002005/6 2006/7 2007/8* 2008/9 2007/8Target282008/9Target7*ytd May 31, 2008 unvalidatedMRSA/HCAI report to Board

Priorities‣ Peripheral line care‣ MRSA screening‣ Care bundle compliance – documentation‣ Holistic management – ward rounds, chasingmicrobiology10MRSA/HCAI report to Board

Audit, training, performance mngt. and Roll out‣ Roll out of Peripheral line packs & transfer forms‣ Ordering and re training in use of Chlora-prep‣ Focus upon Elderly & Emergency Medicine to start with‣ Snap shot Care bundle audits and cross audit by peers to ensure objectivity‣ Observations of Holistic ward round management• HCAI strategic advisor & Head of Nursing to pump prime, Matrons & IC leads to X-review ea. others setting thereafter• Supported by Nursing & Medical Director & Deputies• Devise template for ward round structure - prompts‣ Audit of documentation – Clinical audit to support‣ Ask Ward Srs. for completed, delivered action plans of MRSA Bacteraemias by month end‣ Any Care bundle where score

Summary‣ The MRSA bacteraemia figures for May 2008 have increased significantly (total 7 for themonth) and there is a need to ensure rapid action is taken to return the organisation tothe agreed trajectory.‣ All General managers and Modern matrons have met with CEO to agree and implementfurther actions.‣ Where a recent spate of MRSA Bacteraemia is observed in any one ward / dept. – theCEO has called an MRSA summit of all clinical staff for whole patient journey, e.g. A&E,CADMU, MAU to agree an immediate and far reaching plan of action.‣ Initial impressions gained from snapshot audits on these wards and from the completeroot cause analyses thus undertaken suggest persistent breaches in screening, isolationprocedure, Care bundle compliance and aseptic technique at insertion and continuingmanagement of invasive devices.‣ This is very disturbing, warrants prompt action and a re institution of the very highstandards we all expect.‣ It is imperative that every clinical team recognises their responsibility in diminishing therisk of acquiring a health care associated infection.‣ We have very challenging targets to reduce our numbers of MRSA bacteraemias andclearly two cases in one area will take up the target for the entire trust in any givenmonth.‣ We view the use of RCA, with the resulting action plan, as a significant tool in helping toachieve this target. It is essential that RCA work is undertaken by relevant teams within 5days of notification‣ All Clinical directors have been asked to discuss these cases with their juniordoctors/nursing staff in order to inform discussions at rolling half days and other ward/departmental meetings which should now take place without exception every month.12MRSA/HCAI report to Board