1 Highland NHS Board 29 January 2019 Item 4.6 INFECTION PREVENTION & CONTROL REPORT Report by Catherine Stokoe, Infection Control Manager and Dr Vanda Plecko, Consultant Microbiologist/Infection Control Doctor, on behalf of Heidi May, Board Nurse Director & Executive Lead for Infection Control The Board is asked to: • Note the position for the Board. • Note the update on the current status of Healthcare Associated Infections (HAI) and Infection Control measures in NHS Highland. • Note that we will not achieve the Staphylococcus aureus bacteraemia (SAB) target. • Note that we are over the Clostridium difficile target trajectory but may still meet this target. Contribution to Board Objectives One of the Board key objectives is “to reduce to an absolute minimum the chance of acquiring an infection whilst receiving healthcare and to ensure our hospitals are clean”. This report presents a comprehensive view of HAI data and activities for scrutiny and feedback from the Board. 1. Background and summary The table below shows NHS Highland Infection Prevention and Control targets and performance data. Group Target NHS Highland HEAT rate Clostridium difficile Age 15 and over HEAT rate of 32.0 cases per 100,000 OBDs to be achieved by year ending 03/19 29 Oct-Dec Q4 2018 Green (NHSH data) Staphylococcus aureus bacteraemia HEAT rate of 24.0 cases per 100,000 AOBDs to be achieved by year ending 03/19 26 Oct-Dec Q4 2018 Red (NHSH data) Hand Hygiene 95% Oct-Nov 2018 performance 96% Green Cleaning 92% Oct-Nov 2018 performance 96% Green Estates 95% Oct-Nov 2018 performance 96% Green Source: - Health Protection Scotland/ISD/Local data.
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Highland NHS Board 29 January 2019 Item 4 · bacteraemia (SAB) including MRSA. For NHS Highland this means no more than approximately 60 cases by 31 st March 2019. The local delivery
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Highland NHS Board29 January 2019
Item 4.6
INFECTION PREVENTION & CONTROL REPORT
Report by Catherine Stokoe, Infection Control Manager and Dr Vanda Plecko, Consultant Microbiologist/Infection Control Doctor, on behalf of Heidi May, Board Nurse Director & Executive Lead for Infection Control
The Board is asked to: • Note the position for the Board.• Note the update on the current status of Healthcare Associated Infections (HAI) and
Infection Control measures in NHS Highland.• Note that we will not achieve the Staphylococcus aureus bacteraemia (SAB) target.• Note that we are over the Clostridium difficile target trajectory but may still meet this
target.
Contribution to Board Objectives
One of the Board key objectives is “to reduce to an absolute minimum the chance of acquiring an infection whilst receiving healthcare and to ensure our hospitals are clean”. This report presents a comprehensive view of HAI data and activities for scrutiny and feedback from the Board.
1. Background and summaryThe table below shows NHS Highland Infection Prevention and Control targets andperformance data.
Group Target NHS Highland HEAT rate
Clostridium difficile
Age 15 and over
HEAT rate of 32.0 cases per 100,000 OBDs to be achieved by year ending 03/19
29
Oct-Dec Q4 2018
Green (NHSH data)
Staphylococcus aureus bacteraemia
HEAT rate of 24.0 cases per 100,000 AOBDs to be achieved by year ending 03/19
26
Oct-Dec Q4 2018
Red (NHSH data)
Hand Hygiene 95% Oct-Nov 2018 performance 96%
Green
Cleaning 92% Oct-Nov 2018 performance 96%
Green
Estates 95% Oct-Nov 2018 performance 96%
Green
Source: - Health Protection Scotland/ISD/Local data.
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Achievements • An awareness day highlighting the importance in the insertion and management of
peripheral vascular catheters was held in Raigmore. This was in response to an observed increase in device related Staphylococcus aureus bacteraemia cases. The event was well attended and will become a regular event.
• Over the period of October to December sporadic cases of norovirus and flu have been identified in both hospital and community settings. Due to the vigilance undertaken by all involved the impact on services has so far been minimal.
Challenges • The Board need to note we are above the predicted trajectory for Clostridium difficile at
week 40 by two cases. This position remains changeable and it is still possible that we can achieve the target.
• The Board needs to note that we have not met the Staphylococcus aureus bacteraemia (SAB) including MRSA target. See section 1 for further detail.
• During the winter month’s norovirus and flu viruses become more prevalent in our community. The focus of the Infection Prevention and Control Team will be on prevention and outbreak management over the forthcoming months. See section 4.3 for further detail.
• The Infection Prevention and Control Nurse covering the west (of the North & West Division) is on sick leave till the end of January 2019; they are also due to retire in May 2019, and enter in to a phased retirement from February onwards. Cover is being provided primarily by the Infection Prevention and Control Nurse from the North Division, with additional assistance being provided by the Infection Prevention and Control Nurse from the South and Mid Division. As and when required additional assistance is being provided by the Infection Control Manager.
• Dr J Mills Consultant Microbiologist will be resigning from his position in NHS Highland at the end of January 2019. The appointment to the future vacant position is currently being advertised.
Catherine Stokoe – Infection Control Manager Vanda Plecko – Consultant Microbiologist & Lead Infection Control Doctor, January 2019
1.1 Staphylococcus aureus bacteraemia target The target for 2018/2019 for NHS Highland is 24 cases or less per 100,000 acute occupied bed days for Staphylococcus aureus bacteraemia (SAB) including MRSA. For NHS Highland this means no more than approximately 60 cases by 31st March 2019. The local delivery plan HEAT targets for 2018/2019 are yet to be agreed by NHS Scotland, so we continue to currently report against previous local delivery plan arrangements. At time of writing (9th January 2019) we are reporting 60 cases, yet to be internally verified. Therefore the Board need to note we have not met this target. Local data identifies our internally verified position as of the 30th November 2018 as 55 cases, against a target of approximately 60 cases.
1.2 Trends NHS Highlands position showing actual verified case numbers as of 30th of November 2018 (data not yet validated by HPS) is tabled below. 1st April 2018 – 30th November 2018
MSSA = 55 MRSA = 0 Total SABs = 55 Cases
Preventable = 13 including 2 Contaminant Not preventable = 30 Unknown = 10 Under Investigation = 2 Hospital Acquired Cases = 19 Community Acquired Cases = 19 Healthcare Associated Cases = 17 Undergoing Investigation = 0 For definitions of above classifications please see section 2 page 16
Since April 2018 13 cases have been assessed as being preventable (including 2 contaminants; 3 PVC; 3 PICC; 2 urinary catheter; 1 Central line, 1 associated with skin and the management of leg ulcers and 1 relating to buttonhole fistula). All cases continue to be reviewed. Following the identification of a rise in the number of cases potentially associated with invasive devices in October 2018 the Infection Prevention and Control Team within Raigmore hospital worked in conjunction with the Clinical teams to review and raise the awareness of the care of invasive vascular devices. The formation of a Short life working vascular group has been established. In addition to the focus on vascular devices, the Infection Prevention and Control Doctor and nursing team are also working with tissue viability and the wider teams to prevent infections relating to wound and skin conditions.
Staphylococcus aureus is an organism which is responsible for a large number of healthcare associated infections, although it can also cause infections in people who have not had any recent contact with the healthcare system. The most common form of this is meticillin Sensitive Staphylococcus Aureus (MSSA), but the more well known is MRSA (meticillin Resistant Staphylococcus Aureus), which is a specific type of the organism which is resistant to certain antibiotics and is therefore more difficult to treat. More information on these organisms can be found at:
NHS Boards carry out surveillance of Staphylococcus aureus blood stream infections, known as bacteraemias. These are a serious form of infection and there is a national target to reduce them. Information on the national surveillance programme for Staphylococcus aureus bacteraemias can be found at:
Health Protection Scotland were informed of the position and were assured by the actions undertaken by the Board. At the time of writing (9th January 2019) the last device related SAB was identified on the 27th of November 2018. Figure 1: NHS Highland Staphylococcus aureus bacteraemia Cumulative Case numbers year on year since 2014, based on NHS Highland case number data.
Figure 2: Healthcare associated Staphylococcus aureus bacteraemia (SAB) incidence infection rates (per 100,000 total occupied bed days) for all NHS boards in Scotland in Q3 2018. Created and published by Health Protection Scotland. NHS Ayrshire & Arran, and NHS Tayside overlap.
HG- NHS Highland
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Figure 3: Community associated Staphylococcus aureus bacteraemia (SAB) incidence infection rates (per 100,000 population) for all NHS boards in Scotland in Q3 2018. Created and published by Health Protection Scotland. NHS Orkney and NHS Shetland overlap, as do NHS Borders and NHS Dumfries & Galloway.
HG- NHS Highland
1.3 Current Initiatives The combined CDI/SAB action plan developed to implement actions to reduce staphylococcus aureus bacteraemia is in place and progress is monitored monthly and presented to the Control of Infection Committee.
2. Clostridium difficile
2.1 Clostridium difficile HEAT Target
The target for 2018/2019 for NHS Highland is 32 cases or less in patients aged 15 and over per 100,000 total occupied bed days. For NHS Highland this means no more than approximately 78 cases by 31st March 2019. The local delivery plan HEAT targets for 2018/2019 are yet to be agreed by NHS Scotland, so we continue to currently report against previous local delivery plan arrangements. At the time of writing (9th January 2019) we are reporting 60 cases, yet to be internally verified, and the Board need to note we are above the predicted trajectory for Clostridium difficile by 2 cases at week 40. This position remains changeable and it is still possible that we can achieve the target.
Clostridium difficile is an organism which is responsible for a large number of healthcare associated infections, although it can also cause infections in people who have not had any recent contact with the healthcare system. More information can be found at:
NHS Boards carry out surveillance of Clostridium difficile infections (CDI), and there is a national target to reduce these. Information on the national surveillance programme for Clostridium difficile infections can be found at:
Local data identifies our verified position as of the 30th November 2018 as 53 cases, against a target of approximately 78 cases. 2.2 Trends
NHS Highlands position showing actual case numbers as of 30th November 2018 (data not yet validated by HPS) is tabled below. 1st April 2018 to 30th November 2018
Total CDI Cases aged 15 and over = 53
Aged 15-64 = 16 Aged 65+ = 37
Healthcare Associated = 33 Community Acquired = 15 Unknown = 4 Under Investigation = 1 For definitions of above classifications please see section 2, page 17
Figure 4: NHS Highland Clostridium difficile Infection age 15 and over, case numbers year on year since 2014, based on NHS Highland case number data
Figure 5: Healthcare associated Clostridium difficile Infection (CDI) incidence infection rates (per 100,000 total occupied bed days (TOBD) for all NHS boards in Scotland in Q3 2018. Created and published by Health Protection Scotland. NHS National Waiting Times Centre, NHS Shetlands and NHS Western Isles overlap.
HG- NHS Highland
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NHS Highland Cumulative Toxin Positive Cdifficile age 15 and over
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Figure 6: Community associated Clostridium difficile Infection (CDI) incidence infection rates in community associated cases (per 100,000 total occupied bed days (TOBD) for all NHS boards in Scotland in Q3 2018. Created and published by Health Protection Scotland.
2.4 Antimicrobial Management A number of national antimicrobial quality prescribing indicators have been developed for boards and progress within NHS Highland is detailed below. Acute Hospital Antibiotic Prescribing Measures Downstream ward audit results at the end of November 2018: The audit is conducted in wards 7A, 6C and 6A in Raigmore. The medical notes and drug chart are reviewed to assess compliance with measures 1 to 4. The drug chart should have all doses of antibiotics administered (i.e.no omissions) or a code written to explain the reason for omission. The medical notes should have the indication for antibiotics clearly recorded and the reason for choosing an alternative antibiotic rather than the guideline recommendations is documented. If the patient is on intravenous antibiotics (by injection) this therapy should be reviewed within 72 hours to assess if injection therapy is still required or if the antibiotics can be changed to an oral tablet. If the patient is on oral antibiotics, the total number of days of therapy should be recorded either on the drug chart or in the medical notes (e.g. for 5 days) so the intended stop date is clear.
Data for 7C, 6C and 4C/4A is the median from July 2017 to November 2018
Current target Ward 7A Ward 6C Ward 4A
1. All prescribed doses administered or a reason documented if not 95% 100% 98% 96%
2. Indication documented in Medical Notes 95% 100% 100% 96% 3. Choice compliant with Formulary or reason
for deviation documented in medical notes 95% 96% 96% 96%
4. Oral duration or IV review documented on drug chart or in
medical notes Oral
95% (from
October 2018)
78% 88% 76% 86% 70% 86%
Note the change in target for measure 4 to 95% from October 2018. Robust processes for recording the duration on the drug chart for all patients on oral antibiotics continues to rely on the memory of the person prescribing. The introduction of electronic prescribing will improve this. A recent report discussed by Scottish Antimicrobial Prescribing Group noted board performance was mixed with NHS Highland similar to many other boards. Teams are recommended to use quality improvement methodology to test process measures and find
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solutions to improve reliability. These audits are no longer required to be reported nationally and are to be used locally for quality improvement purposes. An example of such is detailed in the ‘Antibiotic Audits in Caithness General’ section below. National quality prescribing indicators for antibiotic use in both primary and secondary care have not yet been approved by Scottish Government but are likely to focus on reducing total antibiotic use, not increasing the use of antibiotic injections and increasing the use of World Health Organisation approved list antibiotics (generally first line, preferred antibiotics). The introduction of Hospital Electronic Prescribing and Administration system (HEPMA) will greatly enhance the likelihood of achieving the latter two measures and is eagerly awaited. Antibiotic Audits in Caithness General At the most recent Antimicrobial Management Team meeting, a junior doctor presented the results of two antibiotic audit cycles conducted in both the admissions and step down wards in Caithness General. Compliance with all measures was just below target but improved during the second cycle, especially the oral duration recording. Changes made included taking the drug charts to the board round for review, keeping patients on antibiotics as shared responsibility between medical and rehabilitation teams and highlighting the need to record the duration of oral therapy on the drug chart. After the second cycle, improvements in recording the reasons for varying from guidelines and for continuing intravenous treatment were noted. A significant barrier to demonstrating a reliable process for all measures is the number of permanent staff and high numbers of locum staff who may be less familiar with local processes and not fully engaged with existing quality improvement projects as they may only be there for a short time. A review of staffing is ongoing. Primary Care Key Performance Indicator A national report on antibiotic prescribing in primary care was recently published by the Scottish Antimicrobial Prescribing Group. Since 2013, GP practices have been asked to reduce their prescribing to the rate of the lowest 25% of practices in Scotland or make an acceptable reduction. Boards are deemed to have achieved the quality indicator if 50% of practices meet this standard. In this report, prescribing in January to March 2018 was compared to the same months in 2016, the new baseline period. NHS Highland was the top performing board with 70.4% of practices achieving the quality indicator which is fantastic. A further 8 boards met the standard with the national figure being 57.5%. Prescribers in primary care are to be highly commended for acting on the messages to reduce antibiotic use and change their prescribing practice throughout the board. This information will be shared and celebrated with prescribers through the Pink One publication. Management of Infection Guidelines Updates The most recent sections of guidance to be updated are dental infections and urinary tract infections (UTI). 3 Hand Hygiene Reporting
3.1 Current Hand Hygiene Compliance Rates NHS Highland Hand Hygiene Rolling Monthly Audit Programme continues across all clinical areas, and compliance rates are being sustained above the 95% target.
Good hand hygiene by staff, patients and visitors is a key way to prevent the spread of infections. More information on the importance of good hand hygiene can be found at:
http://www.washyourhandsofthem.com./ http://www.washyourhandsofthem.com./documents/hand-hygiene-and-nhs-scotland/your-5-moments-for-hand-hygiene/5-moments-credit-card.aspx Each Board is responsible for monitoring and reporting hand hygiene compliance data.
Compliance data for Oct to Nov 2018 identifies an average of 96% for hand hygiene compliance across NHS Highland. Any areas identified during the audits, as requiring action, are reported immediately to the relevant person for actioning. 4. Cleaning and the Healthcare Environment
• Requirement 1, align line management of the Infection Prevention and Control Nursing team to the Infection Control Manager, as per Vale of Leven recommendation. This action is in progress and due to be completed by March 2019.
• Requirement 2, ensure a reliable system is in place to monitor compliance with infection prevention and control mandatory training. This action is in progress and due to be completed by March 2019.
Benchmarking continues against all the national HEI inspection reports published, in order to ensure learning is disseminated. 4.3 Outbreaks/ clusters and multidrug resistant isolates associated with NHS Highland
There have been two outbreaks reported since the last report. Ward 6C Raigmore Hospital, was closed on 13th December 2018 due to confirmed norovirus, and reopened on the 22nd December 2018. Ward 7C Raigmore is currently closed at time of writing this report due to confirmed norovirus, on the 4th January 2019.
Keeping the healthcare environment clean is essential to prevent the spread of infections. Information on national cleanliness compliance monitoring can be found at:
Sporadic cases of norovirus and influenza are being reported across the NHS Highland area.
The Divisional Units have ensured winter preparedness plans are in place and flu vaccination opportunities provided to all staff. The chart below (taken from the 2018 Staff Flu uptake report week 51) shows a comparison with 2017/18 uptake.
Staff are required to complete a Clinical risk assessment on all acute patient admissions as per the Health Protection Scotland definition defined criteria. The MRSA clinical risk assessment and screening process are embedded into the common admission document and monitoring of compliance occurs by the Infection Prevention and Control Nurses across NHS Highland. The past five quarters show sustained compliance within NHS Highland.
As of 1st April 2016 the surveillance of Escherichia coli (E. Coli) Bacteraemia became a mandatory requirement for all NHS Boards to undertake. Data is collected by the Infection Prevention and Control Team in conjunction with the relevant clinical teams, and cases discussed to identify learning. The data collected and presented below highlights the local case numbers.
NHS Highland Staff Flu Vaccination Uptake: current year (2018/19) vs. trajectory year (2017/18)
Current Year (2018/19)
Trajectory Year (2017/18)
1 Based on the date of input into the Public Health Staff Flu Vaccine Database
In 2010 Health Protection Scotland provided a Clinical Risk assessment tool comprising of three questions, to NHS Boards in order to ensure a consistent risk-based approach to mandatory MRSA swab screening is undertaken. As part of the national mandatory MRSA screening programme quarterly compliance data is submitted by NHS Boards to provide assurance that Clinical Risk Assessment (CRA) compliance is at or above 90%.
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NHS Highlands position showing actual case numbers as of 30th November 2018 (data not yet validated by HPS) is tabled below. 1st April 2018 to 30th November 2018
Total Cases = 131 Hospital Acquired = 18 Healthcare Associated = 28 Community Associated = 84 Not Known = 0 Under Investigation = 1
Figure 7: Healthcare associated Escherichia coli bacteraemia (ECB) incidence infection rates (per 100,000 total occupied bed days) for all NHS boards in Scotland Q3 2018. Created and published by Health Protection Scotland. NHS Orkney and NHS Shetland overlap.
HG- NHS Highland
Figure 8: Community associated Escherichia coli bacteraemia (ECB) infection incidence rates cases (per 100,000 population for all NHS boards in Scotland in Q3 2018. Created and published by Health Protection Scotland. NHS Forth Valley and NHS Highland overlap
HG- NHS Highland
The Board should note that discussions are underway between Health Protection Scotland and National Services Scotland around the formation of a target for the reduction of E.Coli bacteraemia over a period of time. A formal announcement to NHS Boards will be issued at some point.
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6.1 Surgical Site Infections (SSI)
NHS Highland continues to monitor SSI rates through mandatory surveillance. The clinical teams alongside the Infection Prevention & Control Surveillance team and the Scottish Patient Safety Programme team (Acute adult workstream: SSI) are working jointly to review incidents of infection, and ensure that care practices are evidence based and maintained. RAIGMORE 30 DAYS READMISSION ELECTIVE COLORECTAL SSI
There have been 4 colorectal Surgical Site infections reported, from 137 procedures performed between January 2018 to end of October 2018, giving an SSI rate of 2.9%. Figure 9: Monthly SSI rate in elective colorectal surgery, Jan 2015 to October 2018
RAIGMORE 30 DAYS READMISSION ORTHOPAEDIC SSI Total Hip replacement (THR) There was 1 THR infection in August giving an SSI rate of 0.3% for 2018. Figure 10: NHSH Monthly SSI Rate for Total Hip Replacement January 2015 –Oct 2018
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Hemi-arthroplasty There has been 1 hemi - arthroplasty surgical site infections reported, from 147 procedures performed between January 2018 to end of October 2018, giving an SSI rate of 0.7%. Figure 11: Monthly SSI rate for Hemi arthroplasty surgery Jan 2015 to October 2018
NHSH 10 DAYS POST DISCHARGE CAESAREAN SECTION SSI ELECTIVE C-SECTION Elective C-Section There have been 5 C-section Surgical site infections reported, from 293 procedures performed between January 2018 to end of October 2018, giving an SSI rate of 1.7%. Figure 12: Monthly SSI rate for elective C Sections, Jan 2015 to October 2018.
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EMERGENCY C-SECTIONS Emergency C-Section There have been 9 C-Section Surgical site infections reported, from 286 procedures performed between January 2018 to end of October 2018, giving an SSI rate of 3.1%. Figure 13: Monthly SSI rate for emergency C Section, Jan 2015 to October 2018
A meeting with the Raigmore obstetricians has occurred and Dr Darren Thomas has agreed to lead on the C-section SSI improvement group which will review all relevant cases and ensuring learning is disseminated. Figure 14: shows the funnel plot of caesarean section (elective and emergency combined) SSI incidence (per 100 procedures) in inpatients and post discharge surveillance to day 10 of all NHS Boards in Scotland in Q3 2018. Created and published by Health Protection Scotland. NHS Borders and NHS Dumfries & Galloway overlap, as do NHS Orkney, NHS Shetland and NHS Western Isles
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RAIGMORE 30 DAYS READMISSION ELECTIVE VASCULAR SSI Vascular Surveillance became a mandatory requirement from Health Protection Scotland starting 1st April 2017. Only elective procedures are included in this standard surveillance which incorporates those who have undergone planned surgery, and those who are readmitted due to their previous surgery. Patients are monitored 30 days after their operation for infection as part of this mandatory surveillance. This type of surgery includes patients undergoing amputation due to limb ischaemia, and those undergoing surgery on arteries or veins. There have been 3 surgical site infections reported, from 104 procedures performed between January 2018 to end of October 2018, giving an SSI rate of 2.9%. Figure 15: SSI Rate following Vascular Surgery, April 2017 – October 2018
The following section is a series of ‘Report Cards’ that provide information, for each acute hospital and key community hospitals in the Board, on the number of cases of Staphylococcus aureus blood stream infections and Clostridium difficile infections, as well as hand hygiene and cleaning compliance. In addition, there is a single report card which covers all community hospitals [which do not have individual cards], and a report which covers infections identified as having been contracted from outwith hospital. Understanding the Report Cards – Infection Case Numbers Clostridium difficile infections (CDI) and Staphylococcus aureus bacteraemia (SAB) cases are presented for each hospital, broken down by month. SAB cases are further broken down into Meticillin Sensitive Staphylococcus aureus (MSSA) and Meticillin Resistant Staphylococcus aureus (MRSA). For each hospital the total number of cases for each month, been reported as positive from a laboratory report, on samples taken more than 48 hours after admission. Understanding the Report Cards – Hand Hygiene Compliance Hospitals carry out regular audits of how well their staff are complying with hand hygiene. Each hospital report card presents the combined percentage of hand hygiene compliance with both opportunity taken and technique used broken down by staff group. Understanding the Report Cards – Cleaning Compliance Hospitals strive to keep the care environment as clean as possible. This is monitored through cleaning and estates compliance audits. Understanding the Report Cards – ‘Out of Hospital Infections’ CDI and SAB (including MRSA) bacteraemia cases are presented as ‘‘Out of Hospital Infections’ and are not attributable to a hospital. This section identifies those infections from community sources such as GP surgeries and care homes, and those from positive samples taken from patients within 48 hours. Abbreviations
SAB Definitions Definitions: Hospital acquired infection (HAI): Positive blood culture obtained from a patient who has been hospitalised for ≥48 hours. OR patient was transferred from another hospital, the duration of in-patient stay is calculated from the date of the first hospital admission. OR If the patient was a neonate/baby who has never left hospital since being born. OR The patient was discharged from hospital in the 48hr prior to the positive blood culture being taken. OR A patient who receives regular haemodialysis as an out-patient. OR Contaminant if the blood aspirated in hospital Healthcare associated infection (HCAI): Positive blood culture obtained from a patient within 48 hours of admission to hospital and fulfils one or more of the following criteria: 1. Was hospitalised overnight in the 30 days prior to the positive blood culture being taken. 2. Resides in a nursing, long term care facility or residential home. 3. IV, or intra-articular medication in the 30 days prior to the positive blood culture being taken, but excluding IV illicit drug use. 4. Regular user of a registered medical device e.g. intermittent self-catheterisation, home CPD or PEG tube with or without the direct involvement of a healthcare worker (excludes haemodialysis lines see HAI). 5. Underwent any medical procedure which broke mucous or skin barrier i.e. biopsies or dental extraction in the 30 days prior to the positive blood culture being taken. 6. Underwent care for a medical condition by a healthcare worker in the community which involved contact with non-intact skin, mucous membranes or the use of an invasive device in the 30 days prior to the positive blood culture being taken e.g. podiatry or dressing of chronic ulcers, catheter change or insertion. Community infection: Positive blood culture obtained from a patient within 48 hours of admission to hospital who does not fulfil any of the criteria for healthcare associated bloodstream infection. Not known: Only to be used if the SAB is not an HAI, and unable to determine if Community or HCAI.
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CDI definitions Definitions: Healthcare-associated CDI: a case with onset of symptoms on day three or later, following admission to a healthcare facility on day one, OR in the community within four weeks of discharge from any healthcare facility. This may apply to the current hospital or a previous stay in another healthcare facility, e.g. in another hospital, a long-term care facility or other healthcare facilities (e.g. outpatient departments etc.) Community-associated CDI: a case with [onset outside of healthcare facilities, AND without discharge from a healthcare facility within the previous 12 weeks] OR [onset on the day of admission to a healthcare facility or on the following day AND not resident in a healthcare facility within the previous 12 weeks] Unknown association: a case who was discharged from a healthcare facility 4–12 weeks before symptom onset
ADTC Area Drugs & Therapeutics Committee AMT Antimicrobial Prescribing Team
AMAU Acute Medical Admissions Unit CHP Community Health Partnership
CDI Clostridium difficile Infection CMO Chief Medical Officer
CNO Chief Nursing Officer CVC Central Venous Catheter
HEAT Health Improvement, Efficiency, Access, Treatment ECDC European Centre for Disease Prevention & Control
GDP General Dental Practitioner HAI Healthcare Associated Infection
HAI QIF Healthcare Associated Infection
Quality Improvement Facilitator
HAIRT Healthcare Associated Infection
Reporting Template
HPS Health Protection Scotland HSE Health and Safety Executive
JAG Joint Advisory Group HFS Health Facilities Scotland
NHS HIGHLAND NORTH & WEST DIVISION COMMUNITY HOSPITALS REPORT CARD
The community hospitals covered in this report card include: • Dunbar Hospital, Thurso • Town & County Hospital, Wick • Lawson Memorial Hospital Golspie • Migdale Hospital, Bonar Bridge • MacKinnon Memorial Hospital, Broadford • Portree Hospital, Isle of Skye
Staphylococcus aureus bacteraemia monthly case numbers Dec
NHS HIGHLAND SOUTH & MID DIVISION COMMUNITY HOSPITALS REPORT CARD
The community hospitals covered in this report card include: • Ross Memorial Hospital, Dingwall • County Community Hospital, Invergordon • Royal Northern Infirmary Community Hospital, Inverness • Town & County Hospital, Nairn • Ian Charles Hospital, Grantown on Spey • St Vincent’s Hospital, Kingussie • For the purposes of monitoring New Craigs Psychiatric Hospital is included in this
report card. Staphylococcus aureus bacteraemia (SABs) monthly case numbers Dec
NHS HIGHLAND ARGYLL & BUTE IJB COMMUNITY HOSPITALS REPORT CARD
The community hospitals covered in this report card include: • Argyll & Bute Hospital Lochgilphead • Campbeltown Hospital • Cowal Community Hospital, Dunoon, • Dunaros Community Hospital, Isle of Mull • Islay Hospital • Mid Argyll Community Hospital & Integrated Care Centre, Lochgilphead • Victoria Hospital, Rothesay
Staphylococcus aureus bacteraemia (SABs) monthly case numbers Dec