Infection, Prevention & Control-Annual Report 2018-19 1 Quality care – for you, with you BOARD REPORT SUMMARY SHEET Meeting: Date: Trust Board 24 th October 2019 Title: Infection Prevention and Control Annual Report 2018/19 Lead Director: Dr Maria O’Kane, Medical Director Purpose: Approval Key strategic aims: This report outlines the activities of the Southern Health and Social Care Trust relating to Infection Prevention and Control (IPC) for the year April 2018 to March 2019. It outlines Trust initiatives to allow for the early identification of patients with infections on admission to hospital and measures to reduce the spread of infection to others. It also reviews the policies and procedures relating to infection prevention & control, audit, surveillance and education and training. Key issues/risks for discussion: The DHSSPSNI has set Priorities for Action (PfA) reduction targets for Clostridioides difficile (C. difficile) infections and Methicillin-resistant Staphylococcus aureus [MRSA] blood stream infections. o The overall number of C. difficile infections in the Trust has shown reduction over a number of years and the Trust met the DHSSPSNI target of 50 with 45 cases reported. o The number of MRSA bloodstream infections in the Trust in 2018-19 was 3, hence the target was achieved as the PfA target for MRSA bacteraemia for the SHSCT was 4 and 2 cases were considered preventable. o Methicillin Sensitive Staphylococcus Aureus (MSSA) is not part of the PfA target for action set by the Public Health Agency (PHA). However, the Trust has introduced measures to reduce S.aureus bacteraemia (both MRSA and MSSA) as part of patient safety initiatives.
Infection Prevention and Control Annual Report 2018/19
Lead Director:
Dr Maria O’Kane, Medical Director
Purpose:
Approval
Key strategic aims:
This report outlines the activities of the Southern Health and Social Care Trust relating to Infection Prevention and Control (IPC) for the year April 2018 to March 2019. It outlines Trust initiatives to allow for the early identification of patients with infections on admission to hospital and measures to reduce the spread of infection to others. It also reviews the policies and procedures relating to infection prevention & control, audit, surveillance and education and training.
Key issues/risks for discussion:
The DHSSPSNI has set Priorities for Action (PfA) reduction targets for Clostridioides difficile (C. difficile) infections and Methicillin-resistant Staphylococcus aureus [MRSA] blood stream infections.
o The overall number of C. difficile infections in the Trust has shown reduction over a number of years and the Trust met the DHSSPSNI target of 50 with 45 cases reported.
o The number of MRSA bloodstream infections in the Trust in 2018-19 was 3, hence the target was achieved as the PfA target for MRSA bacteraemia for the SHSCT was 4 and 2 cases were considered preventable.
o Methicillin Sensitive Staphylococcus Aureus (MSSA) is not part of the PfA target for action set by the Public Health Agency (PHA). However, the Trust has introduced measures to reduce S.aureus bacteraemia (both MRSA and MSSA) as part of patient safety initiatives.
o The Trust continues to embed and monitor health care-associated infection (HCAI) ‘Care Bundles’ for Central Venous Catheter, Ventilator-Associated Pneumonia and mandatory surgical site infection (Caesarean Section & Orthopaedic).
Antimicrobial stewardship (AMS) is an important element of both the UK Five Year Antimicrobial Resistance Strategy 2013-2018 and the 2011 CMO report. To this end in 2015, the Trust has implemented and continues to monitor compliance with new guidelines for antimicrobial stewardship based on the ‘Start Smart - Then Focus Antimicrobial Stewardship Toolkit for English Hospitals’
Summary of SMT discussion:
Priorities for Action (PfA) for MRSA and C. difficile were achieved Antimicrobial stewardship targets proved more challenging, actions continue to be implemented and compliance is monitored with feedback to clinical teams.
This report outlines the activities of the Southern Health and Social Care Trust relating to Infection Prevention and Control (IPC) for the year April 2018 to March 2019.
It outlines Trust initiatives to allow for the early identification of patients with infections on admission to hospital and measures to reduce the spread of infection to
others.
It also reviews the policies and procedures relating to infection prevention & control, audit, surveillance and education and training.
• Other key points from this annual report are:
• The DHSSPSNI has set Priorities for Action (PfA) reduction targets for Clostridioides difficile (C difficile) infections and Methicillin-resistant Staphylococcus aureus [MRSA] blood stream infections.
• The overall number of C. difficile infections in the Trust has shown substantial reduction over a number of years and the Trust met the DHSSPSNI target of 50 with 45 cases reported.
• The number of MRSA bloodstream infections in the Trust in 2018-19 was 3, hence the target was achieved as the PfA target for MRSA bacteraemia for the SHSCT was 4 and 2 cases were considered preventable.
• Methicillin Sensitive Staphylococcus Aureus (MSSA) are not part of the PfA target for action set by the Public Health Agency (PHA). However, the Trust has introduced measures to reduce S.aureus bacteraemia (both MRSA and MSSA) as part of patient safety initiatives.
• The Trust continues to embed and monitor health care-associated infection (HCAI) ‘Care Bundles’ for Central Venous Catheter, Ventilator-Associated Pneumonia and mandatory surgical site infection (Caesarean Section & Orthopaedic).
• Antimicrobial stewardship (AMS) is an important element of both the UK Five Year Antimicrobial Resistance Strategy 2013-2018 and the 2011 CMO report. To this end in 2015, the Trust has implemented and contiues to monitor compliance with new guidelines for antimicrobial stewardship based on the ‘Start Smart - Then Focus Antimicrobial Stewardship Toolkit for English Hospitals’ .
• Infection Prevention and Control (IPC) continue to support and nurture staff in all 8 Augmented Care Areas identified across all sites following recommendations from the The Regulation and Quality Improvement Authority Independent Review of Incidents of Pseudomonas aeruginosa Infection in Neonatal Units in Northern Ireland Final Report 31 May 2012
• Sisters and Charge Nurses in Augmented Care Areas attend meetings every 3 months hosted by IPC to help enhance their opportunities for sharing ideas and Trust wide learning.
• IPC continue to work collaboratively with Estates colleagues as members of the Trust ‘Water Safety Committee’.
• The IPC team continues to have a structured program of IPC audit (both self and independent) across the Trust.
• The Health Care Associated Infection (HCAI) Clinical Forum meets monthly and the HCAI Strategic Forum meets every 2 months throughout 2018-19.
• IPC continue to engage throughout 2018/19 with colleagues in Education Learning and Development (ELD) to help advance IPC Education & Training across the Trust.
• IPC have successfully completed a bespoke IPC e-learning package now used across the Trust for all staff.
• IPC have successfully created, launched and embedded an infectious agent toolkit in order to support healthcare workers to place and safely manage patients with suspected or confirmed communicable diseases.
The HCAI/IPC/AMS reports are tabled are set out below:
The Chief Executive is the Accountable Officer for IPC within the SHSCT and has designated the Medical Director as the Lead Director for HCAI and IPC at
Board level.
The IPC operational service is led by 2 Consultant Microbiologists and a Lead IPCN and in 2018-19 were supported by a small team of 9 Infection
Prevention & Control Nurses (IPCNs) and 3 IPC Audit Assistants.
Structure: IPC in the Medical Director’s Office, Southern Health and Social Care Trust (SHSCT) 2018-19
The operation of each element of the governance arrangements is as follows:
Medical Director
Assistant Director
Clinical & Social Care Governance
Clinical and Social Care Governance
Infection Prevention
& Control
Patient Safety Data and Improvement
Assistant Director
Medical Directorate
Medical education, development,
appraisal & revalidation
Emergency Planning & Business Continuity
• The IPC Strategic Forum is co-chaired by the Chief Executive and Medical Director with membership from Operational Directors and senior staff from IPC, Pharmacy, Estates and Facilities.
• The HCAI Strategic Forum is responsible for monitoring the Trust’s HCAI infection rates, co-ordinating an effective organisational response to any issues of significant concern relating to HCAI and for overseeing the implementation, review and progress of the Strategy 2018-21 and all initiatives.
• The HCAI Clinical Forum is chaired by the Medical Director or Lead IPC nurse and its purpose is to provide clinical staff with a formal setting to promote excellence throughout the Trust;
• Ensure that standards, guidelines and procedures relating to Infection Prevention & Control; and the management of patients with a HCAI are in place and adhered to; and
• Raises and discusses issues of clinical concern related to HCAI
• The Clinical Forum, assesses, identifies and provides clinical and operational advice & support on IPC issues.
• Throughout 2018-19 the IPC team continues to be managed by a one Lead IPC Nurse (Band 8A), with the support of:
• 9 IPC nurses (9 WTE) providing daily IPC advice and support to staff across all of the SHSCT facilities (Acute, Non-Acute and Community).
• 2 Band 3 (2 WTE) Audit Surveillance Assistants complete a scheduled calender of independent audit where various IPC practices in patient areas are audited regularly i.e. hand hygiene & commode cleanliness.
Reporting to Trust Board
• The Medical Director liaises regularly with the Chief Executive.
• The Board is kept informed of the Trust’s performance in relation to Infection Prevention & Control by:
• Monthly infection rate reports from the Medical Director
• Ad hoc briefings from the Chief Executive in the event of incidents/outbreaks of infection
• IPC continues to utilize the opportunities afforded to engage with Directorate staff at both HCAI Clinical and Strategic Forums.
• These are the platforms for all staff to speak openly and honestly with regard to IPC issues, challenges and successes.
• In addition to this the Lead IPC nurse or nominated deputy represented IPCT at various internal and external committees. Examples include:
• Decontamination Committee
• Health & Safety Committee
• Environmental Cleanliness Committee
• various Clinical Governance Forums
• Water Safety Committee
Community IPC Engagement
• Effective IPC in community healthcare is becoming increasingly important as the balance of care provision continues to shift towards community settings.
• Patients spend significantly less time in hospital and more complex nursing is required to care for patients in their own home, in supported living, in residential care or day care.
• Infection can have a detrimental and potentially life-threatening impact on the health and wellbeing of patients.
• Patient safety is the top priority, and ensuring that safe practices are followed to reduce the risk of infection, regardless of healthcare setting, is paramount.
• IPC in community settings may be challenging to both Infection Control and Community Healthcare Professionals.
• It is therefore imperative that education and training provision recognises the specific requirements of, and challenges for, Healthcare staff working in community settings.
• With consideration given to Transforming Your Care 2011 and Health & Wellbeing 2026, there is focus on delivering care together with a very definite shift to move care back into the community in the client's own home.
• Therefore, for the future, IPC must aim to allocate resources into the community.
• Informal information sessions take place on a daily basis with facility based consultations, via emails and telephone calls.
• The tiered e-learning training package has made access to training easier for staff, at a time convenient to them. However, it was felt some community staff would still require the face to face training to ensure their training needs were met.
• A bespoke face to face training package for the community staff including domiciliary care workers continues to be developed and enhanced in response to their needs.
The community corporate mandatory infection prevention & control training programme
• With the increase in the number of patients with CPE colonisation in the SHSCT the requirement for advice from IPC on management of these patients requires greater resourcing.
• A focus of the IPC Link Member Group, in 2018/2019, was the dissemination of a National Tool Kit for managing patients colonised by CPE in the community.
Carbapenemase Producing
Enterobacteriaceae (CPE) screening and
management of positive cases in the community setting is the reality in
Infection prevention and control is embedded as a core element in the Trust’s residential homes for older people. These homes provide permanent places,
general respite places, dementia specific respite places, intermediate care places and day care.
• There continues to be an IPC focus on the 4 Residential Homes within the Trust.
• Minor refurbishment work has been on-going in 2018-19 in an effort to up-grade surfaces enabling the environment to become more IPC friendly.
• The needs of clients is changing and this can introduce increased risk in relation to IPC.
• IPC continues to work closely with the Home Managers and Head of Service to help ensure safety is the top priority.
• This project involves the building of a CTCC to enable the integration of GP practices with multi-disciplinary SHSCT teams in a new functionally suitable building.
• IPC measures have been ‘designed in’ at the very outset of the planning and design stages of the CTCC and this will continue, up to, into and beyond the final building stage.
The IPC has continued to provide IPC advice into the
A Robust investigation of the 48 cases of MSSA bacteraemia identified that 14 were preventable. Reinforcement of good infection prevention and control practices were reinforced.
• Since 2010/11 the DHSSPS decided that in line with Trusts in England, MSSA will not be part of PfA targets therefore there currently is no performance target associated with MSSA bacteraemia.
• However, in SHSCT is unique in continuing to monitor MSSA bacteraemia incidents with a view to keeeping incidence to a minimum.
• A Post Infection review (PIR) is undertaken for each patient who develops C.difficile infection and any MRSA/MSSA bacteraemia considered preventable.
• This learning is then shared with other healthcare care colleagues across the organisation through various formats i.e. governance meetings, sisters meetings and other Directorate communications.
• Most learning will relate to improvement in clinical practices such as antibiotic prescribing / stewardship and Aseptic Non-Touch Technique (ANTT).
Post Infection Review (PIR) and Shared
Learning
• IPCs facilitate Augmented Care Sister meetings on a quarterly basis.
• Meetings were held every 3 months throughout 2018-19.
• The purpose of the meetings are to give a structure and platform to progress and sustain good practice in IPC Augmented Care areas across the Trust.
• There is positive feedback from all staff attending these meetings.
Acorss the facilities int he SHSCT there were 8 recorded confirmed outbreaks of infection and a significant number of possible outbreaks across the facilities in
the SHSCT.
• Norovirus infection has potential to cause many problems in our hospitals and healthcare settings each year, not least of all ward closures, decreased clinical activity and staff going off duty sick.
• In total, 3 areas had confirmed norovirus outbreaks which placed pressure on the system; 4 had suspected norovirus outbreaks although norovirus was never detected.
Norovirus
• Influenza is also a seasonal infection and incidence and severity of infection will vary from year to year. In 2018-19 we had 1 confirmed influenza outbreak.
• Patients presenting at the hospitals with symptoms of influenza was very significant and placed a massive strain on resources in ED and the clinical wards.
• Pressure on IPC and isolation became extremely challenging
Influenza
• CDI can also be a significant cause of ward disruption/closure when outbreaks occur.
4. Infection Prevention and Control Initiatives 2018/19
• This work is on-going and requires constant drive, focus & energy.
• Responsibility is multi-professional and everyone must comply with standards that help promote, maintain & sustain safety.
• Aseptic Non-Touch Technique [ANTT] workshops.
MRSA & MSSA Bacteraemia Reduction
Plan
• Post -infection reviews are well established and IPC continue to work with clinical teams using this tool with a view to sharing learning.
Post Infection Review[PIR]
• ANTT workshops are delivered by the Association for Safe Aseptic Practice throughout 2018-19. These sessions are organised by the IPCNs and fulfill requirements for a train the trainer approach.
• The ultimate aim is to enable staff to feel confident and competent with ANTT and use this skill set to train each other at local level.
Aseptic Non-Touch Technique (ANTT)
• The PHA mandated collection of incidents and risk factor data has been implemented by the IPC service.
• The Trust continues to recognise the importance of good water management. Given favourable conditions, bacteria can proliferate in water and some of these can be dangerous to humans.
• To ensure effective management of water systems, the Trust has a Water Safety Plan, which sets out the Trusts arrangements for the management of water systems.
• The Water Safety Working Group is meeting on a regular basis. Key measures implemented through this group include:
• Water safety awareness sessions for staff
• Maintenance of control measures
• Continued reinforcement, monitoring and revision of best practice in IPC, FM and Estates
• Sampling and remedial works programme developed in conjunction with Health and Safety Executive (HSENI) and informed through Risk Assessment and Water Sampling;
• Revised methodology for completion of Risk Assessments
• Copper–Silver Ionisation has been installed in 14 locations across the Trust.
• Should any cases of Legionella and Pseudomonas be identified, investigations are completed to ascertain if Trust water supplies were implicated in transmission, a treatment regimen would be instigated immediately based on established guidelines.
• As Pseudomonas and Legionella are commonly occurring bacteria it is not unusual to get some positive results when sampling water systems. However, even though there may be no suspected or confirmed clinical cases of infection, the presence of such bacteria in a water system instigates remedial control measures. These control measures are set out in the Trust Water Safety Plan
• Care bundles are a defined number of elements which, if preformed correctly, have been proven to reduce the risk of health care associated infections.
• The risk of infection reduces when all elements within the clinical process are performed all of the time, by everyone and for every patient.
• The Trust participates in a number of care bundles under the direction of the NI HSC Safety Forum & the PHA.
Care Bundles To Reduce HCAI
• Multidisciplinary improvement teams were also formed in the autumn of 2007 to implement the IHI’s Prevention of Surgical Site Infection (SSI) Care Bundle for Orthopaedic & Caesarean Section patients.
• The SSI Bundle Audit takes place each quarter at CAH & DHH.
• The audit was initially undertaken on elective C section patients only but was spread in 2015/16 to include emergency C sections also.
• The average overall bundle compliance for 18/19 was 69% in CAH, down from 85% in 2017/18 and in 90% in DHH, down from 93% in 2017/18. The decline in compliance in CAH is mainly attributed to 1 element of the bundle i.e. appropriate hair removal. For a period of time the Trust’s SSI patient information leaflet on skin preparation was not in the mother’s medical records. This has been addressed with the aim of improving compliance in 2019/20.
• In Q1 2019 (Jan → Mar 2019), the Trust’s SSI rate was 5.31%, below the NI Average of 6.17%
• The SSI Orthopaedic audit takes place annually. The last audit took place in Sept 18, with overall bundle compliance of 100%, same as Sept 17.
• The Trust’s SSI Rate Q1 2019 (Jan → Mar 19), was 0% (0/574 procedures), compared to the NI average of 0.31% (9/2913).
• The cumulative rate for the past 8 quarters also shows that the Trust’s SSI Rate is below the NI average at 0.19% compared to 0.30%.
• Central Venous Catheters (CVC) are essential for the care of critically and chronically ill patients requiring long-term vascular access for chemotherapy, parenteral nutrition etc.
• Since the introduction of the improvement work, both Craigavon and Daisy Hill Hospitals have seen a substantial reduction in bloodstream infections related to CVC's.
• Auditing of the Central Line Bundle was reintroduced in ICU in November 2017.
• Overall bundle compliance with the central line bundle in ICU 18/19 was 63% up from a Baseline of 55% (Nov 17 → Mar 18). Compliance has improved throughout the financial year with Q4 (Jan 18 → Mar 18) compliance reaching 81%
• Overall bundle compliance with the central line bundle on the wards, CAH 18/19 was 23% up from a baseline of 20% (Nov 17 → Mar 18). Compliance has gradually improved throughout the financial year with Q4 (Jan 18 → Mar 18) compliance reaching 30%.
• The 2 elements of the bundle where compliance has been an issue has been site selection i.e. the subclavian site not been used, with no contraindication indicated & evidence of daily review of the line. With regard to site selection, this element of the bundle is under review as the clinical evidence for the use of the subclavian as opposed to the jugular may not be a strong as when the bundle was initially developed. a review of the audits showed that in many of the cases the daily review of the line was missed on 1 day, on many occasions it was on the day of transfer to the wards. therefore, Ventilated Associated Pneumonia & Central Line Team have put measures in place, to improve compliance with this element of the bundle.
• Currently there are 2 processes in place i.e. theatres are still using the central line insertion record (paper), whilst icu record insertion details via their IntelliSpace Critical Care & Anaesthesia System (paperless). The VAP & Central Line Team are aware of this and working to minimise non-compliance due to the two documentation systems.
• During 2018/19 there were no central line infections reported in CAH or DHH, down from 4 cases in 2017/18.
• The VAP audit takes place annually. The last audit tool place in Sept 18, with overall bundle compliance of 100%, same as Sept 17.
• There was 1 VAP reported during 18/19 (23/09/18). The ICU had achieved a period of 5,373 Vent Days/1,223 Calendar Days since the previous VAP (04/09/16).
• A Root Cause Analysis was carried out by the clinical lead, who concluded that the patient was managed appropriately during his ICU admission with all aspects of the care bundle applied. The RCA was shared with colleagues for information/”shared learning”
Hand Hygiene Acute, Trust wide Monthly or 3 monthly
Commode Acute, Trust wide Monthly
Personal Protective Equipment (PPE) (Resources & availability)
Acute, Trust wide 6 monthly
Sluice Acute, Trust wide 6 monthly (Trigger-positive C difficile result: Audit to be completed next available day after a positive result.)
Visual Infusion Phlebitis (VIP) Charts
Acute, Trust wide (Auditors awaiting training)
Intravenous (IV) Trolley
Acute, Trust wide 3 monthly
IPC independent audit continues throughout 2018/19 both planned and responsive to service needs.
Two Band 3 Audit Assistants completed an agreed IPC audit calendar and in addition to this they complete compliance audit in areas where we have newly diagnosed C. difficile cases or where we have an increased incidence or outbreaks of infection.
7. Infection Prevention & Control Education & Training
IPC training continues to be delivered to all staff across the Trust via an array of platforms
• There is a blended learning strategy to cascade IPC mandatory training to all grades of satff, comprising e-learning and face to face. This is split into Tiers 1, 2 or 3 and Levels A or B.
• IPC have been working closely with Learning & Development colleagues to produce and promote the e-Learning platform.
• IPC nurses continue to provide complementary training when required/requested by clinical staff across the Trust.
• In 2018-19, 1690 staff had completed mandatory IPC training.
• The Infection Control Link System in the SHSCT facilitates engagement and provides opportunity for IPC link members from acute, non-acute and community settings to avail of specialist training and support.
• The IPC Link programme is on-going on a Trust wide basis which involves two hour training in the form of Master-Classes 3 times a year for acute and non-acute staff with community session hosted by IPCNs in 2018/19
• The aim is to communicate and educate ward managers and IPC Link Persons in relation to HCAIs.
• Details are posted on the Trust intranet site.
• The expectation is each clinical area will ensure a nominated Link Person attends each of the sessions and takes information back to their clinical area for sharing and dissemination.
Comments received on feedback forms from Mandatory Training,
April 2018-March 2019
Very informative and delivered in a way that was very interesting. Clear and easy to understand, warm and friendly. Explanation
excellent. Very engaging. Well paced and clear. Excellent knowledge, clearly communicated. Relaxed, approachable. Excellent delivery. Clear and concise. Lots of examples.
Good discussions. Opportunities for further learning. Interactive. Enjoyed group participation. Good to hear other
opinions and questions. Very effective. Was informal which
is great. Lots of new information shared. Good team work. Very beneficial. Helps to understand and remember. Promotes
learning. Good learning approach.
Info very clear. Great learning environment. Good medium of
learning. Was able to clarify many aspects of IPC. Easy to understand and very appropriate to work. Clear, concise
information. Very understandable and delivered in a
way that was enjoyable. Could do with longer. Just enough information. Relatable and easy to understand. ToolKit resource excellent. Valuable and informative.
Clear, concise, informative. Definitely learned more about topics discussed.
Very informative. Better understanding of topics. Reinforced
important information. Structured so that it's easy to remember.
Comprehensive update on information. Very educative and revealing. Informative and up-to-date. Very helpful. Worthwhile. Tailored to the needs of the group. Easy to remember.
8. Antimicrobial Prescribing and Stewardship in the Southern Trust 2018/19
Antimicrobial stewardship (AMS) is an important element of both the UK Five Year Antimicrobial Resistance Strategy 2013-2018 and the 2011 CMO report. To
this end in 2015, the Trust implemented new guidelines for antimicrobial stewardship based on the ‘Start Smart - Then Focus Antimicrobial Stewardship
Toolkit for English Hospitals’ . These are available at http://www.southernguidelines.hscni.net/?wpfb_dl=220
The programme in the SHSCT comprises monitoring of antimicrobial prescribing, feedback regularly to prescribers, education and training on antibiotic use and resistance and the integration of audit into Quality Improvement Programmes.
• Set out a framework for best practice on antibiotic prescribing in order to optimise therapy for individual patients;
• Prevent overuse and misuse of antibiotics in order to preserve the existing antibiotics;
• Minimise development of resistance at patient and community level;
• Promote clinical leadership of antibiotic management among members of all multidisciplinary teams.
• Ensure all antibiotic policies are updated in line with updated national guidance.
• Provide education and training to all staff groups on antibiotic stewardship
• The antimicrobial stewardship programme has been updated as a result, with data collected on the stewardship rounds reflecting the recommendations within the new guideline, focusing on appropriate documentation, durations and review to supplement the antibiotic compliance data.
• Provide direct feedback during and after the stewardship ward rounds to the clinical teams and monthly summary reports for the consultants to monitor monthly antibiotic consumption data in order to achieve PfA antibiotic consumption targets.
• During 2018-19, there were difficulties maintaining the antimicrobial ward rounds due to Consultant Microbiologist and Antimicrobial Pharmacist vacancies. Funding has been approved for an extra 3.6 WTE (1 band 8a and 3.6 band 7) antimicrobial pharmacists with remit for antimicrobial stewardship and Outpatient Antimicrobial Therapy (OPAT). The 8A Lead OPAT pharmacist commenced their post in February 2019, with the remaining pharmnacists expected to take up post in April 2019.
The Trust AMR Programme aims are to:
• 90% target antibiotic compliance has been set for the Trust, with actions to address repeated non-compliance decided by the AMT.
• However, small numbers of patients audited in O&G, Lurgan and STH can adversely affect the compliance data.
•Note: staff shortages have affected the number of ward rounds
Compliance with Antibiotic Policy in Craigavon Area Hospital
CAH Medicine
CAH Surgery
CAH Paeds/NNU
CAH Maternity
90% Target
0
10
20
30
40
50
60
70
80
90
100
Pe
rce
nta
ge
Compliance with Antibiotic Policy in Daisy Hill Hospital
DHH Medicine
DHH Surgery
90% target
No stewardship rounds were undertaken in Craigavon Area Hospital surgical wards in March 2019 Paediatric/NNU stewardship rounds undertaken in July and August 2018. Maternity stewardship rounds undertaken in July, August and November 2018.
No stewardship rounds were undertaken in Daisy Hill Hospital in June 2018 and on surgical wards in March 2019.
Compliance with Antibiotic Policy in Lurgan and South Tyrone Hospitals
Lurgan Hospital
South Tyrone Hospital
90% target
• The Public Health Agency set the following targets for each Trust for the period April 2018 until March 2019 year, using the 2017-2018 consumption as the baseline:
• 1% reduction in total antibiotic use;
• 3% reduction in carbapenem use;
• 3% reduction in piperacillin/tazobactam use;
• At least 55% of antibiotic consumption should be from the WHO AWaRE (Access, Watch and Reserve Antibiotics) Access Antibiotic category*
• A "hard stop" kardex introduced in March 2019 which mandated evaluation of initial antibiotoic therapy to 72 hours. This intervention aimed to reduce the duration of antibiotic therapy, particularly in cases where there is no clear evidence of infection.
Antibiotic Consumption
April 2018-March 2019
Stewardship Rounds were undertaken in Lurgan Hospital in July, September and October 2018, and in South Tyrone in August and September 2018.
• All antibiotic guidelines were published on the 'Microguide' smartphone App.
• The following antibiotic guidelines were updated:
• Ear, Nose and Throat antibiotic guidelines
• Obstetrics and Gynaecology antibiotic guidelines
• C. difficile Infection antibiotic guidelines
• Emergency Department antibiotic guidelines
Antibiotic Policies
April 2018-March 2019
• A total of 50 training sessions on antimicrobial stewardship and antibiotic resistance were delivered to the following groups of staff were delivered to:
• Associate Medical Directors
• Consultant, all specialities
• Specialist and Associate specialists grade medical staff
• Junior Medical Staff
• Pharmacy
• Nursing
• Infection Control Link Nurses (hospital and primary care)
• Podiatrists
Education and Training
April 2018-March 2019
• The Public Health Agency Funded 2.6 WTE OPAT pharmacists (1 WTE x band 8a and 1.6WTE band 7). The 8a pharmacist commenced in February 2019.
• Funding was also provided for 0.2 WTE of consultant microbiologist time for three months.
• A weekly OPAT multidisciplinary team meeting was established which involved a Consultant Microbiologist, Home Intravenous Coordinators and the OPAT Pharmacist.
• A fortnightly clinic was also established for review of all patients at home revceiving OPAT.
• Monthy pharmacist led ward rounds on every ward in the Trust, audit report reported back to AMD, for onward distribution to consultant staff , and to nursing directors, lead nurses and pharmacists.
• Discussion of audit results at Trust monthly Morbidity and Mortality meetings
• Targeted weekly microbiologist led ward rounds on wards with high CDI or high antibiotic consumption.
• Weekly review of all patients prescribed carbapenems with a view to switching to an alternative agent of limiting the duration of therapy.
• Targeted audits on areas of high antibiotic consumption to identify interventions to reduce this.
• Review of antibiotic guidelines as and when new evidence becomes available.
• Develop an antimicrobial stewardship programme for all staff to include a range of learning platforms.
• Further embed the OPAT service in the Trust for sustainability.
• Embed antimicrobial stewardship in the Trust and to engage with clinicians from all specialities to help them identify ways of reducing antibiotic use withing their areas
• An Internal Audit was undertaken and any recommendations will be progressed in 2019 -2020.
