Dr Eleri Davies, Director Infection Prevention and Control
Last update to QSE committee December 2015
HCAI Update Overview of last 9 months. Current position against WG Reduction Expectations
set for 2016/17 Review of current priorities
Antimicrobial Delivery Plan C. difficile disease and Staph. aureus blood stream
infections Multi-Drug Resistant Gram negative organisms.
July 2015
Cases of Acinetobacter baumanni noted in May, June, July (one per month)
August 2015 Further cases presented - screening found
colonisation of several babies. 25th August linked cases of Enterobacter cloacae
also detected on the unit. 26th August full closure of the NNU.
OLD NNU
Interim NNU Facilities - T1 :
28th October 2015!
November 2015 27th November 2015
Blood cultures positive on baby admitted to the unit 8th November confirmed positive for ABAUM
28th November 2015 (Saturday) ET secretions positive on a second baby
30th November 2015 Blood cultures positive from second baby ET secretions positive on 3rd Baby
FURTHER CLOSURE OF NNU
NNU re-opened 23rd December 2015. No further cases of Acinetobacter or Enterobacter
detected. Formal closure of outbreak February 2016.
External Review Professor Mike Sharland – Expert opinion /
teleconference 21st December 2015. Full external Review – 5 – 7th September 2016:
Martin Kiernon – former Nurse Consultant IP&C Dr Bharat Patel – Consultant Microbiologist Dr Mark Turner – Neonatologist (Chair)
Winter 2015/16 299 patients had D&V / Diarrhoea or confirmed
Norovirus 47 patients had influenza
17 staff
234 bed days lost March 2016:
30 wards affected across the whole HB. At peak 12 wards affected concurrently.
Other Issues C. difficile outbreak (ribotype 078) E8 UHL August
2016 Legionella – probable hospital acquisition October
2016 Admission of patient with highly resistant E.coli
(Carbapenemase producing E.coli) – not immediately identified / isolated.
Chart 5. Cardiff and Vale University Health Board monthly rates of C. difficile per 100,00 population from Oct 15 to Sep 16, rate for the current 3 month period and
the expected rate for the period Oct 16 to Mar 17
45.96
28.00
0.010.020.030.040.050.060.0
Oct-1
5
Nov-
15
Dec-
15
Jan-
16
Feb-
16
Mar
-16
Apr-1
6
May
-16
Jun-
16
Jul-1
6
Aug-
16
Sep-
16
Oct-1
6
Nov-
16
Dec-
16
Jan -
17
Feb-
17
Mar
-17
C. difficile/100,000 populationCurrent 3 month rate of C. difficile/100,000 populationExpected rate of C. difficile/100,000 population
C. difficile
C. difficile
Interventions to reduce C. difficile Antimicrobial Policy Changes Antimicrobial Stewardship Hand Hygiene! Collaboration with General Practice re Antimicrobial
Prescribing, use of PPIs and learning from RCA. Rapid isolation of symptomatic patients Improved cleaning – commodes etc. Introduction of new treatment to reduce recurrent disease
– Fidaxomicin. Introduction of Faecal Microbiota Transplantation Service
(FMT)
Hand Hygiene & Bare Below the Elbows (BBE) Actions: • Feedback of data at Big Room • Floor signage • Clinical Leads • All Wales procurement of Hand Hygiene Products and support • Consideration of new signage / screen savers.
Staph. aureus bacteraemia Chart 5. Cardiff and Vale University Health Board monthly rates of S. aureus
bacteraemia per 100,00 population from Oct 15 to Sep 16, rate for the current 3 month period and the expected rate for the period Oct 16 to Mar 17
22.16 20.00
0.010.020.030.040.050.0
Oct-1
5
Nov-
15
Dec-
15
Jan-
16
Feb-
16
Mar
-16
Apr-1
6
May
-16
Jun-
16
Jul-1
6
Aug-
16
Sep-
16
Oct-1
6
Nov-
16
Dec-
16
Jan-
17
Feb-
17
Mar
-17
MRSA bacteraemia/100,000 populationMSSA bacteraemia/100,000 populationCurrent 3 month rate of S. aureus bacteraemia/100,000 populationExpected rate of S. aureus bacteraemia/100,000 population
0
20
40
60
80
100
120
07/0
4/20
14
23/0
4/20
14
29/0
4/20
14
10/0
5/20
14
12/0
5/20
14
03/0
6/20
14
18/0
6/20
14
11/0
8/20
14
19/0
8/20
14
01/0
9/20
14
11/0
9/20
14
05/1
0/20
14
28/1
0/20
14
04/1
1/20
14
14/1
1/20
14
15/1
2/20
14
28/1
2/20
14
27/0
1/20
15
03/0
2/20
15
25/0
2/20
15
14/0
3/20
15
19/0
3/20
15
18/0
4/20
15
06/0
7/20
15
02/0
8/20
15
12/0
8/20
15
24/0
9/20
15
17/1
0/20
15
09/0
1/20
16
20/0
4/20
16
13/0
7/20
16
25/0
8/20
16
Number of days between MRSA bacteraemia cases Cardiff & Vale UHB April 2014 - October 2016
Number of days between cases Mean number of days between cases
13.10.167 days since
last case(06/10/16)
Interventions to reduce Staph. aureus blood stream infections MRSA / MSSA screening
Revised MRSA procedure. MSSA screening introduced in Renal Medicine, consideration
being given to broader MSSA screening. Improving line care (central and peripheral)
Evidence Based Practice Cannulation packs IV access team (Specialist Clinical Board)
Improving Aseptic Technique Roll out of Aseptic Non-Touch Technique (ANTT) across the
Health Board.
Current Priorities Antimicrobial Delivery Plan
Delivery Theme 1 – Improving Infection Prevention and Control
Challenge of Multi-Drug Resistant Gram negative organisms: Acinetobacter outbreak on NNU Carbapenem Resistant Organisms MDRO procedure including screening of patients on
admission to ensure early isolation. Continuing to reduce C. difficile and Staph. aureus BSI Working to prevent Winter Season outbreaks.