Highland NHS Board 26 September 2017 Item 4.5 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 progress to reduce and manage healthcare associated infections. The purpose of this paper is to update Board members of the current status of Healthcare Associated Infections (HAI) and Infection Control measures in NHS Highland. 1. Background and summary The table below shows NHS Highland Infection Prevention and Control targets and performance data. Group Target NHS Highland Clostridium difficile Age 15 and over HEAT rate of 32.0 cases per 100,000 OBDs to be achieved by year ending 03/17 Apr-June 2017 18.2 Green (Not yet validated by HPS) Staphylococcus aureus bacteraemia HEAT rate of 24.0 cases per 100,000 AOBDs to be achieved by yea ending 03/17 Apr-June 2017 19.1 Green (Not yet validated by HPS) Hand Hygiene 95% 98% Green Cleaning 92% 95% Green Estates 95% 96% Green Source: - Health Protection Scotland/ISD/Local data. Contribution to Highland Quality Approach Strategic Framework and Annual Objectives One of the 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 Infection Control and Prevention data and activities relating to annual work plan for scrutiny and feedback.
Transcript
Highland NHS Board 26 September 2017
Item 4.5 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 progress to reduce and manage healthcare associated infections.
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. The purpose of this paper is to update Board members of the current status of Healthcare Associated Infections (HAI) and Infection Control measures in NHS Highland. 1. Background and summary The table below shows NHS Highland Infection Prevention and Control targets and performance data.
Group Target NHS Highland
Clostridium difficile
Age 15 and over
HEAT rate of 32.0 cases per 100,000 OBDs to be achieved by year ending 03/17
Apr-June 2017 18.2
Green (Not yet validated by HPS)
Staphylococcus aureus bacteraemia
HEAT rate of 24.0 cases per 100,000 AOBDs to be achieved by yea ending 03/17
Apr-June 2017 19.1
Green (Not yet validated by HPS)
Hand Hygiene 95% 98% Green Cleaning 92% 95% Green Estates 95% 96% Green
Source: - Health Protection Scotland/ISD/Local data.
Contribution to Highland Quality Approach Strategic Framework and Annual Objectives One of the 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 Infection Control and Prevention data and activities relating to annual work plan for scrutiny and feedback.
Achievements • The telehealth medicine system ‘Florence’ is being implemented as an additional
supportive intervention to patients diagnosed with Clostridium difficile. • The Standard Infection Control Education Pathway (SICEP) recently launched by
Education Scotland to replace the Cleanliness Champions programme, has been incorporated into NHS Highland Statutory and Mandatory training prospectus.
• The team at ICNET (infection control software programme) are now receiving microbiological data from NHS Greater Glasgow and Clyde, which will allow us to create a manual feed of data into Argyll and Bute.
• Work, supported by Service Planning and the Director of Nursing, is underway with E-Health to develop a system for producing automated infection control data reports following the cessation of the data analyst post earlier this year.
• Annual review of Infection Prevention and Control accepted by Clinical Governance Committee.
Challenges • The E-Health teams within NHS Highland and NHS Greater Glasgow & Clyde, and the
ICNET (infection control software programme) Project team continue to work together to create an automated transfer of microbiological data from NHS Greater Glasgow & Clyde to Argyll and Bute. Expected completion date is 30th September 2017.
• The Data analyst post appointed on a fixed term contract ended on the 31st March 2017. The loss of this post resulted in a reduction of a dedicated review of healthcare associated infection cases. Currently the Infection Control and Prevention team are exploring ways in which to ensure the provision of this posts roles and responsibilities continues.
• Microbiology Laboratory samples generated by Argyll and Bute are currently all being processed through NHS Greater Glasgow and Clyde laboratories due to local staffing issues in the Oban laboratory. This is a temporary measure and is being closely monitored by the NHS Highland laboratory manager. The reporting of samples from NHS Greater Glasgow and Clyde laboratories to Argyll and Bute is in process via an email submission of a daily spreadsheet and follow up phone call. This system is human dependant leading to the possibility of error which is acknowledged on the risk register.
Additional Information Bed Occupancy Rates NHS Highland review. In April 2016 the denominator data utilised by Health Protection Scotland (HPS) in their publication of Staphylococcus aureus bacteraemia (SAB) and Clostridium difficile (CDI) rates was noted to be lower than expected for a specific quarter (Oct-Dec 2015) for NHS Highland. This anomaly was queried with the national Information Services Department (ISD), and NHS Highland was informed that the data utilised was 43% complete, so this significantly affected the published rate; as the denominator was significantly under reported. As a result of this the Service Planning Department within NHS Highland were asked to liaise with ISD and HPS, in conjunction with NHS Highland Infection Control Manager to ascertain the level of the anomalies, and subsequently gain a level of assurance for the NHS Board in relation to the accuracy of the reported SAB and CDI rates. A synopsis of their findings is presented below:
3
HPS use a dataset sent to them by Information Services Department and that dataset is based on SMR01 and ISD(S) 1 Card Class national return data. Between March 2014 and August 2015, no ISD(S)1 Card Class submissions were made from NHS Highland to Information Services Department due to data integrity issues. Relevant quarter data from 2013 was used between Q1 2014 and Q3 2015 by Health Protection Scotland to calculate rates for Staphylococcus aureus bacteraemias (SAB) due to ISD(S)1 Card Class data quality issues. Relevant Quarter data from 2013 was used for all subsequent years for the calculation of Clostridium difficile infection (CDI) rates by Health Protection Scotland. From the work undertaken by the NHS Highland Service Planning Team we have been able to demonstrate a very slight variation in the rates when compared between NHS Highland and Health Protection Scotland (HPS). However the significance to the reported SAB and CDI rates is not significant. This information has been shared with Health Protection Scotland. Submission of SMR01 and ISD(S) 1 Card Class data from NHS Highland is now being submitted to Information Services Department with a level of confidence which will give reassurance to the Board. Catherine Stokoe – Infection Control Manager Vanda Plecko – Consultant Microbiologist & Lead Infection Control Doctor, Sept 2017
1.1 Staphylococcus aureus bacteraemia target The target for 2017/2018 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 2018.
1.2 Trends NHS Highlands position as of 31st July 2017 (data not yet validated by HPS) is tabled below. 1st April 2017 - 31st July 2017
MSSA = 18 MRSA = 1 Total SABs = 19 Cases
Preventable = 0 (0%) Not preventable = 13 (70%) Unknown = 3 (15%) Under Investigation = 3 (15%) Hospital Acquired Cases = 5 (26%) Community Acquired Cases = 8 (42%) Healthcare Associated Cases = 4 (22%) Contaminant = 0 (0%) Undergoing investigation = 2 (10%) Total = 19 For definitions of above classifications please see section 2 page 14
Figure 1: NHS Highland Staphylococcus aureus bacteraemia Cumulative Case numbers year on year since 2014. The information presented in the graph below is based on NHS Highland case number data.
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:
All SAB cases undergo a multi-disciplinary team review in order to identify any learning. To date no cases have been deemed preventable following this review. The action plan developed to implement actions to reduce staphylococcus aureus bacteraemia is in place and monitored through the Infection Control Improvement Group and Control of Infection Committee. 1.3 Current Initiatives
• Information from the practice review, performed by the external company Becton
Dickinson, on the insertion and management of peripheral vascular devices, is currently being shared with the clinical teams.
• A trial of a pre-filled Saline syringe has occurred within NHS Highland. Saline is used to flush through peripheral vascular devices to keep the devices functioning. The use of a pre-filled syringe reduces the risk of contamination, needle stick injuries, and releases time to care. The evaluations from this trial are currently being assessed.
2. Clostridium difficile
2.1 Clostridium difficile HEAT Target
The target for 2017/2018 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 2018. 2.2 Trends
NHS Highlands position as of 31st July 2017 (data not yet validated by HPS) is tabled below. 1st April 2017 to 31st July 2017
Total CDI Cases aged 15 and over = 16
Aged 15-64 = 5 Aged 65+=11
Healthcare Associated = 4 (25%) Community Acquired = 8 (50%) Unknown = 2 (12.5%) Under Investigation = 2 (12.5%) For definitions of above classifications please see section 2 page 15
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:
Figure 2: NHS Highland Clostridium difficile Infection age 15 and over, case numbers year on year since 2014. The information presented in the graph below is based on NHS Highland case number data
2.3 Current Initiatives
• The second trial of an Ultra-violet light decontamination system machine is underway within Raigmore Hospital. This technology is proven to reduce the viral and bacterial load of the environment and enhance the effectiveness of manual cleaning. We continue to have the use of this technology within Raigmore hospital which is being utilised to support the enhanced decontamination of the environment. Once the trials have been completed, the systems suitability will be assessed and a procurement process commenced, if applicable.
• The trial of the telehealth medicine system “Florence” has been successful. The aim of “Florence” is to provide support and advice to patients diagnosed with Clostridium difficile infection through an interactive text messaging system.
2.4 Antimicrobial Management National Hospital Antimicrobial Prescribing Quality Indicators As noted in the last board report, the detail of these quality prescribing indicators has recently been shared with Antimicrobial Management Teams across Scotland, for achievement by 31st March 2018. A national baseline report for antimicrobial consumption is awaited but work towards achieving the target has already begun. Antibiotic prescribing audits using the new format commenced in July on wards 6C, 7A and 4C in Raigmore. The main new element is achieving a review of intravenous (IV) therapy or oral duration of therapy in 60% of patients by December 2017, rising to 80% of patients by the end of March 2018. All three wards are already achieving the 80% target with reviewing IV therapy. In terms of documenting the review of oral therapy, ward 4C is achieving the 60% target now with 7A and 6C are achieving 55% and 58% respectively. Feedback on the new audit format and incremental targets has been shared with the clinical teams for discussion and learning. Management of Infection Guidance Review The current version of the intravenous to oral switch guidelines has been reviewed and converted into a policy document to make the daily review of patients on intravenous therapy a “must do” rather than best practice.
7
Antibiotic Audit Project in 7A The clinical team in ward 7A have been reviewing the timely switch of antibiotic therapy from intravenous to oral antibiotics as part of wider efficiency work on the ward. Recognition of possible earlier switching had been noted during consultant wards rounds held on Mondays and has led to the development of an audit project by one of the junior doctors. The results of this were presented at the last Antimicrobial Management Team meeting and noted a small number of patients that could potentially have been switched to oral therapy earlier. Oral antibiotic therapy is cheaper than injections and frees up nurses for more direct patient care. Further work to embed suggested changes is required. The recommended interventions are to highlight patients on IV antibiotics at the morning huddle (specifically to consider IV to oral switch and ensure documentation of duration of oral antibiotics), placing a poster on the wall in front of notes trolley to remind staff about timely IV to oral switch, creating a review tool to aid IV to oral switch especially for the weekends and highlighting patients that could be switched over the weekend when handing over to the weekend team. 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. Compliance data for this year (April to June 2017) identifies an average of 98% 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
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.
Keeping the healthcare environment clean is essential to prevent the spread of infections. Information on national cleanliness compliance monitoring can be found at:
A series of unannounced Independent Public Peer Review audits is in progress; these occur across all hospital sites in NHS Highland. Work continues to implement the revised NHS Scotland National Cleaning Services specification. The revised document allows NHS Boards too accurately and effectively risk assess specific tasks in order to determine the frequency of cleaning, based upon the risk to the patient and also public perception. Progress is reported through the Soft Facilities Management group and monitored through the Infection Control Improvement Group. 4.2 Healthcare Environment Inspections (HEI) The report for the HEI Inspection of MacKinnon Memorial Hospital (18th and 19th April 2017) was published on the 27th of June 2017, and the subsequent 16 week follow up report has been submitted. This was a very positive visit and the requirements, (outlined below) have been met. Requirement 1: NHS Highland must ensure that audit results are fed back to staff to provide assurance, drive improvement and communicate any risks. Requirement 2: NHS Highland must ensure that the current version of Health Protection Scotland’s National Infection Prevention and Control Manual is available to staff. This includes any hard copies of infection prevention and control policies. Requirement 3: NHS Highland must ensure that all waste is disposed of in line with Health Facilities Scotland’s Scottish Health Technical Note 3 (2015) and that all staff involved in the management of waste are aware of their responsibilities.
Benchmarking continues against all the national HEI inspection reports published, in order to ensure learning is disseminated.
5. Outbreaks/ clusters and multidrug resistant isolates associated with NHS Highland
The closure of ward 7A Raigmore Hospital occurred in August due to confirmed norovirus.
The closure of Kylesku ward, Migdale Hospital also occurred in August due to suspected norovirus.
6. Surveillance 6.1 MRSA Clinical Risk Assessment (CRA) Screening Audit 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%. MRSA Key Performance Indicator Compliance %
2014/ 2015 Jan-March Q4
2015/ 2016 Apr- June Q1
2015/ 2016 July - Sept Q2
2015/ 2016 Oct – Dec Q3
2016/ 2017 Jan- March Q4
2016/ 2017 April- June Q1
2016/ 2017 July- Sept Q2
2016/ 2017 Oct- Dec Q3
2017/ 2018 Jan- March Q4
2017/ 2018 Apr- June Q1
NHS Highland
71% 75% 72% 78% 76% 84% 86% 86% 77% 67%
NHS Scotland
78%
83% 78% 83% 80% 82% 84% 82% 79% 85%
9
Staff are required to complete a Clinical risk assessment on all acute admissions as per the HPS 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 two quarters have seen a reduction in staffs compliance with this assessment. This is thought to be related to the introduction of new nursing documentation, changing where the assessment tool can be found; and also staff failing to complete the documentation appropriately. The compliance information has been highlighted to the ward staff, and the relevant Senior Management Teams to raise awareness of the importance of this screening process. Support has also been received from Health Protection Scotland to assist in improving compliance. NHS Highlands data for the months of July and August is highlighting an improvement in the compliance figures. The next quarterly data will be available in October.
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 Highlands position as of 31st July 2017 (data not yet validated by HPS) is tabled below. 1st April 2017 to 31st July 2017
Total Cases = 77 Hospital Acquired = 6 (8%) Healthcare Associated = 16 (21%) Community Acquired = 50 (61%) Not Known = 1 (10%) Under Investigation = 4 (5%)
It should be noted that the majority of E.Coli cases reported within NHS Highland are identified as community associated and are not related to urinary catheters or deemed preventable. Often they are associated with chronic urinary tract problems such as renal impairment and kidney stones. 6.3 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 Currently there have been 6 infections reported from procedures from Jan 2017 to May 2017 (9.8% SSI rate).
Colorectal SSI rate Jan – Dec 2016 was 13.3%. This compares to previous rates of Jan – Dec 2015 9.1%; 9.1%; Jan-Dec 2014 9.7%; and Jan-Dec 2013 15.7%.
Figure 3: highlights the monthly SSI percentage rate in elective colorectal surgery, July 2011 to May 2017, and is annotated to identify improvements introduced.
RAIGMORE 30 DAYS READMISSION ORTHOPAEDIC SSI
Total Hip replacement (THR) surgery continues to have a low rate of SSI. Currently there are no infections to report in 2017 (0% rate of SSI). As of the 30th June it is 242 days since the last THR SSI. THR SSI rate Jan –Dec 2016 was 0.24%; this compares to previous rates of Jan-Dec 2015 0.28%; Jan-Dec 2014 0.66%; and Jan-Dec 2013 0.25%.
11
Figure 4: Monthly SSI rate in Total Hip Replacement surgery Jan 2010- June 2017
Hemi-arthroplasty Surgery continues to have a low rate of SSI. Currently there has been 1 infection reported from 96 procedures between Jan 2017 to June 2017 (1% SSI rate). SSI rate Jan-Dec 2016 was 0%; this compares to previous rates of Jan-Dec 2015 2.4%; 1.7%; and Jan-Dec 2013 2.9%. As of the 30th of June 2017 it is 40 days since the last Hemi-arthoplasty SSI.
Figure 5: Monthly SSI rate for Hemi arthroplasty surgery Jan 2010 to June 2017
NHSH 10 DAYS POST DISCHARGE CAESAREAN SECTION SSI
ELECTIVE C-SECTION
Elective C-Section Currently 4 infections have been reported in 2017, with 169 operations performed (2.4% rate of SSI). SSI rate for Jan-Dec 2016 is 2.7%. This compares to previous rates of Jan-Dec 2015 2%; Jan-Dec 2014 0.7%; and Jan-Dec 2013 1.4%.
Figure 6: shows monthly SSI rate for elective C Sections, Jan 2012 to June 2017
EMERGENCY C-SECTIONS
Currently 5 infections have been reported in 2017 with 176 operations performed (2.8% rate of SSI). SSI rate for Jan-Dec 2016 is 2.4%. This compares to previous rates of Jan-Dec 2016 is 2.4%. This compares to previous rates of Jan-Dec 2015 2.5%; Jan-Dec 2014 1.9%; and Jan-Dec 2013 2%.
Figure 7: Monthly SSI rate for emergency C Section, Jan 2012 to June 2017
13
Bi monthly multi-disciplinary RCA meetings are held between the midwifery, obstetric, theatre and infection control team to review all C-section’s resulting in an SSI.
The communality between all cases is a large body mass index. Consultation with other NHS Boards is identifying this as a similar issue. Work is underway by the Clinical team to review the method of draping larger patients to prevent fluid ingress, and also on antibiotic prescribing for a larger patient prior to surgery.
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.
15
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 OPERATIONAL UNIT 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 August
NHS HIGHLAND SOUTH & MID OPERATIONAL UNIT 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 August
NHS HIGHLAND ARGYLL & BUTE CHP 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 & Annex, Rothesay
Staphylococcus aureus bacteraemia (SABs) monthly case numbers August
