Shetland NHS Board. Control of Infection Committee Annual Report

Transcription

1 Shetland NHS Board Control of Infection Committee Annual Report April March 2013 Prepared by Dr Susan Laidlaw, on behalf of Control of Infection Committee July 2013

2 NHS Shetland Control of Infection Committee Annual Report Acronyms and Abbreviations ARI Aberdeen Royal Infirmary AOBD acute occupied bed days CDI Clostridium difficile infection CDU Central Decontamination Unit CGC Clinical Governance Committee CHCP Community Health & Care Partnership CoIC Control of Infection Committee CRA Clinical risk assessment (for MRSA Screening) CRBN Chemical, Radiological, Biological or Nuclear (Incident) DATIX Software for patient safety, incident and risk reporting and management DPH Director of Public Health HAI Healthcare associated infection HAI SCRIBE Healthcare Associated Infection System for Controlling Risk in the Built Environment HDL Health Department Letter HDU High Dependency Unit HEAT targets Health, Efficiency, Access, Treatment Targets (Scottish Government) HEIS Healthcare Environment Inspectorate Scotland (incorporated into HIS from April 2011) HIS Health Improvement Scotland (new national scrutiny body from April 2011) HPS Health Protection Scotland ICM Infection Control Manager ICT Infection Control Team iiip Infection Improvement and Implementation Programme ISD Information Services Division, National Services Scotland JAG Joint Advisory Group on Gastrointestinal Endoscopy KPI Key Performance Indicator LHBC Local Health Board Co-ordinator (Hand Hygiene Campaign) NES NHS Education Scotland MMR Combined measles, mumps and rubella vaccination PFPI Patient Focus Public Involvement PPE Personal Protective Equipment PPF Public Participation Forum MRSA Meticillin Resistant Staphylococcus aureus MSSA Meticillin Sensitive Staphylococcus aureus QIS Quality Improvement Scotland (superseded by HIS from April 2011) SAB Staphylococcus aureus Bacteraemia SPSP Scottish Patient Safety Programme SSHAIP Scottish Surveillance of Healthcare Associated Infection Programme SSIS Surgical Site Infection Surveillance TOBD total occupied bed days 1

3 NHS Shetland Control of Infection Committee Annual Report Contents 1 Introduction 3 2 Background to Work Programme 6 3 Progress against Work Programme for Occupational Health 21 5 Communicable Disease Control 22 6 Significant Incidents 25 7 References 27 Appendices Appendix A: Communicable Disease & Infection Control Surveillance Report Appendix B: Work Programme for Appendix C: Tuberculosis Annual Report 2

4 NHS Shetland Control of Infection Committee Annual Report Introduction Infection control covers a wide range of activities. These range from preventing patients picking up infections when they come into hospital, to controlling outbreaks of infectious diseases, such as food poisoning, in the community. Although much activity is coordinated by the Infection Control Team (ICT) led by the Infection Control Manager many others are involved in infection control activities. These include NHS clinical staff, cleaning staff and the Estates Department and the Shetland Islands Council s Environmental Health Department. The Control of Infection Committee (CoIC) acts as the central committee to oversee all infection control issues within Shetland NHS Board. The constitution of the Committee was revised in 2009 to bring it up to date with new roles and responsibilities within the Board and again in 2011 to reflect further changes, and the membership and remit of the Infection Control Team was similarly reviewed. During 2011 a new post of Consultant Microbiologist was created, which covered the remit for Infection Control Manager and Infection Control Doctor. Although the post was appointed to, the postholder left in 2012 and it was decided not to re-appoint as it was apparent that the post was unsustainable. The role of Infection Control Manager has therefore returned to the Director of Nursing, Midwifery and Allied Health Professionals. The role of Infection Control Doctor has returned to the Director of Public Health / Public Health Consultant with specialist microbiological support from NHS Grampian. 1.1 Remit of Control of Infection Committee To review and provide advice on Shetland wide infection control strategies and policies within the service To facilitate collaboration and co-ordination between different health service sectors, Shetland Islands Council and other agencies and to liaise with neighbouring NHS Board Control of Infection Committees To provide advice and support to the ICT and to assist the Director of Public Health in providing advice to hospital and community services To endorse the annual infection control programme prepared by the ICT To prepare an annual report for the Board, presented through risk management and clinical governance channels to the Clinical Governance Committee 3

5 NHS Shetland Control of Infection Committee Annual Report Accountability The Control of Infection Committee reports regularly (and also in the event of a significant incident or outbreak) via the Clinical Governance Coordinating Group (CGCG) and Health and Safety Committee to the Clinical Governance Committee (CGC). The Clinical Governance Committee is the Board appointed Committee for health and safety and clinical governance matters in NHS Shetland. The Control of Infection Committee receives reports from the Control of Infection Team, and also a direct report in the event of a significant incident relating to infection control, or outbreak. Shetland NHS Board Clinical Governance Committee (Risk Management) Director of Nursing, Midwifery and Allied Health professionals (Executive Lead for HAI) Director of Public Health (Executive Lead for Communicable Disease Control and Emergency Planning) Clinical Governance Co-ordinating Group Annual Report Health & Safety Committee Control of Infection Committee Antimicrobial Management Team Vacc & Imm Group Cleanliness Champions Infection Control Team Area Drug and Therapeutics Committee Reporting route Minutes shared Executive lead input 4

6 NHS Shetland Control of Infection Committee Annual Report Committee membership April 2012 March 2013 (* Member of Infection Control Team ) Director of Public Health Infection Control Doctor HAI Executive Lead Infection Control Manager Infection Control Manager / Consultant Microbiologist / Infection Control Doctor Infection Control Nurse (Hospital) Public Health Nurse Dr Sarah Taylor* ICD from October 2012 Kathleen Carolan* ICM from October 2012 Dr Adam Brown* until September 2012 Tina Bokor-Ingram* Wendy Hatrick* Lay Representative Janet Manson from June 2012 CHCP representative / Asst. Director of Nursing (Community) Asst. Director of Nursing (Hospital) Consultant Microbiologist (Aberdeen) Edna Mary Watson* Janice McMahon* As required Head of Estates John McBeath* until April 2013 Laboratory service rep Vacant until January 2013 Geoff Day from February 2013 Occupational Health Nurse Pharmacy Manager Medical Director or rep Cleanliness Champion rep Hotel Services Manager SIC Environmental Health Services Manager Consultant in Public Health (Deputy for DPH / ICD) Bernadette Dunne* David Anderson Dr Roger Diggle Edna Peterson Valery Lafferty Maggie Sandison (Dunne) Dr Susan Laidlaw* 5

7 NHS Shetland Control of Infection Committee Annual Report Background to Work Programme The work programme covers a number of areas concerned with infection control both in health care settings and the community. These include: surveillance training policy and procedure development prevention and management of healthcare associated infection audit As in previous years, most of the work programme for was based on developing and implementing local action plans concerned with the prevention and management of healthcare associated infection (HAI), a national priority for the Scottish Government and for the Board. These action plans have been produced in response to the following national initiatives: 2.1 HAI Taskforce Delivery Plan In 2003, the Scottish Executive Healthcare Associated Infection Taskforce was set up in response to the Ministerial Action Plan Preventing infections acquired while receiving healthcare. 1 The Taskforce produced a programme of work which aimed to co-ordinate and build on existing HAI activities across healthcare settings in Scotland, based on the message: 'clean healthcare environments, clean hands, clean instruments'. In 2006 the Taskforce published a Delivery Plan for , which included further work on the areas listed above, along with new initiatives such as the National Hand Hygiene Campaign. A third Delivery Plan was introduced in 2008 for A number of the programmes of work have been embedded into routine practice including hand hygiene audits. 2.2 HAI Action Plan (in response to Vale of Leven C diff outbreak) In 2008 there was an outbreak of Clostridium difficile at the Vale of Leven Hospital in NHS Greater Glasgow and Clyde. 55 patients developed Clostridium difficile infection (CDI) and 18 died. As a result of this there was an Independent Review and a number of issues were identified that had contributed to the problems at Vale of Leven. The Scottish Government subsequently produced a HAI Action Plan to address these issues and ensure good infection prevention and control procedures are in place across all NHS Boards. 2.3 The QIS Standards and Healthcare Environment Inspectorate Scotland (HEIS) Inspection In March 2008 QIS (Quality Improvement Scotland, now Healthcare Improvement Scotland, HIS) published new HAI Standards for local assessment, These standards focus on compliance; patient focus and public involvement; prevention and control of infection; environment and equipment; and education. The aim was to build on the 6

8 NHS Shetland Control of Infection Committee Annual Report previous HAI standards, which focussed on structure and processes, and now to focus on outcome measures that will demonstrate improved Board performance. They recognise the importance of the NHS Scotland Code of Practice for the Local Management of Hygiene and HAI in the development of these standards, to build on work already implemented by the service Announced Inspection 2009 NHS Shetland had its first Inspection visit in 2009, this was an announced visit following submission of a self assessment. The inspection team examined NHS Shetland s selfassessment information and then inspected the hospital to validate this information, meet patients and staff, and visit wards and departments. During the visit, the inspection team also assessed the hospital s physical environment for issues related to healthcare associated infection. The findings from the visit set out five requirements that NHS Shetland was fully expected to address, plus seven recommendations for improvement. These were built into an action plan which was largely completed by March 2010, with some outstanding actions carried on through to Unannounced Inspection 2012 In August 2012, NHS Shetland had its second inspection, this was an unannounced visit to the Gilbert Bain Hospital following submission of a self assessment in June The comprehensive assessment, against the national healthcare associated infection standards, covered Accident & Emergency, the Maternity unit, the Renal unit, Ronas ward, Ward 1 and Ward 3. The Inspection Report noted that the inspection team found evidence that NHS Shetland is complying with the majority of NHS QIS HAI standards to protect patients, staff and visitors from the risk of acquiring an infection. In particular, staff were aware of their individual responsibilities for infection prevention and control, and cleaning in Gilbert Bain Hospital was good and the environment was well maintained. However, there are some areas for improvement, in particular improving communication between estates and ward staff, and improving HAI information for patients and visitors. The Inspection resulted in two requirements and three recommendations for improvement. The requirements were both considered to be of minor priority and had a 9 month deadline (ie by the end March 2013). Requirements - NHS Shetland must: ensure that there is effective two-way communication between estates and ward staff. This will ensure that ward and departmental staff are kept informed of ongoing maintenance issues in their area of responsibility. ensure that there are effective systems in place for the dissemination of HAI information to patients and visitors to ensure patients and visitors are fully informed. Recommendations - NHS Shetland should: finalise the guidelines for surgical antibiotic prophylaxis in adults as soon as possible. This will ensure that staff are confident they have the most up-to-date guidance when prescribing antibiotics for surgical prophylaxis. 7

9 NHS Shetland Control of Infection Committee Annual Report review the frequency of peripheral vascular catheter (PVC) compliance audit activity with the Scottish Patient Safety Programme. This will provide a greater level of assurance that compliance with the PVC bundle is maintained. develop a formal process for communicating information between different shifts of domestic staff. This will ensure that cleaning schedules are fully implemented. These actions were included in the Control of Infection Work Plan for The full report is available at: shetland_reports/gilbert_bain_oct_12.aspx 3 Progress against Work Programme for Surveillance Surveillance is the collection and analysis of information about cases of illness, for example infectious diseases. It is used to understand patterns of illness, particularly to pick up where there is an unexpected increase in the number of cases of a disease. Surveillance is the responsibility of the Public Health Department in NHS Shetland. The Infection Control Team receives monthly surveillance reports to oversee action taken in response to cases or trends in infection. The Control of Infection Committee receives regular surveillance reports on MRSA; Staphylococcus aureus bacteraemias; Clostridium difficile; Surgical Site Infection Surveillance; sharps injuries amongst NHS staff, notifiable diseases and vaccination uptake rates. The Annual Surveillance Report (Appendix A) contains further details of the items summarised below MRSA (Meticillin Resistant Staphylococcus Aureus) MRSA is a bacteria carried by many people that can sometimes cause serious infections, particularly in hospital patients. MRSA is identified in two ways: Screening of patients (now as part of the National MRSA Screening Programme) Isolating MRSA as a cause of infection (for example a wound swab or urine test) During , local surveillance figures show that six patients had infections caused by MRSA, including chest, skin and urinary tract infections. There were also four patients identified as being colonised, three of these through the MRSA screening programme. There were no MRSA bacteraemias Staphylococcus aureus bacteraemia (SAB) Nationally, both meticillin sensitive (MSSA) and meticillin resistant (MRSA) staphylococcus aureus bacteraemias are monitored and reported. The national system 8

10 NHS Shetland Control of Infection Committee Annual Report reports cases of bacteraemia with control limits designed to show where variations in rates might be significant. Staphylococcus aureus bacteraemia data have been monitored in Scotland since 2001 and there have been substantial reductions in these infections since this time. MRSA & MSSA rates are now part of the Board s performance monitoring by the Scottish Government within the HEAT targets. The target was to achieve a 30% reduction in SABS (including both MRSA and MSSA) from the baseline year of As the Shetland baseline was already zero, we could not make a further reduction, but it would be inevitable that we would have a small number of cases. Therefore, we have set a target of 0.26 per 1000 acute occupied bed days (AOBD). During there were three SABs reported in NHS Shetland. This gives us a rolling average 0.28 per 1000 AOBD. This is slightly above the target of 0.26 and therefore we have not met the HEAT target at the end of March However, all the three SABs reported during were MSSA and all three of the patients were admitted to hospital with the bacteraemia, ie they did not acquire the infection in hospital Clostridium difficile Clostridium difficile is a bacterium, widely distributed in the environment and in the gastrointestinal tract of animals and also humans. Clostridium difficile infection (CDI) is a major cause of illness and death, especially as a healthcare associated infection. It usually follows use of antibiotics, with some antibiotics being more likely to trigger infection than others. Disease ranges from mild self-limiting diarrhoea to severe diarrhoea, pseudomembranous colitis, toxic megacolon and potentially death. In recent years, the numbers of infections caused by Clostridium difficile have increased and become more severe. In Scotland, mandatory surveillance of CDI was introduced in 2006 as a result of this changing picture. The surveillance programme was initially set up to record the incidence of CDI in patients aged 65 and over. In April 2009, the programme was expanded to include the age group Cases are identified through laboratory reports. The Incidence rates of CDI in Scotland have continued to decrease between 2011 and 2012 though the overall trend has levelled compared to previous years. The HEAT target for C.difficile is for Boards to reduce the number of their cases to less than 0.39 per 1000 occupied bed days (OBD) by end March 2013, or if the baseline rate was lower than 0.39 the target was to maintain it. As the baseline for Shetland was zero, it would be impossible to maintain the rate at this level as a small number of cases would be inevitable. We therefore have a target of 0.2 cases per 1000 OBD. During , there were three cases in Shetland. One of these was not confirmed as a true clinical case of CDI (the organisms can be isolated in the gut without it causing any illness); one was a patient in the community and the case report for the third patient is included in the significant incidents in section below. Because we have had three cases in the last six months, our rate is now 0.21 per 1000 OBD. This is slightly above our local HEAT target, but still below the national HEAT target. 9

11 NHS Shetland Control of Infection Committee Annual Report Surgical Site Infection Surveillance (SSIS) Surgical site infections (SSIs) are an important cause of healthcare associated infections. They account for 15.9% of all HAI, and cost the NHS in Scotland 30 million per year. 11 SSIs have serious consequences for patients affected as they have been estimated to at least double the length of hospital stay and also result in pain, suffering and possible further surgery. SSI is an important outcome measure for surgical procedures and the key aim of SSI surveillance is to improve the quality of patient care and to provide participating hospitals with robust SSI rates in order for them to compare with similar hospitals against benchmark rates. Evidence suggests that actively feeding back data to clinicians contributes to reductions in rates of infection. The Scottish Surveillance of HAI Programme (SSHAIP) within Health Protection Scotland (HPS) coordinates the SSI surveillance programme that is mandatory in all NHS Boards in Scotland. All NHS Boards are required to undertake surveillance for hip arthroplasty (for fractured hip) and caesarean section procedures as per the mandatory requirements of HDL (2006) 384 and CEL (11) Local data show that we have a small number of procedures and a small number of infections, with no significant trends to date. During there was one SSIS reported from 56 procedures Sharps injury A sharps or contamination injury is when someone receives a puncture wound from a needle or other sharp instrument or object which could be contaminated and which may lead to infection. Also a person could come into contact with blood or body fluid that is blood stained through splashes in the eyes, mouth or broken skin or through a bite from a person. Although rare, there is the risk of contracting a blood borne infection such as HIV, Hepatitis B or Hepatitis C through a sharps or contamination injury. Across Scotland the annual incidence of sharps injury is approximately 15 per 1,000 staff. 4 Shetland NHS Board employs approximately 700 staff and there were 13 recorded sharps injuries during , which gives us a rate of The local rate has remained fairly constant in recent years. It is slightly higher than the national average, but this may be due to high levels of reporting and the effect of small numbers. The Occupational Health department continues to play a significant role in both raising awareness and training, and in responding to incidents see section 4.1 below Communicable disease surveillance The Public Health Department is informed of cases of notifiable disease, both those suspected on clinical grounds, which are notified by the GP or a hospital doctor and those confirmed by the laboratory. This information is forwarded to Health Protection Scotland, which produces weekly updates on a national basis. In January 2010 the list of notifiable diseases and the methods for reporting them to Public Health changed as a result of the new Public Health Act for Scotland. 5 Some common infections have been removed from the list, including chickenpox and clinical suspicion of food poisoning (gastro-intestinal infection). Confirmed cases of salmonella, campylobacter and other gastro-intestinal infections are reported by the laboratory. 10

12 NHS Shetland Control of Infection Committee Annual Report Appendix A shows these figures in detail for , along with commentary on some of the specific infections reported. Of note this year, were 36 confirmed cases of pertussis between April 2012 and March Previously we have had only occasional cases of pertussis in Shetland. However this is part of a wider outbreak across the UK mainly amongst unvaccinated and partially vaccinated individuals, including those too young to be fully vaccinated, as well as some older people where their immunity has waned. There is now an enhanced surveillance programme for pertussis which commenced at the beginning of 2012/13. This year we have also seen two cases of TB; two cases of E Coli 0157 associated with a cluster in Orkney and an outbreak of norovirus in the Gilbert Bain Hospital along with outbreaks in care centres. These cases and incidents are described further in section Vaccination uptake rates Childhood immunisations are managed and monitored through a local Vaccination & Immunisation Group, which reports to the Control of Infection Committee. National uptake figures, broken down by NHS Board and CHP, are reported on a quarterly basis by National Services Scotland Information and Statistics Division (ISD). The Vaccination & Immunisation Group uses these reports to monitor trends and take action if necessary. The Immunisation Co-ordinator also receives uptake figures broken down by GP practice and feeds these back to individual practices. Details of uptake are included in Appendix A. Of note is the continued low uptake of MMR, although there is a gradual trend to children receiving their first MMR earlier and the uptake rates are slowly improving. There is also a relatively low rate of uptake of the pre-school booster by age of school entry which is being addressed through the Vacc & Imm Group and individual practices. The uptake of flu vaccine rose a little this year, but continues to fall slightly short of the target of 75% for people aged 65 and over. There was an increase in the uptake amongst pregnant women in Shetland compared to last year, although still not as high as the rest of Scotland. 3.2 Training Infection control is included in staff induction and compulsory refresher training. Staff are also offered the use of the IT suite to complete mandatory online modules via LearnPro. All training that cannot be delivered internally can be applied for via the training plan examples of this are level 2 and 3 food hygiene programmes Induction & refresher days for all NHS staff The corporate induction continues to be delivered to all staff, except the junior doctors and student nurses, as both of these groups have their own specific induction. The induction day, which is delivered on the first working Monday of every month, has a number of specific sessions, delivered by experts, that the Board has decided are essential for all new staff to be made aware of and control of infection is included on the agenda. The Infection Control 15 session is always delivered by a member of the Infection Control Team which indicates the importance of this topic for new members. Between April 2012 and March 2013, 95 new members of staff attended the induction session. 11

13 NHS Shetland Control of Infection Committee Annual Report Compulsory Refresher Training also runs every month and it is expected that every staff member, including bank staff, attend this course in an 18 month cycle. The course is reviewed and revised every 18 months and in this cycle there are a number of areas where infection control training is delivered. Firstly this day is split into two distinct parts; a morning where sessions are delivered in either presentation or practical session. The second part is for delegates to complete some Learn Pro e-learning modules. There is a practical session on infection control, which can be varied according to the needs of the staff attending, but generally involves an update on current issues and new procedures. Again this session is always delivered by a member of the Infection Control Team. Evaluation of this session is consistently good. Between April 2012 and March 2013, 161 delegates completed this training. One of the Learn Pro modules that delegates are required to complete is on Health Care Associated Infection. 173 staff completed this module during , including both clinical and non-clinical staff. There is an additional module for clinical staff on food hygiene: 108 completed this module last year.. LearnPro Module Staff Completed NHS Shetland Infection control (includes waster procedures) 173 NES HAI Induction 3 Food handling training for clinical staff 108 Aseptic Technique 1 48 Aseptic Technique 2 29 Aseptic Technique 3 30 Aseptic Technique 4 26 Aseptic Technique 5 26 Aseptic Technique 6 25 Figures for April 2012 to March The student nurse induction has been updated and now includes a more comprehensive session on control of infection. This involves hand washing techniques and the proper use of gel dispensers. During the period of this report 46 pre- registration nursing students have undergone induction. Induction materials are reviewed to ensure currency. 12

14 NHS Shetland Control of Infection Committee Annual Report The induction standards and codes of conduct were introduced for all Health Care Support Workers (HCSW) in January This incorporates a work book in which all newly appointed HCSWs must demonstrate their understanding of how they maintain a safe workplace for themselves and others. Standard 2 includes a focus on prevention and control of infection. Currently 23 Handbooks have been completed and returned. The majority of outstanding booklets are for Bank Staff who do not have a fixed return date Decontamination: Central Decontamination Unit (CDU) staff: One member of staff has completed the technical certificate in decontamination which involves completion of a workbook and an examination at the end of training. Another member of the team is due to commence training shortly. The Quality Management Supervisor continues to attend the National Sterile Services Consultative Group on a biannual basis. All mandatory organisational training has been completed by all staff in the department. All CDU staff have an eksf PDP in place and have had a KSF development review Clinical skills training A number of programmes are offered to staff via the Staff Development Course bulletin. Principles of prevention and control of infection underpin these programmes and are related specifically to the skill being taught Contamination Incident/ Needle Stick Injury Training This course is for nursing, dental and medical staff who are involved in the management of employees. It is aimed to educate about their role and responsibilities when a contamination incident/needle stick injury occurs. Two courses were planned during 2012/13 but very few staff attended; the delivery of sharps training is therefore being reviewed Cleanliness Champions (NHS Education Scotland package) Although not compulsory all staff are encouraged to consider completing this course. A total of 152 staff have now completed the course, with 5 currently working on it (June 2013). The process for undertaking the course has changed, so that it can be completed online via the LearnPro platform, Food handling training for ward staff There is a module on the Learn Pro package that all clinical staff must complete on food hygiene, during , 108 staff members have completed this module FFP3 masks fit testing There has been a considerable amount of work in the past year to develop a robust process to ensure that staff are correctly fitted with FFP3 masks in case they are required in an outbreak situation, or as part of the infection control precautions for an individual patient. Work has progressed to fit staff with FFP3 masks through this process, but this is quite slow as it is time intensive for the fitter especially. 53 staff have been fitted with FFP3 masks in the past year. 13

15 NHS Shetland Control of Infection Committee Annual Report The process now involves: Each clinical area is assigned a fitter Mask filters are issued to individual staff for personal use and signed for when the mask is fitted All records held pertaining to size and issue of filters held with Health and Safety team electronically A stock of small masks (the most popular size) and a stock of excess filters are held in the Assistant Director of Nursing (Hospital) s office for use if required. A small stock of masks are held for immediate use in Accident and Emergency Department. The Staff Induction paperwork is to be updated to include the relevant employees arranging to have a mask fitted as part of their induction Other training: Accident and Emergency Decontamination Training Accident and Emergency staff are responsible for the decontamination of patients in the event of a chemical, radiological, biological or nuclear (CRBN) incident and regular training and exercises are run to train staff in the use of the decontamination equipment. Training in the use of decontamination suits and equipment for new and existing hospital staff was run in April 2012, provided by the SORT (Special Operations Response Team) based in Aberdeen, and a refresher was held in autumn The next training session will be in October Staff Development Bulletin The Staff Development Bulletin is released on a quarterly basis. The Bulletin highlights key learning opportunities for all staff. Any programmes that fall out with the release date are advertised on the What s on notice board, message of the day or via to all staff. There is an Infection Control section which highlights key issues and training opportunities for all staff. It also contains a list of useful websites so that staff can access infection control information and training electronically and at a time that suits. The bulletin specifically highlights the NES on-line short courses that are available Infection Control Team: individual training programmes Members of the Infection Control Team have also undertaken specific training within their Personal Development Plans. This includes the Infection Control Nurse who is currently undertaking an MSc in Advanced Practice (Infection; Diseases, Prevention and Control). As part of this qualification the Infection Control Nurse has acquired a Specialist Practitioner Qualification in Infection Control and Prevention. Other members of the team have completed training in HAI Surveillance and incident management. 3.3 Policy and Procedure Development 14

16 NHS Shetland Control of Infection Committee Annual Report During the National Infection Prevention and Control Manual was introduced and replaced all existing Standard Infection Control Precaution Procedures by all NHS Boards. The following new appendices to complement the National Infection Prevention and Control manual were approved by the Control of Infection Committee during : Appendix 7: Decontamination of reusable non-invasive patient care equipment Appendix 8: Decontamination status Certificate Appendix 9: Procuring, trialling or lending any reusable non-invasive patient care equipment Appendix 10: Management of Linen at Care level Appendix 11: Management of Blood and Body fluid Spillages Appendix 12: Management of Waste at Care Area Level Appendix 13: Management of Occupational Exposure Incidents. The following new standard operating procedures were approved by the Infection Control Team: Standard Operating Procedure for Patient Placement/Assessment for Infection Risk Standard Operating Procedure for Personal Protective Equipment Standard Operating Procedure for Management of Care Equipment Standard operating Procedures for Cleaning of Isolation/Barrier Nursing Area Standard Operating Procedures for Safe Management of Linen Standard Operating Procedures for Planned Curtain Changes Standard Operating Procedures for Cleaning Unotron Keyboards Standard Operating Procedures for Cleaning Wheelie Bins Standard Operating Procedures for Healthcare Environment Inspectorate (HEI) Unannounced Visit Procedure The following policies and procedures were reviewed and updated during : Safe Disposal of Healthcare (Clinical) Waste Policy (approved by Control of Infection Committee and Clinical Governance Committee) Shetland Outbreak Plan (approved by Control of Infection Committee and Clinical Governance Committee). Procedure on Cleaning, Maintenance, Audit and Replacement of Mattresses. 3.4 Prevention of Healthcare Associated Infection (HAI) Decontamination The Central Decontamination Unit (CDU) at the Gilbert Bain Hospital provides a decontamination service to ward areas and departments for NHS Shetland. The Glennie 15

17 NHS Shetland Control of Infection Committee Annual Report Report recommended that all decontamination (of surgical instruments and medical devices) should be carried out within a central processing unit. 6 A new Local Decontamination Unit is due to open in June This will undertake work for the Montfield, Yell, Brae and St Olaf Street dental practices. The CDU is scheduled to be re-audited for re-certification to ISO 13485:2012 and the Medical Device Directive in September Task Force Delivery Plan Cleanliness Champions The local Cleanliness Champions continue to take forward the programme of local work on the prevention of HAI. Although not compulsory all staff are encouraged to consider completing this course. A total of 152 staff have now completed the course, with 5 currently working on it (June 2013). The process for undertaking the course has changed, so that it can be completed online via the LearnPro platform, The Cleanliness Champions meet regularly and a Cleanliness Champion representative is a member of the Control of Infection Committee. Hospital cleaning During 2012/13, the hospital cleaning was brought back in house from April 2012 with most of the Sodexo employees moving over to NHS Shetland. The cleaning methods and quality standards are set out in the NHS Scotland National Cleaning Services Specification. Cleaning standards are monitored on a regular basis through quality control system using the NHS Scotland domestic monitoring tool. This latter system gives a numerical score with an overall target level of 90%. We have consistently exceeded the 90% target throughout 2012/13, with only one occasion where the compliance has fallen below 90% within individual areas. Generally the overall figures for the each month have exceeded 95%. A representative from the domestic team is a member of the Control of Infection Committee and the Board s Facilities Manager reported regularly on cleaning monitoring information. Hand Hygiene Campaign Since April 2007, NHS Shetland has participated in the national hand hygiene campaign, with the appointment of a Local Health Board Co-ordinator (LHBC) who has led the awareness and training, and conducted the local audits on hand hygiene within the national programme. These have been reported regularly into the Control of Infection Committee and nationally via Health Protection Scotland. The LHBC role is now covered by the Infection Control Nurse. Figures for are shown in Appendix A and remain consistently high. The audit focuses on compliance with hand washing through observations of hand hygiene opportunities and technique. Testing the knowledge of staff is done through the Infection Control Environmental asking key questions about hand hygiene procedures. 16

18 NHS Shetland Control of Infection Committee Annual Report During hand hygiene audits anyone demonstrating non-compliance is given verbal feedback immediately and given written materials such as a leaflet or pocket credit-sized reminders. Hand hygiene is a major focus of induction and mandatory training for all staff. Additional hand hygiene training has been provided in clinical areas as required. Basic Hand hygiene training was also given to outside contractors carrying out building works within Gilbert Bain Hospital and health centres during Action to achieve HEAT target: to reduce Staphylococcus Aureus bacteraemias MRSA infection surveillance and management In Shetland, the Public Health Department collects information on colonisation and all infections caused by MRSA and report these to the Infection Control Team and Control of Infection Committee. When the Public Health Department receives a positive laboratory report, the referring ward or GP is asked to complete a local MRSA surveillance form. This allows for an investigation of the circumstances surrounding each case of infection, and identification of anything that could have been done differently to prevent the infection. We also take part in the national surveillance system for MRSA (and MSSA) bacteraemias. For all Staphylococcus Aureus Bacteraemias (SABs) a root cause analysis is completed Scottish Patient Safety programme NHS Scotland was the first health service in the world to adopt a national approach to improving patient safety. The Scottish Patient Safety Programme is co-ordinated by Health Improvement Scotland (HIS) and aims to steadily improve the safety of hospital care right across the country. It is not into its second phase with additional targets around reducing mortality in the Adult programme and the introduction of additional workstreams for Maternity, Primary Care, Mental Health, Venous Thromboembolism management and sepsis management. This is being achieved using evidence-based tools and techniques to improve the reliability and safety of everyday health care systems and practice. As part of the Critical Care Workstream within the adult programme we continue to monitor the Central Line Insertion Bundle, Central Venous Catheter (CVC) Maintenance Bundle and the Peripheral Vascular Catheter (PVC) Bundle in the High Dependency Unit (HDU). The consultant anaesthetists ensure that details are updated on Wardwatcher (a national database system) and ward staff ensure that both CVC and PVC bundle compliance stickers are attached to patients notes. The current outcomes identify days between infections. As measured on 30 th May 2013, the number of days in HDU since the last central line bloodstream Infection was 1776 days; the days since the last Staph. aureus bacteraemia (SAB) was 1651 days and the number of days since a C. difficile infection occurrence was Hand hygiene compliance is also audited in the unit. The General Ward Workstream also includes Hand Hygiene and the PVC Bundle process measures which monitor compliance levels monthly as part of the programme. The PVC bundle compliance is 100% and has remained at this level throughout the year. The combined Hand Hygiene compliance is currently at 99.7% and has remained over 98% all year. 17

19 NHS Shetland Control of Infection Committee Annual Report The introduction of the new workstream to implement the Sepsis Six bundle has continued through the year, with this being regularly audited in the surgical team, and now being rolled out to the medical team. For every patient who triggers for sepsis screening (ie has a set of agreed criteria present which relate to a likely infection) their notes are audited to see how many of the bundle components were delivered within the first hour after they screening positive for sepsis. The bundle comprises: Give 100% oxygen Take blood cultures Give IV antibiotics Start IV fluid resuscitation Check haemoglobin and lactate Place urinary catheter and monitor accurate hourly urine output The evidence shows that if all these six steps are undertaken within the first hour then survival from sepsis increases. As with all the bundles introduced through the patient safety programme the goal is to get them reliable and sustainable every patient, every time. MRSA Screening Programme The revised national MRSA screening programme is now in place in NHS Shetland. This involves a two stage process: clinical risk assessment (CRA) of all patients admitted to hospital for at least one night and two site swabbing (nasal and perineal sites) for those deemed to be at increased risk according to the CRA. This includes patients admitted or transferred from anywhere other than home (ie hospitals and residential homes); those who have indwelling devices and those who have been MRSA positive in the past. The new MRSA programme was due to be implemented across all NHS Scotland hospitals by end of March A set of key performance indicators (KPIs) and a national audit process for monitoring these KPIs was developed and refined during In Shetland we undertook the original version of the audit during the first quarter of The new version is due to be implemented during the first quarter of , and we will report the results locally on a quarterly basis to the Control of Infection Committee Prevention Of HAI: HAI Action Plan (Vale Of Leven) Actions from this Action Plan have been fully implemented, including continuing bimonthly reporting on HAI to the Board Integrated HAI Action plan During 2012/13 a number of actions from the Integrated Action Plan have continued or been further developed: Infection control is a key objective for SCNs and members of the infection control team 18

20 NHS Shetland Control of Infection Committee Annual Report Leadership walkarounds, incorporating issues relating to infection prevention are ongoing Regular dialogue with staff and senior management team regarding quality and performance expectations in relation to infection prevention. Patient safety methodology is being used widely, particularly in relation to aseptic technique and device insertion Compulsory and refresher training has been reviewed and continues to be delivered as a taught session with online modules for more detailed topic coverage. Infection prevention is included in all local induction programmes/checklists. Root cause analysis (RCA) protocol has been developed and is embedded in practice. Estates User Forums are held periodically to engage with staff regarding Estates and Facilities services. However, the numbers attending have been dwindling and so this method of engagement is being reviewed Antimicrobial prescribing The use of antimicrobials is important in the management of infections; but appropriate antimicrobial prescribing and management is a priority to reduce the risk of microbial resistance, and development of organisms such as MRSA. It is also a key factor in preventing C.difficile which is associated with certain antibiotics. Compliance with local guidelines remains very good overall and the use of these specific antibiotics in as low as is practicable. A multi-disciplinary Antimicrobial Management Team, led by the Medical Director, supports the management and monitoring of antimicrobial practice across NHS Shetland. The main focus was initially the hospital, but the remit of the team is now extending into primary care. A local Antimicrobial Policy was approved in May 2011 by the Clinical Governance Committee. This had been drawn up as a local response to the national guidance for safe, effective and appropriate antibiotic management and prescribing. A revision of the Surgical Antimicrobial Prophylaxis Guidelines has recently been approved. There is a regular audit of anti-microbial prescribing on wards 1 and 3 which is reported to the Infection Control Team and Control of Infection Committee and to the surgical and medical clinical governance groups. When non-compliance has been noted, the cases are discussed in these groups. This audit looks at case notes of patients prescribed antimicrobials to monitor compliance with antimicrobial prescribing policy. Each week, five patients on antibiotics are sampled in medicine, and five in surgery, with a target of twenty patients in a month. The pharmacist confirms that the indication has been documented in the notes and, when it has, the antibiotic choice is compared to the local empirical guidance. If the choice, differs from local guidance, but the choice was made on the advice from microbiology, that is taken as compliant. These are converted to percentages and provided monthly on run charts. 19

21 NHS Shetland Control of Infection Committee Annual Report Hospital Capital Plan and Estates maintenance work All requests for Estates work, such as issues picked up during Environmental Audits, are now prioritised according to a risk score. A number of estates actions with an impact on infection control have been completed in through an action plan started in Work carried out has included the following projects. Conversion of a chalet into a new surgery for Fair Isle. Due to come into use in May New surgery (portakabin) for Foula. Due to come into use in May Brae, Yell and Montfield Health Centres Dental Local Decontamination Units (LDU) Upgrading: Following a review of options, it was agreed to install a packaged Portakabin LDU at Montfield. This unit will serve the dental facilities at Montfield, Brae and Yell. The unit has been installed and is due to open in June Central Decontamination Unit Ventilation System Upgrading Phase 1 completed8 Upgrading of pipework in Gilbert Bain Hospital 3.5 Patient Focus Public Involvement During , a member of the PFPI steering group became a lay representative on the Control of Infection Committee. There continues to be lay representation on the patient safety walkarounds and Cleaning Audits. Two presentations were held for Public Participation Forum members on Facilities services at the heart of the NHS. These sessions covered the broad range of services provided by the Estates and Facilities teams (Estates, catering, domestic, laundry, portering) and the role that these departments play in ensuring that Infection Control issues are at the forefront of their activities to support the overall effective delivery of Infection Control and Prevention measures across the services Through the PFPI Steering Group, lay members questions regarding Infection Control issues and the management of Infection Outbreaks were discussed. 3.6 Audit Audit activity has been focussed of new and revised infection control procedures. The following audits were conducted during : Mattress Audits (every 6 months) Infection Control Environmental Audit Monthly hand hygiene Audits Monthly cleaning specification audits in every clinical area Antimicrobial prescribing audits 20

22 NHS Shetland Control of Infection Committee Annual Report Fridge audit (every 2 months) Sharps box audit (every 2 months) Standard Infection Control Precaution Audit which include: o Patient Placement o Respiratory Hygiene and Cough Etiquette o Personal Protective Equipment o Managing Patient Care Equipment o Control of the Environment o Linen o Management of Blood and other Body Fluid Spillages o Safe Disposal of Waste o Occupational Exposure Management The Infection Control Environment Audit has continued this year, with every clinical area being audited on a regular basis, based on performance, with lower scoring areas being audited more frequently to check that identified actions have been implemented. 4 Occupational Health The Occupational Health Department has been actively contributing to the work of the Control of Infection Committee and Infection Control Team. The OH staff are particularly involved in management, monitoring and training regarding sharps injuries. They have also been involved in the development of local policies and procedures. 4.1 Prevention of occupational infection with blood borne viruses Although rare, there is the risk of contracting a blood borne infection such as HIV, Hepatitis B or Hepatitis C through a sharps or contamination injury in the healthcare setting. Occupational health start at the pre employment process to ensure applicants working in high risk areas from blood borne viruses are adequately screened according to national guidance. Occupational health is currently in the process of adding data on the Human Resources data systems so applicants can move from NHS Shetland to other NHS Boards in Scotland with their Occupational Health Clearance Passport. This will include fitness to perform exposure prone procedures. The Occupational Health department continues to play a significant role in both raising awareness and in responding to sharps incidents. Incidents are logged and clinical areas that have had more than one incident are provided with additional support. Before starting their post, new staff (including junior doctors on rotation) are given individual advice on sharps injury management. In addition as part of mandatory training on LearnPro some simple training is provided on needlestick injuries. Policies and quick reference flow charts are available on the intranet for staff ease of access. As well as offering advice and support to staff members exposed to risks, the Occupational Health Department monitors compliances with NHS Shetland s procedure for Protection against Occupational Infection with Blood Borne Viruses and feedback any 21

23 NHS Shetland Control of Infection Committee Annual Report need for further action to committee. The local procedures for protection against occupational infection with blood borne viruses were reviewed during Seasonal flu vaccination programme Health and social care staff directly involved in patient care are recommended to have the seasonal flu vaccine. Some of the jobs and areas this covers include anyone who works in a GP practice, pharmacy, hospital, paediatric ward, cancer centre or those caring for patients with cancer, dental surgery or care homes. Not only will it reduce the risk of catching the flu but also will reduce the risks to those being cared for from catching the flu. The Shetland Occupational Health Department provides occupational health services to both NHS staff and other organisations including Shetland Islands Council. During the flu season, Occupational Health was proactive in offering clinical staff the flu vaccine, particularly in the higher risk areas of maternity and elderly care. We promoted the uptake through posters, attending team meetings on wards and on the team brief with the chief executive pictured having the vaccine. Despite this effort it was disappointing that this year numbers are lower than last year. Uptake amongst clinical staff was 15.8%. Uptake for non clinical staff was 12.8%. This year we are getting prepared for the flu season by booking clinics rooms over in the main hospital to reduce time away from the ward and looking at ways we can further promote the uptake of the vaccination. 4.3 Skin problems due to hand hygiene products Issues following the changeover of suppliers of hand hygiene products, soap, alcohol gel and moisturizing lotion in 2011, have now settled. A decision made to trial other products which have generally been better accepted by staff. Occupational Health continues to monitor and encourage staff to be referred promptly with skin problems. Building on the Health and Safety Executive National Inspection Programme, Occupational Health promoted healthy skin as health topic for their health promotion campaign which occurs quarterly. 5 Communicable Disease Control The Public Health Department has an ongoing responsibility for communicable (infectious) disease control in the hospital and the community. The local Public Health Department has continued to deal with communicable diseases notified to the department; offering advice and instituting control measures where necessary, often in conjunction with Environmental Health. Staff have been involved in a range of activities including: Direct contact with and liaison between patients, the public, NHS staff, environmental health and others Dissemination of information including to patients, the public, NHS staff and the media Further development of departmental systems for surveillance and management of communicable diseases and related issues using computerised recording of cases and incidents. 22

24 NHS Shetland Control of Infection Committee Annual Report Management of specific cases and incidents, as detailed in section 6.1 below. Delivery of training, both to NHS staff through the induction and refresher days and to other partner organisations on request. Continued local implementation of the Public Health etc (Scotland) Act Vaccination & Immunisation Group The Board s Vaccination and Immunisation Group meets regularly and reports to the Control of Infection Committee on uptake rates, and on local actions to improve uptake and comply with national policy. During the first quarter on 2013, work started on planning the local implementation of an ambitious programme of changes to the national immunisation programme. These changes will be implemented during and include introduction of a live oral rotavirus vaccine for babies; dropping one of the primary dose of meningitis C and adding in a booster dose for teenagers; introduction of live zoster (shingles) vaccine for 70 year olds and a catch up for year olds. The biggest development is the introduction of live nasal flu vaccination for all children aged 2-17 which will be rolled out over the next three years. This will result in over 4000 children in Shetland being offered flu vaccine every year either in primary care or school. The following areas of work were also covered during : Childhood immunisation programme, through Primary Care Seasonal flu and pneumococcal programme, through Primary Care HPV immunisation programme for teenage girls, through School Health Implementation of a national temporary programme to immunise pregnant women against pertussis. BCG programme for high risk individuals, through Child Health Hepatitis B vaccination for high risk individuals, through a range of services locally including the addictions services, the sexual health clinic, primary care and services in Grampian. A local campaign to promote uptake of the teenage booster and MMR amongst teenagers in 2012 Primary care teams also provide travel health advice and vaccinations to their patients and the Occupational health services provided the relevant vaccinations for health and other staff Immunisation Training The Immunisation Co-ordinator has been actively involved in promoting the on-line Immunisation Training Package. During 2012/13 five staff commenced the course: two completed the whole course, with a further seven with just the practical element to do. This brought the total number of staff commencing the course by the end of March

25 NHS Shetland Control of Infection Committee Annual Report to 34, with 12 who have completed, 16 working on the course and six staff who have left NHS Shetland or their post. There were two local annual immunisation update training sessions held in , in May 2012 and March staff attended in May, and 17 in March and the feedback was excellent, with all staff requesting the annual updates to continue. We also had the opportunity to video-conference into the Health Protection Scotland Biannual immunisation Update Day in September 2012 and five staff attended for parts of the day Surveillance Details of local surveillance and uptake figures are included in Appendix A. 5.2 Emergency Planning The Director of Public Health (DPH) is a member of the Shetland Emergency Planning Forum. The Forum meets at least annually and considers all types of local emergency including incidents that may affect the health of the public such as infectious disease outbreaks and biochemical hazards. The DPH, along with the Assistant Director of Nursing (Hospital), is also a member of the Forum Executive, which meets quarterly. Activity during has included a range of general resilience and business continuity activity responding to events and incidents, none of which specifically related to communicable disease challenges, but all of which served to reinforce familiarity and experience relevant to a robust emergency response. A number of emergency planning exercises and training and training events were held throughout the year including the following which involved NHS Shetland staff on communicable disease related topics: Training in the use of decontamination suits and equipment for new and existing hospital staff (April 2012), provided by the SORT Team based in Aberdeen Response training through Scientific and Technical Advisory Cell (STAC) operation provided in a multi-agency setting with a range of scenarios relevant to the public health and senior management roles in responding to major emergencies including those of a communicable disease nature. A Pandemic Flu tabletop Exercise (January 2013) held involving a range of clinical and managerial staff. The exercise raised awareness and highlighted issues which have been addressed through updating the local Pandemic Flu Plan and other local procedures. An Emergency Planning Annual Report is produced annually and presented to Shetland NHS Board. 24

26 NHS Shetland Control of Infection Committee Annual Report Significant Incidents Significant incidents involving infection control matters are reported regularly to the Control of Infection Committee. Complaints would also be reported, but no complaints on communicable disease or infection control matters have been received during 2011/ Communicable disease incidents Pertussis ( ) The increased number of cases of pertussis has continued in Shetland, as across the rest of the UK. By the end of March 2013, there had been a total of 36 confirmed cases in Shetland during the year, against a background of no more than one a year in the past. Cases in Shetland have largely been isolated, with occasional linked cases within a family. A wide range of ages have been affected, including small children and older adults with an age range of less than one year to aged over 70.. A national programme to immunise pregnant women against pertussis, so that their new baby is protected in the first few months of life, commenced in October 2012; was reviewed in March 2013 and is continuing Meningicoccal disease Single case of suspected meningococcal septicaemia (April 2012) An elderly resident of a Shetland care centre became unwell with clinically suspected meningococcal infection, the illness progressed rapidly and they died before admission to hospital and further investigation. This case was reported as clinically suspected meningococcal septicaemia, there were no samples to confirm diagnosis. All the residents of the care centre and staff caring for the patient within the previous 48 hours were considered as equivalent to household contacts and were offered prophylaxis Tuberculosis TB contact screening exercise (May 2012) A case of TB was diagnosed in Royal Aberdeen Children s hospital and the contact tracing process carried out by NHS Grampian identified eight children in Shetland who were considered close contacts of the index case. All eight children had Mantoux tests in Shetland, which were all negative. As per policy they were all offered BCG and five had the vaccination. Because of the number of positive results identified in the Grampian contact screening, the tracing process was widened to include more contacts and a nurse in Shetland was identified as a contact; she was subsequently screened in Aberdeen. Single case of TB (June 2012) An elderly patient had a routine chest x-ray on admission to the Gilbert Bain hospital for surgery which showed a lesion thought to be either old TB or another condition. They were transferred to ARI for bronchoscopy, and sputum samples taken during this procedure were positive for acid fast bacilli, ie probable active TB. The patient had a history of working in the old TB sanatorium, and had recently been tired and losing weight, but no productive cough. Subsequent results showed that the patient did have TB and they remained in Aberdeen Royal Infirmary for treatment. There was one close 25

27 NHS Shetland Control of Infection Committee Annual Report household contact who was referred to their GP for screening. At the time of the original CXR, the consultants involved in the patient s care at GBH were notified, along with occupational health. The patient had not been coughing on the ward, and there were no patients or staff identified who would have been vulnerable to TB (ie imunosuppressed, or unvaccinated staff). Single case of TB (January 2013) In January 2013 an elderly man was admitted to Ward 3, Gilbert Bain Hospital with a chest infection. He was found to have MRSA in his sputum and was treated accordingly, and recovered clinically, but after discharge he was also found to have acid fast bacilli in his sputum, which suggested TB. A positive lab diagnosis of TB was made following culture of the organism and the patient was then commenced on anti-tb medication supervised by NHS Grampian chest clinic. The patient was smear negative and no close contacts were found on contact tracing. However he did have home carers, and had been in respite care, so staff were given the standard advice that no further action was necessary but to contact their GP if they had concerns E Coli Family cases of E Coli 0157 (August 2012) There were two cases of E Coli, in a parent and child from Shetland, that were initially linked with cases in Orkney. The child had developed symptoms in Orkney and was admitted to ARI. All cases were thoroughly investigated, but no causal source was identified. 6.2 Healthcare associated Infection incidents Norovirus Outbreak (March 2013) There was a small outbreak of D&V on ward 3 of the Gilbert Bain Hospital which commenced on 13th March with a number of patients developing diarrhoea and vomiting, and two staff off sick. The symptoms and course of the illness were suggestive of norovirus. Symptomatic and exposed patients were isolated into single rooms or cohorted into two bays. All appropriate infection control procedures were followed as part of the national guidance on managing norovirus in hospitals. Visiting was restricted to only essential staff and no visitors unless the Senior Charge Nurse agreed that there was a specific reason. The ward was not closed to admissions. The outbreak plan was activated, and the initial outbreak team met on 14th March. A total of seven patients had been symptomatic, two were discharged home. The following day, only one patient remained symptomatic, with no new cases. After 48 hours symptom free, the rooms and bays were deep cleaned and reopened on Sunday 17th March. The servery was also closed for a period over the weekend after two members of staff had symptoms and returned to work. There remained some staff off sick in other departments. There was also an outbreak at Edward Thomason House, and subsequently in Taing House from mid march through to April. 26

28 NHS Shetland Control of Infection Committee Annual Report Clostridium difficle case A patient who was on long term nasogastric tube feeding, was admitted to hospital with aspiration pneumonia. She was treated with antibiotics as per the local protocol. She usually had intermittent loose stools as a result of her feeding regime, but because of her antibiotic history a stool sample was taken to test for Clostridium difficle which was positive. Antibiotics were discontinued when pneumonia resolved. Management of feeding regime was changed and the stools became fully formed. The root cause analysis showed that the antibiotics were prescribed appropriately for aspiration pneumonia and no preventable features were identified. Carbapenemase producing E coli (NDM1) In 2012, a Carbapenemase producing E coli (NDM1), which is multi-drug resistant, was isolated from a Shetland resident with a urinary tract infection. Until 2008, reporting of carbapenemase producing organisms was rare in Scotland, but an increase has been observed since then with all cases in Scotland, and most cases in England, having a history of travel abroad, particularly India. This was the first isolation of an NDM-1 producing Gram-negative organism in a Scottish patient with no obvious direct travel history and who has no known risk factors for development of multidrug resistance. Health Protection Scotland and the Health Protection Agency in England were involved in the investigation of this case. The patient is now well and there is no public health risk as a result. 6.3 Incidents of potential infection risk Apparent failure of cystoscope cleaning process (June 2012) There was an incident in theatres of an apparent failure in the cleaning process between patients for a cystoscope. The appropriate action was taken, however it later emerged that the failure had been in the monitoring equipment rather than the cleaning system itself. 7 References 1 Scottish Executive. Preventing infections acquired while receiving healthcare: The Scottish Executive's Action Plan to reduce the risk to patients, staff and visitors. Scottish Executive, Available at: 2 Scottish Government Healthcare Associated Infection Task Force: Delivery Plan April 2008.Scottish Government; Available at: 3 Scottish Government Health Department. A revised framework for national surveillance of healthcare associated infection and the introduction of a new health efficiency and access to treatment (HEAT) target for Clostridium difficile Associated Disease (CDAD) for NHS Scotland. NHS CEL(2009)11:SGHD;2009. Available at: 4 Source: Information and Statistics Division of NHS National Services Scotland. Data available at the ISD website Scottish Health Statistics (last updated October 2004): 27

29 NHS Shetland Control of Infection Committee Annual Report Public Health etc. (Scotland) Act 2008 available at: Scotland/publicact 28

30 Appendix A: Surveillance Report Appendix A: Communicable Disease and Infection Control Surveillance Draft 1 For the purposes of this annual report, surveillance data have been presented for the six year period April 2007 March 2013 wherever possible. This is with the aim of providing some indication of monthly and seasonal trends. Unless otherwise stated, all data used in this report is from the NHS Shetland Public Health Department s surveillance systems. 1 Healthcare Associated Infection Surveillance 1.1 Staphylococcus Aureus MRSA (Meticillin Resistant Staphylococcus Aureus) MRSA is a bacteria carried by many people that can sometimes cause serious infections, particularly in hospital patients. MRSA is identified in two ways: Screening of patients (now as part of the National MRSA Screening Programme) Isolating MRSA as a cause of infection (for example a wound swab or urine test) During , local surveillance figures show that six patients had infections caused by MRSA, including chest, skin and urinary tract infections. Of these six patients, three were in the community at the time of diagnosis and three were in hospital. There were also four patients identified as being colonised, three of these through the MRSA screening programme. Of the patients identified through the MRSA screening programme, one was screened in the pre-op assessment clinic; one was screened on admission because they had a history of MRSA and the third was screened on transfer back from Aberdeen Royal Infirmary. There were no MRSA bacteraemias. Local surveillance of MRSA New cases of MRSA colonisation and infection in Shetland (excluding MRSA screening programme) Other infection and colonisation Bacteraemia No. of cases Quarter 1

31 Appendix A: Surveillance Report Nationally, the number of new cases has been decreasing in recent years, and local numbers, although remaining small, appear to reflect that trend. Previously MRSA was mostly found amongst hospital patients, but now there are equal numbers from the community MRSA/MSSA (Methicillin Resistant / Sensitive Staphylococcus Aureus) Bacteraemia Nationally, both methicillin sensitive (MSSA) and methicillin resistant (MRSA) staphylococcus aureus bacteraemias (SAB) are monitored and reported. The national system reports cases of bacteraemia with control limits designed to show where variations in rates might be significant. SAB data have been monitored in Scotland since 2001 and there have been substantial reductions in these infections since this time. MRSA bacteraemias have reduced significantly over the last four years in NHSScotland. The incidence of MSSA bacteraemias has also reduced. Health Protection Scotland (HPS) publishes this data in quarterly reports and as an annual report. 1 2 Board level data is contained in the quarterly reports. In the last year, January 2012 to December 2012, 1509 episodes of S. aureus bacteraemia in Scotland were reported to HPS. This represents a decrease of 6.2% on the previous year, January 2011 to December 2011, when 1609 episodes were reported. The national reports show that between January 2012 and December 2012, there were five SABs in Shetland, all MSSA. More up to date local surveillance shows that between April 2012 and March 2013, there were three SABs in Shetland, again all MSSA. All three of the patients were admitted to hospital with the bacteraemia, ie they did not acquire the infection in hospital. In Shetland we investigate all cases of SAB using root cause analysis. Local reporting of MRSA and MSSA bacteraemias Year / Quarter New MRSA bacteraemias New MSSA bacteraemias Total Total Total Apr - Jun 12 Jul Sep 12 Oct Dec 12 Jan Mar Total As can be seen from the table above, numbers of SABs in Shetland are small and vary from year to year. The cases reported here have all been isolated with no outbreaks identified to date. The MRSA & MSSA rates are now part of the Board s performance monitoring by the Scottish Government within the HEAT targets. The target was to achieve a 30% reduction in SABS (including both MRSA and MSSA) from the baseline year of As the Shetland baseline was already zero, we could not make a further reduction, but it would be inevitable that we would have a small number of cases. Therefore, we have set a target of 0.26 per 1000 acute occupied bed days (AOBD). However, having SABs during has given NHS Shetland a rolling average 0.28 per 1000 AOBD. This is slightly above the target of 0.26 and therefore we have not met the HEAT target at the end of March Clostridium Difficile Clostridium difficile is a bacterium, widely distributed in the environment and in the gastrointestinal tract of animals and also humans. Clostridium difficile infection (CDI) is a 2

32 Appendix A: Surveillance Report major cause of illness and death, especially as a healthcare associated infection. It usually follows use of antibiotics, with some antibiotics being more likely to trigger infection than others. Disease ranges from mild self-limiting diarrhoea to severe diarrhoea, pseudomembranous colitis, toxic megacolon and potentially death. In recent years, the numbers of infections caused by Clostridium difficile have increased and become more severe. In Scotland, mandatory surveillance of CDI was introduced in 2006 as a result of this changing picture. The surveillance programme was initially set up to record the incidence of CDI in patients aged 65 and over. In April 2009, the programme was expanded to include the age group Cases are identified through laboratory reports. The Incidence rates of CDI in Scotland have continued to decrease between 2011 and 2012 though the overall trend has levelled compared to previous years. As with SABs, Health Protection Scotland publishes figures for the number of Clostridium difficile isolates in Scotland on a quarterly basis and in the HAI Annual Report: these cases are identified through laboratory reports. Board level figures are contained in the quarterly reports. The national reports show that between January 2012 and December 2012, there was one Clostridium difficile isolate in Shetland. More up to date local surveillance shows that between April 2012 and March 2013, there were three cases in Shetland. All individual cases of CDI in Shetland are investigated using using root cause analysis. Of the three cases in , one was not confirmed as a true clinical case of CDI (the organism can be isolated in the gut without it causing any illness); one was a patient in the community and the third was a patient in hospital. This patient, who was on long term nasogastric tube feeding,was admitted to hospital with aspiration pneumonia. She was treated with antibiotics as per the local protocol. She usually had intermittent loose stools as a result of her feeding regime, but because of her. antibiotic history a stool sample was taken to test for C Diff and it returned positive. Antibiotics were discontinued when pneumonia resolved. Management of feeding regime was changed and the stools became fully formed. The root cause analysis showed that the antibiotics were prescribed appropriately for aspiration pneumonia and no preventable features were identified. Local Reporting of CDI Year / Quarter No. of new cases C.diff Total Total Total Apr Jun 12 Jul Sep 12 Oct Dec 12 Jan Mar Total As can be seen from the table above, numbers of CDI in Shetland are small and vary from year to year. The cases reported here have all been isolated with no outbreaks identified to date. The HEAT target for C.difficile is for Boards to reduce the number of their cases to less than 0.39 per 1000 occupied bed days (OBD) by end March 2013, or if the baseline rate was lower than 0.39 the target was to maintain it. As the baseline for Shetland was zero, it would be impossible to maintain the rate at this level as a small number of cases would be inevitable. We therefore have a target of 0.2 cases per 1000 OBD. Because we have had 3

33 Appendix A: Surveillance Report three cases in the last six months, our rate is now 0.21 per 1000 OBD. This is slightly above our local HEAT target, but still below the national HEAT target. 1.3 Surgical Site Infection Surveillance (SSIS) Surgical site infections (SSIs) are an important cause of healthcare associated infections. They account for 15.9% of all HAI, and cost the NHS in Scotland 30 million per year.11 SSIs have serious consequences for patients affected as they have been estimated to at least double the length of hospital stay and also result in pain, suffering and possible further surgery. SSI is an important outcome measure for surgical procedures and the key aim of SSI surveillance is to improve the quality of patient care and to provide participating hospitals with robust SSI rates in order for them to compare with similar hospitals against benchmark rates. Evidence suggests that actively feeding back data to clinicians contributes to reductions in rates of infection. The Scottish Surveillance of HAI Programme (SSHAIP) within Health Protection Scotland (HPS) coordinates the SSI surveillance programme that is mandatory in all NHS Boards in Scotland. All NHS Boards are required to undertake surveillance for hip arthroplasty (for fractured hip) and caesarean section procedures as per the mandatory requirements of HDL (2006) 384 and CEL (11) Patients who have had hip arthroplasty are followed up to 30 days postoperatively if the patient remains in hospital, or is re-admitted within this period. Patients discharged home before the 30 days are followed up until the point of discharge. Patients who have had a Caesarean section are followed up until 10 days postoperatively, whether or not they have been discharged. SSIS in Shetland Year / Quarter Total Total Total Apr Jun 12 Jul Sep 12 Oct Dec 12 Jan Mar Total C Section Procedures C Section Infections Rate (%) 15.4% 12.5% 5.9% 0% 12.5% 0% 0% 2.6% Hip Fracture Procedures Hip Fracture Infections Rate (%) 7.7% 7.7% 0% 0% 0% 0% 0% 0% Total Procedures Total Infections Total Rate (%) % 10.3% 3.7% 0% 6.67% 0% 0% 1.8% 4

34 Appendix A: Surveillance Report As can be seen from the table above, rates of SSIS in Shetland have gradually fallen over the past four years. This is largely due to a fall in the rate of infections after caesarean section, although the number of infection has remained at 1-1 a year, the number of operations has trebled. Although the figures are still relatively small. 1.4 Surveillance of resistant organisms To date, we have not carried out systematic surveillance of resistant organisms, other than MRSA. The Public Health department does receive notifications of other resistant organisms including ESBL (Extended-Spectrum Beta-Lactamases) producing organisms that are resistant to cephalosprins, but we have not routinely reported these to the Infection Control Team or Control of Infection Committee. In 2012, a Carbapenemase producing E coli (NDM1) was isolated from a Shetland resident with a urinary tract infection. This is a multi-drug resistant organism. Until 2008, reporting of carbapenemase producing organisms was rare in Scotland, but an increase has been observed since then with all cases in Scotland, and most cases in England, having a history of travel abroad, particularly India. This was the first isolation of an NDM- 1 producing Gram-negative organism in a Scottish patient with no obvious direct travel history and who has no known risk factors for development of multidrug resistance. The patient presented to GPs on several occasions with symptoms of a urinary tract infection and was treated initially with trimethoprim and amoxicillin, and subsequently changed over to nitrofurantoin following laboratory results. A multidrug resistant E. coli ESBL-producer was reported initially (including high level resistance to cephalosporins and carbapenems). The HPA AMRHAI Reference unit (Colindale) confirmed NDM-1 carbapenemase production. The patient has no chronic diseases and there is no direct history of travel for the patient nor for other members of the household. There is a possible indirect link to foreign travel through family in the Manchester area and who have links overseas (although not including the Indian subcontinent). There is also an alternative possible link through the Manchester area where a cluster of NDM-1 producers has been reported recently. The patient is now well and is not posing any risk to family members or others in the wider community across Scotland. For 13-14, we plan to introduce routine surveillance of resistant organisms and report on a regular basis to the Infection Control Team and the Control of Infection Committee. 1.5 Hospital Outbreaks Norovirus Outbreak (March 2013) There was a small outbreak of diarrhoea and vomiting on ward 3 which commenced on afternoon / evening of Wednesday 13th March with a number of patients developing symptoms, and two staff off sick. Symptoms and course of the illness were suggestive of norovirus. Symptomatic and exposed patients were isolated into single rooms or cohorted into two bays. All appropriate infection control procedures were followed as part of the national guidance on managing norovirus in hospitals. Visiting was restricted to only essential staff and no visitors unless the Senior Charge Nurse agreed that there was a specific reason. The ward was not closed to admissions. The outbreak plan was activated, and the initial outbreak team met (as part of an already planned Infection Control Team) on 14th March. A total of seven patients had been symptomatic, two were discharged home. The team met again the following day, by which stage only one patient remained symptomatic, with no new cases. After 48 hours symptom free, the rooms and bays were deep cleaned and reopened on Sunday 17th March. The 5

35 Appendix A: Surveillance Report servery was also closed for a period over the weekend after two members of staff had symptoms and returned to work. There remained some staff off sick in other departments. One patient was admitted to Ward 1 with diarrhoea and vomiting from Edward Thomason House for surgical assessment. There was an outbreak at Edward Thomason House from 13th March through to 25th March, and subsequently further cases amongst residents and staff at Taing House. A debrief meeting is planned to review the management of the outbreak and a report will be presented to the Control of Infection Committee in due course. 1.6 Sharps Injuries amongst NHS staff A sharps or contamination injury is when someone receives a puncture wound from a needle or other sharp instrument or object which could be contaminated and which may lead to infection. Also a person could come into contact with blood or body fluid that is blood stained through splashes in the eyes, mouth or broken skin or through a bite from a person. Although rare, there is the risk of contracting a blood borne infection such as HIV, Hepatitis B or Hepatitis C through a sharps or contamination injury. Across Scotland the annual incidence of sharps injury is approximately 15 per 1,000 staff. 4 Shetland NHS Board employs approximately 700 staff and there were 13 recorded sharps injuries during , which gives us a rate of The local rate has remained fairly constant in recent years. It is slightly higher than the national average, but this may be due to high levels of reporting and the effect of small numbers. The Occupational Health department continues to play a significant role in both raising awareness and training, and in responding to incidents. There are clear organisational systems and procedures in place for preventing and managing sharps injuries, but effectiveness is dependant on staff being aware of and following them. Year No. of sharps injuries notified to Occupational Health Communicable disease surveillance The Public Health Department is informed of cases of notifiable disease, both those suspected on clinical grounds, which are notified by the GP or a hospital doctor and those confirmed by the laboratory. This information is forwarded to Health Protection Scotland, which produces weekly updates on a national basis. In January 2010 the list of notifiable diseases and the methods for reporting them to Public Health changed as a result of the new Public Health Act for Scotland.5 Some common infections have been removed from the list, including chickenpox and clinical suspicion of food poisoning (gastro-intestinal infection). Confirmed cases of salmonella, campylobacter and other gastro-intestinal infections are reported by the laboratory. 6

36 2.1 Communicable disease notifications: Quarterly figures for Figures in bold are laboratory confirmed diagnoses Appendix A: Surveillance Report Apr June 2012 July Sept 2012 Oct Dec 2012 Jan - Mar 2013 Campylobacter Salmonella E coli Cryptosporidiosis Measles 1 suspected (negative) Mumps 3 reported (2 confirmed, 1 negative) 4 reported (1 confirmed, 3 negative) 3 reported (2 negative, 1 no result) 3 reported (1 confirmed, 2 negative) Rubella 1 suspected (negative) Pertussis (Whooping Cough) 4 confirmed 11 reported (7 confirmed, 4 no result) 37 reported (24 confirmed, 13 no result) 16 reported (5 confirmed, 4 negative,7 no result) Legionellosis Malaria Hepatitis A Shigella Sonnei Entamoeba histolytica cysts Tuberculosis Meningococcal septicaemia 1 suspected

37 Appendix A: Surveillance Report Annual (calendar years) figures for Figures in bold are laboratory confirmed diagnoses Campylobacter Salmonella E coli Cryptosporidiosis Measles* suspected (negative) Mumps* (1 positive,1 negative, 1 no result) 10 (4 positive, 6 negative) Rubella* suspected (all negative) Pertussis (Whooping cough) confirmed (provisional) Legionellosis Malaria Hepatitis A Shigella Sonnei Entamoeba histolytica Tuberculosis Meningococcal septicaemia suspected * Notified on clinical diagnosis, confirmed by saliva test for measles, mumps and rubella and a nasal swab or blood test for pertussis (if no test is done, then remains unconfirmed). 2.2 Vaccine preventable diseases: measles, mumps, rubella and pertussis Cases of measles and rubella been rare in Shetland, though occasional cases do occur, but the concern is that low levels of immunisation make the local population prone to an outbreak as has been seen in other parts of the UK. We did have an outbreak of mumps during 2005, as in the rest of the UK, due to a cohort of young people who were inadequately vaccinated. The number of cases of measles have been increasing in the UK and other parts of Europe in recent years with a number of outbreaks. In the first half of 2013, there was a large outbreak of measles in Wales, and another outbreak in the North East of England along with a small increase in the number of cases in Scotland. This has resulted in a catch up programme to offer MMR to a cohort of children and young people (aged 10-17) who may have missed MMR vaccination when younger due to parental concern about the vaccination at the time. There is a also a campaign to ensure that healthcare workers are vaccinated if they do not already have immunity to measles and rubella. Similarly, pertussis (whooping cough) had been relatively rare until the past few years when the numbers of cases in the UK had started to increase. This has been reflected in 8

38 Appendix A: Surveillance Report Shetland with 35 confirmed cases of pertussis in 2012 (36 in ). Previously we have had only occasional cases of pertussis in Shetland. The outbreak has been mainly amongst unvaccinated and partially vaccinated individuals, including those too young to be fully vaccinated, as well as some older people where their immunity has waned. The age range has been from less than one year, to over 70 years old and cases have been reported from all parts of Shetland. There is now an enhanced surveillance programme for pertussis which commenced at the beginning of 2012/13. There is also a temporary vaccination programme in place to vaccinate pregnant women against pertussis, and protect their unborn child. Babies are particularly vulnerable to whooping cough in the first few months of life before they have received their primary immunisations. 2.3 Food and waterborne infections The commonest food and waterborne infection is campylobacter, followed by salmonella and occasional cases of cryptosporidium and E coli.. Until January 2010, cases of food poisoning were notified by GPs and hospital doctors based on clinical diagnosis, along with diagnosed cases reported by the laboratory. Since January 2010 notification is not required on clinical suspicion except for suspected E Coli. However, all laboratory diagnosed cases of specific infections are reported. Environmental Health is informed of all cases of diagnosed food poisoning (particularly if a commercial food source is implicated). Food poisoning often peaks in the summer due to warmer weather and incorrect storage or cooking of food. During there were 28 cases of campylobacter; 5 of salmonella; 3 cryptosporidium and 2 cases of E Coli 0157; which is similar to previous years. The two E Coli cases, in a parent and child from Shetland, that were initially linked with cases in Orkney. The child had developed symptoms in Orkney and was admitted to ARI. All cases were thoroughly investigated, but no causal source was identified. None of the other cases were linked. Notifications for selected gastro-intestinal infections Apr 08 - Mar Number of notifications Salmonella Campylobacter Cryptosporidium Quarter 9

39 2.4 Tuberculosis Appendix A: Surveillance Report There were two patients in Shetland diagnosed with TB during Both were elderly people who were admitted to hospital with respiratory symptoms. One patient was found to have active TB and was treated for this. Only one close contact required screening. The second patient was smear negative; he was also treated for TB and no contacts required screening. In both cases, the current illness was thought to be reactivation of previous TB. In addition, eight children were screened for TB as a result of a contact tracing exercise carried out by colleagues in Grampian. A case of TB was diagnosed in Royal Aberdeen Children s Hospital and children in Shetland were identified as close contacts of the index case. All eight children had Mantoux tests in Shetland, which were all negative. As per policy they were all offered BCG and five had the vaccination. Because of the number of positive results identified in the Grampian contact screening, the tracing process was widened to include more contacts and a student nurse in Shetland was identified as a contact; they were subsequently screened in Aberdeen. 2.5 Meningococcal septicaemia There was one unconfirmed case of meningicococcal septicaemia. This was an elderly care centre resident, who displayed clinical signs and symptoms of meningococcal septicaemia which progressed rapidly and they died before admission to hospital and further investigation. All the residents of the care centre and staff caring for the patient within the previous 48 hours were considered as equivalent to household contacts and were offered prophylaxis (ciprofloxacin). There were no further cases reported. 2.6 Viral illness: Influenza and Norovirus The Public Health Department is also notified of a number of other laboratory confirmed infections including norovirus and influenza. This is via the ECOSS (The Electronic Communication of Surveillance in Scotland) system. During there were four laboratory confirmed cases of influenza A and13 cases of influenza B. There were four confirmed cases of norovirus. This reflected disease norovirus and influenza activity in the rest of Scotland. Against a background of a large number of anecdotal reports of viral gastroenteritis (presumed norovirus) in the community during the first quarter of , there were outbreaks in care centres and also on one ward of the Gilbert Bain Hospital. Both staff and residents / patients were affected. It should be noted that laboratory confirmation is often not necessary for flu like illness or viral gastroenteritis except in outbreak situations, as part of a surveillance process or occasionally for individual case management. 3 Immunisation (See also the Immunisation in Shetland Annual Report for further detail.) Childhood immunisations are managed and monitored through a local Vaccination & Immunisation Group, which reports regularly to the Control of Infection Committee. National uptake figures, broken down by NHS Board and CHP, are reported on a quarterly basis by National Services Scotland Information and Statistics Division (ISD). The Vaccination & Immunisation Group uses these reports to monitor trends and take action if necessary. Of note is the continued low uptake of MMR, although there is a gradual trend to children receiving their first MMR earlier and the uptake rates are slowly improving. There is also a 10

40 Appendix A: Surveillance Report relatively low rate of uptake of the pre-school booster by age of school entry. The uptake of flu vaccine again fell short of the target of 75% for people aged 65 and over, at 74.2%. 3.1 Primary Immunisations Immunisation uptake rate at 12 months (previously reported by calendar year) Number in cohort Diptheria Tetanus Total Total Total Apr Jun 12 Jul Sep 12 Oct Dec 12 Jan-Mar Total Pertussis 82.3% 96.9% 96.9% 97.3% 96.4% 100.0% 98.3% 98.0% Polio Hib Men C 83.4% 96.5% 96.1% 97.3% 96.4% 100.0% 98.3% 98.0% PCV 83.4% 97.9% 96.5% 97.3% 96.4% 100.0% 98.3% 98.0% The uptake of primary immunisations in Shetland is generally high. The target is to reach a 95% uptake as this is the level at which herd immunity protects those who have not had or are unable to have the immunisation. The apparent drop in was due to problems with the national surveillance system, SIRS Immunisation uptake rate at 24 months Number in cohort Diptheria Tetanus Total Total Total Apr Jun 12 Jul Sep 12 Oct Dec 12 Jan-Mar Total Pertussis 97.4% 97.5% 99.3% 98.4% 97.1% 95.6% 96.2% 97.2% Polio Hib Men C 96.5% 95.7% 95.8% 96.7% 97.1% 94.1% 96.2% 96.4% PCV 95.2% 96.4% 97.2% 98.4% 95.7% 95.6% 96.2% 96.8% MMR 87.7% 87.0% 87.2% 91.8% 90.0% 89.7% 86.8% 90.4% Hib / MenC booster PCV booster 68.9% 88.4% 91.3% 93.4% 90.0% 85.3% 86.8% 90.0% 88.2% 87.0% 88.9% 93.4% 88.6% 86.8% 88.7% 89.6% 11

41 Appendix A: Surveillance Report The table above shows that by the age of 2 years, the uptake of primary immunisations remains similar. The uptake of the PCV booster and Hib /Men C booster (both now given at months along with the first dose of MMR) has shown a gradual increase since these boosters were introduced in See below for commentary on the uptake of MMR vaccination. 3.2 Pre-school immunisations Immunisation uptake - Pre-school (full course including boosters) at age five years Number in cohort Diptheria (booster) Tetanus (booster) Pertussis (booster) Polio (booster) PCV (booster) Hib/MenC (booster) MMR (2 doses) Total Total Total Apr Jun 12 Jul Sep 12 Oct Dec 12 Jan-Mar Total % 76.4% 77.9% 76.1% 87.3% 93.2% 87.0% 84.1% 82.9% 76.4% 77.9% 76.1% 87.3% 93.2% 87.0% 84.1% 82.9% 76.4% 77.9% 76.1% 87.3% 93.2% 87.0% 84.1% 82.9% 76.4% 77.9% 76.1% 87.3% 93.2% 85.5% 84.1% % 92.5% 89.1% 88.1% 88.4% 90.1% % 91.0% 94.5% 89.8% 84.1% 91.8% 76.1% 72.8% 72.6% 74.6% 83.6% 91.5% 82.6% 81.0% MMR (1 dose) 92.8% 91.7% 92.9% 98.5% 94.5% 96.6% 97.1% 96.6% *Uptake of the combined Hib/MenC booster and the PCV booster, by 5 years, was reported for the first time in fourth quarter of These vaccines were introduced into the routine schedule in September 2006, and these children were the first cohort to be offered the vaccine as part of their routine schedule.. The table above shows uptake of primary immunisation and booster doses by age five (ie around the time of school entry). The Hib / Men C and PCV boosters should be offered at aged months. The diptheria / tetanus / pertussis / polio booster and 2 nd (final) dose of MMR should offered at aged 3yrs and 4months - 3 years and 6 months. Therefore children should be fully protected by the time they go to school aged five. It can be seen that the uptake of the pre-school booster, although gradually increasing, has not reached the 95% level required for herd immunity by the time children are going to school. This is thought to be due to a number of reasons including children and parents being in less contact with the practice and health visitors than when the children were babies, and therefore less likely to be reminded about the pre-school booster. Also, the booster used to be given much later, nearer the age of five, and so many parents do not realise that it 12

42 Appendix A: Surveillance Report should be given earlier. Children should be protected before they go to school, and ideally around about the time they start nursery. Uptake is measured again at age six. This is generally around the time when children get their P1 checks and so parents are reminded about the immunisations being up to date and the uptake measured at this point is generally slightly higher. It should also be noted however, that if a child has not had PCV by the age of two, then they do not need to have it at all and so there is little increase in uptake for that between age two and five or six Immunisation uptake - Pre-school (full course including boosters) at age 6 years Number in cohort Diptheria (booster) Tetanus (booster) Pertussis (booster) Polio (booster) PCV (booster) Hib/MenC (booster) MMR (2 doses) Total Total Total Apr Jun 12 Jul Sep 12 Oct Dec 12 Jan-Mar Total % 89.8% 88.8% 90.6% 91.5% 87.1% 87.0% 89.4% 91.6% 89.8% 88.8% 90.6% 91.5% 87.1% 87.0% 89.4% 91.6% 89.8% 88.8% 90.6% 91.5% 87.1% 87.0% 89.4% 91.2% 89.8% 88.8% 90.6% 91.5% 87.1% 85.5% 89.0% % 86.4% 87.1% 88.4% 87.2% % 91.5% 90% 84.1% 88.3% 85.9% 84.5% 84.9% 82.4% 89.8% 80.0% 82.6% 83.7% MMR (1 dose) 94.0% 93.3% 92.6% 91.8% 93.2% 92.9% 97.1% 94.0% 3.3 MMR As can be seen from the tables and the graph below, uptake of first dose of MMR at two years is showing a slow upward trend, with some variation each quarter, although. it has still not yet reached the 95 % target for herd immunity. However analysis of the figures show the number of children who receive a first dose MMR does increase with age: in , 96.6% of children reaching the age of five had received their first MMR. As in previous years, there appear to be a number of parents who delay vaccination until their child is nearer three or four years of age. These children are therefore not picked up in the 24 month uptake figures. The cohort of children who had their second birthday during are the same cohort who turned five in As can be seen from the figures above, only 87.6% of these children had their 1 st MMR by age 2 but the uptake had increased to 96.6% by the time they were five. 13

43 100 Appendix A: Surveillance Report Since a local campaign two years ago to encourage children to have their first dose of MMR and months, there has been a shift to children getting their first dose earlier, although this has not yet made a significant impact on the uptake as measured at 24 months and five years. The uptake of the 2 nd dose of MMR is still low, with a slight upward trend. We know that some of these children have their first MMR late and so may not get round to having their second MMR before they are six, if ever. We are trying to reduce this problem by encouraging the second MMR vaccination at 1-3 months after the first in this group of children. As there are now more children having their first MMR before the age of two, this should eventually be reflected in an increased number having two doses before they go to school. In the meantime, children who have only had one dose may be unprotected. There are still a number of families who refuse MMR (sometimes all vaccinations) and these appear to be concentrated in certain areas of Shetland. When parents have very fixed views on vaccinations, there is very little that we can do to persuade them to change their beliefs. However, where parents are unsure or ambivalent about vaccination then healthcare staff can help them to make an informed decision based on good scientific evidence. Uptake of MMR at 24 months by quarter % uptake Shetland Scotland Target 30 Quarter 3.4 HPV Vaccination programme The HPV vaccination programme commenced in September All girls in secondary school year S2 are invited to have the vaccination through a schools based programme. The full course consists of three vaccinations over a six month period. In addition, all girls who were above S2 but younger than 18 at the beginning of the programme have been invited for the vaccination as part of a catch up programme. During 2008/09 this included all girls in S5, S6 and those who had left school. In 2009/10 this included girls in S4 and 14

44 Appendix A: Surveillance Report S5 and in 2010/11 any girls in the catch up cohort who has missed their vaccinations previously were offered a final chance to have the immunisations. Uptake amongst girls in Secondary 2 (routine cohort) Cohort Uptake of 1 st dose Uptake of 2 nd dose Uptake of 3 rd dose by end school year Uptake 3 rd dose one year later 2008/09 Shetland Scotland % 94.4% 93.9% 93.6% 93.2% 91.4% 93.9% 92.4% 2009/10 Shetland Scotland % 92.6% 85.1% 91.1% 83.0% 86.9% 85.8% 90.9% 2010/11 Shetland Scotland % 91.8% 89.6% 90.2% 72.0% 81.0% 88.4% 90.1% 2011/12 Shetland Scotland % 93.1% 91.7% 91.7% 85.6% 82.8% Not yet available For the first year of the HPV programme, uptake amongst S2 girls was amongst the highest in Scotland, however it was one of the lowest the following year 2009/10. The figures have improved slightly for 2010/11 and 2011/13. It should be noted that a number of girls / parents had actively declined the vaccination in 2009/10. Uptake amongst girls older girls in school and those under 18 who had left school (catch up cohort) Number of girls in cohort 1 Number 1st dose Uptake of 1st dose Number 2nd dose Uptake of 2nd dose Number 3rd dose Uptake of 3rd dose Shetland % % % Scotland 149, , % 106, % 98, % 1 Girls aged 13 to under 18 years (i.e. born 01/09/90 to 31/08/95), who were resident in Scotland as at 31 August For the catch up cohort, Shetland has had one of the highest uptakes in Scotland. The catch up element of the programme has now finished. 3.5 Influenza vaccination Seasonal flu vaccination for at risk groups Influenza vaccination is offered on an annual basis each autumn / winter to all those aged 65 and over and to those younger adults and children who are in high risk groups (eg with certain medical conditions). Vaccination uptake in the 65+ age group is monitored and reported each year. The national target was 70% in 2009/10, but for 2010/11 it was increased to match the World Health Organisation target of 75%. There is also monitoring 15

45 Appendix A: Surveillance Report of the at risk groups, but this is more difficult to interpret as some patients may fall into more than one group. There is no specific target for this group. In pregnant women were included as an at risk group because of the continuing circulation of Influenza A H1N1. It has now been agreed that pregnant women will continue to be included along with the other clinical risk groups in future years. Provisional uptake of seasonal flu vaccine (by end March 2013) Uptake at end Week 6, 2012 Cohort Uptake Uptake in 2011/12 Over 65s (Target 75%) Under 65 at risk groups Pregnant women - not in at risk group Pregnant women at risk group Carers Shetland Scotland Shetland Scotland Shetland Scotland Shetland Scotland Shetland Scotland 4, ,941 2, , , , % 76.6% 51.7% 56.0% 52.7% 52.8% 60.0% 68.7% 58.9% 51.9% 74.9% 76.2% 53.3% 56.4% 32.0% 39.6% 52.0% 60.0% 63.6% 52.4% These figures are extracted from practice systems by Health Protection Scotland, and are provisional estimates based on data from 99% of practices in Scotland (100% of Shetland practices) The flu vaccination uptake figures for NHS Shetland are slightly lower for all groups other than pregnant women. For the over 65s, the uptake in Shetland has sat just under the 75% target for a number of years. There has been a significant increase in the percentage of pregnant women receiving flu vaccine, although it is still lower than the average for Scotland. In general figures are slightly lower compared to Scotland as a whole, except for carers where we have one of the highest uptakes Seasonal flu vaccination for health and social care staff. During 2012/13, a total of NHS Shetland staff who could have had the vaccine was 586. Of these, 87 had the vaccine, giving an overall uptake rate of 14.8%. This is lower than last year when 19.3% of all staff had the vaccine. 342 staff are categorised as clinical / frontline staff (ie the target group for flu immunisation) and of these only 54 were given the flu vaccine by occupational health, an uptake rate of 15.8%. This is lower than last year when 28.4% of clinical staff were vaccinated. However, a number of staff may attend their GP for flu vaccination if they are in one of the clinical risk groups. Anecdotally, the reasons for staff not having the flu vaccine are around the practicalities of actually getting it. The average for uptake of flu vaccine amongst healthcare workers in Scotland is 35.5%, with some Boards achieving 50-60%. The GP practices that are not directly managed by NHS Shetland provide the flu vaccination for their own staff. Social care staff with direct client contact are also recommended to have the seasonal flu vaccination, provided by their employer. However this year Shetland Islands Council made 16

46 Appendix A: Surveillance Report the decision not to offer vaccination for their staff. It is hoped that this will be addressed in future years, particularly with the integration of health and social care services. 4 References Health Protection Scotland. Healthcare Associated Infection Annual Report Health Protection Scotland; Available at: 3 Scottish Government Health Department. A revised framework for national surveillance of healthcare associated infection and the introduction of a new health efficiency and access to treatment (HEAT) target for Clostridium difficile Associated Disease (CDAD) for NHS Scotland. NHS CEL(2009)11:SGHD;2009. Available at: 4 Source: Information and Statistics Division of NHS National Services Scotland. Data available at the ISD website Scottish Health Statistics (last updated October 2004): 5 Public Health etc. (Scotland) Act 2008 available at: Scotland/publicact 17

47 Control of Infection Committee: Work Programme (Incorporating the Training and Audit Programmes) CoIC Work Programme Action Responsibility Timescale / progress SURVEILLANCE Healthcare Associated Infection MRSA (local surveillance) MRSA & MSSA bacteraemia Use of SAB Investigation Tool Clostridium difficile Infection Use of CDI Trigger Tool Surgical Site Infection Surveillance (SSIS) Patient safety programme Scottish HAI Outbreak Online Reporting System SHORS Resistant organisms surveillance Overall Responsibility: Director of Public Health (ST) Public Health ( SL) Public Health (SL / ST) Public Health (SL / ST) Public Health (SL / ST) Public Health (SL / ST) Theatre staff / Public Health (KG) Clinical Governance (Fiona Morgan) Public Health (SL / ST) Public Health (SL / ST) Ongoing (Quarterly reports) 1.2 Implementation of Scottish Health Protection information management System (SHPIMS) Public Health (ST) through E- health Strategy June Communicable disease surveillance (including immunisation uptake) 1.4 Sharps injuries (Including investigation of increase in sharps injuries in any clinical area) Public Health (KG / SL / David Kerr) Occupational Health (BD) Ongoing (Quarterly reports) Ongoing (Quarterly reports) 1

48 CoIC Work Programme TRAINING (see detailed plan at end) (part of and in line with Board Training Plan) All staff have HAI CPD objectives included within PDPs Overall Responsibility: Infection Control Manager (KC) Line Managers ongoing 2.2 Awareness raising and publicity for infection control training and useful resources through Staff Development Bulletin 2.3 Incorporation of infection control into all training run by Staff Development where appropriate 2.4 Clinical skills training (relevant infection control elements) 2.5 Reviewing and updating of Induction and mandatory refresher training materials as required Staff Development / Infection Control Nurse (TB-I) Staff Development (Andy Glen / Bruce McCullough) / Infection Control Nurse (TB-I) Infection Control Nurse (TB-I) Quarterly updates for bulletins Ongoing Ongoing 2.6 Induction and mandatory refresher Induction infection control Rota of ICT members Ongoing (monthly) 2.7 Mandatory refresher infection control Rota of ICT members Ongoing (monthly) 2.8 LearnPro - waste procedures Staff Development (Andrew Humphrey) / Infection Control Nurse (TB-I) 2.9 LearnPro infection control Staff Development (Andrew Humphrey) / Infection Control Nurse (TB-I) Ongoing Ongoing 2.10 LearnPro food handling training for clinical staff Staff Development (Andrew Humphrey) Ongoing 2.11 FFP3 Fit testing ( process in place to fit existing staff; and new staff as part of induction) H&S Manager (Catriona Oxley) / Asst Director Nursing Hospital (JM) / Infection Control Nurse (TB-I) / Dept Fitters Ongoing 2

49 CoIC Work Programme Staff Nurse Induction Training Infection Control Nurse (TB-I) 2.13 Healthcare Support Worker induction training Infection Control Nurse (TB-I) Ongoing 2.14 Infection control training - through SHO / Medical Student and Postgraduate Education Programmes Infection Control Nurse (TB-I) / Public Health (ST) Ongoing (quarterly) 2.15 Hand hygiene for contractors Infection Control Nurse (TB-I) As required 2.16 CDU staff training CDU Manager (CC) Ongoing 2.17 Hand hygiene educational sessions (including skin care) for teams / departments Infection Control Nurse (TB-I) Ongoing on request 2.18 Contamination Incident/ Needle Stick Injury Training Senior Occupational Health Nurse (BD) Once per quarter and on request 2.19 Cleanliness Champions training (NES on-line package) Staff Development (Mhari Roberts) / Infection Control Nurse (TB-I) / Assistant Director of Nursing Community (EMW) Ongoing 2.20 Other LearnPro HAI modules (previously NES short courses) Staff Development (publicity through Staff Development Bulletin see 2.2) / Individual staff (PDPs) Ongoing 2.21 Infection Control Team: individual PDPs and training programmes ST / SL / EMW / JM / TB-I / WH / KC/ BD /CD /LB Ongoing Immunisation training 2.22 HPS/NES Immunisation on-line training (Promoting Effective Immunisation Practice) Immunisation Co-ordinator (SL) / Immunisers Ongoing 3

50 CoIC Work Programme Local annual Immunisation update training Immunisation Co-ordinator (SL) March Promotion of online training resources on the changes to the Immunisation programme (Rotavirus; meningitis C and Herpes Zoster) 2.25 Training on the extension to flu immunisation programme and flu immunisation pilots Immunisation Co-ordinator (SL) From June 2013 Immunisation Co-ordinator (SL) September CRBN Decontamination CRBN decontamination training A&E staff (Lynda Smith) / Estates / Emergency Planning Officer (Ingrid Gall) October POLICY & PROCEDURE DEVELOPMENT : Infection control in healthcare setting Overall Responsibility: Infection Control Manager 3.1 Ensure all new policies marked with review date Authors of each individual policy Ongoing 3.2 Ensure assessment of all policies against Equality and Diversity Impact Assessment Toolkit 3.3 Continue to update infection control procedures against national guidance Authors of each individual policy Infection Control Nurse (TB-I) Ongoing Ongoing as required Infection Control Procedures due for review 3.4 Hospital Outbreak Plan Public Health (SL) End Dec MRSA procedures Public Health (SL) End Dec Clostridium difficile infection procedures Public Health (WH) End Dec

51 CoIC Work Programme Public Health / Outbreaks Overall Responsibility: Director of Public Health (ST) 3.7 Revised TB Procedures to be approved Public Health (SL) July Complete review of Pandemic Flu Plan Pandemic Flu Co-ordinator (SL) End Dec Review local Blue Green Algae Plan Public Health (SL) & Environmental Health (MS) End Sept Review of local legionella procedures in PH and EH Public Health (SL) & Environmental Health (MS) End Sept PREVENTION OF HAI: DECONTAMINATION CDU: re-certification to ISO 13485:2003 and the Medical Device Directive Overall Responsibility: Infection Control Manager CDU Manager (CC) September PREVENTION OF HAI: INFECTION CONTROL Overall Responsibility: Infection Control Manager (other actions picked up elsewhere in Work Plan) 5.1 Continued Implementation of Hand Hygiene programme Infection Control Nurse (TB-I) Ongoing 5.2 Continue Cleanliness Champions programme Infection Control Nurse (TB-I)/ Staff Development (Mhairi Roberts) / Assistant Director of Nursing Community (EMW) Ongoing 5.3 Action to achieve HEAT target: to reduce SA bacteraemias (including surveillance; implementation of procedures; patient safety bundles) 5.4 Ensure that training and learning outcomes in relation to HAI are standardised and included in: Mandatory training Corporate induction Clinical area level induction New start checklists for HCSWs All members of Infection Control Team / Senior Charge Nurses Infection Control Manager (KC) / Infection Control Nurse (TB-I) Ongoing Ongoing 5

52 Waste management training for all clinical staff Root cause analysis as part of HAI outbreak investigations and incident cases of positive SAB / C. Difficle CoIC Work Programme PREVENTION OF HAI: GOVERNANCE AND REPORTING 6.1 HAI incident and near miss reporting; raise awareness and implement risk matrix. Infection control risks and incidents to be reported to CoIC quarterly Infection Control Team / Public Health (KG) Quarterly reporting 6.2 Organisational lead from CE through SMT on expectations, priority of HAI, follow-up of poor performance demonstrated through team briefs; walk arounds; management of poor performance and zero tolerance 6.3 Performance management of individuals by managers including objective setting Chief Executive (Ralph Roberts) All Senior Managers Ongoing Ongoing 6.4 Regular walk-arounds undertaken by senior managers Senior Managers / Assistant Director of Nursing (Hospital) (JM) / Interim Head of Estates (LB) Ongoing Reporting: monthly Board reports Infection Control Manager (KC) Ongoing 6.6 Produce CoIC Annual Report and present to Clinical Governance Committee CoIC (ST) By June PREVENTION OF HAI: PATIENT SAFETY 7.1 Take forward the patient safety programme methodology as set out in the iiip Infection Control Manager (KC) / Infection Control Nurse (TB-I) Ongoing 6

53 8 PREVENTION OF HAI: ESTATES AND FACILITIES Overall Responsibility: Infection Control Manager CoIC Work Programme Monitoring of Hospital Cleaning Standards Hotel Services Manager (VL)/ Infection Control Nurse (TB-I) / Interim Head of Estates (LB) Ongoing (Quarterly reporting to CoIC) 8.2 Review current Estates User Forum to enable discussion about HAI and facilities issues 8.3 Hospital Capital Plan Ensure infection control issues addressed within plans for building works including: Design of clinical areas New fixtures, fittings & equipment Appropriate infection control measures during building works Reports to CoIC Repeat HAI SCRIBES after works completed Interim Head of Estates (LB) Overall Responsibility: Head of Estates Review by end September 2013 Ongoing 8.4 Specific capital projects: Interim Head of Estates (LB) 9 PREVENTION OF HAI: Antimicrobial prescribing Overall responsibility: Medical Director 9.1 Implementation of Anti-microbial Prescribing action plan 2013 Members of Antimicrobial Prescribing Team 9 Pandemic Flu Planning Overall Responsibility: Director of Public Health 9.1 Finalise revised Local Plan - including comments from Scottish Government on the draft and feedback from Pandemic Flu Tabletop Exercise. Pandemic Flu co-ordinator (SL) End December

54 CoIC Work Programme Audit Projects (see Audit Plan at end) Overall Responsibility: Infection Control Manager Monthly ongoing 10.1 Hand hygiene audit as part of national campaign Local Board Hand Hygiene Co-ordinator (TB-I) 10.2 Monthly Cleaning Facilities Manager (MF), ICT rep, Lay member Monthly ongoing 10.3 MRSA Screening KPIs quarterly audit ICN (TB-I) Quarterly 10.4 HAI Environmental Audit programme ICN (TB-I) As per programme 10.5 Mattress Audit ICN (TB-I) As per programme 13 Patient Focus Public Involvement Overall Responsibility: Infection Control Manager 13.1 Increase public involvement in policy & procedures development and review Infection Control Nurse (TB-I) / Cleanliness Champions Ongoing 13.2 Continue to develop & disseminate HAI information to the public, patients, families & carers Infection Control Nurse (TB-I) / Cleanliness Champions Ongoing 13.3 Increase public involvement in cleanliness monitoring & hand hygiene Infection Control Nurse (TB-I) / Cleanliness Champions Ongoing 13.4 Public involvement with Environmental Audit of Non- Doctor island Premises specifically new surgeries at Foula and Fair Isle Assistant Director of Nursing - Community (EMW) From September

55 Control of Infection Training Programme: April Resources identified, and recording, reporting & evaluation via Board s Training Plan CoIC Work Programme Action Responsibility Timescale GENERAL 1 All staff have HAI CPD objectives included within PDPs Line managers Ongoing 2 Awareness raising and publicity for infection control training through Staff Development Bulletin 3 Incorporate infection control into all training run by Staff Development Staff Development / Public Health (SL) Staff Development (Andy Glen / Bruce McCullough) / Infection Control Nurse (TB-I) Quarterly updates for bulletins Ongoing 4 Clinical skills training (relevant infection control elements) Staff Development Ongoing 5 Reviewing and updating of Induction and mandatory refresher training materials as required INDUCTION & MANDATORY REFRESHER TRAINING Infection Control Nurse (TB-I) Staff Development (Andy Glen & Staff Development Team) Ongoing 6 Induction infection control Rota of ICT members Ongoing (monthly) 7 Mandatory refresher infection control Rota of ICT members Ongoing (monthly) 8 Learnpro - waste procedures Staff Development (Andrew Humphrey) / Infection Control Ongoing 9

56 Nurse (TB-I) CoIC Work Programme Learnpro infection control Staff Development (Andrew Humphrey) / Infection Control Nurse (TB-I) 10 Learnpro food handling training for clinical staff Staff Development (Andrew Humphrey) Ongoing Ongoing 11 FFP3 Fit testing ( process in place to fit existing staff; and new staff as part of induction) 12 Staff nurses H&S Manager (Catriona Oxley) / Asst Director Nursing Hospital (JM) / Infection Control Nurse (TB-I) / Dept Fitters Ongoing (new staff) Induction training Infection Control Nurse (TB-I) Ongoing 13 Healthcare Support Workers Induction training Infection Control Nurse (TB-I) Ongoing 14 Infection control training for doctors SHO Educational Programme session on infection control Public Health (ST) / TB-I Ongoing (Approx quarterly) Postgraduate Education Programme (SWIDDER) - IC session to be offered Public Health (ST /SL) As required Medical students infection control session offered Public Health (ST) / TB-I As required 15 Contractors 10

57 CoIC Work Programme Hand hygiene for contractors Infection Control Nurse (TB-I) As required 16 CDU staff training CDU Manager (CC) NVQ in decontamination (level 3) for operators CDU Manager (CC) Ongoing Other relevant training CDU Manager (CC) Ongoing 17 HAND HYGIENE Infection Control Nurse (TB-I) Hand hygiene educational sessions (including skin care) for teams / departments Infection Control Nurse (TB-I) Ongoing on request 18 PREVENTION OF BBV THROUGH OCCUPATIONAL EXPOSURE Contamination Incident/ Needle Stick Injury Training Occupational Health Dept Senior Occupational Health Nurse (BD) Once per quarter and on request 19 CLEANLINESS CHAMPIONS Co-ordinated through Staff Development (Mhairi Roberts) NES training package for - All registered nurses - All registered AHPs - other nursing staff and other disciplines 20 OTHER LEARNPRO MODULES (PREVIOUSLY NES SHORT COURSES) 11 Mhairi Roberts / EMW/ JM / TB-I AHP Manager (Jo Robinson) Staff Development (Mhairi Roberts) Staff Development Ongoing Ongoing

58 CoIC Work Programme Antibiotic prescribing for today s practitioners Aseptic technique Bacterial resistance: an online tutorial Basic Microbiology (publicity through Staff Development Bulletin) / Infection Control Nurse (TB-I) Individual staff (PDPs) C difficile: a clinical scenario & C difficile : a clinical tutorial Hand Hygiene Helping patients cope with isolation in hospital Hospital Outbreak Management Management of legionella incidents in the community MRSA Screening programme MRSA: a clinical scenario & MRSA : a clinical tutorial Multi-resistant Gram Negative Bacilli (MRGNB) Needlestick Injury: a Clinical Scenario Presentation of Infection in the Older Person Preventing Catheter Related Blood Stream Infections Preventing Ventilator Associated Pneumonia Prevention and Management of Pressure Ulcers Urinary Catheterisation 21 INFECTION CONTROL TEAM: INDIVIDUAL PDPS AND TRAINING PROGRAMMES ST / SL / EMW / JM / TB-I / WH / KC/ BD / AB /CD /LB 12

59 21.1 Infection control nurse Continue with MSc in Advanced Practice (Infection; Diseases Prevention and Control) and a Specialist Practitioner Qualification 21.2 DPH & CPHM RCPE Symposium on Infectious Diseases Appropriate CPD 21.3 Public Health Nurse Continue with PhD (on Hepatitis C) Appropriate CPD TB-I SL SL/ST WH CoIC Work Programme Ongoing May 2013 Ongoing Ongoing 21.4 Head of Estates Appropriate CPD LB Ongoing 21.5 Director of Nursing; Assist. Directors of Nursing; Snr Occupational Health Nurse; Dental Nurse (infection Control) Appropriate CPD IMMUNISATION TRAINING 22 HPS/NES Immunisation on-line training (Promoting Effective Immunisation Practice) for practice nurses; community nurses; pharmacy staff and other staff involved in immunisation. KC/ JM / EMW / BD / CD Immunisation Co-ordinator (SL) Immunisation Co-ordinator (SL) / Immunisers Ongoing Ongoing 23 Local annual Immunisation update training for practice nurses; community nurses; pharmacy staff and other staff involved in immunisation. Half day training. Immunisation Co-ordinator (SL) March

60 CoIC Work Programme Promotion of online training resources (produced by NHS Education for Scotland) on the changes to the Immunisation programme (Rotavirus; meningitis C and Herpes Zoster). Immunisation Co-ordinator (SL) From June 2013 (Rotavirus and meningitis C) From September 2013 (herpes zoster- shingles) 25 Training on the extension to flu immunisation programme and flu immunisation pilots CRBN DECONTAMINATION Immunisation Co-ordinator (SL) September 2013 Emergency Planning Exec Lead (ST) 26 CRBN decontamination training for A &E staff A&E (Lynda Smith) / Estates / Emergency Planning Officer (Ingrid Gall) October

61 Control of Infection Audit Programme: April March 2013 CoIC Work Programme Audit Frequency Person Responsible Hand hygiene audit 1 monthly Infection Control Nurse and ward nurse Environmental Audit 1 monthly as required based on risk basis Infection Control Nurse and estates Leaflet Audit 3 monthly Infection Control Nurse Catheter associated urinary tract infection 3 monthly Infection Control Nurse Green tape 3 monthly Infection Control Nurse Infection control manual audits 3 monthly Infection Control Nurse MRSA Screening KPI Audit 3 monthly Infection Control Nurse Fridge Audit 6 monthly Infection Control Nurse Sharps Audit 6 monthly Infection Control Nurse Patient Placement 6 monthly Infection Control Nurse PPE 6 monthly Infection Control Nurse Mattress Audit 6 monthly Ward Nurse Managing patient care equipment 6 monthly Infection Control Nurse Control of the environment 6 monthly Infection Control Nurse Managing Linen 6 monthly Infection Control Nurse Managing of blood spillage and other bodily fluids 6 monthly Infection Control Nurse Safe disposal of waste 6 monthly Infection Control Nurse Occupational exposure Management 6 monthly Infection Control Nurse 15

62 Respiratory hygiene 6 monthly Infection Control Nurse Audit Programme for year: month by month Month Audit Person Responsible CoIC Work Programme August September October November December January Infection Control Nurse Leaflet Audit Mattress Audit Environmental audit Green tape Hand Hygiene Audit Patient Placement Respiratory hygiene Personal Protective Equipment Environmental audit Infection Control Manual Audits Hand Hygiene audit Environmental audit Catheter associated urinary tract infection auditm Hand Hygiene Audit Leaflet audit Environmental audit Managing patient care equipment Control of the environment Managing Linen MRSA KPI Audit Hand Hygiene Audit Environmental Audit Green Tape Infection Control Manual Audits Fridge Audit Sharps Audit Hand Hygiene Audit Environmental Audit Management of Spillage of Blood and Body fluids Safe Disposal of waste Occupational Exposure Management Ward Nurse Infection Control Nurse Ward Nurse Infection Control Nurse and Estates Infection Control Nurse Infection Control Nurse Infection Control Nurse Infection Control Nurse Infection Control Nurse Infection Control Nurse and estates Infection Control Nurse Ward Nurse Infection Control Nurse and Estates Infection Control Nurse Infection Control Nurse Infection Control Nurse Infection Control Nurse and Estates Infection Control Nurse Infection Control Nurse Infection Control Nurse Infection Control Nurse Infection Control Nurse Infection Control Nurse and Estates Infection Control Nurse Infection Control Nurse Infection Control Nurse Infection Control Nurse Infection Control Nurse Infection Control Nurse/Estates Infection Control Nurse Infection Control Nurse Infection Control Nurse 16

63 February March Leaflet Audit Hand Hygiene Audit Environmental Audit Mattress Audit MRSA KPI Audit Hand Hygiene Environmental Audit Patient Placement Respiratory hygiene and Cough Etiquette Personal Protective Equipment Infection Control Manual Audit CoIC Work Programme Infection Control Nurse Ward Nurse Infection Control Nurse/Estates Ward Nurse Infection Control Nurse Infection Control Nurse Infection Control Nurse/Estates Infection Control Nurse Infection Control Nurse Infection Control Nurse Infection Control Nurse 17

64 KEY: CoIC Work Programme LB Lawson Bisset* Interim Head of Estates TB-I Tina Bokor Ingram* Infection Control Nurse KC Kathleen Carolan* Director of Nursing / Infection Control Manager CC Carol Colligan CDU Manager BD Bernadette Dunne* Senior Occupational Health Nurse KG Kim Govier Public Health Secretary WH Wendy Hatrick* Public Health Nurse SL Susan Laidlaw* Consultant in Public Health Medicine JM Janice McMahon* Assistant Director of Nursing (Community) MS Maggie Sandison* Head of Service Environmental Health (SIC) ST Sarah Taylor* Director of Public Health EMW Edna Mary Watson* Assistant Director of Nursing (Community) *member of Control of Infection Committee 18

65 NHS SHETLAND TUBERCULOSIS ANNUAL REPORT Prepared by Wendy Hatrick March 2013