NHS Board 26 March 2019 Item 4.6

INFECTION PREVENTION & CONTROL REPORT

Report by Catherine Stokoe, Infection Control Manager and Dr Vanda Plecko, Consultant Microbiologist/Infection Control Doctor, on behalf of Heidi May, Board Nurse Director & Executive Lead for Infection Control

The Board is asked to: • Note the position for the Board. • Note the update on the current status of Healthcare Associated Infections (HAI) and Infection Control measures in NHS Highland. • Note that we will not achieve the Staphylococcus aureus bacteraemia (SAB) target. • Note that we are over the Clostridium difficile target trajectory but may still meet this target.

Contribution to Board Objectives

One of the Board key objectives is “to reduce to an absolute minimum the chance of acquiring an infection whilst receiving healthcare and to ensure our hospitals are clean”. This report presents a comprehensive view of HAI data and activities for scrutiny and feedback from the Board.

1. Background and summary The table below shows NHS Highland Infection Prevention and Control targets and performance data.

Group Target NHS Highland HEAT rate

Clostridium Age 15 and HEAT rate of 32.0 cases 29 Green (NHSH difficile over per 100,000 OBDs to be data) achieved by year ending Oct-Dec 03/19 Q4 2018 Staphylococcus HEAT rate of 24.0 cases 28 Red (NHSH data) aureus per 100,000 AOBDs to be bacteraemia achieved by year ending Oct-Dec 03/19 Q4 2018

Hand Hygiene 95% Oct-Dec Green 2018 performance 95% Cleaning 92% Oct-Dec Green 2018 performance 96% Estates 95% Oct-Dec Green 2018 performance 96% Source: - Health Protection /ISD/Local data.

1 Achievements • The Colorectal Surgical site infection (SSI) rate for 2018 has significantly reduced compared to last year’s figure (2018 SSI rate is 4.4% compared to 9.4% in 2017). This reflects the amount of work undertaken by the Surveillance and Clinical teams to implement standardised work. • Over the previous few months sporadic cases of norovirus and flu have been identified in both hospital and community settings. Due to the vigilance undertaken by all involved the impact on services has so far been minimal. • The line management of the Infection Prevention and Control Nursing team will transfer on the 1st of April 2019 from the Divisional Lead Nurses to the Infection Control Manager. The transition will be formally reviewed in October 2019. This fulfils a requirement from the Healthcare Environment Inspection (HEI) relating to HEI Inspection July 2018. • The Learning and Development Team have developed a ‘Qlikview’ report published on the NHS Highland Information Portal to aid managers and staff to view compliance with mandatory training data. This fulfils a requirement from the Healthcare Environment Inspection (HEI) relating to Argyll and Bute HEI Inspection July 2018.

Challenges

• The Board need to note we are two cases below the predicted trajectory for Clostridium difficile at week 44. This position remains changeable. • The Board need to note that we have not met the Staphylococcus aureus bacteraemia (SAB) including MRSA target. See section 1 for further detail. • The Infection Prevention and Control Nurse covering the west (of the North & West Division) is on long term sick leave; they are also due to retire in May 2019. The loss of a 1 whole time equivalent post is impacting on the wider Infection Prevention and Control team. Cover is being provided primarily by the Infection Prevention and Control Nurse from the North Division, with additional assistance being provided by the Infection Prevention and Control Nurse from the South and Mid Division. As and when required additional assistance is being provided by the Infection Control Manager. This post will be actively recruited too, in the interim the option of funding additional hours is also being explored in order to support existing service provision. • Dr J Mills Consultant Microbiologist resigned from his position in NHS Highland at the end of January 2019. Locum cover has been implemented whilst the vacant post is advertised, and future appointment made.

Catherine Stokoe – Infection Control Manager Vanda Plecko – Consultant Microbiologist & Lead Infection Control Doctor, April 2019

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NHS Highland Healthcare Associated Infection Report

1. Staphylococcus aureus (including MRSA)

Staphylococcus aureus is an organism which is responsible for a large number of healthcare associated infections, although it can also cause infections in people who have not had any recent contact with the healthcare system. The most common form of this is meticillin Sensitive Staphylococcus Aureus (MSSA), but the more well known is MRSA (meticillin Resistant Staphylococcus Aureus), which is a specific type of the organism which is resistant to certain antibiotics and is therefore more difficult to treat. More information on these organisms can be found at: http://www.nhs.uk/conditions/staphylococcal-infections/Pages/Introduction.aspx NHS Boards carry out surveillance of Staphylococcus aureus blood stream infections, known as bacteraemias. These are a serious form of infection and there is a national target to reduce them. Information on the national surveillance programme for Staphylococcus aureus bacteraemias can be found at: http://www.hps.scot.nhs.uk/haiic/sshaip/publicationsdetail.aspx?id=30248

1.1 Staphylococcus aureus bacteraemia target

The target for 2018/2019 for NHS Highland is 24 cases or less per 100,000 acute occupied bed days for Staphylococcus aureus bacteraemia (SAB) including MRSA. For NHS Highland this means no more than approximately 60 cases by 31st March 2019. The local delivery plan (HEAT) targets for 2018/2019 are yet to be agreed by NHS Scotland, so we continue to currently report against previous local delivery plan arrangements.

NHS Highland data is reporting 63 cases as of 31st January 2019; this data is yet to be externally verified by Health Protection Scotland. The Board need to note we have not met this target. Our validated position will be known in July 2019.

1.2 Trends NHS Highlands position showing actual verified case numbers as of 31st of January 2019 (data not yet validated by HPS) is tabled below.

1st April MSSA = 63 Preventable = 13 including 2 Contaminant (21%) 2018 – 31st MRSA = 0 Not preventable = 36 (57%) January Unknown = 12 (19%) 2019 Total SABs Under Investigation = 2 (3%) = 63 Cases Hospital Acquired Cases = 21 (33%) Community Acquired Cases = 21 (33%) Healthcare Associated Cases = 19 (31%) Undergoing Investigation = 2 (3%)

For definitions of above classifications please see section 2 page 12

1.3 Current Initiatives

The combined CDI/SAB action plan developed to implement actions to reduce staphylococcus aureus bacteraemia is in place and progress is monitored monthly and presented to the Control of Infection Committee.

A short life working group (SLWG) for vascular access was established in January 2019 and is being led by the Lead Nurse, Hospital. The first meeting of the SLWG was a process mapping event which was attended by representatives from acute, community, education and specialist staff. The work is now being progressed by means of four work streams with a senior lead for each one

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• Training and education of medical and nursing staff in insertion of devices

• Referral and insertion of devices

• Care and Maintenance of devices

• CVC Policy update

The work stream leads will be reporting back to the next SLWG meeting due to be held at the end of April.

Figure 1: NHS Highland Staphylococcus aureus bacteraemia Cumulative Case numbers year on year since 2014, based on NHS Highland case number data.

NHS Highland Cumulative staph aureus Bacteraemia 80

70 60 50 40 30 20

Cumulative Case Numbers 10 0 April May June July Aug Sept Oct Nov Dec Jan Feb March

2015-2016 2016-2017 2017-18 2018-19 Heat Target to 31-3-19

2. Clostridium difficile

Clostridium difficile is an organism which is responsible for a large number of healthcare associated infections, although it can also cause infections in people who have not had any recent contact with the healthcare system. More information can be found at: http://www.nhs.uk/conditions/Clostridium-difficile/Pages/Introduction.aspx NHS Boards carry out surveillance of Clostridium difficile infections (CDI), and there is a national target to reduce these. Information on the national surveillance programme for Clostridium difficile infections can be found at: http://www.hps.scot.nhs.uk/haiic/sshaip/ssdetail.aspx?id=277

2.1 Clostridium difficile HEAT Target

The target for 2018/2019 for NHS Highland is 32 cases or less in patients aged 15 and over per 100,000 total occupied bed days. For NHS Highland this means no more than approximately 78 cases by 31st March 2019. The local delivery plan (HEAT) targets for 2018/2019 are yet to be agreed by NHS Scotland, so we continue to currently report against previous local delivery plan arrangements.

NHS Highland data is reporting 63 cases as of 31st January 2019; this data is yet to be externally verified by Health Protection Scotland. The Board need to note we are below the predicted trajectory for Clostridium difficile by 2 cases at week 44, this position remains changeable.

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2.2 Trends

NHS Highlands position showing actual case numbers as of 31st January 2019 (data not yet validated by HPS) is tabled below.

1st April 2018 Total CDI Cases aged 15 and over = 63 (this Aged 15-64 = 19 to includes 5 cases of re-occurrence; defined as a Aged 65+ = 44 31st January 2019 patient having a further episode within 8 weeks of previous episode) Healthcare Associated = 38 (60%) Community Acquired = 20 (32%) Unknown = 4 (6%) Under Investigation = 1 (2%)

For definitions of above classifications please see section 2, page 12

Figure 2: NHS Highland Clostridium difficile Infection age 15 and over, case numbers year on year since 2014, based on NHS Highland case number data

NHS Highland Cumulative Toxin Positive Cdifficile age 15 and over 100

80

60

40

20 Cumulative Case Numbers 0 April May June July Aug Sept Oct Nov Dec Jan Feb March 2015-2016 2016-2017 2017-2018 2018-19 Heat Target to 31-3-19

2.4 Antimicrobial Management

A number of national antimicrobial quality prescribing indicators have been developed for boards in the past. At present, indicators to be achieved by 2021 have not yet been formally agreed and shared with board Antimicrobial Management Teams (AMT).

At the last AMT meeting in January 2019, the committee discussed the national review paper of antibiotic audit performance across all boards recently presented at the Scottish Antimicrobial Prescribing Group (SAPG) meeting. The recommendation from SAPG is that these audits (previously reported in board reports) should be used for local quality improvement. In order to achieve improved outcomes, the AMT has approved a local proposal to use the audit resource to look at specific issue, such as timely switching from intravenous to oral antibiotics in hospital. This is based on the proposed national quality indicator on reversing the upward trend in the volume of antibiotic injections used in acute hospitals. It is anticipated that boards will be asked to ensure that the use of intravenous antibiotics in secondary care (measure as “defined daily dose per 1000 population per day”) will be no higher in 2021 than it was in 2018. Investigating and improving safe and timely switch from injection to oral antibiotic therapy is the first area for this quality improvement work and is supported by the Raigmore Control of Infection Committee. This quality improvement initiative was chosen as the initial focus following the review of the volume of intravenous antibiotics used in each ward within , and the highest user

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(ward 6C) was chosen. We will review the progress of this work and consider moving to another area once a reliable process has been demonstrated. There may well be aspects of the process that can be shared with other clinical areas for consideration. Ongoing work will be informed by outcomes from the national 3 day review short life working group which are anticipated in April 2019.

Management of Infection Guidelines Updates The most recent sections of guidance to be updated are genital tract infections, vancomycin prescribing guidelines, surgical prophylaxis and urinary tract infections (UTI).

3 Hand Hygiene Reporting

Good hand hygiene by staff, patients and visitors is a key way to prevent the spread of infections. More information on the importance of good hand hygiene can be found at: http://www.washyourhandsofthem.com./ http://www.washyourhandsofthem.com./documents/hand-hygiene-and-nhs-scotland/your-5-moments-for-hand- hygiene/5-moments-credit-card.aspx

Each Board is responsible for monitoring and reporting hand hygiene compliance data.

3.1 Current Hand Hygiene Compliance Rates NHS Highland Hand Hygiene Rolling Monthly Audit Programme continues across all clinical areas, and compliance rates are being sustained above the 95% target. Compliance data for Oct to Dec 2018 identifies an average of 95% for hand hygiene compliance across NHS Highland. Any areas identified during the audits, as requiring action, are reported immediately to the relevant person for actioning.

4. Cleaning and the Healthcare Environment

Keeping the healthcare environment clean is essential to prevent the spread of infections. Information on national cleanliness compliance monitoring can be found at: http://www.hfs.scot.nhs.uk/online-services/publications/hai/ Healthcare environment standards are also independently inspected by the Healthcare Environment Inspectorate. More details can be found at: http://www.nhshealthquality.org/nhsqis/6710.140.1366.html Each Board is responsible for monitoring and reporting the cleanliness of hospitals.

4.1 Cleaning and Estates audit data The monthly cleaning and estates audits, conducted as per the National Cleaning Services Specification and through the use of Synbiotix© (the Facilities Management Scotland web based audit tool), demonstrate compliance rates are being sustained above the locally defined targets (92% domestic monitoring and 95% estates monitoring). The data for Oct to Dec 2018 identifies an average compliance of 96% for domestic monitoring, and 96% for estates across NHS Highland. Any areas identified during the audits, as requiring action are reported immediately to the relevant person.

A series of unannounced independent Public Peer Review audits is in progress; these occur across all hospital sites in NHS Highland.

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4.2 Healthcare Environment Inspections (HEI)

There have been no HEI inspections carried out within NHS Highland since the last report. Benchmarking continues against all the national HEI inspection reports published, in order to ensure learning is disseminated.

The report for the announced HEI Inspection that occurred across three sites in Argyll and Bute in July 2018,(, Mid Argyll Community Hospital and ), and the subsequent 18 week follow up report have two requirements which will be completed by 1st of April 2019, these are • Requirement 1, align line management of the Infection Prevention and Control Nursing team to the Infection Control Manager, as per Vale of Leven recommendation. • Requirement 2, ensure a reliable system is in place to monitor compliance with infection prevention and control mandatory training.

4.3 Outbreaks/ clusters and multidrug resistant isolates associated with NHS Highland There has been one outbreak reported since the last report. Ward 7C Raigmore Hospital, was closed on 4th January 2019 due to confirmed norovirus, and reopened on the 12th January 2019. Sporadic cases of norovirus and influenza are being reported across the NHS Highland area.

5. Surveillance 5.1 MRSA Clinical Risk Assessment (CRA) Screening Audit

In 2010 Health Protection Scotland provided a Clinical Risk assessment tool comprising of three questions, to NHS Boards in order to ensure a consistent risk-based approach to mandatory MRSA swab screening is undertaken. As part of the national mandatory MRSA screening programme quarterly compliance data is submitted by NHS Boards to provide assurance that Clinical Risk Assessment (CRA) compliance is at or above 90%.

Staff are required to complete a Clinical risk assessment on all acute patient admissions as per the Health Protection Scotland definition defined criteria. The MRSA clinical risk assessment and screening process are embedded into the common admission document and monitoring of compliance occurs by the Infection Prevention and Control Nurses across NHS Highland. The past five quarters show sustained compliance within NHS Highland.

MRSA Key 2016 2016 2016 2017 2017 2017 2017 2018 2018 2018 2018 Oct – Performance April July Oct – Jan – Apr July – Sept Jan – April July Dec Q3 Indicator – – Dec March – Sept – Dec March – – Compliance % June Sept Q3 Q4 June Q2 Q3 Q4 June Sept Q1 Q2 Q1 Q1 Q2 NHS 84% 86% 86% 77% 67% 94% 94% 94% 95% 98% Available Highland from HPS April NHS 82% 84% 82% 79% 85% 90% 88% 83% 84% 84% Available Scotland from HPS April

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6. Escherichia coli (E.Coli) Bacteraemia surveillance

As of 1st April 2016 the surveillance of Escherichia coli (E. Coli) Bacteraemia became a mandatory requirement for all NHS Boards to undertake. Data is collected by the Infection Prevention and Control Team in conjunction with the relevant clinical teams, and cases discussed to identify learning. The data collected and presented below highlights the local case numbers.

NHS Highlands position showing actual case numbers as of 31st January 2019 (data not yet validated by HPS) is tabled below.

1st April 2018 Total Cases = 164 to Hospital Acquired = 21 (13%) 31st January 2019 Healthcare Associated = 34 (20%) Community Associated = 108 (66%) Not Known = 0 Under Investigation = 1 (1%)

The Board should note that discussions are underway between Health Protection Scotland and National Services Scotland around the formation of a target for the reduction of E.Coli bacteraemia over a period of time. A formal announcement to NHS Boards will be issued at some point.

6.1 Surgical Site Infections (SSI)

NHS Highland continues to monitor SSI rates through mandatory surveillance. The clinical teams alongside the Infection Prevention & Control Surveillance team and the Scottish Patient Safety Programme team (Acute adult workstream: SSI) are working jointly to review incidents of infection, and ensure that care practices are evidence based and maintained.

RAIGMORE 30 DAYS READMISSION ELECTIVE COLORECTAL SSI

A significant reduction has been seen in 2018 were 160 procedures were undertaken and 7 SSIs recorded, giving a rate of 4.4%. 2017 Colorectal SSI rate was 9.4% achieved with 159 procedures with 15 infections. Comparable figures from previous years are 2013 -15.6%, 2014 – 9.7%, 2015 – 9.1% and 2016 -13.3%.

Figure 3: Monthly SSI rate in elective colorectal surgery, Jan 2015 to December 2018

60%

50%

40% UCL

30%

20%

10% percentage of infection

0% LCL

Month

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RAIGMORE 30 DAYS READMISSION ORTHOPAEDIC SSI

Total Hip replacement (THR) surgery continues to have a low rate of SSI on the comparable figures for 2013 - 0.25%, 2014 – 0.66%, 2015 – 0.28%, 2016 0.24% and 2017 - 0%. There was 1 THR infection in August giving an SSI rate of 0.3% for whole of 2018.

Figure 4: Monthly SSI Rate for Total Hip Replacement January 2015 – Dec 2018 9% 8%

7% 6% 5% UCL 4% 3% 2% 1% percentage of infection 0% LCL

Month

Hemi-arthroplasty surgery continues to have a low rate of SSI on the comparable figures for 2013 - 2.9%, 2014 – 1.7%, 2015 – 2.4%, 2016 - 0 %, and 2017 - 0.5%. There have been 2 hemi-arthroplasty infections in 2018 giving an SSI rate of 0.6% for the year.

Figure 5: Monthly SSI rate for Hemi arthroplasty surgery Jan 2015 to December 2018

16%

14%

12%

10%

8% UCL

6%

4% percentage of infection 2%

0% LCL

Month

NHSH 10 DAYS POST DISCHARGE CAESAREAN SECTION SSI ELECTIVE C-SECTION Elective C-Section the SSI rate for 2017 was 1.1%; this is a reduction from 2.7% in 2016. For the whole of 2018 the SSI rate is 1.7%, 347 procedures with 6 infections identified.

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Figure 6: Monthly SSI rate for elective C Sections, Jan 2015 to December 2018. 14%

12%

10% UCL

8%

6%

4%

percentage of infection 2%

0% LCL

Month

EMERGENCY C-SECTIONS

Emergency C-Section the SSI rate for 2018 is 3.0% (this is the same rate as 2017), 334 procedures carried out with 10 infections identified.

Figure 7: Monthly SSI rate for emergency C Section, Jan 2015 to December 2018

18% 16%

14%

12% UCL 10% 8% 6% 4% 2% percentage of infections 0% LCL

Month

RAIGMORE 30 DAYS READMISSION ELECTIVE VASCULAR SSI

Vascular Surveillance became a mandatory requirement from Health Protection Scotland starting 1st April 2017 .The SSI rate for 2017 given that it was not a full year of data was 8.3%. For whole of 2018 the SSI rate was 4%, 5 infections identified from 124 procedures.

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Figure 8: SSI Rate following Vascular Surgery, April 2017 –December 2018

35%

30% UCL

25%

20%

15%

10%

5% percentage of infection 0% LCL

Month

Healthcare Associated Infection Reporting Template (HAIRT)

Section 2 – Healthcare Associated Infection Report Cards

The following section is a series of ‘Report Cards’ that provide information, for each acute hospital and key community hospitals in the Board, on the number of cases of Staphylococcus aureus blood stream infections and Clostridium difficile infections, as well as hand hygiene and cleaning compliance. In addition, there is a single report card which covers all community hospitals [which do not have individual cards], and a report which covers infections identified as having been contracted from outwith hospital. Understanding the Report Cards – Infection Case Numbers Clostridium difficile infections (CDI) and Staphylococcus aureus bacteraemia (SAB) cases are presented for each hospital, broken down by month. SAB cases are further broken down into Meticillin Sensitive Staphylococcus aureus (MSSA) and Meticillin Resistant Staphylococcus aureus (MRSA).

For each hospital the total number of cases for each month, been reported as positive from a laboratory report, on samples taken more than 48 hours after admission.

Understanding the Report Cards – Hand Hygiene Compliance Hospitals carry out regular audits of how well their staff are complying with hand hygiene. Each hospital report card presents the combined percentage of hand hygiene compliance with both opportunity taken and technique used broken down by staff group.

Understanding the Report Cards – Cleaning Compliance Hospitals strive to keep the care environment as clean as possible. This is monitored through cleaning and estates compliance audits.

Understanding the Report Cards – ‘Out of Hospital Infections’ CDI and SAB (including MRSA) bacteraemia cases are presented as ‘‘Out of Hospital Infections’ and are not attributable to a hospital. This section identifies those infections from community sources such as GP surgeries and care homes, and those from positive samples taken from patients within 48 hours.

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Abbreviations

SAB Definitions Definitions: Hospital acquired infection (HAI): Positive blood culture obtained from a patient who has been hospitalised for ≥48 hours. OR patient was transferred from another hospital, the duration of in-patient stay is calculated from the date of the first hospital admission. OR If the patient was a neonate/baby who has never left hospital since being born. OR The patient was discharged from hospital in the 48hr prior to the positive blood culture being taken. OR A patient who receives regular haemodialysis as an out-patient. OR Contaminant if the blood aspirated in hospital

Healthcare associated infection (HCAI): Positive blood culture obtained from a patient within 48 hours of admission to hospital and fulfils one or more of the following criteria: 1. Was hospitalised overnight in the 30 days prior to the positive blood culture being taken. 2. Resides in a nursing, long term care facility or residential home. 3. IV, or intra-articular medication in the 30 days prior to the positive blood culture being taken, but excluding IV illicit drug use. 4. Regular user of a registered medical device e.g. intermittent self-catheterisation, home CPD or PEG tube with or without the direct involvement of a healthcare worker (excludes haemodialysis lines see HAI). 5. Underwent any medical procedure which broke mucous or skin barrier i.e. biopsies or dental extraction in the 30 days prior to the positive blood culture being taken. 6. Underwent care for a medical condition by a healthcare worker in the community which involved contact with non-intact skin, mucous membranes or the use of an invasive device in the 30 days prior to the positive blood culture being taken e.g. podiatry or dressing of chronic ulcers, catheter change or insertion. Community infection: Positive blood culture obtained from a patient within 48 hours of admission to hospital who does not fulfil any of the criteria for healthcare associated bloodstream infection. Not known: Only to be used if the SAB is not an HAI, and unable to determine if Community or HCAI.

CDI definitions Definitions: Healthcare-associated CDI: a case with onset of symptoms on day three or later, following admission to a healthcare facility on day one, OR in the community within four weeks of discharge from any healthcare facility. This may apply to the current hospital or a previous stay in another healthcare facility, e.g. in another hospital, a long-term care facility or other healthcare facilities (e.g. outpatient departments etc.) Community-associated CDI: a case with [onset outside of healthcare facilities, AND without discharge from a healthcare facility within the previous 12 weeks] OR [onset on the day of admission to a healthcare facility or on the following day AND not resident in a healthcare facility within the previous 12 weeks] Unknown association: a case who was discharged from a healthcare facility 4–12 weeks before symptom onset

ADTC Area Drugs & Therapeutics Committee AMT Antimicrobial Prescribing Team AMAU Acute Medical Admissions Unit CHP Community Health Partnership CDI Clostridium difficile Infection CMO Chief Medical Officer CNO Chief Nursing Officer CVC Central Venous Catheter HEAT Health Improvement, Efficiency, Access, Treatment ECDC European Centre for Disease Prevention & Control GDP General Dental Practitioner HAI Healthcare Associated Infection HAI QIF Healthcare Associated Infection HAIRT Healthcare Associated Infection Quality Improvement Facilitator Reporting Template HPS Health Protection Scotland HSE Health and Safety Executive JAG Joint Advisory Group HFS Health Facilities Scotland CPE Carbapenemase-producing Enterobacteriaceae MRSA Meticillin Resistant Staphylococcus Aureus PICC Peripherally Inserted Central Catheter MSSA Meticillin Sensitive Staphylococcus Aureus PVC Peripheral Venous Catheter SAB Staphylococcus aureus Bacteraemia PPI Proton Pump Inhibitor SPC Statistical Process Chart RIDDOR Reporting of Injuries, Diseases & Dangerous Occurrences Hemiarthroplasty: Operation to treat fractured hip (only involves half Regulations 1995 of hip) SHPN Scottish Health Planning Note SHTM Scottish Health Technical Memoranda SICPs Standard Infection Control Precautions SAPG Scottish Antimicrobial Prescribing Group IPCT Infection prevention & control team SPSP Scottish Patient Safety Programme

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NHS HIGHLAND REPORT CARD NHS Highland Staphylococcus aureus bacteraemia (SABs) monthly case numbers

SAB's NHS Highland 16 MRSA MSSA Total SABS

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6

1

-4

Feb March April May June July August Sept Oct Nov Dec Jan 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2019

MRSA 1 0 0 0 0 0 0 0 0 0 0 0 MSSA 6 5 9 6 7 3 6 9 7 8 2 6 Total 7 5 9 6 7 3 6 9 7 8 2 6 SABS

NHS Highland Clostridium difficile infection monthly case numbers

C.difficile NHS Highland 16 Ages 15-64 Ages 65 plus Ages 15 plus

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-4

Feb March April May June July August Sept Oct Nov Dec Jan 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2019 Ages 2 3 2 0 5 5 2 1 0 1 3 0 15- 64 Ages 7 7 9 8 4 2 5 1 6 3 4 3 65 plus Ages 9 10 11 8 9 7 7 2 6 4 7 3 15 plus

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Hand Hygiene Monitoring Compliance (%)

Feb March April May June July August Sept Oct Nov Dec Jan 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2019 Board Total 96 96 97 96 99 96 97 96 97 95 95 97

AHP 99 97 99 97 99 99 99 94 96 98 92 96 Ancillary 90 93 96 95 99 94 96 97 98 98 98 99 Medical 95 95 93 92 97 96 92 94 94 87 89 98 Nurse 98 99 98 98 99 95 99 99 99 98 99 97

Cleaning Compliance (%) Feb March April May June July August Sept Oct Nov Dec Jan 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2019 Board Total 96 96 96 96 97 96 96 96 96 96 95 97

Estates Monitoring Compliance (%)

Feb March April May June July August Sept Oct Nov Dec Jan 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2019 Board Total 97 96 98 97 97 96 96 96 96 96 95 97

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NHS HIGHLAND RAIGMORE HOSPITAL REPORT CARD

Staphylococcus aureus bacteraemia (SABs) monthly case numbers Feb March April May June July August Sept Oct Nov Dec Jan 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2019 MRSA 0 0 0 0 0 0 0 0 0 0 0 0 MSSA 1 0 0 0 2 2 2 3 2 2 0 0 Total 1 0 0 0 2 2 2 3 2 2 0 0 SABS

Clostridium difficile infection monthly case numbers Feb March April May June July August Sept Oct Nov Dec Jan 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2019 Ages 0 0 0 0 0 0 0 0 0 0 0 0 15- 64 Ages 3 1 2 1 0 2 1 0 2 1 1 1 65 plus Ages 3 1 2 1 0 2 1 0 2 1 1 1 15 plus

Hand Hygiene Monitoring Compliance (%) Feb March April May June July August Sept Oct Nov Dec Jan 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2019 Total 93 92 95 98 96 97 87 93 95 95 97 96

AHP 95 89 94 100 95 100 93 90 89 97 97 100 Ancillary 89 86 87 96 95 97 90 90 98 92 95 94 Medical 91 90 88 94 95 93 67 93 96 93 96 92 Nurse 97 98 97 98 99 97 99 99 98 97 99 98

Cleaning Compliance (%) Feb March April May June July August Sept Oct Nov Dec Jan 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2019 95 94 94 95 94 95 94 94 94 95 93 94

Estates Monitoring Compliance (%)

Feb March April May June July August Sept Oct Nov Dec Jan 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2019 Total 97 98 97 97 97 96 96 96 96 96 92 94

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NHS HIGHLAND GENERAL HOSPITAL REPORT CARD

Staphylococcus aureus bacteraemia (SABs) monthly case numbers Feb March April May June July August Sept Oct Nov Dec Jan 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2019 MRSA 0 0 0 0 0 0 0 0 0 0 0 0 MSSA 0 0 2 0 0 0 0 0 0 0 0 1 Total 0 0 2 0 0 0 0 0 0 0 0 1 SABS

Clostridium difficile infection monthly case numbers Feb March April May June July August Sept Oct Nov Dec Jan 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2019 Ages 0 0 0 0 0 0 0 0 0 0 0 0 15- 64 Ages 0 0 0 1 0 0 0 0 1 0 0 1 65 plus Ages 0 0 0 1 0 0 0 0 1 0 0 1 15 plus

Hand Hygiene Monitoring Compliance (%) Feb March April May June July August Sept Oct Nov Dec Jan 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2019 Total 99 96 98 100 100 89 98 96 97 99 99 90

AHP 100 100 100 100 100 100 100 91 100 100 100 83 Ancillary 100 100 100 100 100 60 100 100 100 100 100 100 Medical 100 85 90 100 100 94 91 95 90 95 95 76 Nurse 96 100 100 100 99 100 100 97 97 100 100 99

Cleaning Compliance (%) Feb March April May June July August Sept Oct Nov Dec Jan 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2019 Total 95 95 97 94 95 94 95 94 95 95 94 94

Estates Monitoring Compliance (%)

Feb March April May June July August Sept Oct Nov Dec Jan 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2019 Total 95 96 95 95 94 95 96 91 93 93 96 94

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NHS HIGHLAND REPORT CARD

Staphylococcus aureus bacteraemia (SABs) monthly case numbers Feb March April May June July August Sept Oct Nov Dec Jan 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2019 MRSA 0 0 0 0 0 0 0 0 0 0 0 0 MSSA 0 0 0 0 0 0 0 0 0 0 0 0 Total 0 0 0 0 0 0 0 0 0 0 0 0 SABS

Clostridium difficile infection monthly case numbers Feb March April May June July August Sept Oct Nov Dec Jan 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2019 Ages 0 0 0 0 0 0 0 0 0 0 0 0 15- 64 Ages 0 0 0 0 0 0 0 0 0 0 0 0 65 plus Ages 0 0 0 0 0 0 0 0 0 0 0 0 15 plus

Hand Hygiene Monitoring Compliance (%) Feb March April May June July August Sept Oct Nov Dec Jan 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2019 Total 93 89 98 89 100 96 100 96 95 90 83 97

AHP 100 93 100 79 100 91 100 89 83 100 50 90 Ancillary 83 67 100 86 100 100 100 100 100 100 100 100 Medical 91 100 96 96 100 94 100 95 95 64 86 100 Nurse 98 95 97 96 100 99 98 98 100 94 97 97

Cleaning Compliance (%)

Feb March April May June July August Sept Oct Nov Dec Jan 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2019 Total 96 97 100 97 96 98 99 97 97 97 98 100

Estates Monitoring Compliance (%)

Feb March April May June July August Sept Oct Nov Dec Jan 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2019 Total 99 99 97 100 99 98 99 98 97 100 100 100

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NHS HIGHLAND LORN & ISLANDS HOSPITAL REPORT CARD

Staphylococcus aureus bacteraemia (SABs) monthly case numbers Feb March April May June July August Sept Oct Nov Dec Jan 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2019 MRSA 0 0 0 0 0 0 0 0 0 0 0 0 MSSA 0 0 0 0 0 0 0 0 0 0 0 0 Total 0 0 0 0 0 0 0 0 0 0 0 0 SABS

Clostridium difficile infection monthly case numbers Feb March April May June July August Sept Oct Nov Dec Jan 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2019 Ages 0 0 0 0 0 0 0 0 0 0 0 0 15- 64 Ages 0 0 1 1 0 0 0 0 0 0 0 0 65 plus Ages 0 0 1 1 0 0 0 0 0 0 0 0 15 plus

Hand Hygiene Monitoring Compliance (%)

Feb March April May June July August Sept Oct Nov Dec Jan 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2019 Total 98 100 100 97 97 100 96 98 94 98 89 100

AHP 100 100 100 100 100 100 97 100 100 94 100 100 Ancillary 100 100 100 88 100 100 100 100 91 100 100 100 Medical 90 100 100 100 88 100 88 94 90 100 57 100 Nurse 100 100 100 100 99 100 100 98 99 98 98 100

Cleaning Compliance (%) Feb March April May June July August Sept Oct Nov Dec Jan 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2019 Total 100 99 99 99 99 99 99 99 99 97 99 96

Estates Monitoring Compliance (%)

Feb March April May June July August Sept Oct Nov Dec Jan 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2019 Total 96 94 95 95 93 95 96 94 94 96 95 96

18

NHS HIGHLAND NORTH & WEST DIVISION COMMUNITY HOSPITALS REPORT CARD

The community hospitals covered in this report card include: • Dunbar Hospital, Thurso • Town & County Hospital, Wick • Golspie • , Bonar Bridge • MacKinnon Memorial Hospital, Broadford • ,

Staphylococcus aureus bacteraemia monthly case numbers Feb March April May June July August Sept Oct Nov Dec Jan 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2019 MRSA 0 0 0 0 0 0 0 0 0 0 0 0 MSSA 0 0 0 0 0 0 0 0 0 0 0 0 Total 0 0 0 0 0 0 0 0 0 0 0 0 SABS 0 Clostridium difficile infection monthly case numbers Feb March April May June July August Sept Oct Nov Dec Jan 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2019 Ages 0 0 0 0 0 0 0 0 0 0 0 0 15- 64 Ages 0 1 1 1 0 0 0 0 0 0 0 0 65 plus Ages 0 1 1 1 0 0 0 0 0 0 0 0 15 plus

Hand Hygiene Monitoring Compliance (%) Feb March April May June July August Sept Oct Nov Dec Jan 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2019 Total 94 100 94 91 100 94 100 96 100 94 100 99

AHP 100 100 100 100 100 100 100 89 100 100 100 100 Ancillary 83 100 100 100 100 100 100 100 100 100 100 100 Medical 100 100 80 67 100 100 100 95 100 75 100 100 Nurse 100 98 96 97 98 75 98 98 99 100 99 95

Cleaning Compliance (%)

Feb March April May June July August Sept Oct Nov Dec Jan 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2019 Total 95 95 96 64 95 94 96 95 97 95 96 98

Estates Monitoring Compliance (%)

Feb March April May June July August Sept Oct Nov Dec Jan 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2019 Total 97 97 99 64 96 97 97 96 96 95 99 98

19

NHS HIGHLAND SOUTH & MID DIVISION COMMUNITY HOSPITALS REPORT CARD

The community hospitals covered in this report card include: • , Dingwall • County Community Hospital, Invergordon • Community Hospital, • Town & County Hospital, Nairn • Ian Charles Hospital, Grantown on Spey • St Vincent’s Hospital, Kingussie • For the purposes of monitoring New Craigs Psychiatric Hospital is included in this report card.

Staphylococcus aureus bacteraemia (SABs) monthly case numbers Feb March April May June July August Sept Oct Nov Dec Jan 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2019 MRSA 0 0 0 0 0 0 0 0 0 0 0 0 MSSA 0 1 0 0 0 0 0 0 0 0 0 0 Total 0 1 0 0 0 0 0 0 0 0 0 0 SABS

Clostridium difficile infection monthly case numbers Feb March April May June July August Sept Oct Nov Dec Jan 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2019 Ages 0 0 1 0 1 0 0 0 0 0 0 0 15- 64 Ages 1 0 0 0 0 0 1 1 0 0 0 0 65 plus Ages 1 0 1 0 1 0 1 1 0 0 0 0 15 plus

Hand Hygiene Monitoring Compliance (%) Feb March April May June July August Sept Oct Nov Dec Jan 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2019 Total 99 98 99 99 100 99 99 99 99 99 98 98

AHP 100 97 100 100 100 100 100 97 99 98 99 100 Ancillary 100 98 100 97 100 98 98 100 98 100 98 96 Medical 96 98 96 100 98 100 100 98 100 98 95 98 Nurse 98 99 99 98 100 99 99 100 100 99 98 99

Cleaning Compliance (%) Feb March April May June July August Sept Oct Nov Dec Jan 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2019 Total 97 96 97 97 97 96 97 97 99 96 95 97

Estates Monitoring Compliance (%)

Feb March April May June July August Sept Oct Nov Dec Jan 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2019 Total 96 98 96 98 96 96 96 97 97 98 98 97

20

NHS HIGHLAND ARGYLL & BUTE IJB COMMUNITY HOSPITALS REPORT CARD

The community hospitals covered in this report card include: • Argyll & Bute Hospital Lochgilphead • Campbeltown Hospital • Cowal Community Hospital, Dunoon, • Dunaros Community Hospital, Isle of Mull • • Mid Argyll Community Hospital & Integrated Care Centre, Lochgilphead • Victoria Hospital, Rothesay

Staphylococcus aureus bacteraemia (SABs) monthly case numbers Feb March April May June July August Sept Oct Nov Dec Jan 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2019 MRSA 0 0 0 0 0 0 0 0 0 0 0 0 MSSA 0 0 0 0 0 0 0 0 0 0 0 0 Total 0 0 0 0 0 0 0 0 0 0 0 0 SABS

Clostridium difficile infection monthly case numbers Feb March April May June July August Sept Oct Nov Dec Jan 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2019 Ages 0 0 0 0 0 0 0 0 0 0 0 0 15- 64 Ages 0 0 0 1 0 0 0 0 0 0 0 0 65 plus Ages 0 0 0 1 0 0 0 0 0 0 0 0 15 plus

Hand Hygiene Monitoring Compliance (%) Feb March April May June July August Sept Oct Nov Dec Jan 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2019 Total 93 94 96 97 100 97 97 94 96 94 96 98

AHP 100 100 100 97 100 100 100 100 100 100 100 100 Ancillary 78 100 85 100 100 100 86 88 100 91 93 100 Medical 96 95 100 89 100 90 100 87 86 86 93 91 Nurse 99 100 97 100 99 98 100 100 98 98 99 99

Cleaning Compliance (%) Feb March April May June July August Sept Oct Nov Dec Jan 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2019 Total 95 96 97 74 97 97 97 98 97 95 97 96

Estates Monitoring Compliance (%) Feb March April May June July August Sept Oct Nov Dec Jan 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2019 Total 97 96 95 75 96 97 96 96 96 96 97 96

21

NHS HIGHLAND OUT OF HOSPITAL REPORT CARD

Staphylococcus aureus bacteraemia monthly case numbers Feb March April May June July August Sept Oct Nov Dec Jan 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2019 MRSA 1 0 0 0 0 0 0 0 0 0 0 0 MSSA 5 4 7 6 5 1 4 6 5 6 2 5 Total 6 4 7 6 5 1 4 6 5 6 2 5 SABS

Clostridium difficile infection monthly case numbers Feb March April May June July August Sept Oct Nov Dec Jan 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2019 Ages 2 3 1 0 4 5 2 1 0 1 3 0 15- 64 Ages 3 5 5 3 4 0 3 0 3 2 3 1 65 plus Ages 5 8 6 3 8 5 5 1 3 3 6 1 15 plus

22