1. Progress Report on CHP Infection Control Work Plan

Mid Highland CHP Committee: Mid Highland CHP

Infection Control Report Date: June 2010

Priority areas at present are the annual environmental audits and the preparation for the future HEI Inspectorate visits to the Belford and MacKinnon Memorial, ongoing monitoring and surveillance, particularly in relation to C Difficile and Noro Virus and ensuring prevention/control of infection is well embedded in health care practice.

2. Infection Control – CHP/Hospital/Ward problems identified and solutions

See section 5 below

3. CHP Infection Control Risk Register

The corporate risk register for HAI has now been incorporated into the CHP register and is regularly reviewed at the CHP Infection Control Team meeting and CHP Clinical Governance/Risk Management Group.

4. CHP HAI Monitoring

4a) Clostridium Difficile

Table 1 shows a comparison of C Diff isolates across Highland by CHP/Raigmore.

NHS Highland Clostridium difficile toxin isolates by CHP and Raigmore

0 Jun 2009 Jul 2009 Aug 2009 Sep 2009 Oct 2009 Nov 2009 Dec 2009 Jan 2010 Feb 2010 Mar 2010 Apr 2010 May 2010

Raigmore North CHP Mid CHP SE CHP A&B CHP

1 Mid Highland CHP Committee: Mid Highland CHP

Infection Control Report Date: June 2010

Table 2 Mid CHP Clostridium difficile toxin isolates since April 2008

Mid Highland CHP Clostridium difficile toxin isolates

0 Jun 2009 Jul 2009 Aug 2009 Sep 2009 Oct 2009 Nov 2009 Dec 2009 Jan 2010 Feb 2010 Mar 2010 Apr 2010 May 2010 Table 3 below provides details of where the cases were located (not necessarily where acquired). It can be seen that across the CHP incidence of C difficile incidence has shown a decrease in the hospitals overall and an increase within the community (defined by GP sample).

Table 3 CHP wide Cumulative Clostridium difficile Toxin Positive Totals since December 2009 associated with hospitals April 2008/2009 and 2010 to date as follows;

2008 2009/10 2010/11

MacKinnon Memorial - 3 7 (last episode 10/2/10) 0 Portree - 1 3 (last episode 18/3/10) 0 Ross Memorial - 4 2 0 Belford - 11 1 0 County Community - 2 5 0 Total hospitals 21 18 Community (by GP sample) 11 14 5

Total 32 32 4

Table 4 Cumulative Clostridium difficile Toxin Positive Totals by GP Sample 2008/2009 and since 1st April 2010

2008 2009 2010 NORTH CHP GPs 7 10 1 Mid CHP GPs 11 15 5 SE CHP GPs 14 9 1

2 Mid Highland CHP Committee: Mid Highland CHP

Infection Control Report Date: June 2010

2009/10 Analysis of C Difficile in Mid Highland;

A review of all the cases last year has been undertaken and the results demonstrate that of the cases associated with Mid Highland CHP hospitals, 3 of these were confirmed as acquired out with Highland, and three can be defined as Out of Hospital Infections. Given the complex variety of sources for these infections it is not possible to break this data down in a more detailed way. Antimicrobial prescribing practice in the community is monitored closely by the CHP Lead Pharmacist.

4b) Staph aureus Bacteraemia (SABS);

5. Incidents Outbreaks

Noro virus

In line with the Scotland wide position, which has shown a three fold increase, during the first half of this year we have seen an increase in norovirus in a number of our hospitals, with the greatest impact in the Belford (Table below). No patients or staff became particularly unwell as a result although a few did take longer than the 48hrs to recover. There was no ward closure but visiting was restricted – all staff worked extremely hard while it was at its peak. Learning points are to ensure communication with staff groups that come onto the wards sporadically e.g. dieticians. Education re the transmission of the virus required as staff were frustrated that despite their best Infection control practices they were still succumbing to the virus. The Infection Control Nurse is planning to roll out some debrief education sessions in the near future.

As reported in April, the County Community Hospital Invergordon and more recently the Ross Memorial Hospital were also affected. Whilst there have been some isolated cases of staff with symptoms in Skye, these have been contained to date and no patients affected.

Diarrhoea & Vomiting Belford Hospital 2010: Cumulative Episodes

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0 Date 01-May 02-May 03-May 04-May 05-May 06-May 07-May 08-May 09-May 10-May 11-May 12-May 13-May 14-May

3 Mid Highland CHP Committee: Mid Highland CHP

Infection Control Report Date: June 2010

6. Hand Hygiene National Audit Results

6.1 In Mid Highland the Rheumatology Unit in Dingwall scored 100% for compliance. This result is largely reflected in the monthly audits, the results of which are shown in appendix 1.

7. Environmental & Cleaning

7.1. Audits throughout Belford are being undertaken in preparation for the HEI inspection and yearly audits maintained elsewhere. The SCRIBE bed spacing requirements are being reviewed in MMH and a risk assessment tool is to be piloted in the hospital. The review of bed spacing/single room and toilet facilities in MMH is ongoing (in line with CEL 48 (2008) of 3.6m x 3.7m) and a report for the CHP Clinical Governance Committee is available.

A recent audit in the Ross Memorial hospital has identified some significant environmental problems in an in-patient area and plans are being developed to identify the extent of the refurbishment required as a matter of priority. In view of this the existing patients in ward 5 are to be relocated, either to home or to County Community Hospital, Invergordon.

7.2 Keeping the healthcare environment clean is essential to prevent the spread of infections. NHS Boards monitor the cleanliness of hospitals and there is a national target to maintain compliance above 90%. The design and development of the Domestic/Estates Monitoring Tool has originated from the National Cleaning Specification Document and the Quality Manager has developed a database for collating the cleanliness performance of each individual ward/clinical area in each of NHS Highland’s 25 hospital locations and a copy of performance charts will be forwarded to each Lead Nurse across NHS Highland for display/circulation at Ward level.

The initial chart will include overall performance over 2009 and monthly over 2010. The Quality Manager will collate such requirements and alert locations on a quarterly basis if required to do so. Quarterly action plans will be forwarded by him to HFS Glasgow on behalf of NHS Highland.

Also circulated was a Generic Risk Assessment Form which can be used for risk assessing the ward and areas identified as being within the red or amber within a quarterly reporting period. They can be completed and held locally. The CHP hospitals scored over 90% with the exception of the Belford which scored 89.7%. The next Peer/Public Peer Reviews will be carried out across NHS Highland over June 2010.

The new maintenance system MAXIMO will be introduced this year and will allow staff to report faults either by e-mail or in the same way as usual.

4 Mid Highland CHP Committee: Mid Highland CHP

Infection Control Report Date: June 2010

8. Horizon Scanning

The HAI Independent Inspectorate is intending to undertake a visit to Belford or MacKinnon Memorial Hospital this year and pre assessment preparations are in hand and the CHP Clinical Governance/risk Management group has been advised of the key findings from the recent round of inspections in Grampian, Borders, Lothian and Inverclyde.

The main findings/themes will be converted to a ‘checklist’ for the Senior Charge Nurses and CHP Lead Nurse and Managers when undertaking visits in our hospitals across the CHP. Although the community hospitals are not expected to be inspected this year, the learning can be applied to improve the patient environment and audits continue to these areas.

A significant amount of estates work continues in the Belford and MMH in preparation for a HEI Inspectorate visit. The Board Director of Nursing and Head of Facilities visited the Belford early May and has recently undertaken a visit to MMH. Work continues to complete the pre assessment audit tool and all staff are working hard to address factors which have been identified as environmental risks and ensuring good housekeeping.

9. Education & Training

Mandatory HAI Training Policy document

The final document is to be distributed in the near future.

Training Needs according to Role

This is a requirement in respect of the QIS HAI Standards. Training will be undertaken in relation to need and will be included in the PDP of all staff.

The new hand hygiene education pack is being piloted in a number of areas across Highland. This is intended for use as part of the mandatory and refresher training of all staff that have patient contact. A Highland mandatory training policy is currently under consultation.

10. National and Local Policy / Guidance Update

10.1 MRSA Screening Programme

All elective patients (except paediatrics, obstetrics, psychiatry and day cases, all emergency admissions to Nephrology/Renal, Vascular, Dermatology, Care of the Elderly) is now established in the Belford and MacKinnon Memorial Hospital. Highland wide, whilst the number of patients screened has increased significantly as a result of the screening programme, the numbers of positive cases has not risen to date. The final report form the Scottish Government with regard to a possible National Screening Programme is awaited. It is anticipated that Community Nursing will be expected to support the decolonization of MRSA positive patients in the community prior to surgery.

10.2 Policy for Care of Equipment

5 Mid Highland CHP Committee: Mid Highland CHP

Infection Control Report Date: June 2010

It is expected that a list of all equipment, how often it should be cleaned; together with room for appropriate signatures to verify cleaning should be posted in every ward. A list should be displayed in every area which contains patient equipment and it was agreed that the Infection Control Nurses will identify relevant areas. A system for taping and tagging to indicate when equipment is clean is to be introduced. The system approved by HEI is the one used in Raigmore.

6 Mid Highland CHP Committee: Mid Highland CHP

Infection Control Report Date: June 2010

Appendix 1 Hand hygiene audit results by Ward / Dept March 10-May 10. Date % of Technique Actions Taken opportunities March 10 Completed taken Belford CAU(prevSurgical) 09/03/2010 100% 90% Belford Step down unit(prevMedical) 09/03/2010 100% 100% Belford Belhaven 01/03/2010 100% 85% Belford Renal Unit 10/03/2010 100% 95% HRU RMH 04/03/2010 100% 100% MMH Skye Fyrish Ward, CCHI 19/03/2010 75% 80% to be repeated General Ward, RMH 09/03/2010 95% 90% Sutor Ward, CCHI 04/03/2010 90% 72% Portree Hospital 05/03/2010 100% 100% Belford A&E 10/03/2010 100% 100% Belford Endoscopy 11/03/2010 100% 90% Apr-10 Belford CAU(prevSurgical) 23/03/2010 100% 55% Belford Step down unit(prevMedical) 24/03/2010 100% 75% Belford Belhaven 01/04/2010 95% 89% Belford Renal Unit 07/04/2010 100% 100% HRU RMH 06/04/2010 100% 100% MMH Skye 08/04/2010 100% 95% Fyrish Ward, CCHI 05/04/2010 80% 75% to be repeated General Ward, RMH 09/04/2010 95% 95% Sutor Ward, CCHI results to follow Portree Hospital 08/04/2010 100% 95% Belford A&E 07/04/2010 100% 60% to be repeated – Belford Endoscopy 09/04/2010 70% 60% result 100% May-10 Belford CAU(prevSurgical) Norovirus Belford Step down unit(prevMedical) Norovirus Belford Belhaven 14/05/2010 100% 85% Belford Renal Unit 05/05/2010 100% 100% HRU RMH 04/05/2010 100% 95% MMH Skye 05/05/2010 100% 70% Fyrish Ward, CCHI 05/05/2010 100% 80% General Ward, RMH 14/05/2010 90% 90% In house training being Sutor Ward, CCHI 10/05/2010 80% 75% carried out next week. Portree Hospital Belford A&E Belford Endoscopy 14/05/2010 100% 80%