Healthcare Associated Infections Report July 2013

Healthcare Associated Infection Bimonthly Report July 2013 Section 1 – Board Wide Issues

This section of the HAIRT covers Board wide infection prevention and control activity and actions. For reports on individual hospitals, please refer to the ‘Healthcare Associated Infection Report Cards’ in Section 2.

A report card summarising Board wide statistics can be found at the end of section 1.

Key Healthcare Associated Infection Headlines NHS Grampian  Monthly ward hand hygiene audit results for April and May 2013 show that compliance remained at or over 95% across NHS Grampian.  Cleaning and estates monitoring compliance remains stable and well above the 90% target.  Clostridium difficile infection (CDI) case numbers for April and May were 5 and 11 respectively.  There were 9 Staphylococcus aureus bacteraemias (SABs) in April and 11 in May.

Aberdeen Royal Infirmary  Monthly ward hand hygiene audits show that compliance remained above national 90% target during April and May but fell below the local 95% in November.  Cleaning and estates monitoring compliance remains above the 90% target.  The number of CDI cases numbered 0 in April and 5 in May.  There were 4 SABs in April and 1 in May.

Dr Gray’s Hospital  Monthly ward hand hygiene audit results for May show that compliance did not meet the 90% target in Dr Gray's Hospital. 3 wards were affected. A hospital-wide multi-disciplinary meeting took place to discuss the reasons for this and agree actions. These included actions to address communication issues, the siting of gel dispenses and to increase education. Initial indications are that Dr Gray's is once again compliant.  Cleaning and estates monitoring results are comfortably above the 90% target.  There were no cases of CDI in April and May  There was a single case of MSSA bacteraemia in May.

1 Woodend Hospital  Hand hygiene compliance again hit 100% in April and remained there in May.  Cleaning monitoring compliance remains stable and estates monitoring compliance is has remained above the 90% for 6 months.  There were 2 cases of CDI in Woodend Hospital in May but no cases of S aureus bacteraemia in April or May.

Other Hospitals  Due to the size of these hospitals and the number of SABs and CDIs, Aberdeen Maternity Hospital, Royal Cornhill Hospital, Royal Aberdeen Children's Hospital, Roxburgh House and all Community Hospitals figures are included in this scorecard.  There was a single case of CDI in May.

Out of Hospital  There were 5 cases of CDI in April and 3 in May diagnosed out with or within 48 hours of being admitted to hospital.  SABs numbered 5 in April and 9 in May.

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:

Staphylococcus aureus : http://www.nhs24.com/content/default.asp?page=s5_4&articleID=346

MRSA: http://www.nhs24.com/content/default.asp?page=s5_4&articleID=252 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. The number of patients with MSSA and MRSA bacteraemias for the Board can be found at the end of section 1 and for each hospital in section 2. 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

Staphylococcus aureus Bacteraemia Surveillance

The Health Protection Scotland (HPS) quarterly report on the surveillance of Staphylococcus aureus bacteraemias was published on 3 July 2013. This showed that between 1 January and 31 March 2013 the reported SAB rate in NHS Grampian was 0.246 episodes per 1000 acute occupied bed days (AOBDs) compared with 0.301 for NHS Scotland as a whole. While this quarterly rate is well below the national target of 0.26, our quarterly rolling year rate was just above target at 0.269.

2 For MRSA bacteraemia, the rate was 0.008 episodes per 1000 AOBDs compared with 0.029 in NHS Scotland. For MSSA bacteraemia, the rate was 0.238 cases per 1000 AOBDs compared with 0.272 in NHS Scotland.

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. The number of patients with CDI for the Board can be found at the end of section 1 and for each hospital in section 2. 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

Clostridium difficile Infection Surveillance

The HPS quarterly report on the surveillance of CDI which was also published on 3 July 2013 showed that between 1 January and 31 March 2013 the reported CDI rate in patients over 65 years old in NHS Grampian was 0.182 episodes per 1000 total occupied bed days (TOBDs) compared with 0.242 for NHS Scotland as a whole.

Hand Hygiene

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/ NHS Boards monitor hand hygiene and ensure a zero tolerance approach to non compliance. The hand hygiene compliance score for the Board can be found at the end of section 1 and for each hospital in section 2. Information on national hand hygiene monitoring can be found at: http://www.hps.scot.nhs.uk/haiic/ic/nationalhandhygienecampaign.aspx

The NHS Hand Hygiene Campaign 25th Bi-monthly (18/03/2013 to 29/03/2013) Audit Report which was published on 29 May 2013 confirmed that NHS Grampian achieved a compliance figure of 98%.

3 Cleaning and the Healthcare Environment

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 with standards above 90%. The cleaning compliance score for the Board can be found at the end of section 1 and for each hospital in section 2. 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

Cleaning and Estates Monitoring

The Health Facilities Scotland (HFS) National Cleaning Compliance Report Quarter 1 to 3: April 2012 – December 2012 results were published in March 2013.

The report shows that NHS Grampian achieved 94.5-95% compliance with the NHSScotland National Cleaning Services Specification across all hospital sites.

In relation to estates monitoring compliance, overall NHS Grampian is compliant at 96% in Quarter 3. During that period, Woodend Hospital was 87.9% compliant. However, more recent monitoring data (unpublished) demonstrates that this hospital site has now been compliant since December 2012. This is largely due to ward moves associated with the opening of the new ECC and Aberdeen Royal Infirmary Development Programme.

More information can be found at: www.nhsnss.org/supplementary_pages/publication_detail.php?pid=149

Healthcare Environment

The recent Healthcare Environment Inspectorate (HEI) visit to Aberdeen Royal Infirmary on 4 and 5 June 2013 is due to be reported on 6 August 2013. Overall, the inspectors recognised that NHS Grampian had made progress against the NHS QIS standards to protect patients, staff and visitors from the risks of acquiring an HAI. In particular, they observed that:

 Senior charge nurses were able to demonstrate a good understanding of their roles and responsibilities in relation to audit, leadership and being role models in relation to infection prevention and control  Quarterly infection control audits are carried out by a senior charge nurse from another ward or department (peer audit)  Ward staff were able to describe good communication links with their line management structure and how this was used to support improvement work in the clinical area

The inspectors stated that further improvement is required in the following areas:  Patient equipment must be clean and ready to use in accordance with local policy

4  Staff should fully implement the local peripheral venous catheter (PVC) care bundles and complete the associated documentation  Staff should implement standard infection prevention and control precautions in relation to waste management and, in particular, the disposal of gloves.

The full report will be available at: http://www.healthcareimprovementscotland.org/HEI.aspx

Incidents and Outbreaks

Norovirus Prevalence

Monday Point Prevalence Surveillance figures are reported to Health Protection Scotland. These capture the significant outbreaks of Norovirus in NHS Grampian and the prevalence of Norovirus activity in close to real time. They are not, and should not be interpreted as data for benchmarking or judgement. The data can be used for the assessment of risk and Norovirus outbreak preparedness only.

During April and May 2013 the following instances of Norovirus were submitted:

On Monday 1 April, 0 hospitals in NHS Grampian had wards or bays closed. On Monday 8 April, 0 hospitals in NHS Grampian had wards or bays closed. On Monday 15 April, 0 hospitals in NHS Grampian had wards or bays closed. On Monday 22 April, 0 hospitals in NHS Grampian had wards or bays closed. On Monday 29 April, 1 hospital in NHS Grampian had 2 wards and no bays closed with 13 patients and 1 staff member affected. On Monday 6 May, 0 hospitals in NHS Grampian had wards or bays closed. On Monday 13 May, 2 hospital in NHS Grampian had 2 wards and no bays closed with 8 patients and 0 staff members affected. On Monday 20 May, 0 hospitals in NHS Grampian had wards or bays closed. On Monday 27 May, 1 hospital in NHS Grampian had 1 ward and no bays closed with 2 patients and 4 staff members affected.

Data on the numbers of wards closed due to confirmed or suspected norovirus is available from HPS on a weekly basis at: http://www.hps.scot.nhs.uk/haiic/ic/noroviruspointprev.aspx

5 Other HAI Related Activity

Surgical Site Infection (SSI) Surveillance

NHS Grampian participates in the Surgical Site Infection (SSI) surveillance programme that is mandatory in all NHS boards in Scotland. All NHS boards are required to undertake surveillance for hip and knee arthroplasty and caesarean section procedures as per the mandatory requirements of HDL (2006) 38 and CEL (11) 2009. In addition NHS Grampian carries out surveillance for in-patient breast surgery.

Readmission surveillance is carried out using prospective readmission data on orthopaedic and breast procedure categories under inpatient surveillance up to 30 days post operatively. Post discharge surveillance until day 10 post operation is also carried out for all caesarean sections performed.

Last available quarter (1 January to 31 March 2013)

Category of Number of Number of NHS Grampian National dataset Procedure operations Infections SSI rate (%) SSI rate (%)

Breast Surgery 149 0 0.0 0.0

Caesarean section 369 6 1.6 1.3

Hip arthroplasty 159 0 0.0 1.0

Knee arthroplasty 155 0 0 0.1

6 NHS Grampian Total Staphylococcus aureus Bacteraemia Cases (all ages)

• Monthly ward hand hygiene audit results for April and May 2013 show that 30 compliance remained at or over 95% across NHS Grampian. 25 • Cleaning and estates monitoring compliance remains stable and well above the 20 90% target. • Clostridium difficile infection (CDI) case numbers for April and May were 5 and 11 15 respectively. 10 • There were 9 Staphylococcus aureus bacteraemias (SABs) in April and 11 in 5 May. 0 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13

Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Hand Hygiene Monitoring Compliance (%) 16 7 14 13 16 13 12 11 8 12 9 11 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 96 97 97 97 96 96 95 94 96 98 98 96 MRSA Bacteraemia Cases (all ages)

Cleaning Compliance (%) 25 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 20 95 95 95 95 96 96 94 96 96 95 95 95 15

5 Estates Monitoring Compliance (%) 0 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 96 94 94 94 95 95 95 97 98 97 97 98

Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 3 1 0 1 2 3 1 0 2 0 0 0

Clostridium difficile Cases (all ages) MSSA Bacteraemia Cases (all ages)

30 10030

25 25 80 20 20 60 15 15 40 10 10 20 5 5

0 00 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-12Jun-12 Jul-12Jul-12 Aug-12Aug-12 Sep-12Sep-12 Oct-12Oct-12 Nov-12Nov-12Dec-12Dec-12Jan-13Jan-13Feb-13Feb-13Mar-13Mar-13Apr-13Apr-13May-13May-13

Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 19 12 18 15 11 11 9 9 7 8 5 11 13 6 14 12 14 10 11 11 6 12 9 11

7 Quarterly rolling year Clostridium difficile Infection Cases (aged 65 and over) per 1000 total occupied bed days for HEAT Target Measurement

1 0.9 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0 Apr 10 - Jul 10 - Oct 10 - Jan 11 - Apr 11 - Jul 11 - Oct 11 - Jan 12 - Apr 12 - Mar 11 Jun 11 Sept 11 Dec 11 Mar 12 Jun 12 Sept 12 Dec 12 Mar 13 Actual Performance Target

Apr 10 - Jul 10 - Oct 10 - Jan 11 - Apr 11 - Jul 11 - Oct 11 - Jan 12 - Apr 12 - Mar 11 Jun 11 Sept 11 Dec 11 Mar 12 Jun 12 Sept 12 Dec 12 Mar 13 Actual Performance 0.41 0.36 0.30 0.26 0.25 0.26 0.27 0.26 0.28 Target 0.89 0.52 0.50 0.49 0.47 0.45 0.43 0.41 0.39

Quarterly rolling year Staphylococcus aureus Bacteraemia Rates per 1000 Acute Occupied Bed Days for HEAT Target Measurement

0.4

0.35

0.3

0.25

0.2

0.15

0.1

0.05

0 Apr 10 - Jul 10 - Oct 10 - Jan 11 - Apr 11 - Jul 11 - Oct 11 - Jan 12 - Apr 12 - Mar 11 Jun 11 Sept 11 Dec 11 Mar 12 Jun 12 Sept 12 Dec 12 Mar 13 Actual Performance Target

Apr 10 - Jul 10 - Oct 10 - Jan 11 - Apr 11 - Jul 11 - Oct 11 - Jan 12 - Apr 12 - Mar 11 Jun 11 Sept 11 Dec 11 Mar 12 Jun 12 Sept 12 Dec 12 Mar 13 Actual Performance 0.36 0.36 0.34 0.30 0.32 0.28 0.28 0.29 0.27 Target 0.32 0.31 0.30 0.29 0.28 0.28 0.27 0.26

8 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 (also broken down into MSSA and MRSA) and Clostridium difficile infections, as well as hand hygiene, cleaning and estates monitoring 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. The information in the report cards is provisional local data, and may differ from the national surveillance reports carried out by Health Protection Scotland and Health Facilities Scotland. The national reports are official statistics which undergo rigorous validation, which means final national figures may differ from those reported here. However, these reports aim to provide more detailed and up to date information on HAI activities at local level than is possible to provide through the national statistics.

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. Staphylococcus aureus bacteraemia (SAB) cases are further broken down into Meticillin Sensitive Staphylococcus aureus (MSSA) and Meticillin Resistant Staphylococcus aureus (MRSA). Data are presented as both a graph and a table giving case numbers. More information on these organisms can be found on the NHS24 website:

Clostridium difficile : http://www.nhs24.com/content/default.asp?page=s5_4&articleID=2139§ionID=1

Staphylococcus aureus : http://www.nhs24.com/content/default.asp?page=s5_4&articleID=346

MRSA: http://www.nhs24.com/content/default.asp?page=s5_4&articleID=252§ionID=1 For each hospital the total number of cases for each month are those which have been reported as positive from a laboratory report on samples taken more than 48 hours after admission. For the purposes of these reports, positive samples taken from patients within 48 hours of admission will be considered to be confirmation that the infection was contracted prior to hospital admission and will be shown in the “out of hospital” report card. Understanding the Report Cards – Hand Hygiene Compliance Good hand hygiene is crucial for infection prevention and control. More information can be found from the Health Protection Scotland’s national hand hygiene campaign website: http://www.washyourhandsofthem.com/ Hospitals carry out regular audits of how well their staff are complying with hand hygiene. The first page of each hospital report card presents the percentage of hand hygiene compliance for all staff in both graph and table form.

Understanding the Report Cards – Cleaning Compliance

Hospitals strive to keep the care environment as clean as possible. This is monitored through cleaning compliance audits. More information on how hospitals carry out these audits can be found on the Health Facilities Scotland website: http://www.hfs.scot.nhs.uk/online-services/publications/hai/ The first page of each hospital Report Card gives the hospitals cleaning compliance percentage in both graph and table form.

Understanding the Report Cards – ‘Out of Hospital Infections’ Clostridium difficile infections and Staphylococcus aureus (including MRSA) bacteraemia cases are all associated with being treated in hospitals. However, this is not the only place a patient may contract an infection. This total will also include infection from community sources such as GP surgeries and care homes and. The final Report Card report in this section covers ‘Out of Hospital Infections’ and reports on SAB and CDI cases reported to a Health Board which are not attributable to a hospital. Given the complex variety of sources for these infections it is not possible to break this data down in any more detail.

9 Aberdeen Royal Infirmary Total Staphylococcus aureus Bacteraemia Cases (all ages)

10 9 • Monthly ward hand hygiene audits show that compliance remained above 8 national 90% target during April and May but fell below the local 95% in November. 7 6 • Cleaning and estates monitoring compliance remains above the 90% target. 5 • The number of CDI cases numbered 0 in April and 5 in May. 4 • There were 4 SABs in April and 1 in May. 3 2 1 0 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13

Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Hand Hygiene Monitoring Compliance (%) 4 1 3 3 6 1 1 6 1 3 4 1 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 95 97 95 94 95 95 94 94 95 98 99 97 MRSA Bacteraemia Cases (all ages)

10 9 Cleaning Compliance (%) 8 7 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 6 94 93 94 94 95 94 95 96 95 95 95 96 5 4 3 2 1 Estates Monitoring Compliance (%) 0 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 97 96 97 98 98 98 98 98 99 98 98 99

Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 0 0 0 0 2 0 0 0 0 0 0 0

Clostridium difficile Cases (all ages) MSSA Bacteraemia Cases (all ages)

10 10010 9 9 8 880 7 7 6 660 5 5 4 440 3 3 2 220 1 1 0 00 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-12Jun-12 Jul-12Jul-12 Aug-12Aug-12 Sep-12Sep-12 Oct-12Oct-12 Nov-12Nov-12 Dec-12Dec-12Jan-13Jan-13Feb-13Feb-13Mar-13Mar-13Apr-13Apr-13May-13May-13

Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 6 2 3 6 2 1 2 1 0 4 0 5 4 1 3 3 4 1 1 6 1 3 4 1

10 Dr Gray's Hospital Total Staphylococcus aureus Bacteraemia Cases (all ages) • Monthly ward hand hygiene audit results for May show that compliance did not 3 meet the 90% target in Dr Gray's Hospital. 3 wards were affected. A hospital-wide multi-disciplinary meeting took place to discuss the reasons for this and agree actions. These included actions to address communication issues, the siting of gel 2 dispenses and to increase education. Initial indications are that Dr Gray's is once again compliant. • Cleaning and estates monitoring results are comfortably above the 90% target. 1 • There were no cases of CDI in April and May

• There was a single case of MSSA bacteraemia in May. 0 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13

Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Hand Hygiene Monitoring Compliance (%) 2 0 2 0 1 1 0 0 0 0 0 1 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 100 99 97 99 97 97 100 98 94 97 90 83 MRSA Bacteraemia Cases (all ages)

Cleaning Compliance (%) 2 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 97 98 98 94 97 94 94 96 96 97 93 94

Estates Monitoring Compliance (%) 0 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 98 98 99 99 96 99 98 99 99 98 98 97

Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 1 0 0 0 0 0 0 0 0 0 0 0

Clostridium difficile Cases (all ages) MSSA Bacteraemia Cases (all ages)

3 1003

80 2 2 60

40 1 1 20

0 00 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-12 Jul-12Jul-12 Aug-12Aug-12 Sep-12Sep-12 Oct-12Oct-12 Nov-12Nov-12Dec-12Dec-12Jan-13Jan-13Feb-13Feb-13Mar-13Mar-13Apr-13Apr-13May-13May-13

Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 2 0 1 0 0 0 1 0 0 0 0 0 1 0 2 0 1 1 0 0 0 0 0 1

11 Woodend Hospital Total Staphylococcus aureus Bacteraemia Cases (all ages)

• Hand hygiene compliance again hit 100% in April and remained there in May. • Cleaning monitoring compliance remains stable and estates monitoring 2 compliance is has remained above the 90% for 6 months. • There were 2 cases of CDI in Woodend Hospital in May but no cases of S aureus bacteraemia in April or May. 1

0 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13

Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Hand Hygiene Monitoring Compliance (%) 1 0 0 0 1 0 0 1 0 0 0 0 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 95 98 96 94 95 94 90 93 100 97 100 100 MRSA Bacteraemia Cases (all ages)

Cleaning Compliance (%) Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 2 94 95 95 95 95 95 95 95 94 95 96 96

Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 0 0 0 0 0 0 0 0 0 0 0 0

Clostridium difficile Cases (all ages) MSSA Bacteraemia Cases (all ages)

3 1003

80 2 2 60

40 1 1 20

0 0 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-12 Jul-12Jul-12 Aug-12Aug-12 Sep-12Sep-12 Oct-12Oct-12 Nov-12Nov-12 Dec-12Dec-12Jan-13Jan-13Feb-13Feb-13Mar-13Mar-13Apr-13Apr-13May-13May-13

Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 0 0 1 1 0 0 0 0 0 0 0 2 1 0 0 0 1 0 0 1 0 0 0 0

12 Other Hospital Infections Clostridium difficile Infection Cases

• Due to the size of these hospitals and the number of SABs and CDIs, Aberdeen

Maternity Hospital, Royal Cornhill Hospital, Royal Aberdeen Children's Hospital, 2 Roxburgh House and all Community Hospitals figures are included in this scorecard. • There was a single case of CDI in May. 1

0 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13

Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 4 0 0 0 0 2 0 0 1 0 0 1

MSSA Bacteraemia Cases MRSA Bacteraemia Cases

4 4

3 3

2 2

1 1

0 0 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13

Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 0 0 0 0 0 1 3 0 0 0 0 0 1 0 0 0 0 1 0 0 1 0 0 0 13 Out of Hospital Infections Clostridium difficile Infection Cases

• There were 5 cases of CDI in April and 3 in May diagnosed out with or within 48 8 hours of being admitted to hospital.

• SABs numbered 5 in April and 9 in May. 6

0 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13

Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 7 10 13 8 9 8 6 8 6 4 5 3

MSSA Bacteraemia Cases MRSA Bacteraemia Cases

16 16

14 14

12 12

10 10

8 8

6 6

4 4

2 2

0 0 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13

Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 7 5 9 9 8 7 7 4 5 9 5 9 1 1 0 1 0 2 1 0 1 0 0 0