Board Paper Template

Paper 3

Ayrshire and Arran NHS Board

Monday 2 February 2015

Healthcare Associated Infection Position Report

Author: Sponsoring Director: Bob Wilson, Infection Control Manager Alison Graham, Medical Director Babs Gemmell, Business Manager

Date: 7 January 2015

Recommendation

The Board is asked to review the latest update against the Healthcare Associated Infection HEAT Targets and other HAI related activity.

Summary

Since 1 April 2013, the Infection Prevention and Control Team (IPCT) have worked towards achieving the HAI HEAT targets which are:

 To achieve a rate of no more than 0.32 cases per 1,000 occupied bed days for Clostridium difficile Infections (CDIs) in the 15 and over age group by the year ending 31 March 2015; and  To achieve a rate of no more than 0.24 cases per 1,000 acute occupied bed days for Staphylococcus aureus bacteraemias (SABs) by the year ending 31 March 2015.

The organisation is currently over the local trajectory levels set against the HAI HEAT targets from 1 April – 30 November 2014:

 CDIs – There is a total of 99 cases placing the organisation 19 cases above the local trajectory level.  SABs – There is a total of 87 cases placing the organisation 31 cases above the local trajectory level.

All NHS Board’s are required to use the standardised Healthcare Associated Infection Reporting Template (HAIRT) for all mandatory HAI reporting as can be found in Appendix 1.

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Glossary of Terms AMT Antimicrobial Management Team CDI Clostridium difficile Infection HAI Healthcare Associated Infection HAIRT Healthcare Associated Infection Reporting Template HEAT Health, Efficiency, Access, Treatment HEI Healthcare Environment Inspectorate HPS Health Protection Scotland ICN Infection Control Nurse IPCT Infection Prevention & Control Team MRSA Meticillin Resistant Staphylococcus aureus MSSA Meticillin Sensitive Staphylococcus aureus NES National Education for Scotland NHS National Health Service PPE Personal Protection Equipment PVC Peripheral vascular cannula SAB Staphylococcus aureus bacteraemia SBAR Situation Background Assessment Recommendation Report SOP Standard Operating Procedure UHA University Hospital Ayr UHC University Hospital Crosshouse VHF Viral Haemorrhagic Fever

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1. Staphylococcus aureus Bacteraemias

. A numerical target of no more than 7 cases per month has been established to allow real time monitoring of the organisation’s progress against the SAB HEAT target. . Since 1 April 2014, there have been 87 SABs cases (Chart 1). This places the organisation 31 SABS above the locally set trajectory. . The organisation has now exceeded the HEAT target by 3 cases at month 8 of the activity year confirming that the organisation will be over the target by 31 March 2015. . Forty-six percent of the cases were hospital acquisitions (40 cases), 22% were community acquired (19 cases) and 32% community onset/healthcare associated (28 cases). . During November 2014, there were 7 SABs (3 hospital acquisitions and 4 community onset/healthcare associated). The probable source of each case included 2 contaminants, 1 PVC, 1 Renal Fistula, 1 Central Line and 2 Other. . The verified SAB rate for the quarter ending September 2014 was 0.36 (Chart 2), this compares with 0.42 for the quarter ending June 2014. The organisation was above the Scottish mean for the quarter ending September 2014. The projected SAB rate for the quarter ending December 2014 is 0.34. . A comparison of annual rates with other mainland territorial boards shows that NHS Ayrshire and Arran shifted in the first six months of the year from having one of the lowest SAB rates to slightly above the Scottish mean of 0.31 (Chart 3).

TOTAL87 SAB CASES (31 SABS above the local trajectory)

Chart 1 – SAB HEAT Target 2014-15 monthly position (Year 2)

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Chart 2 - NHS Ayrshire and Arran Rolling Annual SAB rate

Chart 3 - Mainland Territorial NHS Boards Rolling Annual SAB Rate

. A review of each SAB is undertaken by the Infection Control Nurses (ICNs) and Consultant Microbiologists. Those considered to be potentially preventable undergo a multi-disciplinary review by an ICN, Consultant Microbiologist, Consultant(s) and Senior Charge Nurse(s). The findings of the review are collated into an SBAR for feeding back to the relevant clinical team(s). The process is well established with strong clinical involvement. There is however some further work required in the process which includes: reporting the findings via the relevant clinical governance routes; actions followed through to ensure completion; and themes collated and shared to ensure wider learning. . The primary focus for further SAB reductions continues to target those associated with vascular access. . Renal services developed a comprehensive action plan to address the renal fistula related SABs. Implementation of the Action Plan is being monitored via the Medical Services Clinical Governance Committee. There are indications that the action plan is now having an impact with only 2 fistula related SABs between occurring between July - December 2014 compared with 6 between April - June 2014. . A comprehensive review of PVC management procedures including insertion process; maintenance process; documentation; monitoring/auditing arrangements; and training requirements/resources is required. However it has not been possible to commence this work due to the very significant IPCT resource that has had to be directed to ensuring Ebola preparedness across the organisation. This work will be prioritised early in 2015. . A programme of work aimed at reducing blood culture contamination rates is currently being led by the clinical team in the Emergency Department at UHC. Consideration is required as to how this can be extended to other areas of the organisation. . It should be noted that in the absence of any vascular related SABs, the organisation would still be above the HEAT Target trajectory as a result of the increase in SABs with other primary causes. . All NHS Boards in Scotland are participating in a programme of enhanced surveillance of SABs from 1st October 2014. This will standardise the definitions used across Scotland and have the ability to review all Board’s data. This will facilitate benchmarking and the sharing of good practice between NHS Boards.

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2. Clostridium difficile Infections

. In order to allow real time monitoring of the organisation’s progress against the CDI HEAT target, a numerical target of no more than 10 cases per month has been established. . Since 1 April 2014, there have been 99 CDI cases (Chart 4). This places the organisation 19 cases above the locally set trajectory. Of the 99 cases, 63 were out of hospital cases. . In November 2014 alone, there were 12 CDI cases, of which 8 were out of hospital cases (67%). . At this stage in the activity year, it is unlikely that the organisation will achieve the HEAT Target 2014-15. In order to achieve the target, there can be no more than 5.25 cases per month in the remaining 4 months which is a significant challenge to the organisation. . The verified annual rate for CDI in the 15 and over age group for the year ending September was 0.36. This is the lowest annual rate since mandatory testing of all stool samples for Clostridium difficile toxin was introduced in April 2009. . The projected rate for the year ending December 2014 is also 0.36 (Chart 5). If confirmed this will be the first quarter in which a decrease in the CDI rate was not recorded.

TOTAL 99 CDI CASES (19 CDIs above local trajectory)

Chart 4 - CDI HEAT Target 2014 – Position at Month 15 (Year 2)

Chart 5 - NHS A&A Rolling Annual CDI rate (15 and above)

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. The most significant contributing factor to the development of a CDI is antibiotics in both primary and secondary care. There has been an increased focus on the use of high risk antibiotics known as the 4Cs which has played a significant role in achieving the earlier reductions. However all antibiotics present an increased risk to a patient in developing a CDI. Therefore to achieve lower levels, the overall number of antimicrobials prescribed must be reduced and this continues to be reinforced throughout the organisation. . The Antimicrobial Management Team (AMT) continues to engage with clinical teams in primary and secondary care to review prescribing practices from local antimicrobial usage and resistance data. The aim is to reduce the overall level of antimicrobial prescribing in order to slow the development of antimicrobial resistance, as well as reduce the CDI risk associated with antibiotic usage.

3. Viral Haemorrhagic Fever / Ebola Preparedness

There has been a considerable amount of work undertaken to date in ensuring that local arrangements are in place for any suspected cases that potentially present in the organisation. Training sessions have been undertaken since 17 November 2014. At the time of writing this report, 104 members of staff have attended the training. Further sessions are planned throughout January 2015 and into February 2015. Areas prioritised for training included:

. Accident & Emergency Departments – University Hospitals Ayr and Crosshouse . Ward 2D, Infectious Disease Unit – University Hospital Crosshouse . Intensive Care Units - University Hospitals Ayr and Crosshouse . Anaesthetic Team – University Hospital Crosshouse . Clinical Decisions Unit – University Hospital Ayr . Arran War Memorial Hospital . Lady Margaret Hospital

Ongoing work includes: . Developing a process for transferring possible cases from the Accident and Emergency Department at University Hospital Crosshouse to Ward 2D Infectious Diseases Unit. . Liaising with clinical services to advise them on local operational plans

4. Norovirus Season

There have been three confirmed Norovirus Outbreaks in December 2014. The wards affected were 3D (Gastroenterology/Short Stay Medical) and 4E (Medical) in the University Hospital Crosshouse and Roseburn Ward in East Ayrshire Community Hospital. All three outbreaks were successfully managed with only short term closure and no spread to other areas of the hospitals.

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Monitoring Form

Policy/Strategy Implications Not required. This update report has no policy/strategy implications.

Workforce Implications Not required. This update report has no workforce resource implications.

Financial Implications The continual management and monitoring of HAIs in NHS Ayrshire and Arran in driving down infection rates as far as possible will ensure that costs per patient stay (ie treatments, length of stay, terminal ward cleaning etc) will not be impacted upon, ensuring that costs are minimised across the organisation.

Consultation (including The HAI update is provided to the NHS Board, Professional Committees) Healthcare Governance Committee bi-monthly and to the Prevention & Control of Infection Committee at every meeting (4 times per year).

Risk Assessment Assessments are carried out on the HAI alert organisms by the Infection Control Nurse responsible for that particular clinical area to ensure that all necessary standard infection control precautions are initiated as appropriate in managing the patients care.

Best Value - Vision and leadership - Effective partnerships Yes - Governance and Yes accountability - Use of resources - Performance management Yes Compliance with Corporate Patient Safety Objectives

Single Outcome Agreement Not required. This is an update report to NHS Board (SOA) members.

Impact Assessment Equality Impact Assessment (EQIA) not required as this is an update report to NHS Board members.

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Appendix 1

Healthcare Associated Infection Reporting Template (HAIRT) 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 . From 1 April – 30 November 2014: - 87 SABs contributing to the HEAT target (Year 2) - 31 cases over the trajectory. - 99 cases of CDI contributing to the HEAT target (Year 2) - 19 cases above trajectory.

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

. In this activity year, 87 SAB cases contributed towards the HEAT target. This places the organisation 31 SABS above the local trajectory level set. . In order to allow real time monitoring of the organisation’s progress, a numerical target of no more than 7 cases per month has been established. . Enhanced SAB case reviews continue by the IPCT in a bid to determine particular areas to be targeted to reduce the SABs levels as far as possible by activity year end.

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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

. In order to allow real time monitoring and management of the CDI HEAT target, a numerical target of no more than 10 cases per month has been established. . In this activity year, 99 CDI cases contributed towards the HEAT target. This places the organisation, 19 CDIs above the local trajectory level set.

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 HAIRT contains hand hygiene compliance obtained through local hand hygiene auditing.

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

. The HAIRT contains cleaning and the healthcare environment compliance obtained through local auditing.

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Outbreaks 2014-15

This section should give details on any outbreaks that have taken place in the Board since the last report, or a brief note confirming that none have taken place. Where there has been an outbreak then for most organisms as a minimum this section should state when it was declared, number of patients affected, number of deaths (if any), actions being taken to bring the outbreak under control and whether this was reported to the Scottish Government. For outbreaks of norovirus a more general outline of the outbreak may be more appropriate. Outbreaks of Diarrhoea and/or Vomiting

Length of Causative Number of Number Room/Ward Organism Mont Patients of Staff closure Ward Hospital h Affected Affected (Days) Dec1 Norovirus 3D UHC 4 6 1 7 Dec1 Norovirus 4E UHC 4 17 8 9 Dec1 Norovirus Roseburn EACH 4 6 1 4

Other HAI Related Activity Viral Haemorrhagic Fever / Ebola Preparedness There has been a considerable amount of work undertaken to date in ensuring that local arrangements are in place for any suspected cases that potentially present in the organisation. Training sessions have been undertaken since 17 November 2014. At the time of writing, 104 members of staff have attended the training. Further sessions are planned throughout January and into February. Areas prioritised for training are:

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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 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. 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). 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.

Targets There are national targets associated with reductions in C.diff and SABs. More information on these can be found on the Scotland Performs website: http://www.scotland.gov.uk/About/Performance/scotPerforms/partnerstories/NHSScotlandperforma nce

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. 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/

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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.

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NHS AYRSHIRE & ARRAN REPORT CARD

Staphylococcus aureus bacteraemia monthly case numbers Dec Jan Feb Mar Apr May June July Aug Sept Oct Nov 2013 2014 2014 2014 2014 2014 2014 2014 2014 2014 2014 2014 MRSA 1 2 1 0 0 2 1 3 2 0 2 2 MSSA 8 7 4 8 15 13 6 8 14 5 9 5 Total SABS 9 9 5 8 15 15 7 11 16 5 11 7

Clostridium difficile infection monthly case numbers Dec Jan Feb Mar Apr May June July Aug Sept Oct Nov 2013 2014 2014 2014 2014 2014 2014 2014 2014 2014 2014 2014 Ages 15-64 2 2 1 4 1 3 7 4 4 3 3 3 Ages 65 7 6 5 7 5 11 3 7 11 17 7 9 plus Ages 15 9 8 6 11 6 14 10 11 15 20 10 12 plus

Hand Hygiene Monitoring Compliance (%) Dec Jan Feb Mar Apr May June July Aug Sept Oct Nov 2013 2014 2014 2014 2014 2014 2014 2014 2014 2014 2014 2014 AHP 99.1 98.5 87.8 98.6 96.5 97.6 99.2 99.4 98 98.6 96.7 97.2 Ancillary 97.4 97.2 96 92.8 98.8 95.6 97.2 95.4 99.2 93.7 98.1 97.9 Medical 99.4 98 96.2 95.3 97.5 95.8 98.3 95.9 98.1 97.1 96.4 97 Nurse 97.1 99.2 100 99.4 98.8 99.1 98.5 98.1 98.9 98.9 99 98.9 Board Total 98.5 98.6 96.7 97.7 98.2 97.8 98.4 97.5 98.6 97.9 98.1 98.2

Cleaning Compliance (%) Dec Jan Feb Mar Apr May June July Aug Sept Oct Nov 2013 2014 2014 2014 2014 2014 2014 2014 2014 2014 2014 2014 Board Total 95 95 95 96 94 94 96 95 95 95 95 94

Estates Monitoring Compliance (%) Dec Jan Feb Mar Apr May June July Aug Sept Oct Nov 2013 2014 2014 2014 2014 2014 2014 2014 2014 2014 2014 2014 Board Total 98 97 98 100 95 96 97 96 97 97 97 94

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UNIVERSITY HOSPITAL AYR REPORT CARD

Staphylococcus aureus bacteraemia monthly case numbers Dec Jan Feb Mar Apr May June July Aug Sept Oct Nov 2013 2014 2014 2014 2014 2014 2014 2014 2014 2014 2014 2014 MRSA 0 1 1 0 0 0 0 0 0 0 0 0 MSSA 0 0 0 2 0 2 1 0 1 1 1 2 Total SABS 0 1 1 2 0 2 1 0 1 1 1 2

Clostridium difficile infection monthly case numbers Dec Jan Feb Mar Apr May June July Aug Sept Oct Nov 2013 2014 2014 2014 2014 2014 2014 2014 2014 2014 2014 2014 Ages 15-64 0 0 0 1 0 0 0 0 0 0 0 0 Ages 65 0 0 0 1 1 3 0 0 2 1 1 0 plus Ages 15 0 0 0 2 1 3 0 0 2 1 1 0 plus

Cleaning Compliance (%) Dec Jan Feb Mar Apr May June July Aug Sept Oct Nov 2013 2014 2014 2014 2014 2014 2014 2014 2014 2014 2014 2014 Ayr 94 93 94 95 92 93 94 94 94 95 95 94

Estates Monitoring Compliance (%) Dec Jan Feb Mar Apr May June July Aug Sept Oct Nov 2013 2014 2014 2014 2014 2014 2014 2014 2014 2014 2014 2014 Ayr 96 97 97 97 94 95 94 95 95 95 95 95

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UNIVERSITY HOSPITAL CROSSHOUSE REPORT CARD

Staphylococcus aureus bacteraemia monthly case numbers Dec Jan Feb Mar Apr May June July Aug Sept Oct Nov 2013 2014 2014 2014 2014 2014 2014 2014 2014 2014 2014 2014 MRSA 0 1 0 2 0 0 0 3 4 0 2 1 MSSA 0 1 1 0 2 4 1 1 1 2 4 1 Total SABS 0 2 1 2 2 4 1 4 5 2 6 2

Clostridium difficile infection monthly case numbers Dec Jan Feb Mar Apr May June July Aug Sept Oct Nov 2013 2014 2014 2014 2014 2014 2014 2014 2014 2014 2014 2014 Ages 15-64 0 0 0 0 0 0 1 1 0 0 0 2 Ages 65 2 2 0 0 0 2 3 2 0 1 1 1 plus Ages 15 2 2 0 0 0 2 4 3 0 1 1 3 plus

Cleaning Compliance (%) Dec Jan Feb Mar Apr May June July Aug Sept Oct Nov 2013 2014 2014 2014 2014 2014 2014 2014 2014 2014 2014 2014 Crosshouse 95 95 95 96 95 95 95 96 96 95 95 95

Estates Monitoring Compliance (%) Dec Jan Feb Mar Apr May June July Aug Sept Oct Nov 2013 2014 2014 2014 2014 2014 2014 2014 2014 2014 2014 2014 Crosshouse 97 97 97 97 97 96 97 97 97 97 97 97

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AYRSHIRE CENTRAL HOSPITAL REPORT CARD

Staphylococcus aureus bacteraemia monthly case numbers Dec Jan Feb Mar Apr May June July Aug Sept Oct Nov 2013 2014 2014 2014 2014 2014 2014 2014 2014 2014 2014 2014 MRSA 0 0 0 0 0 0 0 0 0 0 0 0 MSSA 0 0 0 0 0 0 0 0 0 1 0 0 Total SABS 0 0 0 0 0 0 0 0 0 1 0 0

Clostridium difficile infection monthly case numbers Dec Jan Feb Mar Apr May June July Aug Sept Oct Nov 2013 2014 2014 2014 2014 2014 2014 2014 2014 2014 2014 2014 Ages 15-64 0 0 0 0 0 0 0 0 0 0 1 0 Ages 65 0 0 0 1 0 0 0 1 1 2 1 0 plus Ages 15 0 0 0 1 0 0 0 1 1 0 2 0 plus

Cleaning Compliance (%) Dec Jan Feb Mar Apr May June July Aug Sept Oct Nov 2013 2014 2014 2014 2014 2014 2014 2014 2014 2014 2014 2014 ACH 98 97 96 97 95 95 98 96 96 96 96 93

Estates Monitoring Compliance (%) Dec Jan Feb Mar Apr May June July Aug Sept Oct Nov 2013 2014 2014 2014 2014 2014 2014 2014 2014 2014 2014 2014 ACH 100 99 99 99 95 98 99 99 100 99 97 95

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BIGGART HOSPITAL REPORT CARD

Clostridium difficile infection monthly case numbers Dec Jan Feb Mar Apr May June July Aug Sept Oct Nov 2013 2014 2014 2014 2014 2014 2014 2014 2014 2014 2014 2014 Ages 15-64 0 0 0 0 0 0 0 0 0 0 0 0 Ages 65 0 0 0 1 0 2 0 0 0 1 1 1 plus Ages 15 0 0 0 1 0 2 0 0 0 1 1 1 plus

Cleaning Compliance (%) Dec Jan Feb Mar Apr May June July Aug Sept Oct Nov 2013 2014 2014 2014 2014 2014 2014 2014 2014 2014 2014 2014 Biggart 100 95 97 95 - 94 97 92 95 - - 94

Estates Monitoring Compliance (%) Dec Jan Feb Mar Apr May June July Aug Sept Oct Nov 2013 2014 2014 2014 2014 2014 2014 2014 2014 2014 2014 2014 Biggart 99 99 97 97 - 96 98 94 95 - - 88

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NHS COMMUNITY HOSPITALS REPORT CARD

The community hospitals covered in this report card include:  Ailsa Hospital  Arran War Memorial Hospital  Arrol Park Resource Centre  East Ayrshire Community Hospital  Girvan Community Hospital  Kirklandside Hospital  Lady Margaret

Staphylococcus aureus bacteraemia monthly case numbers Dec Jan Feb Mar Apr May June July Aug Sept Oct Nov 2013 2014 2014 2014 2014 2014 2014 2014 2014 2014 2014 2014 MRSA 0 0 0 0 0 1 0 1 0 0 0 0 MSSA 0 0 0 0 1 1 0 0 0 0 0 0 Total SABS 0 0 0 0 1 2 0 1 0 0 0 0

Clostridium difficile infection monthly case numbers Dec Jan Feb Mar Apr May June July Aug Sept Oct Nov 2013 2014 2014 2014 2014 2014 2014 2014 2014 2014 2014 2014 Ages 15-64 0 0 0 0 0 0 0 0 0 0 0 0 Ages 65 1 0 0 0 1 0 0 0 0 1 0 0 plus Ages 15 1 0 0 0 1 0 0 0 0 1 0 0 plus

NHS OUT OF HOSPITAL REPORT CARD

Staphylococcus aureus bacteraemia monthly case numbers Dec Jan Feb Mar Apr May June July Aug Sept Oct Nov 2013 2014 2014 2014 2014 2014 2014 2014 2014 2014 2014 2014 MRSA 1 0 1 0 0 1 1 4 8 0 0 1 MSSA 8 5 3 4 11 6 4 1 1 1 4 2 Total SABS 9 5 4 4 11 7 5 5 9 1 4 3

Clostridium difficile infection monthly case numbers Dec Jan Feb Mar Apr May June July Aug Sept Oct Nov 2013 2014 2014 2014 2014 2014 2014 2014 2014 2014 2014 2014 Ages 15-64 2 2 1 3 1 3 2 3 4 3 2 1 Ages 65 4 3 4 4 3 4 4 4 8 11 3 7 plus Ages 15 6 5 5 7 4 7 6 7 12 14 5 8 plus

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