Agenda Items ICC: December 2007

HOMERTON UNIVERSITY HOSPITAL NHS FOUNDATION TRUSTDirector of Infection Prevention & Control (DIPC) & Infection Prevention & Control Team (IPCT)Annual ReportApril 2015 - March 2016Author: Dr Alleyna Claxton – Director of Infection Prevention & Control (DIPC), Infection Control Doctor (ICD) & Microbiology ConsultantOn behalf of the: Homerton University Hospital Infection Prevention & Control Team (IPCT)DIPC and ICT Annual Report 2015-2016 Dr Alleyna Claxton, DIPC1 Table of Contents 1 Executive Summary...... 4 2 Healthcare Associated Infection Objectives 2015- 2016...... 9 3 Hygiene Code Compliance 2015-2016...... 10 4 Infection Prevention and Control Arrangements...... 11 4.1 IPC Accountability and Assurance Framework...... 11 4.2 Summary table of IPC accountability and assurance framework...... 12 4.3 Infection Prevention & Control Team overview...... 13 4.3.1 Membership of the IPCT...... 13 4.3.2 IPCT team monthly meetings...... 13 4.3.3 Responsibilities of the IPCT...... 14 4.3.4 IPCT technical support...... 15 4.3.5 IPCT reports to the ICC...... 15 4.4 Infection Control Committee overview...... 16 4.5 DIPC reports to the Trust Board...... 18 4.6 IPC reports to other Trust assurance frameworks...... 18 5 IPCT Healthcare Associated Infection Reduction Plan 2015-2016...... 19 6 IPCT Healthcare Associated Infection Reduction Plan 2016-2017...... 28 7 HCAI Statistics: 2015-2016...... 36 7.1 Results of Mandatory Surveillance Reporting: 2015-2016...... 36 7.1.1 MRSA bacteraemias 2015-2016...... 36 7.1.2 CDI (Clostridium difficile infections) 2015-2016...... 37 7.1.3 MSSA Bacteraemia 2015-16...... 41 7.1.4 E.coli Bacteraemia 2015 - 2016...... 43 7.1.5 GRE Bacteraemias 2015-2016...... 46 7.1.6 Orthopaedic surgical site infections (SSI) 2015-2016...... 46 7.2 Incidents and outbreaks (non-MRSA bacteraemia or CDI) 2015-2016...... 50 8 Antimicrobial Stewardship 2015-2016...... 50 8.1 Antimicrobial Management Group...... 50 8.2 Antibiotic prescribing compliance audits 2015-2016...... 52 8.3 Antimicrobial resistance patterns 2015-2016...... 53 8.3.1 Carbapenemase Producing Enterobacteriaceae (CPE):...... 53 8.3.2 ESBL +ve E.coli bacteraemias:...... 53 8.3.3 MRSA bacteraemias...... 54 9 IPC audit programme 2015 -2016...... 55 9.1 IPC audit programme overview...... 55 9.2 Departmental/ward IPC audits 2015-2016...... 56 9.3 High Impact Intervention audits...... 56 9.4 5:5 HII validation audits 2015-2016...... 57 9.5 Blood Culture Contamination audits: 2015-2016...... 58 9.6 Patient isolation audit 2015-2016...... 58 9.7 IV line audit 2015-2016...... 59 10 IPC education programme 2015 -2016...... 59 10.1 Induction Training...... 59 10.2 Annual Update Training...... 59 10.3 IPCT and DIPC training activities & presentations 2015-2016...... 60 11 Cleaning Services IPC arrangements 2015-2016...... 61 12 Estates and Facilities reports 2015-2016...... 62 12.1 Decontamination...... 62 DIPC and ICT Annual Report 2015-2016 Dr Alleyna Claxton, DIPC2 12.2 Ventilation planned preventative maintenance programme...... 63 12.3 Legionella & Pseudomonas planned preventative maintenance programme63 13 Employee Health Medical Services IPC reports 2015-2016...... 63 13.1 EHMS balanced Scorecards...... 63 13.2 EHMS staff influenza vaccination data...... 63 13.3 EHMS needlestick injuries...... 64 14 IPC policies endorsed by the ICC in 2015-2016...... 64 15 Influenza – winter 2015-2016...... 65 16 Other IPC updates 2015-2016...... 65 17 IPC Balanced Scorecard 2015-2016...... 66 18 Appendix 2 - Glossary of terms...... 67DIPC and ICT Annual Report 2015-2016 Dr Alleyna Claxton, DIPC3 1 Executive Summary a) Healthcare Associated Infection (HCAI) Objectives 2015-2016: Since 2013-2014, the Department of Health has moved from a numerical MRSA Objective target for all Trusts to a ‘zero tolerance’ approach to any MRSA bacteraemias. For this Trust, the end of year 15/16 total was 1 Trust-attributable case. This case was deemed to be due to a contaminant and not clinically significant.  The 2015-2016 national C.difficile Objective target for the Trust was 7 Homerton- attributable cases. The ‘Monitor’ C.difficile target was 12 Homerton-attributable cases. The end of year total was 10 Trust-attributable cases. Of these 10 cases, it has been agreed with Hackney CCG and the NELCSU Specialist Expert in Infection Prevention & Control that only 4 were due to a ‘lapse in care’ and there was no evidence of ‘lapse in care’ in the other 6 cases. b) Hygiene Code compliance 2015-2016: There was a focused Care Quality Commission visit to the Trust’s maternity department in March 14/15 and re-inspected in October and November 2015. There were cleaning-related issues noted which have since been addressed.  There was a Care Quality Commission visit to Mary Seacole Nursing Home in September 2015. There were no infection prevention & control-related issues noted. c) Infection Prevention and Control (IPC) arrangements 2015-16: The Infection Prevention and Control (IPC) assurance framework from ward level to Trust Board of Directors and the IPC risk register are detailed in this report. d) IPCT Healthcare Associated Infection Reduction Plans 15/16 and 16/17 The DIPC and IPCT annual programmes for 2015-2016 and 2016-2017 are presented as part of this DIPC and IPCT annual report. e) HCAI statistics 2015-2016: MRSA bacteraemias & C.difficile toxin positive results: o See section a) above on HCAI objectives for MRSA bacteraemia and C.difficile data.  Other mandatory data on bacteraemias: o In line with mandatory DH requirements, the Trust IPCT also collects and submits data on the number of Meticillin Sensitive Staphylococcus aureus (MSSA) bacteraemias, E.coli bacteraemias and Glycopeptide Resistant Enterococci (GRE) bacteraemias processed by the Trust Microbiology laboratory. There are no targets DIPC and ICT Annual Report 2015-2016 Dr Alleyna Claxton, DIPC4 set for these bacteraemias. The numbers of cases for 15/16 are presented in this report. Orthopaedic Surgical Site Infections: o In response to ongoing issues with the Orthopaedic SSI rates an extensive programme of remedial actions was carried out in 14/15. As a result of this action plan there has been a significant reduction in Orthopaedic SSIs in 15/16. o In 15/16, the work plan around surgical practices has been completed alongside an internal assessment of practices and development of standards. This was based on a collaborative piece of work and development of a tool called ‘One Together’. The work the Trust has done around this has been presented externally. o In the Autumn of 2015, the Trust also introduced a ‘ring-fenced’ bay for orthopaedic patients on each of the two surgical wards. o There were no THR SSIs in Jan 15 – Dec 15 (benchmarked data) and 1 THR in Jan-Mar 16 (local data) compared with 2014 (3 cases) and 2013 (2 cases). o On review of the data for the previous 5 years, which PHE regard as most representative of the SSI rate, the Trust THR SSI rate is 2.5% compared with an ‘all other hospitals’ rate of 1.1%. This is an improvement from the previous ‘5 year rate’ of 3.3%. o There were no TKR SSIs in Jan 15 – Dec 15 (benchmarked data) and 1 TKR in Jan-Mar 16 (local data) compared with 2014 (4 cases) in comparison with 2013 (9 cases). o On review of the data for the previous 5 years, which PHE regard as most representative of the SSI rate, the Trust TKR SSI rate is 2.9% compared with an ‘all other hospitals’ rate of 1.6%. This is an improvement from the previous ‘5 year rate’ of 3.1%.  A summary of outbreaks, other Serious Incidents (SIs) and incidents is presented in this report as is a summary of antimicrobial resistance data. f) Antimicrobial Stewardship 2015-2016 The Antimicrobial Management Group meets on a quarterly basis.  Details of the bi-annual antimicrobial compliance point prevalence audits are presented in this report.  As part of the Trust’s antimicrobial stewardship CQUIN, the Trust submitted data on the 48h review of intravenous antibiotics  Analysis of antimicrobial resistance patterns are presented in this report. g) IPC audit programme 2015-2016: The IPC audit programme for 2015-2016 was completed for all high and medium risk areas and all action points were followed up. However due to low staffing levels in the IPCT team in 15/16, some of the ICN-led audits of low risk community areas were not completed. In total, 26 of 51 audits were completed. The IPCT is now fully staffed and these areas will be prioritised for audit in 16/17. DIPC and ICT Annual Report 2015-2016 Dr Alleyna Claxton, DIPC5 h) IPC education programme 2015-2016: Induction training - all staff either attend the Trust induction or complete the IPC induction e-learning module on line.  By the end of the 14/15 financial year, 94.4% of staff had received an IPC level 1 annual update.  IPCT and DIPC training activities – the IPCT and DIPC continue to attend postgraduate education and other courses to ensure ongoing professional development. i) Cleaning Services IPC arrangements 2015-2016: The cleaning services for the Hospital acute site changed contractors from Medirest to ISS and, for the community sites, the East London Consortium continue to provide and monitor the cleaning services. Monitoring within the Trust’s premises is undertaken as prescribed within ‘The National Specifications for Cleanliness in the NHS (2007), Revised Guidance on Contracting for Cleaning (2004), current legislation, codes of practice and best practice’.  Cleaning service performance is formally audited by technical audits & monitoring and validation audits.  Cleaning service performance is reviewed at the Estates and Facilities ISS contract review group which reports to the Board of Directors. j) Estates and Facilities reports 2015-2016: The ICC receives quarterly reports from the Trust’s: o Decontamination monitoring committee o Estates team - ventilation planned preventative maintenance programme and Legionella & Pseudomonas planned preventative maintenance programme. o Water Safety Group No major issues of concern were reported to the ICC in 15/16. k) Employee Health Medical Services (EHMS) IPC reports 2015-2016: An Employee Health Management Service (EHMS) balanced scorecard is presented to the ICC on a quarterly basis. This document includes details of compliance with the Exposure Prone Procedure (EPP) register and measles, rubella, chickenpox and tuberculosis screening register.  In 2015/16, the EHMS department led the Trust’s Flu Staff Vaccination Campaign. In total, 44.49% (1570) of front-line healthcare workers (FHCWs) were vaccinated in 15/16. Although this is a decrease from the 47.6% (1520) of FHCWs vaccinated in 14/15, there was an increase in the total number of FHCWs vaccinated overall in 15/16. The decreased percentage reflects the increase in the size of the workforce. Overall the Trust ranked 171st of 254 Trusts nationally with the top ranked Trust achieving 83.5% vaccination rates and the DIPC and ICT Annual Report 2015-2016 Dr Alleyna Claxton, DIPC6 lowest ranked Trust achieving 10.9 % vaccination rates. The average Trust vaccination rate was 50.5%. o In response to the issue of how to encourage staff to have flu vaccination, the EHMS has proposed that for 16/17 the following action plan is followed:. Appoint a lead champion . Recruit more flu champions . More involvement of senior management team . Lead Champion to attend staff team meetings . Consultations with staff using Survey Monkey and face-to-face questionnaires . Enhanced data recording . Learning from other Trusts who have achieved high uptake percentages Needlestick Injury (NSIs) data are discussed by EHMS and the IPCT to risk assess any potentially preventable incidents and introduce remedial measures where appropriate. Further analysis is detailed in this section of the report. l) IPC policies endorsed by the ICC in 2015 -2016:The following IPC policies have been reviewed and endorsed by the ICC in 15/16: IV line management  Multi-resistant gram negative rods  Measles  VZV  iGAS  IPC SOP (including annual review of ICC ToR)  Rabies  Norovirus D&V  PICC line policy  MRSA policy  Food Hygiene policy  GRE policy m) Influenza – Winter 2015-16: Over the winter months influenza activity was moderate with a late surge in flu B admissions in the early Spring. There were few admissions to critical care. There was no adverse impact on bed or isolation capacity.DIPC and ICT Annual Report 2015-2016 Dr Alleyna Claxton, DIPC7 n) Other IPC updates: This DIPC/ICT annual report 2015-2016 will be presented to the Board of Directors and then made available to the public on the Trust internet site in accordance with the requirements of the Code of Practice for reducing HCAI.  The IPCT continue to maintain Service Level Agreements (SLAs) to provide IPC cover for Mildmay, St Joseph’s Hospice and the East London Foundation Trust (ELFT).  One of the ICNs, Ms. Gema Martinez Garcia, has left the HUH IPCT to take up a promotion at another Trust. The DIPC & IPCT would like to officially thank her for all her enthusiasm and hard work in the years she has worked in the IPCT at HUH and wish her every success in her future career.DIPC and ICT Annual Report 2015-2016 Dr Alleyna Claxton, DIPC8 2 Healthcare Associated Infection Objectives 2015- 2016 Since 2013-2014, the Department of Health has moved from a numerical MRSA Objective target for all Trusts to a ‘zero tolerance’ approach to any MRSA bacteraemias. For this Trust, the end of year 15/16 total was 1 Trust-attributable case. This case was deemed to be due to a contaminant and not clinically significant.  The 2015-2016 national C.difficile Objective target for the Trust was 7 Homerton- attributable cases. The ‘Monitor’ C.difficile target was 12 Homerton-attributable cases. The end of year total was 10 Trust-attributable cases.  Of these 10 cases, it has been agreed with Hackney CCG and the NELCSU Specialist Expert in Infection Prevention & Control that only 4 were due to a ‘lapse in care’ and there was no evidence of ‘lapse in care’ in the other 6 cases. A ‘lapse in care’ is defined as any issue identified on the post Infection Review (PIR) which could have contributed either to the patient’s acquisition of C.difficile infection during that episode of admission (e.g. inappropriate antibiotic use, evidence of cross-infection on C.difficile ribotyping) or any issue regarding their management which was non-compliant with the Trust’s policy for the management of possible cases of C.difficile (e.g. significant delay in sending of stool sample for testing, significant delay in side room isolation). All 4 cases deemed to have ‘lapse in care’ issues were related to management issues and none to acquisition-related issues.  All HUH-attributable MRSA bacteraemias are automatically reviewed as potential Serious Incidents (SIs) with ‘24h meetings’ to which the NELCSU Specialist Expert in Infection Prevention & Control is invited. They are then investigated according to the national MRSA Bacteraemia Post Infection Review (PIR) process as required by the Department of Health and the PIR is presented at the Trust’s Patient Safety Committee. The PIR is also submitted electronically to the Public Health England (PHE) surveillance team within 14 days as per the national requirements.  All HUH-attributable C.difficile cases are automatically reviewed as potential Serious Incidents (SIs) with ‘24h meetings’ to which the NELCSU Specialist Expert in Infection Prevention & Control is invited. They are then investigated using a PIR tool which has been validated as ‘fit for purpose’ by the CCG and NELCSU Specialist Expert in Infection Prevention & Control. The completed PIR is presented at the Trust’s Patient Safety Committee and sent to the NELCSU Specialist Expert in Infection Prevention & Control for comment on ‘lapse of care’ status.  All non-HUH-attributable (pre-48h) MRSA bacteraemias and C.difficile cases have a Root Cause Analysis (RCA) completed using the relevant PIR tools which are also presented at the Trust’s Patient Safety Committee.DIPC and ICT Annual Report 2015-2016 Dr Alleyna Claxton, DIPC9 3 Hygiene Code Compliance 2015-2016 There was a focused Care Quality Commission visit to the Trust’s maternity department in March 14/15. There were cleaning-related issues noted which have since been addressed. The report was published in August 2015. Please see below for the full report: http://www.cqc.org.uk/sites/default/files/new_reports/AAAD8683.pdfThe maternity department was re-inspected in October and November 2015. The report was published in February 2016. The CQC confirmed that: ‘The cleanliness and hygiene of the unit had improved significantly. The areas we inspected were visibly clean and there was a system of checking processes for ensuring high standards of cleanliness were adhered to. However we found a few isolated incidents where cleanliness could be improved. There was sufficient evidence that the warning notices for care and welfare of women and their babies and cleanliness and infection control had been met.’ Please see below for the full report: http://www.cqc.org.uk/sites/default/files/new_reports/AAAE3960.pdf There was a Care Quality Commission visit to Mary Seacole Nursing Home in September 2015. There were no infection prevention & control-related issues noted. The report was published in November 2015. Please see below for the full report: http://www.cqc.org.uk/sites/default/files/new_reports/AAAE1660.pdfDIPC and ICT Annual Report 2015-2016 Dr Alleyna Claxton, DIPC10 4 Infection Prevention and Control ArrangementsIPC Accountability and Assurance FrameworkWARDS & DEPARTMENTSDivisional Decontamination Performance Meetings Monitoring CommitteeWater Safety GroupEHMS Divisional Lead Nurses Estates & FacilitiesInfection Control CommitteeDIPC Quarterly ReportBOARD OF DIRECTORSDIPC and ICT Annual Report 2015-2016 Dr Alleyna Claxton, DIPC11 Summary table of IPC accountability and assurance framework Regularity Information Tree Reporting Response to Variance Quarterly Trust Board DIPC report – surveillance data, incidents and outbreaks, SIs, audit programme, education programme, IPC BSC, risk register, cleaning standards, estates and facilities reports (Legionella, Frequency of ventilation, decontamination) meetings may and employee health reports be increased Quarterly Infection Control Committee Surveillance data, incidents or decreased and outbreaks, SUIs, audit in response to programme, education specific programme, IPC BSC, risk situations register, cleaning standards, such as an estates and facilities reports outbreak. This (Legionella, ventilation, would be decontamination) and reflected in employee health reports IPC reports Quarterly Health and Safety Committee Needle stick injuries, latex and DIPC allergy reports to the Quarterly Water Safety Group Monitors the water safety plan Board. and arrangements. Quarterly Antimicrobial Management Antimicrobial stewardship Group issues e.g. new antimicrobials, antibiotic prescribing incidents, antibiotic policy updates Monthly Chief Executive and DIPC Key issues Ad hoc Director of Nursing and DIPC Instant reporting of HCAI Director of Nursing and issues Infection Control Nurse Consultant Monthly Domestic and Catering Performance against National Services Review Group Standards of Cleanliness Monthly Patient Safety Committee PIRs, SIs Monthly Joint Prescribing Group Antimicrobial prescribing Quarterly Decontamination Monitoring Decontamination of Group equipment, SSD audits and compliance, endoscopy audits and compliance Monthly Infection Control Team Surveillance data, SIs, policy meetings review programme, audit programme, antimicrobial prescribing, education Monthly Divisional HII, audit, cleanliness, Governance/Performance decontamination, SIs and meetings educationDIPC and ICT Annual Report 2015-2016 Dr Alleyna Claxton, DIPC12 Weekly DIPC and ICN meetings Key issues Instant reporting of HCAI issues Monthly Wards HII, audit, C.difficile, MRSA Daily and cleaning Ad hocInfection Prevention & Control Team overviewMembership of the IPCTThe Infection Prevention & Control Team (IPCT) comprises of: a) One full-time Consultant Microbiologist, Dr Alleyna Claxton, who is the Infection Control Doctor (ICD) & Director of Infection Prevention and Control (DIPC). b) Two Microbiology/Infectious Diseases Consultants, Dr Annette Jepson and Dr Aileen Boyd who act as the deputy Infection Control Doctor as required. c) One full-time Microbiology Specialist Registrar (in 2015-2016, Dr Lynette Phee followed by Dr Stephanie Smith). d) One full-time Infection Control Nurse Consultant (ICNC) and Deputy DIPC, Ms. Victoria Longstaff. e) In 15/16, there were four full-time Band 7 Infection Control Nurses, Ms. Gema Martinez-Garcia, Ms. Martha Ugwu, Ms. Monique Laberinto and Ms. Meri Awudu (ICN for ELFT). Ms. Gema Martinez-Garcia left the team to take up a new post in February 2016 and subsequently a Band 6 Infection Control Nurse, Ms. Daneil Budhai has been appointed. f) One full time band 7 OPAT/Vascular Access Specialist Nurse, Ms. Jenniferth Aviles Moreta. g) One full-time Lead Pharmacist for antimicrobials & e-prescribing, Ms. Luisa Cabrero-Moreno supported by a rotational Band 6 Pharmacist, Ms. Priti Kukadia followed by Ms. Busra Cinciler. h) One part time administrator, Ms. Sharon Dilworth.4.1.1 IPCT team monthly meetings  The IPCT meets monthly on the second Thursday of every month. The IPCT (as above) and Health Protection Unit Nurse Consultant attend.  The regular agenda items for meetings are:Clinical items: MRSA cases (bacteraemia, infected, colonised) C. difficile infections & PCR positive cases MSSA bacteraemias E.coli bacteraemias GRE Pseudomonas in NICU/SCBU/ITU Incidents and outbreaks Policy review programme Antimicrobial prescribing DIPC and ICT Annual Report 2015-2016 Dr Alleyna Claxton, DIPC13 Infection control audit programme – IPC, ICNA & HII Education programme PHE update Divisional updates ELFT update Vascular Access/OPAT service update Orthopaedic SSIs update AOB Issues discussed at the IPCT meetings may be included on the Infection Control Committee agenda as necessary.4.1.2 Responsibilities of the IPCT  The DIPC provides a report to the Board of Directors on a quarterly and annual basis.  The Nurse Consultant/Infection Control Nurse attends the Trust Health and Safety and Patient Safety Committee meetings.  The IPC team provides specialist advice, formulates, monitors and evaluates the implementation of policies.  The use of evidence-based practice is supported and used in the writing and reviewing of policies.  The IPC team are responsible for the daily management and advice on infection control clinical cases and incidents. They also advise the Trust at a strategic level on service and building developments which will have an impact on IPC and required remedial actions.  The IPC team develop and provide education to all Trust staff on infection prevention and control.  The IPC team develop and complete a programme of audit relating to infection prevention and control.  An Annual Report is produced by the DIPC and Deputy DIPC and presented to the Trust Board.  An Infection Prevention and Control Team Annual Programme is produced by the ICNC and DIPC and presented to the ICC for agreement.  All members of the IPC team are registered for and fulfil Continuing Professional Development requirements.  The IPC team will identify requirements for additional resources to support and promote infection control practices and present these to the ICC.  The IPC team will fulfil the requirements of any SLA for a service with outside organisations. Currently SLAs are held with the East London and City Mental Health Trust, St Joseph’s and Mildmay Hospital.  The IPC team report to the Infection Control Committee.DIPC and ICT Annual Report 2015-2016 Dr Alleyna Claxton, DIPC14 IPCT technical support The IPCT is supported by the in-house Microbiology laboratory and the Virology laboratory situated at Royal London Hospital.  In 2014-2015, the IPCT has used a web-based Infection Prevention Audit System (IPAS) to assist with local data collection for ward based monitoring of High Impact Interventions.4.1.3 IPCT reports to the ICC4.1.3.1 IPCT Quarterly report The IPCT present a quarterly summary report to the ICC which details surveillance data (MRSA bacteraemias, C.difficile infection, MSSA bacteraemias, E.coli bacteraemias, GRE bacteraemias, Pseudomonas in augmented care units, orthopaedic surgical site infections), incidents and outbreaks, SIs, audit programme, education programme, policy review programme and Service Level Agreements.4.1.3.2 IPC Risk RegisterAt the end of 2015-16, the following risks remain on the IPC Risk Register as ongoing risks requiring further acute action after review by the ICC. Those risks that, after discussion at the ICC, have been confirmed as ongoing risks for which no further acute actions can be identified have been closed on the risk register with the proviso that they may be put back on at any time should their risk profile change.At the end of 15/16 the following ongoing IPC risks remain on the risk register:  Risk 520 – Surgical Site Infections in Orthopaedics. The risk score has been reduced from 12 to 9 as the previous action plan has been completed and there have been no new cases in the 2015-2016 calendar year.  Risk 661 – Cubicle capacity in Starlight – this is not an IPC risk but a capacity issue. The classification is to be changed accordingly and the risk removed from the IPC Risk Register.  Risk 504 – Infection control approved computer key boards. IT have confirmed that all keyboard replacements will be with IPC approved keyboards. The risk is now due to be removed from the IPC register.The following risk has been closed on the risk register in 15/16: Risk 599 – Bed pan washer-disinfectors replacement. This risk has been removed as the new bed pan washers-disinfectors are now in situ on all wards.DIPC and ICT Annual Report 2015-2016 Dr Alleyna Claxton, DIPC15 4.1.3.3 IPC Balanced Score Card The IPC Balanced Score Card (BSC) is used to summarise Trust wide IPC data and is presented to the ICC quarterly. The IPC BSC comprises of summary statistics of the following: o DH Indicators (MRSA bacteraemias, Trust-attributable C.difficile infections, GRE bacteraemias) o SIs (Trust-attributable MRSA-related deaths, C.difficile-related deaths, other SIs) o Orthopaedic Surgical Site Infections (SSIs) o ‘Alert organism’ trigger events (MRSA, CDI) o National Standards Monitoring tool (cleaning) o Outbreaks (Diarrhoea & Vomiting, other) o Audits completed (ICNA, Trustwide, HIIs) o IPC training completed4.2 Infection Control Committee overview Authority The Infection Control Committee has been established to evaluate and report on all aspects of infection prevention and control and compliance with the Health and Social Care Act on behalf of the Board of Directors. The committee is a subcommittee of the Trust Board and reports directly to the Board via the DIPC Quarterly reports and Annual Report. Purpose The purpose of the committee is to ensure that there is a managed environment within the Trust that minimises the risk of infection to patients, staff and visitors. The committee provides the Board of Directors with assurance that it has control of the HCAI agenda through compliance with HCAI regulatory requirements. Duties  To ensure strategic and operational infection prevention and control risks are identified, assessed, evaluated and managed according to the risk management and assurance frameworks.  To provide strategic direction and guidance to facilitate the development and implementation of infection prevention initiatives Trustwide.  To promote a culture in which infection prevention and control will continue as an integral and seamless component of the healthcare process.  To receive and approve the Infection Prevention and Control annual programme and audit programme ensuring the programme has clearly defined objectives.  To monitor progress against Infection Prevention and Control performance key performance indicators using the balanced score card.  To consider and respond to reports on: DIPC and ICT Annual Report 2015-2016 Dr Alleyna Claxton, DIPC16 Incidence and prevalence of alert organisms and important infectious disease Serious Incidents Infection prevention and control education and training Infection prevention and control practice and hospital hygiene Outbreaks of infection Audit  To ensure structures and processes are in place that enable hygiene code self- assessment and compliance.  To define priorities based on current risk ratings detailed in the Infection Prevention and Control risk register.  To review and endorse Trust policies for infection prevention and control, procedures and guidance and monitor their implementation through an annual programme of audit.  To review and monitor outbreak management plans and monitor their implementation.  To review other infection control issues as necessary, including those relating to catering, decontamination, engineering, ventilation and water services, employee health, pharmacy, procurement, capital strategy etc.  To promote and facilitate education of all grades and disciplines of staff in procedures for the prevention and control of infection.  To monitor the performance of the IPCT and make suggestions for improvement.  To review the performance of the committee. Membership Director of Infection Prevention and Control (DIPC) - CHAIR Chief Nurse/Executive Director for IPC – DEPUTY CHAIR Medical Director Clinical Risk Manager Consultant Microbiologists Employee Health Lead Infection Control Nurse Consultant/Deputy DIPC Senior Nurse Children’s services, diagnostics & outpatients Senior Nurse Integrated medical & rehabilitation services Senior Nurse Surgery, women’s and sexual health services Head of Midwifery Infection Control Nurses Director of Environment (Trust Decontamination Lead) Trust Decontamination manager Facilities manager Estates water/ventilation lead Health Protection Team representative (nurse or CCDC) The Terms of Reference (ToR) are reviewed annually and were reviewed and agreed at the ICC in January 2016.DIPC and ICT Annual Report 2015-2016 Dr Alleyna Claxton, DIPC17 4.3 DIPC reports to the Trust Board Dr Alleyna Claxton, the current DIPC, Infection Control Doctor (ICD) and Microbiology Consultant is accountable to and reports directly to the Chief Executive Officer (CEO), Ms. Tracey Fletcher.  The DIPC presents a Quarterly DIPC report to the Trust Board of Directors (in person on request). The DIPC quarterly reports summarises the minutes of the ICC and any other issues of importance to the Trust Board.  Board decisions regarding Infection Prevention & Control issues are recorded in the minutes of the Board meetings.  Incident, outbreak and SI reports are presented to the Board in the Quarterly DIPC reports.  The DIPC quarterly reports are available on request.  The DIPC/IPCT annual programme is approved by the ICC.  The DIPC/IPCT annual report is presented to the Board in person by the DIPC and ratified by the Board.  The DIPC/IPCT annual report is then made available to the public on the Trust internet web site in accordance with the requirements of the Health and Social Care Act.4.4 IPC reports to other Trust assurance frameworks  The Trust’s Patient Safety Committee meets monthly and reports to the Risk Committee which reports to the Board of Directors. The ICNC/Deputy DIPC sits on the Patient Safety Committee and reports all IPC-related SIs, outbreaks and other relevant IPC issues to the committee.  One of the ICNs sits on the Domestic and Catering Services Review Group  The DIPC chairs the Antimicrobial Management Group which reports to the ICC.DIPC and ICT Annual Report 2015-2016 Dr Alleyna Claxton, DIPC18 5 IPCT Healthcare Associated Infection Reduction Plan 2015-2016Objective Actions Leads Timescale ProgressSurveillance MRSA bacteremia - objective – zero IPC team April 2015 – March 2016 Ongoing To undertake surveillance tolerance which is compliant national  Report monthly cases as per DH requirements and to mandatory reporting system achieve reduction in HCAI  Perform Post Infection Review of all cases to identify lapses in care if present and implement preventative measures MSSA bacteremia - no objective set IPC team April 2015 – March 2016 Ongoing  Report monthly cases as per DH mandatory reporting system  Review cases to identify source and preventative actions if necessary Clostridium difficile (CDI) – objective – 7 IPC team April 2015 – March 2016 Ongoing cases  Report monthly cases as per DH mandatory reporting system  Perform Post Infection Review of all cases to identify lapses in care if present and implement preventative measures E.coli bacteraemia – no objective set IPC team April 2015 – March 2016 Ongoing  Report monthly cases as per DH mandatory reporting system  Review cases to identify source and preventative actions if necessaryDIPC and ICT Annual Report 2015-2016 Dr Alleyna Claxton, DIPC19 GRE bacteraemia – no objective set IPC team April 2015- March 2016 Ongoing  Report monthly cases as per DH mandatory reporting system  Review cases to identify source and preventative actions if necessary Multi-resistant Gram Negative bacteria IPC team April 2015-March 2016 Ongoing  Review cases of MRGN bacteria as required and identify clusters of cases  Monitor and manage cases of CPE and CRO as per Public Health England guidancePseudomonas in augmented care units IPC team April 2015-March 2016 Ongoing  Review cases of pseudomonas in NICU and ITU as required and identify clusters of cases  Monitor and manage cases and clusters as per DH guidanceSurgical site infection IPCT team/ April 2015-March 2016 Ongoing  Perform surveillance of THR and orthopaedic team TKR surgical site infections  Perform RCA into any infections  Produce quarterly report of surveillance and recommendations  Explore the establishment of protocols for surveillance of C C section SSI section SSI and RCA for severe surveillance not infections requiring readmission completedDIPC and ICT Annual Report 2015-2016 Dr Alleyna Claxton, DIPC20 Monthly HCAI data IPC team April 2015-March 2016 Ongoing  Ensure that all mandatory surveillance is inputted on the DH system  Perform reviews/PIR of cases and produce reports to wards, divisions and Trust board with areas for improvement identified Outbreaks/Incidents IPC team April 2015-March 2016 Ongoing  Identify outbreaks and incidents and manage according to clinical indication  Produce reports and reviews of incidents and outbreaks identifying any recommendations for reducing the risk of further outbreaks/incidents Audit  IV line (including peripheral and IPC team April 2015 – March 2015  IV line audit – Monitor compliance with central) Point Prevalence - Acute completed IPC practices/policies and site - September  Sharps audit – environmental standards  Sharps audit - Trust wide - July completed  5:5 audits – bi-monthly  5:5 audits – one  Isolation Facility Audit – Acute site completed in – September, March November and  Urinary Catheter Point Prevalence February – November (quarterly)  Blood culture contamination -  Isolation audit – quarterly September  Department/ward Infection control completed. audit –  Urinary catheter  IMRS – services audit – not  CSDO – services completed  SWSH – services  Blood culture – completed  Department ward DIPC and ICT Annual Report 2015-2016 Dr Alleyna Claxton, DIPC21 audits –26 out of 51 completedTraining Induction IPC team April 2015-March 2016 Ongoing Provide training and  To provide induction lecture for all education to health care new staff (non-clinical, AHP, workers as per Trust nurses and doctors) Training Needs analyses to reduce the risk of HCAI Update Ongoing  To provide annual IPC updates (including hand hygiene training) for all clinical staff Ongoing Clinical skills  To provide training on clinical skills to reduce risk of HCAI e.g. IV line management, urinary catheterisation study days, ANTT, blood culture taking procedureTraining development  Continue to develop education Clinical skills on programme for IPC link Elsevier developed practitioners for  To review staff training in all PICC line access aspects of infection prevention PICC line dressing and control to ensure training is Adult blood culture effective and meets the needs of taking procedure staff and the organisation. Paediatric blood  To develop to online training and culture taking online clinical skills training procedure awaiting portfolio review Communication  Information on infection prevention IPC team April 2015-March 2016 Ongoing To promote the work the and control strategies will be IPCT does to reduce the available to the public, service DIPC and ICT Annual Report 2015-2016 Dr Alleyna Claxton, DIPC22 risk of infection to patients users and staff and staff  There are robust systems of communication in place between the IPCT and all Trust staff via: email updates; monthly infection control newsletter; up-to-date IPCT policies on intranet  There are robust systems of communication in place between the IPCT and Public and patients via: patient information leaflets; Trust website, prompt response to all Freedom of Information and other enquiries through the Communications and Information Governance departments Policies and guidelines IPC policies due for revision and update IPC and facilities April 2015-March 2016 Food hygiene policy Review all policies due for in 2015-2916 team to be completed by review or sooner if new 1. Food hygiene ( September 2015) facilities team guidance is published. 2. Invasive group A strep (November iGAS – completed 2015) VZV – completed 3. VZV (November 2015) Measles – 4. Measles (November 2015) completed IPC operational policy - completed Decontamination  IPCT members to sit on and IPC team April 2015-March 2016 Ongoing To comply with National contribute expert advice to the regulations to reduce the Decontamination Monitoring risk of HCAI Group  Advise the Trust Lead for Decontamination on decontamination issues both at the regular Decontamination Monitoring Group meetings and on an ad hoc basisDIPC and ICT Annual Report 2015-2016 Dr Alleyna Claxton, DIPC23  Ensure compliance with CFPP for decontaminationCleanliness  IPCT members to sit on and IPCT team April 2015-March 2016 Ongoing To comply with national contribute expert advice to the standards for cleanliness to Cleanliness monitoring groups reduce the risk of HCAI to  IPCT to advise on national patients, visitors and staff monitoring standards Estates and building  IPCT to advise on new builds and IPCT team April 2015-March 2016 Ongoing To ensure the building and refurbishments to ensure IPC is estates management is considered inline national guidance to  IPCT to be involved in PPM as reduce the risk of HCAI necessary  IPCT to receive and advice on waters sampling results as necessary Antimicrobial prescribing Audit Antimicrobial April 2015-March 2016 To ensure that prescribing  Biannual point prevalence abx pharmacist June 2015 audit is in line with national policy compliance & stop/review completed guidance and best practice date audits – June 2015 & to reduce the risk of HCAI January 2016 and antimicrobial  IV abx 48h Stop/ review date Nov 2015 audit resistance compliance audit – scheduled 4th completed Nov 2015 & March 2016  Data validation for ESPAUR on total abx usage for inter-Trust Completed May comparison data benchmarking 2015 Daily report of restricted antimicrobials run by Pharmacy Ongoing and and any queries raised with teams complete /escalated to Microbiology when necessary.  Undertaking quarterly assessment July & Oct 2015 using the Antimicrobial Self- reports completed & Assessment Toolkit (ASAT) submitted to CCG DIPC and ICT Annual Report 2015-2016 Dr Alleyna Claxton, DIPC24 Education  Antimicrobial stewardship info in Ongoing/completed mandatory junior doctors induction lecture & annual docs update lecture  Antimicrobial prescribing in Completed – in pharmacy “Safe prescribing” junior pharmacy induction doctors induction lecture (incl. lecture penicillin allergy awareness)  European Antibiotic Awareness Completed - EAAD Day promotional work – Nov 15 November 2015  Additional teaching for junior Completed – Sep 15 doctors on how to ensure Stop/Review dates in the system are set up and reviewed Ongoing/completed  Antimicrobial stewardship for Pharmacists, lecture circa twice a Completed – lecture year given by  Antimicrobial stewardship for GPs antimicrobial pharmacist & Micro ConsultantE-prescribing Prescribing indication made compulsory. System places an automatic 48h stop/review date and shows a warning for those patients whose stop/review date has passed without review date being changed  Prescribers are offered standard duration for all oral antibiotics by the system – this encourages stopDIPC and ICT Annual Report 2015-2016 Dr Alleyna Claxton, DIPC25 dates being enforced as Completed August prescriptions for these oral 2015/on antibiotics will finish after the implementation of prescribed course length has ACE EPR system passed (no need for active stop by clinicians).  Prescribers cannot start a restricted antibiotic without documenting whether Micro approved its use or the reason why Microbiology was not contacted.  Identity of prescriber always clear – easier to query inappropriate prescribing. Jan 16 update – Reporting antimicrobial  E-prescribing will provide the pharmacist met with ability to report on all the above Head of Information aspects of antimicrobial team & building prescribing instantly and to feed report tool for ACE back to prescribers in a much EPR system for more timely manner. The Trust these reports to be reporting team is currently in the produced has been process of building the first prioritised automatic restricted antibiotic report at the moment, as per instructed by the antimicrobial pharmacist – planned date Dec 2015 – Jan 2016.Clinical practices Surgical management IPC team April 2015- March 2016 To ensure that clinical  To review surgical practices and In progress practices are in line with procedures (pre, peri and post- national guidance and best operative) in line with externally DIPC and ICT Annual Report 2015-2016 Dr Alleyna Claxton, DIPC26 practice to reduce the risk developed tool called ‘One of HCAI Together’. Where required make changes to practices to ensure evidence based  The One Together assessment and actions will be completed with full compliance and evidence availableVascular access Completed  To develop the vascular access service (adult, paediatrics, neonates) within the Trust ensuring correct IV access is available, products and staff are trained.  A review of vascular access In progress requirements with an action plan will be developed and completed ensuring correct IV access, products and training.New Services  Support services in generating, capturing and investing in service development and innovation ideas as an IPC link and process to ensure IPC involvement is establishedDIPC and ICT Annual Report 2015-2016 Dr Alleyna Claxton, DIPC27 6 IPCT Healthcare Associated Infection Reduction Plan 2016-2017Objective Actions Leads Timescale ProgressSurveillance MRSA bacteremia - objective – zero IPC team April 2016 – March 2017 To undertake surveillance tolerance which is compliant national  Report monthly cases as per DH requirements and to mandatory reporting system achieve reduction in HCAI  Perform Post Infection Review of all cases to identify lapses in care if present and implement preventative measures MSSA bacteremia - no objective set IPC team April 2016 – March 2017  Report monthly cases as per DH mandatory reporting system  Review cases to identify source and preventative actions if necessary Clostridium difficile (CDI) – objective – 7 IPC team April 2016 – March 2017 cases  Report monthly cases as per DH mandatory reporting system  Perform Post Infection Review of all cases to identify lapses in care if present and implement preventative measures E.coli bacteraemia – no objective set IPC team April 2016 – March 2017  Report monthly cases as per DH mandatory reporting system  Review cases to identify source and preventative actions if necessaryDIPC and ICT Annual Report 2015-2016 Dr Alleyna Claxton, DIPC28 GRE bacteraemia – no objective set IPC team April 2016 – March 2017  Report monthly cases as per DH mandatory reporting system  Review cases to identify source and preventative actions if necessary Multi-resistant Gram Negative bacteria IPC team April 2016 – March 2017  Review cases of MRGN bacteria as required and identify clusters of cases  Monitor and manage cases of CPE and CRO as per Public Health England guidance Pseudomonas in augmented care units IPC team April 2016 – March 2017  Review cases of pseudomonas in NICU and ITU as required and identify clusters of cases  Monitor and manage cases and clusters as per DH guidance Surgical site infection IPCT team/ April 2016 – March 2017  Perform surveillance of THR and orthopaedic team TKR surgical site infections  Perform RCA into any infections  Produce quarterly report of surveillance and recommendations Monthly HCAI data IPC team April 2016 – March 2017  Ensure that all mandatory surveillance is inputted on the DH system  Perform reviews/PIR of cases and produce reports to wards, divisions and Trust board with areas for improvement identifiedDIPC and ICT Annual Report 2015-2016 Dr Alleyna Claxton, DIPC29 Outbreaks/Incidents IPC team April 2016 – March 2017  Identify outbreaks and incidents and manage according to clinical indication  Produce reports and reviews of incidents and outbreaks identifying any recommendations for reducing the risk of further outbreaks/incidents Surveillance/screening swab regimes  Review MRSA admission screening in line with national guidance and cost effective treatment  Review GRE screening regime to ensure safe and cost effective regimes  Review multi-resistant gram negative screening in line with national guidance and cost effective treatment Audit  IV line (including peripheral and IPC team April 2016 – March 2017 Monitor compliance with central) Point Prevalence - Acute IPC practices/policies and site - September 2016 environmental standards  Sharps audit - Trust wide - July  5:5 audits – quarterly  Isolation Facility Audit – Acute site – September 2016 , March 2017  Urinary Catheter Point Prevalence – November 2016  Blood culture contamination - quarterly  Department/ward Infection control audit – DIPC and ICT Annual Report 2015-2016 Dr Alleyna Claxton, DIPC30  IMRS – services  CSDO – services  SWSH – services Training Induction IPC team April 2016 – March 2017 Provide training and  To provide induction lecture for all education to health care new staff (non-clinical, AHP, workers as per Trust nurses and doctors) Training Needs analyses to reduce the risk of HCAI Update  To provide annual IPC updates (including hand hygiene training) for all clinical staffClinical skills  To provide training on clinical skills to reduce risk of HCAI e.g. IV line management, urinary catheterisation study days, ANTT, blood culture taking procedureTraining development  Continue to develop education programme for IPC link practitioners  To review staff training in all aspects of infection prevention and control to ensure training is effective and meets the needs of staff and the organisation.  To develop to online training for IPC mandatory updates  To continue to develop online clinical skills training portfolio Communication  Information on infection prevention IPC team April 2016 – March 2017 To promote the work the and control strategies will be DIPC and ICT Annual Report 2015-2016 Dr Alleyna Claxton, DIPC31 IPCT does to reduce the available to the public, service risk of infection to patients users and staff and staff  There are robust systems of communication in place between the IPCT and all Trust staff via: email updates; monthly infection control newsletter; up-to-date IPCT policies on intranet  There are robust systems of communication in place between the IPCT and Public and patients via: patient information leaflets; Trust website, prompt response to all Freedom of Information and other enquiries through the Communications and Information Governance departments Policies and guidelines IPC policies due for revision and update IPC and facilities April 2016 – March 2017 Review all policies due for in 2016-2017 team review or sooner if new 5. CJD/TSE – Nov 2016 guidance is published. 6. MRSA – Sep 2016 (to include review of admission screening in line with new guidance) 7. Death of infectious patient – Nov 2016 8. Hand hygiene – Nov 2016 9. IC operational policy – Jan 2017 10. Isolation policy – Nov 2016 11. Laundry – Sep 2016 12. D&V – May 2016 13. Notification of ID – Sep 2016 14. Rabies – Feb 2016 15. Surveillance of HCAI – Sep 2016 16. TB – May 2016DIPC and ICT Annual Report 2015-2016 Dr Alleyna Claxton, DIPC32 Decontamination  IPCT members to sit on and IPC team April 2016 – March 2017 To comply with National contribute expert advice to the regulations to reduce the Decontamination Monitoring risk of HCAI Group  Advise the Trust Lead for Decontamination on decontamination issues both at the regular Decontamination Monitoring Group meetings and on an ad hoc basis  Ensure compliance with CFPP for decontaminationCleanliness  IPCT members to sit on and IPCT team April 2016 – March 2017 To comply with national contribute expert advice to the standards for cleanliness to Cleanliness monitoring groups reduce the risk of HCAI to  IPCT to advise on national patients, visitors and staff monitoring standards Estates and building  IPCT to advise on new builds and IPCT team April 2016 – March 2017 To ensure the building and refurbishments to ensure IPC is estates management is considered inline national guidance to  IPCT to be involved in PPM as reduce the risk of HCAI necessary  IPCT to receive and advice on waters sampling results as necessaryAntimicrobial prescribing Audit To ensure that prescribing  Biannual point prevalence abx Antimicrobial April 2016 – March 2017 is in line with national policy compliance & stop/review pharmacist & guidance and best practice date audits – June 2016 & DIPC to reduce the risk of HCAI January 2017 and antimicrobial  IV abx 48h Stop/review date Antimicrobial resistance compliance audit - March 2017 & Pharmacist March 2017 & Nov 2017 Nov 2017 DIPC and ICT Annual Report 2015-2016 Dr Alleyna Claxton, DIPC33  ?Data validation for ESPAUR on total abx usage for inter-Trust TBC by DOH if required comparison data benchmarking  Quarterly ASAT report to identify gaps in antimicrobial stewardship programme  Daily report of restricted antimicrobials run by Pharmacy and any queries raised with teams /escalated to Microbiology when necessary. Education  Antimicrobial stewardship info in mandatory junior doctors ‘Infection prevention & Control’ induction lecture & annual docs update Antimicrobial April 16 – March 17 lecture - Pharmacist  Antimicrobial prescribing in “Safe prescribing & electronic prescribing” junior doctors induction lectures (incl. penicillin allergy awareness & stop/review dates)  European Antibiotic Awareness Day promotional work – November 2017  Antimicrobial stewardship for Pharmacists, lecture circa twice a year  Antimicrobial stewardship for GPs Reporting  E-prescribing: DIPC and ICT Annual Report 2015-2016 Dr Alleyna Claxton, DIPC34 The Trust Information reporting team is currently in the process of building the first automatic restricted antibiotic report, as per Antimicrobial Implementation date instructions from the antimicrobial pharmacist/ Head TBC. Dependent on pharmacist. of Information resources within  Quarterly Antimicrobial team Information team. Management Group – oversees antimicrobial stewardship activities & reports to ICC & Board of DIPC April 16 – March 17 Directors via DIPC quarterly reportsClinical practices Surgical management IPC team April 2016 – March 2017 To ensure that clinical  The One Together assessment practices are in line with and actions will be embedded in national guidance and best practice with full compliance and practice to reduce the risk evidence available from audit of HCAI Vascular access  A review of vascular access requirements with an action plan will be developed and completed ensuring correct IV access, products and training.New Services  Support services in generating, capturing and investing in service development and innovation ideas as an IPC link and process to ensure IPC involvement is establishedDIPC and ICT Annual Report 2015-2016 Dr Alleyna Claxton, DIPC35 7 HCAI Statistics: 2015-20167.1 Results of Mandatory Surveillance Reporting: 2015-20167.1.1 MRSA bacteraemias 2015-2016 For 2013-2014, the Department of Health moved from a numerical MRSA Objective target for all Trusts to a ‘zero tolerance’ approach to MRSA bacteraemias. For this Trust, the end of year total was 1 Trust-attributable case.7.1.1.1 Summary of HUH-attributable MRSA bacteraemias for FY 15/16:Date and place of Comments Learning outcomes from PIR specimen & Source April 15 Likely contaminant Reminder sent to all staff via IPC newsletter to start Lamb – not clinically significant. MRSA decolonisation protocol on previously known Patient previously known to be MRSA patients immediately on admission rather than Contaminant MRSA colonised. waiting for the results of the MRSA admission screen.7.1.1.2 Summary of Non- HUH-attributable MRSA bacteraemias for FY 15/16: There were zero non-Trust-attributable MRSA bacteraemia in 15/16.7.1.1.3 Graph of Trust-attributable MRSA bacteraemia cases from 2007- 2016DIPC and ICT Annual Report 2015-2016 Dr Alleyna Claxton, DIPC36  There are low numbers of MRSA bacteraemias over the past 5 years. Each case is fully investigated to ensure all ‘lessons learnt’ are implemented and the Trust continues to aim for ‘zero tolerance’ to preventable MRSA bacteraemias. However it must be recognised that not all MRSA bacteraemias are preventable or clinically significant. The single Trust-attributable MRSA bacteraemias in 15/16 was deemed to be a contaminant on PIR.7.1.1.4 MRSA bacteremia comparator data  From a benchmarking perspective, the Trust’s 15/16 MRSA bacteraemia rate of 0.78 per 100,000 occupied bed days is one of the lowest in North East North Central London (NENCL) and below the national average of 0.87 per 100,000 occupied bed days for England. However it should be noted that the hospitals in NENCL are a mix of tertiary referral centres, specialist hospitals and acute trusts and may not be directly comparable as their patient mix and risk profiles are not the same. Table of MRSA bacteraemia rates 15/16 for North East North Central London:Name MRSA bacteraemia rate 15/16 (per 100,000 occupied bed days) & [number of cases] Barking, Havering & Redbridge Hospitals NHS Trust 1.51 [5 cases] Barts Health NHS Trust 1.86 [12 cases] Great Ormond Street Hospital for Children 1.09 [1 case] Homerton University Hospital 0.78 [1 case] Moorfields Hospital 0.00 North Middlesex University Hospital 0.00 Royal Free London 0.93 [3 cases] Royal National Orthopaedic Hospital 0.00 The Whittington Hospital 0.99 [1 case] University College London Hospitals 0.79 [2 cases] NENCL Health Protection Team 1.20 England Total 0.87CDI ( Clostridium difficile infections) 2015-2016 The HUH national target for the financial year 15/16 was 7 hospital-attributable cases (defined as all C. difficile toxin positive stool sample from patients admitted to the Trust, except those collected during the first 3 days of admission) which was the lowest national target for any acute Trust. The ‘Monitor’ C.difficile target was 12 Homerton-attributable cases.  The end of year total was 10 Trust-attributable cases. Of these 10 cases, it has been agreed with Hackney CCG and the NELCSU Specialist Expert in Infection Prevention & Control that only 4 were due to a ‘lapse in care’ and there was no evidence of ‘lapse in care’ in the other 6 cases. A ‘lapse in care’ is defined as any issue identified on the post Infection Review (PIR) which could have contributed either to the patient’s acquisition of C.difficile infection during that episode of admission (e.g. inappropriate antibiotic use, evidence of cross-infection on C.difficile ribotyping) or any issue regarding their management which was non-compliant with the Trust’s policy for the DIPC and ICT Annual Report 2015-2016 Dr Alleyna Claxton, DIPC37 management of possible cases of C.difficile (e.g. significant delay in sending of stool sample for testing, significant delay in side room isolation). All 4 cases deemed to have ‘lapse in care’ issues were related to management issues and none to acquisition- related issues. This indicates that the Trust continues to maintain very low rates of CDI.7.1.1.5 Summary table of Trust-attributable CDI cases FY15/16:Date and place of Comments Learning outcomes from PIR specimen & age of patient (years) April 15 Delay in isolation: ECU staff reminded of ECU Patient not isolated until CDT result received (minor importance of isolating patients delay). with diarrhoea promptly on a Age: 88 symptomatic basis No ‘lapse in care’ issues identified.April 15 Delay in sending stool sample for CDT testing: ECU staff reminded of ECU Patient had diarrhoeal symptoms for 5 days before importance of sending stool sample sent for CDT testing. sample for CDT testing & Age: 87 isolating patients with Delay in isolation: diarrhoea promptly on a Patient not isolated until CDT result received (5 symptomatic basis days delay).‘Lapse of care’ issues as above.June 15 Delay in sending stool sample for CDT testing: ACU staff reminded of ECU importance of sending stool Stool sample for CDT testing requested on sample for CDT testing admission but not sent from ACU/received in Micro Age: 81 promptly on a symptomatic lab. Patient treated for CDT on a clinical basis on basis admission. Patient’s diarrhoeal symptoms relapsed and sample then sent for CDT testing. No ‘lapse in care’ issues identified.June 15 Delay in sending stool sample for CDT testing: GSU medical & nursing staff GSU Patient had diarrhoeal symptoms for 21 days before reminded that a CDT test sample sent for CDT testing. Diarrhoeal symptoms should be sent to exclude CDI Age: 74 were reported to medical staff by nursing staff but it as a cause of chronic was initially decided that symptoms were due to diarrhoea in all cases where incontinence secondary to reduced anal tone and there is no definite alternative an infective cause was not considered likely. explanation for the patient’s diarrhoea. Also reminded that Delay in isolation: patients with diarrhoeal Patient not isolated until ICN request for CDT symptoms should be isolated sampling and isolation after 21 days of symptoms. as per Trust policy until CDT result. ‘Lapse of care’ issues as above.July 15 No lapse of care issues identified. Nil Priestley Not likely to be a clinical case of CDI as diarrhoea was expected post patient’s abdominal surgery. Age: 54DIPC and ICT Annual Report 2015-2016 Dr Alleyna Claxton, DIPC38 Aug 15 Delay in sending stool sample for CDT testing: Medical & nursing teams Edith Cavell Patient’s stool samples sent for incorrect stool test reminded of importance of (M,C&S rather than CDT) on 2 occasions. Correct choosing correct test request & Age: 75 sample sent 7 days after onset of symptoms. prompt side room isolation of patient’s with diarrhoeal Delay in isolation: symptoms as per Trust policy. Patient not isolated until CDT result received.‘Lapse of care’ issues as above.Sep 15 Delay in sending stool sample for CDT testing: GSU staff & all doctors GSU Patient had diarrhoeal symptoms for 11 days before reminded of importance of sample sent for CDT testing and laxatives restarted sending stool sample for CDT Age: 85 when should have been withheld. testing & isolating patients with diarrhoea promptly on a Delay in isolation: symptomatic basis. Patient not isolated until 10 days after onset of diarrhoeal symptoms. Focus of Infection prevention Awareness week Oct 2015 on ‘Lapse of care’ issues as above. management of diarrhoea.Sep 15 Delay in sending stool sample for CDT testing: Medical & nursing teams ECU Patient’s stool samples sent for incorrect stool test reminded of importance of (M,C&S rather than CDT) on 1st occasion. 2nd choosing correct test request & Age: 84 sample sent for CDT testing 11 days later. However decision made for the Micro lab patient had constipation with overflow diarrhoea – to add CDT testing use of laxatives & timing of stopping laxatives and automatically to any M,C&S observation reasonable given clinical scenario. request for adult inpatientsNo lapse of care issues identified.Nov 15 No lapse of care issues identified. Nil ECUAge: 92 Dec 15 No lapse of care issues identified. Nil ECUAge: 907.1.1.6 Summary table of Non-attributable CDI cases FY15/16: There were 4 non-trust attributable CDI cases in 15/16. Of these 3 were in the first 3 days of admission to HUH as one outpatient sample. There were no samples from the local hospice or GP samples.Date & location of Comments specimen & age of patient (years) May 15 Recurrence of CDI. Previously repatriated to the Trust with CDI after 2 month Admitted +ve stay at neighbouring Trust.Age: 72 DIPC and ICT Annual Report 2015-2016 Dr Alleyna Claxton, DIPC39 Jun 15 Recent prior hospital admissions with antibiotic use (compliant with Trust Admitted +ve policy) & use of prophylactic antibiotics by GP in community.Age: 85 Sep 15 Doubtful clinical significance. Outpatient sampleAge: 69 Oct 15 OPAT patient on ertapenem for ESBL+ve E.coli pyelonephritis. Admitted +veAge: 277.1.1.7 Graph of Trust-attributable C.difficile cases from 2006-16  In response to a national sharp increase in the number of C.difficile infection cases (partially due to the introduction of the type 027 strain of C.difficile), in 2005-6, the Trust initiated a C.difficile risk reduction strategy including strict isolation of patients with diarrhoea, environmental cleaning and a restrictive antibiotic policy. This has led to the number of CDI cases falling year on year to a sustained low level since 2010-11.7.1.1.8 Clostridium difficile comparator data From a benchmarking perspective, the Trust’s 15/16 Clostridium difficile rate of 7.85 per 100,000 occupied bed days remains one of the lowest in North East North Central London (NENCL) and below the national average of 14.94 per 100,000 occupied bed days for England. Homerton’s low Clostridium difficile target (which is the lowest for any non-specialist Trust in the sector) reflects the fact that the target is calculated as a year-on-year percentage decrease and that the Trust has had sustained low Clostridium difficile rates over the past few years. It should be noted that the hospitals DIPC and ICT Annual Report 2015-2016 Dr Alleyna Claxton, DIPC40 in NENCL are a mix of tertiary referral centres, specialist hospitals and acute trusts and may not be directly comparable as their patient mix and risk profiles are not the same. Table of Clostridium difficile rates 15/16 for North East North Central London:Name Clostridium difficile Clostridium difficile rate 15/16 target 15/16 (per 100,000 occupied bed days) (per 100,000 occupied & [number of cases] bed days) & [number of cases] Barking, Havering & Redbridge 8.62 [30 cases] 11.47 [38 cases] Hospitals NHS Trust Barts Health NHS Trust 13.01 [82 cases] 10.39 [67 cases] Great Ormond Street Hospital 13.78 [15 cases] 7.63 [7 cases] for Children Homerton University Hospital 5.55 [7 cases] 7.85 [10 cases] Moorfields Hospital 0.00 [0 cases] 0.00 [0 cases] North Middlesex University 25.80 [34 cases] 22.17 [37 cases] Hospital Royal Free London 41.95 [66 cases] 21.00 [68 cases] Royal National Orthopaedic 3.82 [2 cases] 4.54 [2 cases] Hospital The Whittington Hospital 17.34 [17 cases] 6.92 [7 cases] University College London 36.39 [97 cases] 35.39 [90 cases] Hospitals NENCL Health Protection Team 18.22 15.71 England Total 13.55 14.94MSSA Bacteraemia 2015-16Mandatory surveillance of MSSA bacteraemia started in January 2011. No objective has been set. In 15/16 there was a total of 36 MSSA bacteraemias of which 12 were HA (post- 48h) and 24 were non-HA (pre-48h). The source of each post 48h bacteraemia is investigated by the IPCT and any concerns e.g. IV line-related are datixed and any remedial factors identified are addressed. There were only 3 post-48h MSSA bacteraemias thought to be IV line-related on investigation in 15/16.7.1.1.9 Summary of MSSA bacteraemia cases for 2015-2016Apr-15 Total 1 (1 admitted +ve) Source A&E- 1 admitted +ve Bone & jointMay-15 Total 3 (3 admitted +ve) Source ACU - 2 admitted +ve Bone & joint, contaminant ECU - 1 admitted +ve UnknownDIPC and ICT Annual Report 2015-2016 Dr Alleyna Claxton, DIPC41 Jun-15 Total 3 (3 admitted +ve) Source ACU - 1 admitted +ve Skin & soft tissue A&E - 1 admitted +ve Bone & joint Lamb - 1 admitted +ve Respiratory Jul-15 Total 1 (1 admitted +ve) Source A&E - 1 admitted +ve Unknown Total 3 (2 admitted+ve & 1 Aug-15 Source HA) ITU- 1 admitted +ve Respiratory ECU- 1 admitted +ve Unknown ACU- 1 HA Skin/soft tissue Total 2 (1 admitted+ve & 1 Sep-15 Source HA) Graham- 1 admitted +ve Skin/soft tissue Lamb- 1 HA Contaminant Total 3 (1 admitted+ve & 2 Oct-15 Source HA) Defoe- 1 admitted +ve Skin/soft tissueNICU- 2 HA IV line Total 5 (3 admitted+ve & 2 Nov-15 Source HA) Defoe- 1 admitted +ve Skin/soft tissue ITU- 1 admitted +ve Unknown Lloyd - 1 HA Unknown Cardiology - 1 HA, 1 admitted +ve Unknown, urinary Dec-15 Total 1 (1 admitted +ve) Source A&E - 1 admitted +ve Unknown Jan-16 Total 0 Source nil Feb-16 Total 3 (2 admitted+ve & 1 HA) Source SCBU - 1 HA unknown A&E - 1 admitted +ve unknown ACU - 1 admitted +ve cholecystitis Mar-16 Total 6 (3 admitted+ve & 3 HA) Source A&E - 1 admitted +ve chest infection ACU - 2 admitted +ve unknown Cardiology - 1 HA unknown Thomas Audley - 1 HA IV line NICU- 1 HA unknownDIPC and ICT Annual Report 2015-2016 Dr Alleyna Claxton, DIPC42 7.1.1.10 Graph of MSSA bacteraemias cases 2015-2016E.coli Bacteraemia 2015 - 2016Mandatory surveillance of E. coli bacteraemias started in June 2011. No objective has been set. There was a total of 138 cases of which 116 were HA (post 48h) and 22 were non-HA (pre-48h). The source of each post 48h bacteraemia is investigated by the IPCT and any concerns are presented to the ICC in the IPCT quarterly report and any remedial factors identified are addressed. There were no post 48h E. coli bacteraemias where investigation of the source caused any concerns in 15/16.7.1.1.11 Summary of E.coli bacteraemia cases for 2015-2016April = 2015 Total - 6 (1 HA +ve & 5 admitted +ve) Source Templar - 1 admitted +ve UTI A&E - 1 admitted +ve Respiratory tract ECU - 1 HA, 1 admitted +ve UTI ACU - 1 admitted +ve UTI Defoe - 1 admitted +ve UTI May=2015 Total - 15 (4 HA & 11 admitted +ve) Source Lloyd - 1 admitted +ve UTI A&E - 4 admitted +ve UTI ECU - 2 admitted +ve UTI, respiratory Cardiology - 1 admitted +ve UTI SCBU - 1 HA UnknownDIPC and ICT Annual Report 2015-2016 Dr Alleyna Claxton, DIPC43 ITU - 1 admitted +ve Gastro-intestinal Lamb - 1 HA, 1 admitted +ve Unknown Edith Cavell - 1 HA Unknown Templar - 1 HA, 1 admitted +ve Chorioamnionitis, UTI Jun-15 Total 6 (6 admitted +ve) Source A&E - 2 admitted +ve UTI, unknown ACU - 2 admitted +ve UTI, genital tract Lamb - 1 admitted +ve UTI Starlight - 1 admitted +ve UTI Jul-15 Total 16 (14 admitted +ve and 2 HA) ECU - 5 admitted +ve, 1 HA 4 urinary, 1 cellulitis, 1 unknown ACU - 4 admitted +ve 3 urinary, 1 gastro-intestinal Edith Cavell - 1 admitted +ve Gastro-intestinal Thomas Audley - 2 admitted +ve 1 skin & soft tissue, 1 hepatobiliary A&E - 2 admitted +ve 2 urinary Lamb - 1 HA Skin & soft tissue Aug-15 Total 12 (11 admitted +ve and 1 HA) ECU- 2 admitted +ve, 1 HA 1 respiratory, 1 urinary, 1 skin/soft tissue A&E- 1asmitted +ve Urinary Priestley- 1 admitted +ve Urinary ACU- 2 admitted +ve 2 Skin/soft tissue Lamb- 1 admitted +ve Unknown E. Cavell- 1 admitted+ve Urinary Templar- 1 admitted +ve Chorioamnionitis CEA- 1 admitted+ve Urinary OMU- 1 admitted +ve Pyelonephritis Sep-15 Total 18 (15 admitted +ve and 3 HA) ECU- 3 admitted +ve 3 urinary A&E- 3 admitted +ve 2 Urinary, 1 hepatobiliary ACU- 5 admitted +ve 4 urinary, 1 cholecystitis Cardiology- 1 HA hepatobiliary T Audley- 1 HA Skin & soft tissue Lamb- 1 admitted +ve Urinary Lloyd- 3 admitted+ve Urinary, skin and soft tissue, GU tract SCBU- 1 HA unknown Oct-15 Total 12 (11 admitted +ve and 1 HA) ECU- 1 admitted +ve, 1 HA urinary A&E- 1 admitted +ve urinary ACU- 2 admitted +ve urinary Priestley - 1 admitted Biliary Lamb- 3 admitted +ve Urinary Lloyd- 2 admitted+ve Urinary DIPC and ICT Annual Report 2015-2016 Dr Alleyna Claxton, DIPC44 ITU - 1 admitted +ve urinary Nov-15 Total 7 (6 admitted +ve and 1 HA) A&E - 1 admitted +ve urinary Lamb - 2 admitted +ve, 1 HA respiratory, hepatobiliary, urinary Lloyd - 1 admitted +ve urinary Starlight - 1 admitted +ve urinary Edith Cavell - 1 admitted +ve urinary Dec-15 Total 13 (10 admitted +ve and 3 HA) Lamb - 4 admitted +ve 2 urinary, 2 hepatobiliary ACU - 2 admitted +ve urine ECU - 1 admitted +ve urine Templar - 1 HA, 1 admitted +ve urine/GI RNRU - 1 HA urine Graham - 1 HA urine Lloyd - 1 admitted +ve unknown Jan-16 Total 10 (8 admitted +ve and 2 HA) Source Templar - 1 HA, 1 admitted +ve urine Lamb - 2 admitted +ve urine ACU - 3 admitted +ve hepatobiliary, respiratory, unknown ITU - 1 admitted +ve hepatobiliary Defoe - 1 admitted +ve respiratory SCBU - 1 HA unknown Feb-16 Total 8 (6 admitted +ve and 2 HA) Source A&E - 2 admitted +ve urine, GI Lamb - 1 admitted +ve, 2 HA 2 unknown, urine ACU - 1 admitted +ve hepatobiliary Priestley - 1 admitted +ve abdominal ECU - 1 admitted +ve urine Mar-16 Total 15 (13 admitted +ve and 2 HA) Source A&E - 4 admitted +ve 2 urine, unknown, hepatobiliary Defoe - 3 admitted +ve urine ACU - 1 admitted +ve urine Templar - 1 admitted +ve unknown ECU - 1 admitted +ve urine Graham - 1 HA urine Cardiology - 1 HA urine Thomas Audley - 1 admitted +ve joint Starlight - 1 admitted +ve urine NICU - 1 admitted +ve unknownDIPC and ICT Annual Report 2015-2016 Dr Alleyna Claxton, DIPC45 7.1.1.12 Graph of E.coli bacteraemias 2015-2016 Resistance rates in E.coli bacteraemias are discussed in section 8.3 below.GRE Bacteraemias 2015-2016 Although the reporting of Glycopeptide Resistant Enterococci (GRE) bacteraemias is mandatory, currently there are no targets set.  GRE bacteraemias are usually an HCAI issue for tertiary referral centres with large renal or oncology units and are unusual in the acute hospital setting.  In 2015-2016 the Trust had 1 GRE bacteraemia case.Orthopaedic surgical site infections (SSI) 2015-2016 Surgical Site Infection (SSI) data is collected on Total Hip Replacements (THR) and Total Knee Replacements (TKR) as part of the national SSI Surveillance programme. The summary data, with national comparisons, is available c. 6 months after the time period for which the data is collected. Therefore the latest available benchmarked data is for Oct-Dec 2015.  From April 2014 the Trust also initiated ‘real time’ Trust level data collection as part of an augmented, ‘proactive’ surveillance programme alongside a formalised process for RCA reviews of all cases and dedicated Microbiology Consultant support for all Bone & Joint infection cases.  In response to an increased number of cases of TKR SSIs resulting in the Trust receiving ‘SSI outlier status’ letters for TKRs from the SSI surveillance programme, the Senior Epidemiologist from the Department of Healthcare Associated Infections & Antimicrobial Resistance was invited to present her analysis of the Jan 2012- March 2014 Trust’s Orthopaedic SSI data by the DIPC. No direct issues were identified on DIPC and ICT Annual Report 2015-2016 Dr Alleyna Claxton, DIPC46 statistical analysis but it was recommended that the ‘underlying processes’ were reviewed.  In 14/15 an orthopaedic SSI action plan was agreed. This consisted of the following actions: o Pre-operative - patient information on pre-operative showering; review of maintenance of peri-operative normothermia practices o Intra-operative – review of laminar flow ventilation in theatres (satisfactory on review); review of skin closure technique; review of timing of orthopaedic drain removal; change of orthopaedic surgical antibiotic prophylaxis and reminder on timing of prophylaxis. o Post-operative – surgical wound management teaching session programme; review of choice of anticoagulants In 15/16, the work plan around surgical practices has been completed alongside an internal assessment of practices and development of standards. This was based on a collaborative piece of work and development of a tool called ‘One Together’. The work the Trust has done around this has been presented externally.  The Trust was also invited to submit a short summary on the work around reducing orthopaedic SSI rates for the Surgical Site Infection Surveillance Service Annual Report 14/15.  In the Autumn of 2015, the Trust also introduced a ‘ring-fenced’ bay for orthopaedic patients on each of the two surgical wards.  In 2015, the Senior Epidemiologist from the Department of Healthcare Associated Infections & Antimicrobial Resistance was asked to review the March 2014-March 2015 Trust SSI data to analyse whether there was statistical evidence of the changes implemented in 14/15 improving 'underlying processes’. Her analysis of the data showed that the Trust was no longer an outlier for TKR SSIs from the 14/15 data (calendar year).  In the first 3 quarters of 15/16 (financial year), there were no TKR or THR SSIs. The last previous reported TKR SSI was related to an operation performed in March 2015. In the 4th quarter of 15/16 there has been 1 superficial TKR SSI and 1 deep THR SSI reported from operations performed in Jan 16 (local data not yet benchmarked). RCA reports are currently underway for these 2 cases.7.1.1.13 Total Hip Replacement summary data  Benchmarked summary data for THRs is available until Oct-Dec 2015. There were no THR SSIs in Jan 15 – Dec 15 (benchmarked data) and 1 THR in Jan-Mar 16 (local data) compared with 3 THR SSIs in 2014 and 2 in 2013.  On comparison of the Trust data with ‘all other hospitals’ for the last 4 quarters, the Trust is not classed as an outlier with regards to THR SSIs.  Given the Trust performs a relatively small number of procedures the statistical interpretation of quarterly data is difficult. On review of the data for the previous 5 years, which PHE regard as most representative of the SSI rate, the Trust THR SSI rate is 2.5% compared with an ‘all other hospitals’ rate of 1.1%. This is an improvement from the previous ‘5 year rate’ of 3.3%. Both the decrease in rate and numbers of cases of THR SSIs show that the SSI action plan of 14/15 has decreased the THR SSI risk.DIPC and ICT Annual Report 2015-2016 Dr Alleyna Claxton, DIPC47  Graphs of numbers and rates of THR SSI from July 2013 – Dec 2015:7.1.1.14 Total Knee Replacement (TKR) summary data Benchmarked summary data is available until Oct-Dec 2014 for TKRs. There were no TKR SSIs in Jan 15 – Dec 15 (benchmarked data) and 1 TKR in Jan-Mar 16 (local data) compared with 2014 (4 cases) in comparison with 2013 (9 cases).  Given the Trust performs a relatively small number of procedures the statistical interpretation of quarterly data is difficult. On review of the data for the previous 5 years, which PHE regard as most representative of the SSI rate, the Trust TKR SSI rate is 2.9% compared with an ‘all other hospitals’ rate of 1.6%. This is an improvement from the previous ‘5 year rate’ of 3.1%. Both the decrease in rate and numbers of cases of TKR SSIs show that the SSI action plan of 14/15 has decreased the TKR SSI risk. DIPC and ICT Annual Report 2015-2016 Dr Alleyna Claxton, DIPC48  The Trust is therefore still currently classed as an outlier with regards to TKR SSIs but the TKR rate continues to decrease with each quarter. However this is expected despite the significant decrease in numbers of orthopaedic SSIs in 15/16 as the results for the Trust ‘outlier status’ letters are based on the previous 4 quarter’s results due to small numbers in the denominator data.  Graph of numbers of cases and rates of TKR SSI from July 2013 – Dec 2015:DIPC and ICT Annual Report 2015-2016 Dr Alleyna Claxton, DIPC49 7.2 Incidents and outbreaks (non-MRSA bacteraemia or CDI) 2015-2016 In 2015-2016 the following other incidents, outbreaks and SIs were managed by the IPCT in liaison with the relevant ward-based and other teams:Month Incident April 15 CPE on Thomas Audley Ward April 15 Shingles on Cardiology ward June 15 Chickenpox in Antenatal clinic July 15 Measles in A&E Aug 15 TB on ACU Aug 15 Pertussis (whooping cough) on Starlight Sep 15 Chicken pox on Priestley Sep 15 CPE on ACU & ECU Nov 15 TB on ACU & Edith Cavell Nov/Dec 15 RSV on NICU Mar 16 Measles in CEA Mar 16 PVL +ve Staph aureus bacteraemia on Thomas Audley Mar 16 TB on Lamb Further details of all incidents, outbreaks and serious incidents are documented in the Infection Prevention & Control Team’s Quarterly Reports to the ICC 2015-2016 which are available on request.8 Antimicrobial Stewardship 2015-20168.1 Antimicrobial Management Group The Antimicrobial Management Group (AMG), which meets on a quarterly basis, was formed in March 2013 and initially chaired by Dr John Coakley (the then Medical Director) and subsequently chaired by Dr Alleyna Claxton (DIPC). The membership includes Consultant representatives from all adult service disciplines, the Antimicrobial Lead Pharmacist and the Nurse Consultant for medicines Management. The AMG reports to the ICC and to the Board of Directors via the DIPC quarterly reports.  The overall aims and objectives of the Antimicrobial Management Group (AMG) are to follow the recommended key roles in the Department of Health (DoH) guidance ‘Antimicrobial Stewardship: “Start Smart – Then Focus” (SSTF) to: Ensure that evidence-based local antimicrobial guidelines are in place and reviewed regularly  Ensure regular auditing of the guidelines, antimicrobial stewardship practice and quality assurance measures  Formally report a regular review of the organisation’s retrospective antibiotic consumption data (especially highlighting the uses of broad-spectrum antibiotics such as cephalosporins, quinolones and carbapenems)DIPC and ICT Annual Report 2015-2016 Dr Alleyna Claxton, DIPC50  Identify actions to address: non-compliance with local guidelines; general antimicrobial stewardship issues; and other prescribing issues  Endorse the use of new antimicrobials for use at HUH The Antimicrobial Management Group (AMG) met quarterly in 15/16 and there was Consultant representation from all adult service disciplines. As part of the guidelines on ‘Surviving Sepsis’, Dr Manab Mohanty, the Trust’s Sepsis Lead also joined the group.  The DIPC and antimicrobial pharmacist produced a Trust antimicrobial stewardship annual plan for 16/17 which was approved by the AMG to formally capture the ongoing antimicrobial stewardship work performed at the Trust.  The DIPC and antimicrobial pharmacist were requested to produce a post-AMG quarterly AMG newsletter highlighting issues of importance regarding antimicrobial stewardship raised at the previous AMG meeting.  The DIPC completed the IPC and antimicrobial stewardship induction and annual update e-learning module for the Trust in order to facilitate completion of this mandatory training.  In November 2015, as part of the Trust’s antimicrobial stewardship CQUIN, the antimicrobial pharmacist carried out a baseline ‘48h review of intravenous antibiotics’ audit. This audit demonstrated that there was evidence of review in the patient’s notes in all cases but not on the electronic drug chart. The need for this decision to be documented on the electronic drug chart will be highlighted at future prescribing education sessions.  A surgical antibiotic prophylaxis audit was carried out by the Anaesthetists reviewing the use of peri-operative antibiotic prophylaxis in arthroplasty patients from July-Oct 2015. This audit highlighted that there was a lack of clarity as to which speciality was responsible for writing up peri-operative antibiotic prophylaxis. As a result of this audit, it was decided between the Anaesthetists and the Surgeons, that in future the Anaesthetists would be responsible for writing up all doses of peri-operative antibiotic prophylaxis. A re-audit is underway to assess this change in practice.  Version 4 of the Trust Microguide® antimicrobial policy (available as a smartphone app & website) was released in 15/16 with new ENT & podiatry surgical prophylaxis, OPAT and IV to oral switch sections and minor updates to several other sections: http://microguide.horizonsp.co.uk/viewer/huh/adult  The ‘English Surveillance programme for antimicrobial utilisation and resistance (ESPAUR) 2010 to 2014’ report to which the Trust contributed its data, was published in November 2015: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/477962/ES PAUR_Report_2015.pdf  A new PHE fingertips website on Antimicrobial Resistance (AMR) and HCAIs has been launched: http://fingertips.phe.org.uk/profile/amr-local-indicatorsDIPC and ICT Annual Report 2015-2016 Dr Alleyna Claxton, DIPC51 8.2 Antibiotic prescribing compliance audits 2015-2016The antibiotic pharmacist monitors antimicrobial prescribing practice in order to ensure safe and appropriate prescribing of antimicrobials by:- Daily liaison with the Microbiology/IPCT teams - Interaction with other pharmacists and prescribers to enhance prudent antibiotic prescribing - Compiling evidence-based responses to antibiotic queries - Updating of each new edition of the Trust electronic Antibiotics policy (available on intranet and as smartphone app) in liaison with the Trust’s Antibiotic Lead Microbiologist (Dr Claxton, who is also the DIPC) - Carrying out the Antibiotic Policy Compliance Audit The results of the quarterly audits up to December 2010 and now bi-annual antibiotic compliance (defined as correct choice, route, dose and duration not exceeding HUH policy recommendation) audits including the June 15 & February 16 audits are detailed in the table below. These audits are discussed at the AMG and submitted to the ICC:Audit Audit Audit Audit Audit Audit Audit Audit Audit Audit Audit Audit Feb 16 Jan Jul Dec Jun Dec Jun 15 Jan 15 Jul 14 Jan 14 Jul 13 Sep 10 13 12 11 11 10 Total patients 299 318 339 331 310 268 311 317 288 234 138 113Patients on 95 91 86 73 99 61 100 77 86 87 45 31 antibiotics (32%) (29%) (25%) (22%) (32%) (23%) 32% 25% 30% 37% (33%) (32%) Compliance: Compliant 89.5% 86.00% 89.40% 91% 78.60% 88% 84% 86% 79% 92% 82% 79%Non- 9.0% 11.00% 5.30% 5.40% 10.70% 4.7% 10% 13% 15% 8% 12% 12% compliant Off-policy 1.5% 3% 5.30% 3.60% 10.70% 7% 6% 1% 6% 3% 6% 9% Indication 100% 100% 100% 99% 96.40% 95.30% 97% 98% 97% 97% 97% 93% Indication on drug chart 98.5% 96.00% 94% 86.60% 70.90% 88.40% 94% 85% 70% Stop/Review 100%* 83.00% 80% 82.10% 71.40% 80.20% 72% 77% 68% N/A 62% 46.50%Compliant & all documentation 65% 76% 68% 63.40% 46.10% 65% 60% updated A new category was introduced in to the antibiotic audit summary in 2013-2014 to look at overall compliance with both documentation and the antibiotic policy. For example, the Jan 15 audit shows 89.4% compliance with the Trust antibiotic policy if we define compliance DIPC and ICT Annual Report 2015-2016 Dr Alleyna Claxton, DIPC52 as, correct choice, route, dose and duration, but the overall compliance falls to 68% when we add the requirement of appropriate documentation on the drug chart (written indication and stop/review timeframe).  A high and stable rate of compliance with the antibiotic policy in terms of choice of antibiotic etc. continues in 15/16 with a rate of 86% in June 15 and 89.5% in February 16.  The move to electronic prescribing in Summer 2015 as part of the ACE EPR project has addressed the documentational issues of the stop/review dates identified in previous audits.8.3 Antimicrobial resistance patterns 2015-2016 There have been no new local antimicrobial resistance issues identified by the Microbiology laboratory in 2015-2016. 8.3.1 Carbapenemase Producing Enterobacteriaceae (CPE): o There have been several clusters of cases of Carbapenemase Producing Enterobacteriaceae (CPE) in the London region which are widely viewed to be the major antimicrobial resistance threat in the coming decade. o There have been no CPE clusters at this Trust to date although 3 cases of colonisation/infection with Carbapenemase producing bacteria have been identified. In 2 cases, the patients were transfers from other Trusts in London & 1 patient had a recent healthcare admission overseas in India. o No CPE bacteraemias were identified at the Trust in 15/16.8.3.2 ESBL +ve E.coli bacteraemias: o Extended Spectrum β-Lactamase positive (ESBL +ve) E.coli are an increasingly common type of multiply antibiotic resistant E.coli which are resistant to many antibiotics including cephalosporins and piperacillin-tazobactam and therefore drive the use of carbapenems. o Extended spectrum β- lactamase (ESBL) - producing E.coli accounted for 7.5% (8 of 107) of E.coli bacteraemias in 2012-13; 7% (10 of 144) of E.coli bacteraemias in 2013-14 and 5% in 2014-15 (6 of 121) and 6.5% (9 of 138) in 2015-16. Therefore the ESBL + ve E.coli bacteraemia rate at this Trust is currently stable.DIPC and ICT Annual Report 2015-2016 Dr Alleyna Claxton, DIPC53 o Graph of total number of cases of E.coli bacteraemia (E.coli-B) and number of ESBL + ve E.coli bacteraemias from 2012-2016:8.3.3 MRSA bacteraemias MRSA bacteraemia cases (all i.e. both Trust-attributable and non-attributable) accounted for only 2.7% (1 of 37) of all Staph aureus bacteraemias in 15/16. This is the lowest number of MRSA bacteraemias since 2008. Graph of all Staph aureus bacteramias compared with MRSA bacteraemias from 2008-2016:DIPC and ICT Annual Report 2015-2016 Dr Alleyna Claxton, DIPC54 9 IPC audit programme 2015 -20169.1 IPC audit programme overview  The IPC audit programme for 2015-2016 is detailed below:Audit title/ Reason for Lead Forum for Date for Description of completion presenting / sign Completion Quality off Improvement recommendations Project Incident/patient Infection Infection control September IV line (including Safety prevention committee 2015 – peripheral and Complaint/Patient and control complete. central) Point Experience team (Gema Report Prevalence - Acute Service Evaluation and Vickie) completed site Other-Epic 3 and disseminated. 3 actions completed. Sharps audit - Trust NHSLA Infection Infection control July 2015 – wide Incident/patient control committee completed. Safety team Full report /Daniels disseminated Company (Monique and Martha) HII validation audits Patient Infection Infection control April 2015- safety/Patient prevention committee/trust completed experience and control board To be replaced team with 5:5 audits (Gema, first Monique completed in and Martha) November and February– report sent out. Isolation Facility Incident/patient Infection Infection control September Audit – Acute site Safety prevention committee 2015 – Complaint/Patient and control completed. Experience team Full report (Vickie) disseminated. March 2016DIPC and ICT Annual Report 2015-2016 Dr Alleyna Claxton, DIPC55 Audit title/ Reason for Lead Forum for Date for Description of completion presenting / sign Completion Quality off Improvement recommendations Project Urinary Catheter Incident/patient Infection Infection control November Point Prevalence Safety prevention committee 2015 – Complaint/Patient and control cancelled. Experience team Other-Epic 3 (Monique and Martha)9.2 Departmental/ward IPC audits 2015-2016 The Infection Control Nurse-led Infection Prevention and Control (IPC) audits were completed for all high & medium risk areas and all action points were followed up. Due to low staffing levels in the IPCT, audits were not performed in 15/16 for some low risk sites. This issue was highlighted and minuted at the ICC. The IPCT is now fully staffed and these sites will be prioritised for audits in 16/17. Please see the IPC BSC (appendix 1) for further details.9.3 High Impact Intervention audits  A summary of the High Impact Interventions (HII) and hand hygiene monitoring Trustwide results for 2013-2016 is detailed in the graph below: The wards and departments collecting their HII data monthly via the Infection Prevention Audit System. Detailed results for each ward and intervention are sent to wards and departments and are available on the intranet or directly DIPC and ICT Annual Report 2015-2016 Dr Alleyna Claxton, DIPC56 from IPAS. The ICNs liaise with the wards and departments to offer support for remedial actions for any below target results. For division results see the IPC balanced score card (Appendix 1).  MRSA screening data is collected by the information team using EPR and Winpath data and matching MRSA screens to patients. The report includes universal emergency admissions and elective admission as per Trust policy. The report is produced every month and made available for each Division. 9.4 5:5 HII validation audits 2015-2016 The 5:5 audit looks at 5 elements of infection prevention and control on 5 patients. The elements can be changed as required to address current practice or concerns. This can be done on a reactive basis or as part of a rolling programme. Some of the elements are covered by local monitoring of high impact interventions and other data collection. The 5:5 audit allows for a form of validation to be performed using a different approach and method of data collection to high impact intervention monitoring which is locally performed and owned. The first 5:5 audit data collection started in November 2015 with a planned trial period of 6 months to assess if data collected is useful. The elements to be covered will be:  MRSA screening  Multi-resistant gram negative screening  IV device management  Urinary catheter management  Bowel management  The data was collected using a set of questions based on the above elements. The data collection was done by the infection prevention and control nurses during February. All adult in-patient wards were included. The source of data was patients on the wards and the Electronic Patient Records. The data was collected from patients in one of the side rooms and the first bed in each bay to ensure a consistent approach and no bias on patient inclusion.  The local results are available in the tables below. In most cases the documentation of the insertion of IV lines and urinary catheters has improved. Trust wide there were 18 patients with an IV line and of these 77% had insertion details documented on EPR. On-going care of IV lines was documented in 77% of cases. Trust wide there were 7 patients with a urinary catheter and of these 57% had insertion details documented on EPR. Continued indication documentation was completed in 71%. There were 6 patients with diarrhoea and of these, five had been managed correctly and isolation and specimen sent according to Trust policy and the one did not:DIPC and ICT Annual Report 2015-2016 Dr Alleyna Claxton, DIPC57 November 2015 results February 2016 results Patients with IV lines – 23 Patients with IV lines – 18 Insertion details documented – 57% Insertion details documented – 77% Ongoing care (cont. indication, VIP score) Ongoing care (cont. indication, VIP score) documented – 87% documented – 77% Patients with urinary catheter – 11 Patients with urinary catheter – 7 Insertion details documented – 36% Insertion details documented – 57% Ongoing care documented (cont. indication) Ongoing care documented (cont. indication) – 64% – 71%Patients with diarrhoea – 2 Patients with diarrhoea – 6 Patient managed correctly – (1) 50% Patient managed correctly – (5) 83%9.5 Blood Culture Contamination audits: 2015-2016 In 2010 the Trust introduced a specific pack for blood culture collection, a training programme and training film available on the Trust intranet and YouTube. The blood culture contamination rate is monitored as an indicator for blood culture taking practice due to the difficulty of monitoring through observation of practice. The presence of coagulase negative staphylococci or diphtheroids is used as evidence of contamination.  In Jan-March 2010 8.2% of blood cultures were contaminated using the above definition and in 15/16 the contamination rate has stayed below 4% indicating that good practice in blood culture collection continues.9.6 Patient isolation audit 2015-2016 No issues of concern were identified in the patient isolation audit in September 2015.DIPC and ICT Annual Report 2015-2016 Dr Alleyna Claxton, DIPC58 9.7 IV line audit 2015-2016 The IV line point prevalence audit was performed in September 2015. On the day of the audit there were a total of 356 beds included in 12 clinical areas. There were 327 patients reviewed. There were a total of 110 (34%) patients with a peripheral cannula on the day of the audit. These included 48 males and 62 females. The age range was 16 to 95 years of age. There were 6 (1.8%) patients with central lines (3 PICC lines and 3 non- tunnelled CVCs which were on ITU).From the audit findings it was recommended that:  An awareness plan and programme is put in place for the results of the audit across the organisation. To include documentation of insertion, daily observation and review of continued indication. Extra training is arranged for all clinical staff on the use of the Vygon® Bionnector The current IV packs used by the Homerton include obsolete documentation stickers. A Survey Monkey was performed by the infection Prevention and Control team looking at elements staff thought were needed inside an IV cannula pack. It is recommended the IV cannula pack is changed for a different and more appropriate one. BD Posi-flushes to be available in the wards. Ward managers to be highlighted of the importance of increasing their stock levels if needed and to create a designated area within the treatment room for the flushes.These recommendations have subsequently been actioned.10 IPC education programme 2015 -201610.1 Induction Training All staff attended the Trust induction. Infection Prevention & Control is also part of junior medical staff induction arranged by medical staffing on a monthly basis and in 2015/2016 the DIPC write an e-learning module for this induction/annual update lecture to improve ease of access.10.2 Annual Update Training Infection prevention and control is included in the Trust Mandatory Training policy and all clinical staff are required to attend annual update.  In June 2012 a Statutory and Mandatory Training booklet which included a section on Infection Prevention & Control was sent out to all staff as a level 1 update.  In 15/16 e-learning modules were developed by the DIPC & ICNC for level 2 IPC training for induction & annual update for the medical and other Trust staff.  By the end of the 14/15 financial year, 91.5% of staff had received an IPC level 1 annual update. DIPC and ICT Annual Report 2015-2016 Dr Alleyna Claxton, DIPC59 10.3 IPCT and DIPC training activities & presentations 2015-2016 Infection Control Nurse Consultant: The ICNC is a member of the Infection Prevention Society, Education and Professional Development Committee.Attended:  Turning high-performing individuals into a high-performing team (2 hours) Tavistock Consulting, London. 17th April 2015  Working with staff in conflict (2 hours) Tavistock Consulting, London. 28th April 2015  Theatres Safety Culture. NHS Quest (1 day) Salford NHS Foundation Trust. 18th June 2015. (presented)  GovToday Reducing HCAI Conference. (1 day) Mermaid Centre London. 30th June 2015.  IPS Conference. Liverpool. 28th September -30th September 2015. (3 day) 2016  Infection Prevention & Control. Sharing knowledge improving care. (1 day) 23rd February 2016. London  One Together Expert Conference, (1 day)28th April 2016, Think Tank, Birmingham Science Museum. (presented)  One Together surgical site infection workshop, IPS & AFPP joint one day conference, (1 day) 24th May 2016, Kempton Park race course, Sunbury on Thames (presented)Presented:  A Programme of Reviewing and Standardising Theatre Practices to reduce the risk of Surgical Site Infection to patients - making sure it happens for all patients every time! NHS Quest - Theatre Safety Culture Clinical Community, 18th June 2015, Salford NHS Foundation Trust Hospital.  Making sure it happens for all patients every time! A Programme of Reviewing and Standardising Theatre Practices to reduce the risk of Surgical Site Infection to patients - One Together Expert Conference, 28th April 2016, Think Tank, Birmingham Science Museum.  Making sure it happens for all patients every time! A Programme of Reviewing and Standardising Theatre Practices to reduce the risk of Surgical Site Infection to patients - One Together surgical site infection workshop, IPS & AFPP joint one day conference, 24th May 2016, Kempton Park race course, Sunbury on Thames. ICNs have attended: IPS Joint Branches professional development days. London. April 2015.  IPS Conference. Liverpool. 28th September -30th September 2015. (3 day) 2016DIPC and ICT Annual Report 2015-2016 Dr Alleyna Claxton, DIPC60  ICD/DIPC attended the following conferences: IPC conference: Reducing HCAIs – combating pervasive threats. London. June 2015.  Prevention of Group B Strep infection in neonates: The way forward in the UK. London. November 2015.  IPC 2016 conference. London. February 2016.  BSAC meeting: Carbapenemase-producing Gram-negative Micro-organisms – where are we now? Challenges in prevention, diagnosis, detection and therapy. London. June 2016. The ICD/DIPC has also: o Chaired the London-wide quarterly DIPC forum o Been a guest lecturer at Barts and the London School of Medicine and Dentistry, Queen Mary, University of London. o Been a member of the Royal College of Pathologists MCQ writing group for the Combined Infection Certificate examination (CICE)11 Cleaning Services IPC arrangements 2015-2016 In 15/16 the Trust changed its cleaning services provider for the Hospital acute site from Medirest to ISS and, for the community sites, the East London Consortium provide and monitor the cleaning services. Monitoring within the Trust’s premises are undertaken as prescribed within The National Specifications for Cleanliness in the NHS (2007), Revised Guidance on Contracting for Cleaning (2004), current legislation, codes of practice and best practice. Specific guidance has been provided to all those required to undertake monitoring & auditing through the Board approved Policy ‘Cleaning Standards Monitoring Policy’.  The formal auditing arrangements to measure service performance are: - Technical Audits & Monitoring: . Technical monitoring is carried out by the cleaning service provider and relevant ward/department head using the 49 element audit score sheet contained within the National Specification for cleanliness in the NHS. . The frequency for formal audit is at least in accordance with risk category agreed with the infection prevention & control team and as stated in National Specification for Cleanliness in the NHS, which are as follows: - Very high-risk functional areas (main theatre, ITU, NICU, etc.) at least once a week. - High-risk functional areas (general wards, A&E, public areas, etc.) at least once a month. - Significant -risk functional areas (pathology, outpatient, etc.) at least once every 3 months. - Low- risk functional areas (offices, stores, etc.) at least twice a year. DIPC and ICT Annual Report 2015-2016 Dr Alleyna Claxton, DIPC61 . Failure reports arising from technical monitoring are agreed between the cleaning service provider and ward/department head with sign off of rectification being undertaken within one day/week of the initial audit, depended on risk category.  The National Standards Monitoring Tool audit quarterly results for 15/16 are detailed in the table below. The scores are RAG rated ‘green’ in all areas.Quarter Quarter Quarter Quarter 2015/16 National Standard Monitoring Tool 1 2 3 4 total (%) (%) (%) (%) (%) CSDO 98.2 97.7 97.0 97.2 97.5 IMRS 97.6 98.2 95.9 97.2 97.2 SWSH 97.8 98.4 97.2 97.1 97.6 Trust 97.0 97.5 96.0 97.2 96.9- Cleaning service performance is formally audited by technical audits & monitoring and validation audits. Cleaning service performance is reviewed at the Estates and Facilities ISS contract review group which reports to the Board of Directors. 12 Estates and Facilities reports 2015-2016The ICC receives quarterly reports on the Trust’s decontamination monitoring (from the Decontamination Monitoring Committee), ventilation planned preventative maintenance programme and Legionella planned preventative maintenance programme (including a report from the Water Safety group). 12.1 Decontamination The Decontamination Monitoring committee is required to manage all elements of the Trust’s Decontamination Policy in relation to national guidance / performance criteria and report the progress on actions and issues to the Trust’s Infection Control Committee. It is a multidisciplinary professional group with members from all relevant stakeholder disciplines across the Trust. The Trust Director of Estates, Facilities and Capital Projects is the Trust Lead for Decontamination and chairs the Decontamination Monitoring Committee.  Decontamination monitoring and management responsibility now sits within the Trust Estates team.  The Decontamination KPI monthly and quarterly audit reports for 15/16 were initialled carried out by an external contractor, Decontamination Solutions, who have provided this service to the Trust for the past 8 years. From January 2016, these audit reports have been carried out by the Estates team in house with support from the Trust Authorised Engineer.  Audit reports in Quarter 1 15/16 highlighted quality management issues in Endoscopy which have subsequently been addressed. There do however continue to be some DIPC and ICT Annual Report 2015-2016 Dr Alleyna Claxton, DIPC62 issues and areas of non-compliance within endoscopy and work continues to reduce this.  The Bed pan washer disinfectors failed soil tests in ward areas in March 15 & new machines were purchased by Trust and installed in Summer 2015.12.2 Ventilation planned preventative maintenance programme The Director of Estates, Facilities & Capital projects also submits reports on the ventilation programme of planned preventative maintenance to the ICC and covers the maintenance, sampling and testing of the Trust’s negative pressure room facilities and theatre facilities. There were no major IPC issues of concern in 15/16.  It has been highlighted that the Air Handling Units (AHUs) in theatres require upgrading to meet the current guidance on required air changes and the need for new AHUs has been entered on the Estates risk register. However, regular microbiological ‘settle plate’ tests are conducted in theatre and the results do not show any current cause for concern.12.3 Legionella & Pseudomonas planned preventative maintenance programme The Director of Estates, Facilities & Capital projects also submits the Legionella prevention report which covers the Legionella policy; sampling and testing arrangements; risk assessment; general engineering works and training arrangements. There were no major issues identified in the Legionella prevention programme in 2015-2016.  The Department of Health document ‘Sources and potential Pseudomonas aeruginosa contamination of taps and water systems. Advice for augmented care units’ was published in March 2012. As a result a ‘Water Safety Plan’ has been developed by Estates and the ICT and endorsed by the ICC and there is ongoing surveillance both by the Estates team and IPCT to ensure environmental and clinical monitoring of pseudomonas on the Trust’s augmented care units (adult and neonatal ICUs).  In accordance with the DH guidance, the Trust has a Water Safety Group that meets on a quarterly basis. This group is chaired by the DIPC and has representatives from estates & facilities, ISS (cleaning), the IPCT, the augmented care units (ITU & NICU), maternity & endoscopy.13 Employee Health Medical Services IPC reports 2015-201613.1 EHMS balanced Scorecards  An Employee Health Management Service (EHMS) balanced scorecard is presented to the ICC on a quarterly basis. This document includes details of compliance with the Exposure Prone Procedure (EPP) register and measles, rubella, chickenpox and tuberculosis screening register.13.2 EHMS staff influenza vaccination data  In 2015/16, the EHMS department led the Trust’s Flu Staff Vaccination Campaign. In total, 44.49% (1570) of front-line healthcare workers (FHCWs) were vaccinated in 15/16. Although this is a decrease from the 47.6% (1520) of FHCWs vaccinated in 14/15, there DIPC and ICT Annual Report 2015-2016 Dr Alleyna Claxton, DIPC63 was an increase in the total number of FHCWs vaccinated overall in 15/16, the decreased percentage reflects the increase in the size of the workforce.  No official ranking of Trusts for 15/16 has been made publically available. However the PHE document ‘Seasonal influenza vaccine uptake amongst frontline healthcare workers (HCWs) in England – Winter season 2015 to 2016’: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/526041/Sea sonal_influenza_vaccine_uptake_HCWs_2015_16_Annual_Report.pdf reports that the mean English Trust vaccination rate was 50.6%, the median vaccine uptake was 49.2% and the interquartile range (IQR) was 39.6% to 60.4%. The highest seasonal influenza vaccine uptake reported by a trust was 83.5% and the lowest 10.9%. Only 6.8% of all trusts achieved vaccine uptake rates of 75% or more. Overall the highest vaccination uptake was achieved in North of England (62.8%) with London reporting the lowest uptake (43.2%). Uptake by acute trusts had decreased in 15/16 compared to 14/15. o In response to the issue of how to encourage staff to have flu vaccination, the EHMS has proposed that for 16/17 the following action plan is followed: . Appoint a lead champion . Recruit more flu champions . More involvement of senior management team . Lead Champion to attend staff team meetings . Consultations with staff using Survey Monkey and face-to-face questionnaires . Enhanced data recording . Learning from other Trusts who have achieved high uptake percentages13.3 EHMS needlestick injuries  During 15/16, EHMS & the IPCT continue to monitor all sharps injuries reports to ensure that all potentially preventable sharps injuries are investigated and any educational or equipment issues identified are addressed. o In 15/16 there has been a total of 62 needle stick injury/blood splash incidents with an overall downward trend in reported incidents most notably since August 2014. o In 15/16 the most common NSI was venepuncture followed by suturing and cannulation. The majority of these incidents were related to human error e.g. doctor being distracted by colleague/patient during procedure or incorrect use/not using safety device provided. There were very few incidents related to cleaning e.g. emptying bin which indicates that safe sharps disposal is being carried out. o In 15/16 the most common groups of staff to receive NSI were doctors, nurses and clinical support staff. This is to be expected given that doctors carry out venepuncture/suturing/cannulation and nursing staff give injections and remove cannulae and so are the two staff groups most likely to be exposed to sharps- related risks.DIPC and ICT Annual Report 2015-2016 Dr Alleyna Claxton, DIPC64 14 IPC policies endorsed by the ICC in 2015-2016The following IPC policies have been reviewed and endorsed by the ICC in 15/16: IV line management  Multi-resistant gram negative rods  Measles  VZV  iGAS  IPC SOP (including annual review of ICC ToR)  Rabies  Norovirus D&V  PICC line policy  MRSA policy  Food Hygiene policy  GRE policy 15 Influenza – winter 2015-2016 Over the winter months influenza activity was low to moderate with several admissions due to influenza B to the acute hospital in the early Spring although there were only a couple of admissions to critical care. There was no adverse impact on bed or isolation capacity.  The DIPC is the Trust’s Pandemic Flu Planning Lead and Ms Deborah Wallis, the Trust’s Resuscitation and Emergency Planning Officer, is the Deputy Pandemic Flu Planning Lead. 16 Other IPC updates 2015-2016 This DIPC/ICT annual report 2015-2016 will be presented to the Board of Directors and then made available to the public on the Trust internet site in accordance with the requirements of the Code of Practice for reducing HCAI.  The IPCT continue to maintain Service Level Agreements (SLAs) to provide IPC cover for Mildmay, St Joseph’s Hospice and the East London Foundation Trust (ELFT).  One of the ICNs, Ms Gema Martinez Garcia, has left the HUH IPCT to take up a promotion at another Trust. The DIPC & IPCT would like to officially thank her for all her enthusiasm and hard work in the years she has worked in the IPCT at HUH and wish her every success in her future career.DIPC and ICT Annual Report 2015-2016 Dr Alleyna Claxton, DIPC65 17 IPC Balanced Scorecard 2015-2016Infection Prevention & Control Scorecard2014/15 2015/162014/15 2015/16 2015/16 Units Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Target Status Out-Turn Target Out-TurnRed Amber Green DH IndicatorsIC Indicators (Reported to DH) MRSA Bacteraemia (MRSAB) Cases 2 0 0 1 3 0 1 0 0 0 1 CDT (HUH Attributable) Cases 2 2 2 1 7 7 4 4 2 0 10 GRE Bacteraemia Cases 0 0 1 1 2 0 0 0 0 0 0Serious Untoward Incident (SUI)Trust attributable C-Diff Deaths Cases 0 0 0 0 0 0 0 0 0 0 0 Trust attributable MRSA Deaths Cases 0 0 0 0 0 0 0 0 0 0 0 Other SUIs Cases 0 0 0 0 0 0 0 0 0 0 0Surgical site infectonsTotal hip replacement Cases 1 2 0 0 3 0 0 0 0 1 1 Total knee replacement Cases 1 0 1 1 3 0 0 0 0 0 0Alert Organisms Trigger EventsMRSA Number 0 0 0 0 0 0 0 0 0 0 0 CDT Number 0 0 0 0 0 0 2 0 0 0 2National Standard Monitoring ToolCleaning Service CSDO % 98.35% 98.50% 98.10% 98.5 98.3% 95% 98.20% 97.70% 97.00% 97.23% 97.5% IMRS % 98.03% 98.50% 97.90% 97.8 98.1% 95% 97.60% 98.20% 95.90% 97.20% 97.2% SWSH % 98.44% 98.40% 98.10% 98.3 98.3% 95% 97.80% 98.40% 97.20% 97.10% 97.6% Trust % 97.90% 98.50% 97.80% 97.6 98.1% 95% 97.00% 97.50% 96.02% 97.17% 96.9%OutbreaksDiarrhoea and Vomiting Number 0 0 0 1 1 0 0 0 0 0 0 Other Number 0 0 0 0 0 0 0 0 1 0 1Audits CompletedIPC Department Audits % 9% 33% 58% 77% 77% 100% 16% 28% 49% 49.0% 26 out of 51 Trustwide Audits % 0% 25% 50% 100% 100% 100% 11% 57% 71% 71.0% 6 out of 7 HII Audit Compliance IV line ongoing care CSDO % 100% 100% 100% 100% 100% 95% 100.0% 84.0% 90.7% 98% 93.2% IMRS % 100% 100% 98% 94% 99% 95% 94.0% 92.0% 98.8% 97% 95.4% SWSH % 100% 99% 98% 98% 99% 95% 98.3% 96.1% 98.3% 98% 97.6% Urinary catheter ongoing care IMRS % 100% 100% 99% 99% 100% 95% 100.0% 100.0% 96.1% 96% 98.1% SWSH % 97% 97% 96% 96% 97% 95% 100.0% 100.0% 100.0% 100% 100.0% IV cannula insertion CSDO % 91% 82% 90% 95% 88% 95% 94.3% 70.8% 85% 91% 85.3% IMRS % 100% 99% 93% 96% 97% 95% 95.0% 94.0% 98% 96% 95.8% SWSH % 98% 97% 98% 98% 98% 95% 96.0% 92.9% 96% 95% 95.0% Hand hygiene CSDO % 100% 100% 100% 99% 100% 95% 99.9% 99.8% 99.6% 100% 99.8% IMRS % 100% 100% 100% 100% 100% 95% 99.0% 98.0% 98.5% 98% 98.4% SWSH % 98% 98% 96% 98% 97% 95% 97.4% 97.1% 96.0% 98% 97.2% MRSA screening IMRS % 96% 94% 95% 94% 95% 95% 97.8% 95.1% 94.3% 96% 95.8% SWSH % 99% 98% 96% 99% 98% 95% 97.6% 97.6% 96.8% 96% 97.0%IC Training CompletedCSDO % 95.9% 80.3% 94.4% 92.2% 90.2% 80% 95.1% 95.4% 97.0% 96.4% 96.0% IMRS % 96.5% 85.8% 91.9% 88.2% 91.4% 80% 91.9% 92.2% 96.0% 96.4% 94.1% SWSH % 90.2% 77.3% 90.6% 88.6% 86.0% 80% 91.7% 91.3% 92.9% 95.1% 92.8% Environment % 99.7% 79.5% 99.2% 99.8% 92.8% 80% 99.3% 100.0% 100.0% 98.1% 99.4% Workforce % 93.4% 87.7% 93.6% 95.7% 91.6% 80% 97.6% 99.4% 98.0% 100.0% 98.8% Corporate % 95.1% 90.6% 89.7% 93.1% 91.8% 80% 94.4% 94.5% 92.9% 92.5% 93.6% Trust % 94.7% 87.7% 92.1% 90.1% 91.5% 80% 93.1% 93.3% 95.5% 95.9% 94.4%DIPC and ICT Annual Report 2015-2016 Dr Alleyna Claxton, DIPC66 18 Appendix 2 - Glossary of termsBacteraemia blood stream infection; blood poisoning BBV Blood Bourne Viruses BSC Balanced Score Card CDI Clostridium difficile infection CFPP Choice Framework for Local Policies and Procedures CCG Clinical Care Group CQC Care Quality Commission CPE (O) Carbapenemase Producing Enterobacteriacea (Organisms) DIPC Director of Infection Prevention & Control ELFT East London Foundation Trust EPR Electronic Patient Record GRE Glycopeptide Resistant Enterococci HCAI Healthcare Associated Infections; ‘any infection by any infectious agent acquired as a consequence of a person’s treatment by the NHS or which is acquired by a healthcare worker in the course of their NHS duties’ HCW Healthcare WorkerHII Saving Lives High Impact InterventionsHPU Health Protection Unit; ‘Public Health’ HUH Homerton University Hospital NHS Foundation Trust ICC Infection Control Committee ICD Infection Control DoctorICN(C) Infection Control Nurse (Consultant) IPCT Infection Prevention and Control Team IV Intravenous IPC Infection Prevention and Control MRGNR The term ‘multi-resistant gram negative rods’ (MRGNR) covers the laboratory finding of GNRs resistant to gentamicin and a 3rd generation cephalosporin. These include both those GNRs who are multi-resistant due to the production of extended spectrum ß-lactamases (ESBL- producers) e.g. multi-resistant E.coli, multi-resistant Klebsiella and those GNRs who are multi-resistant due to other resistance mechanisms including amp C, carbapenemases and porin channel loss e.g. KPC- Klebsiella, multi-resistant Acinetobacter MRSA Meticillin Resistant Staphylococcus aureus MSSA Meticillin Sensitive Staphylococcus aureus NELCSU North East London Commissioning Support Unit NPSA National Patient Safety Agency NSI Needle Stick Injury DIPC and ICT Annual Report 2015-2016 Dr Alleyna Claxton, DIPC67 OPAT Outpatient Parenteral Antimicrobial Therapy PCR Polymerase Chain Reaction PHE Public Health England PIR Post Infection Review RCA Root Cause Analysis SI Serious Incident SSI Surgical Site Infection TB Tuberculosis THR Total Hip Replacement TKR Total Knee ReplacementDIPC and ICT Annual Report 2015-2016 Dr Alleyna Claxton, DIPC68

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