INFECTION PREVENTION & CONTROL ANNUAL REPORT …

2013-2014 IP&C Report West Essex CCG Chris Patridge April 2014 Page 1 of 43

INFECTION PREVENTION & CONTROL ANNUAL REPORT

INTRODUCTION

This report reviews Infection Prevention & Control (IP&C) performance, activities and risk in

2013-2014 for West Essex CCG and considers risk reduction strategies for 2014-2015.

Available data and intelligence from a number of sources has been reviewed across North

Essex to provide a higher level of analytical validity. Tables within the body of this report

include West Essex data only, comparators for North East and Mid Essex can be found in

appendices to this report in Appendix 4 (pages 39-40)..

A collaborative North Essex IP&C Committee (IPCC) is in place and meets quarterly. There

is good representation at these meetings, and the associated task and finish Group

activities, by West Essex providers. This group designed and worked to deliver a Health

Care Associated Infection (HCAI) Action Plan. The completed 2013-2014 plan is attached at

Appendix 1, pages 7-17). 2014-2015 plan was agreed at IPCC in April and is attached at

Appendix 2 (pages 19-20). with minutes and action log (Appendix 2a pages 21-33) from that

meeting. The plan has been redrawn to address risks identified from review of all available

intelligence across North Essex.

MANDATORY SURVEILLANCE OF HCAI (See Appendix 3, (pages 35-37) for HCAI

performance tables and graphs)

Microbiology laboratories are required to upload information on cases of Clostridium difficile,

MRSA bacteraemia, MSSA bacteraemia and Escherichia coli bacteraemia infections to a

national database maintained by Public Health England.

Clostridium difficile and MRSA bacteraemia infections are attributed to the CCG where the

patient’s GP resides. If the samples are taken more than 48 hour (MRSA bacteraemia) or 72

hours (Clostridium difficile) after admissions to an Acute Trust the case is also assigned to

that Trust. Acute Trusts and CCGs are measured against nationally set ceilings for

Clostridium difficile which have required year on year reduction of incidence. MRSA

bacteraemia ceilings were replaced, in April 2013, by a requirement for ‘zero tolerance’. The

meaning of ‘zero tolerance’ has been discussed in year with NHS England Area Team. NHS

England believe this means zero cases however the North Essex IPPC believe this

expression refers to an approach whereby it is acknowledged that this infection is not an

acceptable side effect of treatment and care. Additionally the group believe all efforts should

be maintained to reduce incidence including thorough investigation of cases which do occur

with requisite actions to reduce risk.

Clostridium difficile

Table 1 shows 2013-2014 ceiling and incidence of this infection for West Essex CCG,

Princess Alexandria Hospital, Barts Health (figures for Whipps Cross Hospital are in

brackets) and Cambridge Universities Hospital Foundation Trust. Figures from 2012-2013

are also presented.


The figures for the Acute Trusts are all cases attributed to that organisation and thus

includes some patients from other CCGs.

2012-2013 2013-2014 Ceiling 2013-2014

West Essex CCG 51 51 51

PAH 15 18 9

Barts Health (Whipps Cross)

34 – Whipps Cross only

82(25) 75

CUHFT, (Addenbrookes)

72 50 39

Table 1: C difficile incidence data West Essex CCG

National contracts for NHS Acute Trusts include financial penalty processes for breach of

annual ceilings. North Essex CCGs, with the approval of NHS England Area Team,

implemented an appeals processes for those cases, identified in and attributed to North

Essex Acute Trusts, which were considered to:-

have occurred despite all policies being followed

be not clinically significant and thus ‘colonisation’ not ‘infection’ OR

have been present before admission where clear evidence exists

A paper detailing this process is attached at Appendix 5 (pages 41-44) with Terms of

Reference for the Scrutiny Panel. This process will be slightly modified for 2014-2015 in line

with new national guidance.

PAH brought 10 cases to appeal, 6 were upheld at IP&C HCAI Scrutiny panel and North

Essex CCG Serious Incident and Never Event Panel.

MRSA bacteraemia

No cases of this infection have been reported in West Essex patients during 2013-2014.

PAH also reported zero cases. Barts Health had 12 attributed cases, 4 of these from Whipps

Cross Hospital, and CUFHT reported 4 cases.

During 2012-2013 there were 5 cases in West Essex patients. 2 of these were also

attributed to PAH.

HCAI INVESTIGATIONS

All cases of Clostridium difficile and MRSA bacteraemia are subject to Root Cause Analysis

with consideration of all care given during 6-12 month period prior to the infection diagnosis.

This information is gathered from Acute and Community providers as well as relevant

Primary Medical Care practices.

Clostridium difficile

Completed timelines and RCA forms are reviewed and discussed at North Essex Scrutiny

panel by Acute and CCG specialists as well as, where relevant, community provider IPC

leads. Cases are not deemed ‘closed’ until the panel agree all required questions have been

asked and answered. Where appropriate feedback on investigation findings is given to

provider colleagues including GPs..


Investigations have not highlighted evidence of transmission in acute or community hospital

wards. The majority of cases involve patients over 65 years of age who have received

antibiotics during the 3-6 months prior to diagnosis. In many cases patients have received

multiple course of antibiotics. Consultant Medical Microbiologists contact prescribers to

discuss prescribing decisions where there are queries raised at panel about the

appropriateness of antibiotic use. CGG Medicines Management leads will join Scrutiny

Panels from April 2014.

A small number of patients are known to have passed away after diagnosis however none

had the infection recorded as a primary cause of death.

Table 2 below gives data on the location of West Essex patients when sample was taken.

Data is also given of those patients with repeat positive samples (more than 28 days after

initial diagnosis) and Care Home residency. 15 patients were diagnosed with the infection in

2013-2014 whilst in hospitals outside West Essex localities. Table 3 details this.

2012-2013 2013-2014

GP samples 12 17

PAH post 72 hours 7 (out of 15) 8 (out of 18)

PAH pre 72 hours 13 7

Community Hospital 0 4

Out of area hospitals (see below)

19 15

Previous positive patients 6 3

Care Home resident 4 7

Total 51 51 Table 2: Detail of location of positive cases and those with previous positive results

Investigation of cases in SEPT premises did not highlight evidence of transmission.

Trust 2012-2013 2013-2014 2013-2014 year end

position/ceiling

Pre 72 hours

Post 72

hours

Pre 72 hours

Post 72 hours

Addenbrookes 3 4 3 3 50/39

Whipps Cross (Barts Health) 4 2 4 2 82/75 (Barts Health

data and ceiling)

Basildon& Thurrock 1 20/26

Southend 1 31/18

Royal National Orthopaedic 1 9/3

Royal Marsden 1 19/11

Royal Free Hospital 1 35/33

University College Hospital London 1 1 99/39 Table 3: Detail of cases in Trusts outside West Essex

There have been no cases considered attributable to SEPT, NEP or Ramsey hospitals.


MRSA bacteraemia

There have been 12 cases across North Essex with one involving a patient from outside the

county. Of these 12 cases 5 were considered at Post Infection Review to be probably

preventable.

Two of these involved contaminated Blood culture samples. One involved frequent

manipulation of a urinary catheter where there was a lack of clear management plan. One

patient, a Care Home resident, had a heel pressure ulcer which deteriorated from a minor

graze to an infected Grade 3 ulcer. Referral to the district nursing service was delayed. The

fifth preventable case involved a renal dialysis patient whose skin preparation for Venous

Arterial Shunt access was insufficient because the patient was allergic to the disinfectant

agent used.

In all cases actions were implemented to manage risk however there were no breaches in

policy current at the time. Those policies were in line with guidance.

PAH implemented universal disinfectant washes for all admitted patients during the year. It is

possible this has contributed to reducing incidence in West Essex to zero. It should however

be noted that none of the 5 ‘preventable’ cases in North Essex would have benefitted from

this intervention had it been in place.

INCIDENTS AND OUTBREAKS

PAH reported 5 Norovirus outbreaks during April 2013. During winter 13-14 there was only

one ward affected by Norovirus in just one bay. Unlike previous winter seasons there was no

evidence of ward to ward spread in this hospital. SEPT reported 2 outbreaks on different

wards, at different times in St. Margaret’s. NEP reported only 1 outbreak, in Chelmsford.

There were only a small number of outbreaks reported in Care Homes in West Essex. One

outbreak appeared to have very high percentage of resident involvement. Visits by Health

Protection Nurses identified significant failings. Following discussions with West Essex CCG

Adult Safeguarding Lead Nurse this has been raised by the report author to ECC as a

Safeguarding Alert. ECC Quality Improvement Team are investigating the concerns.

PAH investigated an incident involving a patient with active Pulmonary Tuberculosis where

there was a risk of transmission prior to diagnosis. There has been no evidence to date that

transmission occurred. The final report of this investigation is awaited.

PAH raised a Serious Incident notification following transmission of Scabies to both staff and

patients in one ward. The final report of the investigation highlighted shortfalls in staff

understanding of Scabies and the importance of communicating with the IP&C team when

risk is identified or suspected. Following the incident a microteaching programme has been

delivered for all clinical staff.


There have been 2 Legionella incidents in sites in West Essex. The first involved a renal

dialysis unit on the PAH Harlow site where clinical service is provided by East & North Herts

NHS Trust (ENH) with facilities management delivered by an organisation contracted by

ENH. A Serious Incident report was made by PAH however this was de-escalated by the

CCG as all actions rested with ENH who did not report the incidence as an SI. Review of

water safety across the remainder of the Harlow site did not highlight any issues or

concerns. The second incident concerned parts of the St. Margaret’s hospital site in Epping.

The site concerned is owned by NHS Property Services Ltd who contract with SEPT for

estates management including water safety. Clinical out patient services in the affected area

is provided by PAH. The CCG IP&C Lead Nurse raised the incident as a Serious Incident

and is leading the investigation. Final report is due in June. Further detail of this will be

presented to Patient Safety & Quality committee at that time.

IP&C ASSURANCE INFORMATION 2013-2014

Information on IP&C risk and activity is produced by Acute, Mental Health and Community

providers in monthly reports to contract review meetings as required by contracts.

All providers undertake audits of key IP&C policies in accordance with CQC regulatory

requirements laid out in the Code of practice for the prevention & control of infections

(Hygiene Code). These include:-

Hand Hygiene

Prevention of Surgical Site Infections (PAH only)

Prevention of Ventilator associated Pneumonia (PAH only)

Environmental Hygiene

Insertion and care of Peripheral Venous cannulae (SEPT only)

Insertion and care of Urinary Catheters (SEPT only)

Compliance scores for these audits are reported consistently above 95%. PAH plan to

introduce audit of invasive devices in 2014-2015 as a staged programme.

All providers report delivery of their organisation’s Annual Plan for IP&C to the

commissioner. Annual reports will be produced in May-July and presented to CCG at

contract review meetings. Plans are designed to evidence compliance with the Hygiene

Code. Quarterly reports from PAH, NEP and SEPT have not highlighted any compliance

failures.

CCG Quality team members undertake regular walk-abouts of provider premises to seek

assurance on safety and quality. Key IP&C measures are reviewed. This includes clinical

area environments and equipment decontamination. Staff compliance with IP&C policies is

also assessed; for example compliance with the organisation’s dress code. Feedback is

given at the time of the visit and also through formal documented report. Walkabout reports

have been reviewed for this report.

PAH and SEPT ward visits have not shown any concerning trends. Environment and

equipment cleaning policies are seen to be in place and followed. Staff were largely

compliant with ‘bare below the elbow’ policies.


An emerging potential risk concerns health care premises where service is delivered by

multiple providers and where there appears to be lack of certainty amongst staff about

facilities management. The legionella incident at St. Margaret’s hospital is one example of

this. In addition visits were made to a number of sites where clinical services were provided

by CRS contracted services. In some cases these involved shared use premises and staff

questioned were not always aware of how to report estates and facilities concerns including

cleaning standards. Management of risk in shared premises will be added to HCAI Action

Plan for 2014-2015 following the St. Margaret’s Legionella investigation..

EMERGING IP&C RISKS

The emphasis nationally has for some time remained on MRSA bacteraemia and Clostridium

difficile infections. There are however other infections causing harm to patients. This

includes growing resistance to antimicrobial agents by bacteria other than Staphylococcus

Aureus. A Safety Alert was issued by NHS England in February concerning Carbapenemase

producing enterobacteriace organisms. These are developing resistance to a group of

antibiotics (Carbapenems) named by WHO as ‘critically important’. Acute Trusts are

reviewing their policies and procedures to reduce risk from these infections and are required

to draw up plans to address this increasing risk. There have been very few cases to date in

North Essex however there have been transmission incidents in neighbouring areas. North

Essex actions in this regard will be discussed and monitored through North Essex Scrutiny

and IPCC meetings.

A national study on incidence of Health Care Associated Infections in 2011 showed an

increase in relative incidence of Surgical Site Infections. There is a collaborative approach

being developed by PAH and Mid Essex Hospitals Trust to study incidence of infection in

post-operative Caesarean Section wounds. This will be in addition to existing mandatory

surveillance of some elective orthopaedic procedures.

CONCLUSION

This report has highlighted current and emerging IP&C risks posed to West Essex patients.

These were reviewed at North Essex IPCC with new actions agreed for 2014-2015, (see

Appendix 2 for 2014-2015 HCAI Action plan). This plan, as for 2013-2014, is designed to be

dynamic and will be reviewed and updated quarterly. Additional actions will be added should

local or national information highlight need.

A significant change in approach to maintain and improving IP&C standards is being

developed which will use information on patient experience obtained through survey. For

example, patients’ perception of Hand Hygiene compliance may be used to refine and

refocus IP&C initiatives whilst also encouraging staff to tell patients when they are, or have,

decontaminated hands..


APPENDIX 1: 2013-2014 HCAI ACTION PLAN

NORTH ESSEX HCAI ACTION PLAN

2013 – 2014

This Action Plan will capture all actions and will be led by CCG Directors of Nursing. The plan is updated quarterly, in line with RCA findings and identified

best practice, at North Essex IPCC and communicated with CCG Boards via Quality Committees.

Objective Action Responsibility Timescale Update/comment

1: Develop robust CCG leadership for HCAI strategies across North Essex

CCG DoNs to discuss at CCG Board and agree development plans

CCG DoNs End January 2013 Completed

20.03.13 Approved at West, Mid and North East Essex CCG Boards. Updated HCAI Action Plan to be presented to CCG Quality Committees and Boards following IPCC meetings. 04.04.13 Action completed. To remain on plan to ensure this is sustained. 15.01.14 Provider members to consider which Director/AD is IPC champion in their organisations.

Plans to include nominated HCAI CCG lead GP and lay member

CCG DoNs End January 2013 Completed July 2013

Mid Essex: Dr. McGeachy/Dr. Spencer North East Essex: Dr. Simon Sherwood West Essex: Dr. Rory Mcrae Lay member involvement is via CCG Quality Committees Each CCG has named GP Lead. CP to ensure representation on Task & Finish Groups.


CP to revise this action and add to new HCAI Action Plan 2014-2015 following discussion with GP colleagues.

2: Ensure maximal learning from HCAI investigation processes

Timeline template to be prepared and used for all HCAI investigations.

CCG IPNs End December to be implemented January 2013 July 2013 Completed

Agreed at North Essex IP&C meeting January 10th 2013 20.03.13 Timelines in use in Mid Essex. To be used in North East and West 04.04.13 Timelines ready for use in all areas with action log and review summary templates Providers using own templates but all asking the same questions.

CCG IPNs to collate timeline data from all relevant providers

CCG IPNs January 2013 October 2013

20.03.13 In process 04.04.13 continuing Continuing


Monthly Scrutiny panels to include relevant GPs as well as Acute and community providers. Action plans produced at Scrutiny panels to be monitored monthly at scrutiny panels and reported to CCG Quality meetings

CCG IPNs CCG IPNs collating action plan delivery information

February 2013 July 2013 October 2013 January 2014 February 2013 July 2013 October 2013

04.04.13 Not yet implemented. April Scrutiny panels to include visit of panel to minimum of 1 practice to discuss case with GP. Agreed to hold monthly North Essex RCA review tele-conferences using SINE panel format. CP/TN/LC to arrange. North Essex Scrutiny Panel process now in place with monthly meetings arranged for rest of current year. Continuing North Essex Scrutiny panels continue and Appeals Process now in place and working well. Appeals to be brought for consideration in a timely manner and not all at year end Action Plan template redesigned to be approved at April IPCC. 04.04.13 not seen at IPCC. Will be taken to April Scrutiny panels. Collated North Essex Action Log now in use. Use of lessons logs being explored by CCG IPN Action completed.


3: Optimise assurance of provider compliance with:-

Hand Hygiene

Antimicrobial Compliance

Agree reporting requirements to provider CQRG Develop and implement community provider antimicrobial audit programmes.

CCG DoNs CCG Medicines Management leads

End January 2012 repeated for 2013-2014 October 2013 End January 2013

Utilising existing audit programmes in providers. 10.01.13 – All carrying out internal or peer audits which are good. 10.01.13 - All auditing and reporting is a contractual requirement & need to incorporate Community Providers into this. Providers reviewing audit tools to enhance value. 20.03.13 included in contracts for 13-14 for all providers. 04.04.13 Prospective audits of prescribing to be undertaken in A&E depts. CP to prepare tool with Chief Pharmacists: pilot undertaken in MEHT A&E This is considered in RCA investigations. Awaiting MEHT pilot audit findings. Report to October IPCC Community provider audit feedback to next meeting. CP to attend Medicine Management Boards and discuss delayed prescription in community wards. See also action point 10 re UTI diagnosis and management. 10.01.13 – [Action: CP to meet separately with the Community Providers to discuss]. 20.03.13 Meeting held. Providers to report progress at April IPCC.


Isolation policies


Report outcome of Primary Care antimicrobial prescribing audit undertaken November 2012

CCG Lead IPN

October 2013 January 2014 January 25th 2013 October 2013 October 2013 January 2014

04.04.13 CP to seek update in implementation from SEPT, ACE and CECS at CQRG meetings April. July: Reports from providers required to next IPCC PN to collate community antibiotic audit programmes and results and take to Antimicrobial Stewardship group meeting for consideration. Continuing. Report to be discussed at April 2013 IPCC and further actions agreed. 04.04.13 Report to be sent to all members as well as GP practices. This was done. July 2013: Mid Essex Medicines Management Lead conducting further primary care audits. Report required to next IPCC. October 2013 : Report awaited January 2014 Report received. For further consideration at Antimicrobial Stewardship group meeting 10.01.13 – Assurance responses were received but there are variants between the meaning of ‘Deep Cleaning’ in hospitals as supposed to terminal or barrier clean. Sharing with Providers is required. 20.03.12 RAG process used at CHUFT shared with all providers. 04.04.13 Reports to CQRG meetings should include detail on implementation. Continuing.


IP&C Staff Training requirements

Resources October 2013

10.01.13 - Issues with training attendance and slippage. All group have confirmed they have competency processes in place (infection prevention engagement is the key) and there are benefits on sharing training methodologies. 20.03.13 To be discussed at April IPCC re-establishing working party for this. 04.04.13. Working party to share training methodologies and resources to be held this month. Group to also look at potential changes to HH audit programmes to achieve greater validity and value. Agree to extend patient/carer inclusion in audit processes. July – training resources to be shared.

Development of inter-organisational peer audit processes.

CCG DoNs/CCG Lead IPN

End February 2013

10.01.13 – [Action: Exec input is required from CCG Formal Board. CP to pull together a proposal for agreement with the Committee & then take to Formal Board]. CCG Directors of Nursing to agree with providers at relevant CQRGs 20.03.13 Draft process written. Once approved and detail agreed at IPCC to be tabled at CQRG meetings and commence from April 2013. 04.04.13 Process agreed. First round of Acute and Community audits to be undertaken in Q1. CP to send out paper for provider board approval. Consideration to be given to how to involve MH provider in this project after first round of peer audits.


October 2013

Audits not yet taken place. To be prioritised with feedback to CQRGs and to next meeting. January 2014 – All acute trust peer audits now completed and deemed useful. Actions are completed and ongoing. Development of inter-organisational peer audit processes will be added to 2014-2015 HCAI Action Plan to extend to Community Providers including hospices and mental health.

4: Minimise unnecessary repeat sampling for C difficile

Review other area use of web based systems to allow sharing of known infection status of patients. Recommendations to CCG DoNs and North Essex IPCC

CCG Lead IPN

End January 2013

Review to include processes in Norfolk and South Essex 20.03.13 Information request sent and being chased 04.04.13 No response. Discussed at IPCC and agreed IC Net systems not currently required 04/04/13 CHUFT IPN drafting card and information. To be shared with group April 2013. Further work needed on patient education to support concept of expert patient with C difficile. No further development.

Review existing communication with GPs and other care providers when patients are diagnosed with C difficile. Recommendations to develop this to be agreed with CCG ICDs and implemented.

CCG Lead IPN

End January 2013 October 2013 April 2014

2013-2014 contracts to include reporting requirements of transfer/discharge information sharing compliance. CCG lead IPN to draft. 20.03.13 quarterly audits of this in 13-14 contracts as a reporting requirement without thresholds. No update at this time.


Development and implementation of C difficile and MRSA passport for patients

CCG Lead IPN All

End February 2013 By end Q113-14 October 2013 April 2014

A lead to share outcomes from West Midlands’ project. ACE Lead IPN to lead on development of North Essex passports. 20.03.13 Update required at April IPCC 04/04/13 CHUFT IPN drafting card and information. To be shared with group April 2013. Further work needed on patient education to support concept of expert patient with C difficile. CHUFT and PAH proceeding with this. Reports required to next IPCC. PAH have implemented this for in patients. Action closed. Incidence has reduced significantly. Further evaluation of passport in West Essex to be undertaken.

5: Ensure patients at high risk of HCAI in non-hospital settings are identified and managed appropriately through key worker referral.

To be agenda item at Community Provider CQRG and further actions agreed.

January 2013

CECS/CCG IPNs/BS October 2013

0.03.13 Discussed at Mid community CQRG re PIR existing action plan. April IPCC to discuss and formulate plan for further development in all areas with leads nominated 04.04.13 Meeting booked to review progress. Work needs to link into Mid Essex CCG frailty pathway project. July – no developments To be addressed via MRSA Task & Finish Group . Action closed.


6. MRSA Screening ADDED JULY 2013

Review of cases since April 2012 showed the majority of cases were not previously known to be colonised with MRSA. Risk factors for significant infection however were present. Increase of MRSA screening into the community to be implemented to include high risk patients, i.e.:- Patients with broken skin Patients with invasive devices

October 2013 October 2013 January 2014

July 2013: CP to set up Task and Finish Group to design and implement this. MRSA Task & Finish Group to meet on 26th November 2013. Group have met and draft protocol produced. For final review and implementation planning at Scrutiny panel Action closed.

7: Ensure good IP&C practice is shared across North Essex

North Essex IPCC to include sharing of processes and protocols re:-

Deep/terminal clean

IP&C training methodologies

Initiatives to reduce contaminated blood culture sampling

IP&C competency programmes

CCG Lead IPN January 2013 October 2013

Consider increasing frequency of IPCC from 3 to 2 monthly. 10.01.13 - [Action: Keep North Essex IP& C Meetings every 3 months & increase the level of commissioning clinician input & sharing of information]. 04.04.13 Agreed meetings to stay quarterly. Increase use of teleconferencing for working party/project activities. IP&C to be one work stream in wider Harms Free Care Strategy. CP/RH working on this plan. To be addressed in 2014-2015 Action closed.


ADDED APRIL 2013 8: C difficile zero tolerance

Strategy to be designed using Berkshire model and framework. To include:-

Health intelligence mapping systems to target initiatives

Increased engagement with Primary and Social Care

To work on opening a new Strategy Harms Free Care Event and will get dates out asap

CA to look at approval via DONs

To involve Quality Team and Essex County Council

Mid Essex IPT

Strategy draft by end May 2013

Meeting planned 30.04.13. To include CCG GP and PH representatives. Chief Pharmacist involvement will be required once strategy drafted. Project to 1) prepare and 2) a Vision for zero tolerance using NHS Change Management model. See 7 above. Action closed.


ADDED APRIL 2013 9: Reduction in incidence of Hospital Acquired Pneumonia 10: Urinary Tract Infections (diagnosis and management) to ensure optimal antibiotic use and avoid over diagnosis

Raising Bed Heads and use of antiseptic mouthwashes to be implemented in all in patient areas. (Relevant in MH to Older adult in patient wards) Guidelines required for diagnosis and management of UTI in all care settings

All in patient providers CCG Lead IPN

Q1 13-14 October 2013 October 2013

This is in contracts as Service Development Improvement Plan requirement. Action plans for implementation will be requested at CQRGs in April for May. Further work needed to implement in community i.e. patient’s own homes. To update October 2013 Update via CQRG. Action closed. Task and Finish Group to be established for this work including acute and community providers, ambulance paramedic, Primary Medical Care, Social Care. UTI Task and Finish Group meeting on 22nd October 2013. January 2014: Group has met and drafted information leaflet. CP to investigate funding for print costs and circulate draft leaflet + action cards to group members. Action closed. It was agreed that UTI Prevention Diagnosis and Management should be included on 2014-2015 HCAI Action Plan.



APPENDIX 2: 2014-2015 HCAI ACTION PLAN

NORTH ESSEX HCAI ACTION PLAN

2014 – 2015

This Action Plan will capture all actions and will be led by CCG Directors of Nursing. The plan is updated quarterly, in line with RCA findings

and identified best practice, at North Essex IPCC and communicated with CCG Boards via Quality Committees.

Objective Action Responsibility Timescale Update/comment

1. Prevention, diagnosis and management of UTI

(a) Guidelines for diagnosis and management of UTI in all care settings require printing and publishing (b) Optimise catheter management i.e. use of catheter passport or similar processes

CCG Lead IPN

2. Prevention of blood culture contamination

Share strategies of 3 Acute Trusts at Scrutiny panel

CCG Lead IPN

3. Develop information and guidance for carers of patients receiving IV drugs in community and mental health settings.

Task and Finish Group to be formed for this and to include mental health colleagues

CCG Lead IPN .


4. Utilising Patient Experience

A Task and Finish Group to be set up to consider how this would work in different settings, alongside existing engagement work, and draft suitable questions for IP&C.

CCG Lead IPN

5. Enhance robust CCG leadership for HCAI strategies across North Essex

Seek views of CCG GP colleagues on engagement processes

CCG Lead IPN

6. Support Antimicrobial Stewardship

Revise and refresh Terms of Reference for sub group including detail of audit data required

CCG Lead IPN

7. Support providers delivering IP&C training to:-

Medical Staff

Locum/Agency staff

Task & Finish Group to be set up

CCG Lead IPN

8. Peer audit processes to be extended to all

providers and settings

Plan to be developed CCG Lead IPN


APPENDIX 2A: Minutes & Action log North Essex IPCC April 2014

MINUTES

NORTH ESSEX CLUSTER INFECTION CONTROL COMMITTEE

Held on Wednesday 16th April 2014

Wren House Boardroom 2, Wren House, Hedgerows Business Park, Colchester

Road, Chelmsford CM2 5PF

Present Name Organisation

Yes Rachel Hearn (Chair) Mid Essex CCG

Yes Chris Patridge Mid Essex CCG working for CCGs across North Essex

Yes Trish Newton Mid Essex CCG working for CCGs across North Essex

Yes Alyson Taylor North East Essex CCG

Yes Dr Bryan Spencer Mid Essex CCG

Yes Dr Shico Visuvanathan PAH

Yes Heather Dakin CHUFT

Yes Jenny Kirsh PAH

Yes Julia Shields PROVIDE

Yes Kathy Ramsay SEPT

Yes Lisa Llewellyn North East Essex CCG

Yes Dr Louise Teare MEHT

Yes Richard Miller-Holliday West Essex CCG

Yes Rachel Cryne NEPFT

Yes Mel Hanmore Ramsay Health

Yes Paula Wilkinson Mid Essex CCG

Yes Kelly Lee St Helena Hospice

Yes Karen Fyatt St Helena Hospice

Dialled in Deborah Beardsell Ramsay Health

Dialled in Prof. Nancy Fontaine PAH

Dialled in Sheila Baldwin North East Essex CCG

Dialled in Sheila O’Mahony South West Essex CCG

Dialled in Danny Showell Essex County Council

Dialled in Tony Elston CHUFT


Apologies

Carol Anderson Mid Essex CCG

Amanda Kirkham MEHT

Ann Smits Farleigh Hospice

Gerard Cronin NHS England

Jane Kinniburgh West Essex CCG

Jeni Hough Ramsay Health

Joanne Mayhew Southend CCG

Kevin Baker ACECIC

Kim Shaw SEPT

Lesley Cruickshank Essex County Council

Linda Moncur North East Essex CCG

Dr Donald McGeachy Mid Essex CCG

Monica Clarke Ramsay Health

Morag Kirkpatrick St Helena Hospice

Anurita Rohilla West Essex CCG

Siobhan Kearney SEPT

Tanya Curry St Clare Hospice

Teresa Kearney SEPT

Carla Mountney NEPFT

Sue Champion NEPFT

Action

1. INTRODUCTIONS & APOLOGIES RH chaired the meeting. Introductions were made around the table and with teleconference attendees. Apologies were noted.

2. MINUTES OF THE LAST MEETING LT requested corrections to the previous meeting minutes :- Page 3 Item No. 5 HCAI Action Plan – Objective 2) Ensure maximal learning from HCAI investigation processes – line 6 and lessons learnt from RCA’s to RCAs. Objective 4) Review existing communications with GPS’s re C difficile to communications with GPs re C difficile.

LC

3. 3a.

ACTION LOG Acute Trust Toolkit – Management and Control of Carbapenem Resistant Enterobacteriaceae CP suggested this action could close for the financial period 2013-2014 and a new action open for 2014-2015 following a


3b. 3c. 3d. 3e. 3f. 3g.

new Patient Safety Alert to be discussed later in the meeting. HCAI Action Plan Hand Hygiene, FIT Project Action not completed. CP to discuss possible funding through ARU with CA. UTI Action completed. Draft literature distributed. Antimicrobial Prescribing All actions completed. Respiratory Outbreak Management DS mentioned that it was a relatively mild winter. DS emphasised the need to get contract ready for next winter. Unfortunately, there is no swabbing contract in place for West Essex. Discussion continues between DS and SEPT. DS confirmed that the contracts will be managed by ECC although he believes it is the CCGs responsibilities. Pathology transformation plans CP informed that GC is on annual leave and she has no feedback on this and therefore cannot brief the attendees of outcome. LT said that MEHT has pulled out of this transformation plan as cost saving is not thought proven and there are significant safety concerns. TE confirmed that CHUFT are signed up with this plan and transition will start in May 2014. CP will contact GC on outcome from discussion with NHS England Area Team. Estates and Facilities CP informed the committee that DA has retired and therefore this action cannot be completed. Action closed. Estates and Facilities matters were discussed later in the meeting. (see page 9).

CP CP


4.

MRSA AND C difficile FIGURES MRSA CP briefed that a total of 12 cases were noted across North Essex. 11 cases concerned North Essex patients and the 12th case involved a burns patient from Norfolk. PIR was completed for all 12 cases; 7 were deemed unavoidable. 5 cases thus deemed avoidable which included 2 contaminated samples. RH and CP reported that there was an MRSA Bacteraemia over the weekend in Mid Essex. CP reported that she is preparing a year-end report to include lessons learned which will be shared across North Essex. SV shared with the Group that PAH will be using Octenisan washes for all patients. The Trust extended Stellisept washes to all patients in year which may have influenced risk in West Essex where there have been no cases since 2012. KR mentioned that Southend has the same policy. SV also said that Octenisan should be applied correctly to be effective. To be considered by all Providers of inpatient services and discussed further at Scrutiny Panel and Antimicrobial Stewardship meetings. C difficile CP reported 4 of 6 North Essex ceilings were not breached. PAH and MEHT breached their low ceilings. However, numbers were reduced, for contractual purposes, by successful appeal. Calculation of C difficile ceilings for 2014-2015 has used different methodologies which aims to normalise the improvement achieved to date. All North Essex ceilings are raised from the previous year.

CP


5. 2013-2014 HCAI ACTION PLAN It was agreed 2013-2014 plan should be updated and closed and a new plan drawn up for 2014-2015. 1. Develop robust CCG leadership for HCAI strategies

across North Essex

CP suggested this action although completed, is not sufficiently embedded. Involvement of GP colleagues in the Group activities is felt to be key. CP to revise this action and add to new plan following discussion with GP colleagues.

2. Ensure maximal learning from HCAI investigation

processes

Action completed. PW suggested involving community pharmacies in the learning. It was agreed CCG Medicine Management Leads should be included in the Scrutiny Panel. LC to invite.

3. Optimise assurance of provider compliance with :

It was agreed actions are completed and ongoing

Hand Hygiene

Antimicrobial Compliance

Isolation Policies


IP&C Staff Training Requirement

CP proposed taking development of inter-organisational peer audit processes into 2014-2015 HCAI Action Plan to extend to Community Providers including hospices and mental health.

LL informed that Essex County Council is introducing the safety thermometer into care homes. CP confirmed she is linked into this project and will discuss implementing peer audit into this sector.

CP LC


4. Minimise unnecessary repeat sample for C difficile

CP reported this is significantly reduced on previous years. Action to be closed with ongoing monitoring via RCA process. Catheter passport implemented in PAH with internal monitoring of use. It was agreed feedback from GPs on the use of this passport would be helpful. CP to discuss this with Dr Christine Moss, Medical Director West Essex CCG.

5. Ensure patients at high risk of HCAI in non-hospital settings are identified and management appropriately through key worker referral.

CP and JS to discuss sharing the Provide and MEHT initiatives. Action closed on HCAI Plan.

6. MRSA screening in the Community

This has not been implemented. Several concerns were raised by colleagues about resistance development, impact on social care providers and availability of resource to support. Action closed.

7. Ensure good IP&C practice is shared across North Essex CP confirmed this is embedded. Action closed.

8. C difficile zero tolerance

CP reported implementation of the Berkshire Strategy has not progressed. The software is not nationally available. It was agreed that the action will close, however, CP will maintain contact with the Strategy Leads.

9. Reduction in incidence of Hospital Acquired Pneumonia (HAP). CP briefed the action of raising bed heads and the use of mouthwashes to prevent HAP is now implemented and monitored through CQRG. RH commended JS and Provide for sharing this work with care homes. Action closed.

CP CP/JS


10. Urinary Tract Infections (diagnosis and

management) to ensure optimal antibiotic use and avoid over diagnosis

CP confirmed the brochure is prepared. TN and LC seeking publication information including funding. Action closed on HCAI Plan.

It was agreed that UTI Prevention Diagnosis and Management should be included on 2014-2015 HCAI Plan.

CP/TN/LC

6. Antimicrobial Prescribing Data And Initiatives CP said the next Antimicrobial Stewardship meeting will be on Tuesday, 20th May 2014 and suggested the Group will revisit and refresh the Terms of Reference. CP suggests a key requirement is to define audits to be undertaken in all settings to provide the most useful data. PW gave feedback on the Mid Essex GP audit underway.

7. Horizon Scanning Ebola CP briefed that a letter has been issued by PHE about the outbreak of Ebola Virus in Africa. The letter included a copy of National Guidance on VHF. CP suggested all should ensure their Policies are current. Please contact LC for a copy of the letter and Guidance, if required. SV noted the letter implies basic IP&C actions were not in place which allowed the outbreak to develop. Carbapenem Resistant Enterobacteriaceae (CRE) The toolkit, issued by PHE in January 2014, was agreed at the last meeting to be difficult to implement at this time and possibly not yet necessary. In March however, NHS England issued a Patient Safety Alert which requires providers to review the toolkit and produce a plan to control incidents of CRE. CP reported learning of a transmission incident in Norfolk recently and it is known that incidents have also occurred in London.


The deadline for completion of PSA actions, for Acute Trusts is 30th June 2014. CP suggested this be discussed further at Scrutiny Panel. Draft of Cleanliness in Hospital, NICE Guidance of SEPSIS, NHS England Management of Tuberculosis (TB) in England and Venous Leg Ulcers LC has forwarded this document to all. Collaborative Tuberculosis Strategy for England 2014 to 2019 CP reported that PHE are calling for the development of strategy to be led by Healthwatch. CP thanked LT who had found the HPA Guidance of Venous Leg Ulcers. This is a useful document. BS suggested it would be helpful for GPs. LC to send to GPs.

LC

8. 2014-2015 HCAI Action Plan CP suggested :

a) Prevention of UTI, catheter management i.e. catheter passport or similar processes.

b) Initiatives to prevent blood culture contamination. As

this is predominantly an issue for Acute Trust to be discussed in Scrutiny Panel.

c) Information and Guidance for carers of patients

receiving IV drugs in community and mental health settings. Admission avoidance projects are being developed to keep patients who need IV drugs in care homes, own homes and mental health wards in all three CCGs. Task and Finish Group to be formed for this and to include mental health colleagues.

d) Utilising Patient Experience. CP suggests this as a

new approach to both audit and training. Providers already have system in place to survey patients. A Task and Finish Group to be set up to consider how this would work in different settings and draft suitable questions for IP&C.


e) Engagement with and of Primary Care. f) Antimicrobial Stewardship. g) Training for Medical Staff and Locum/Agency Staff

A Task and Finish Group to be set up to identify and share successful strategies.

h) Development of peer audit processes across all sectors including social care.

CP to draft Terms of Reference for Task and Finish Group and LC to set dates and invite interested parties.

CP/LC

9. ANY OTHER BUSINESS Estates Occupancy Recent incidents involving high counts of Legionella Sp in West Essex has highlighted the complexities of Estate Management when multiple organisations are involved. CP has raised the most recent incident at St Margaret’s as an SI and is leading the investigation. CP will report investigation findings and actions to the next meeting for consideration of further actions to be taken by the Group. ESBL in Antenatal Clinics LT reported that she has observed a rise in incidence of ESBL organisms in antenatal clinic urine samples. She will continue to monitor this. CP suggested this be discussed further at Scrutiny Panel.

CP

10.

FUTURE MEETING DATES 1st October 2014, 7th January 2015 and 1st April 2015. Venue : Wren Boardroom 1 & 2, Wren House,

Hedgerows Business Park, Colchester Road, Chelmsford CM2 5PF

Time : 1030 to 1230


ACTION LOG

NORTH ESSEX CLUSTER INFECTION CONTROL COMMITTEE

16th April 2014

Meeting Dates

Subject Action Lead Estimated Time Scale

Update Date Completed

16/04/2014 HCAI Action Plan

Hand Hygiene. FIT project

CP to discuss possible funding through ARU with CA.

CP Apr-14

03/10/2013 Respiratory Outbreak Management

Contract for provision of swabbing & prophylaxis required

DS Jan 2014 Update from DS. Invitation to tender not yet issued but imminent. Update next meeting.

15/01/2014 15/01/2014 - DS advised that a service is in place for both North East Essex and Mid Essex but there is currently a problem in West Essex. Discussions are ongoing with SEPT DN's to provide a swabbing service and PELK (WE out of hours GP) are a possibility for antivirals. There have been a couple of flu outbreaks in West Essex. The feeling is that if the DN's are providing this service anyway they may as well be


commissioned for it. KS agreed to feedback to SEPT DN's .DS agreed to keep AR and CP in loop regarding progress. Action ongoing.

16/04/2014 Contract to cover West Essex required

DS DS emphasised the need to get contract ready for winter. Unfortunately, there is no swabbing contract in place for West Essex. Discussion continues between DS and SEPT.

03/10/2013 Pathology transformation plans

To discuss groups' concerns with NHS England Area Team

GC Jan 2014 15/01/2014 - GC advised that Pol Toner has been e-mailed but has not yet responded therefore happy to chase. There is currently no progress and this is having a knock on effect in recruiting to microbiology. In addition Dr SV advised that there is a potential move planned for Pathology in the next 5yrs from Collingdale to Glaxo. GC to chase.

16/04/2014 CP to contact GC CP

16/04/2014 Hand Hygiene, FIT Project

CP to discuss possible funding through ARU with CA.

CP


16/04/2014 MRSA: Application of Octenisan and Stellisept washes

TN and LC to add this to the Agenda of Scrutiny Panel and Antimicrobial Stewardship meetings.

TN/LC

16/04/2014 Develop robust CCG leadership for HCAI strategies across North Essex

CP to revise this action and add to new plan following discussion with GP colleagues.

CP

16/04/2014 Ensure maximal learning from HCAI investigation processes

LC to invite with Scrutiny Panel dates CCG Medicine Management Leads

CP

16/04/2014 Catheter passport initiative in West Essex

CP to discuss this with Dr Christine Moss, Medical Director West Essex CCG.

CP

16/04/2014 Ensure patients at high risk of HCAI in non-hospital settings are identified and management appropriately through key worker referral.

CP and JS to discuss sharing the Provide and MEHT initiatives.

CP/JS

16/04/2014 Urinary Tract Infections (diagnosis and management) to ensure optimal antibiotics use and avoid over diagnosis

TN and LC seeking publication information including funding.

TN/LC/CP


16/04/2014 Carbapenem Resistant Enterobacteriaceae (CRE) Toolkit and Safety Notice

CP suggested this be discussed further at Scrutiny Panel. LC to add this to the Agenda of Scrutiny Panel meeting.

CP

16/04/2014 HPA Guidance of Venous Leg Ulcers

LC to send to GPs. LC

16/04/2014 Information and Guidance for carers of patients receiving IV drugs in community and mental health settings.

CP to draft Terms of Reference for Task and Finish Group and LC to set dates and invite interested parties

CP/LC

16/04/2014 Utilising Patient Experience


CP/LC

16/04/2014 Training for Medical Staff and Locum/Agency Staff


CP/LC

16/04/2014 Estates issues where multiple organisations are involved

CP will report West Legionella investigation findings and actions to the next meeting for consideration of further actions to be taken by the Group.

CP


Chris Patridge: Lead IPN Page 35 of 43 October 2nd 2013

APPENDIX 3: WEST ESSEX PERFORMANCE TABLES & GRAPHS

Healthcare Associated Infection (HCAI) MRSA Bacteraemia

YTD Apr 13 May 13 Jun 13 July 13 Aug 13 Sept 13 Oct 13 Nov 13 Dec 13 Jan 14 Feb 14 Mar 14

West Essex CCG 0 0 0 0 0 0 0 0 0 0 0 0 0

PAH 0 0 0 0 0 0 0 0 0 0 0 0 0

Addenbrookes 4 0 0 0 0 1 0 0 1 0 1 1 0

Colchester Hospital 1 0 0 0 0 0 0 0 0 0 1* 0 0

Barts Health/Whipps Cross Hospital

12/4 0 1/1 2/0 0 0 1/0 0 3/2 0 2/1 2/0 1/0

MEHT 2 0 0 0 0 0 1 0 0 0 1** 0 0

No cases have been reported in West Essex patients. *Colchester reported a case 2 days after admission, however post-infection review identified no failings in care; therefore the case is ‘assigned’ to the CCG. ** MEHT laboratory reported 2 cases in January, 1 pre and 1 post 48 hrs. Both cases, however, were contaminated samples; the PIR (Post infection Review) process assigns both cases to the Trust.


Healthcare Associated Infection (HCAI) Clostridium difficile (C-Diff)

Annual Ceiling

YTD Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14

West Essex CCG 51 51 4 3 3 3 7 12 8 2 2 2 2 3

PAH 9 18 3 1 3 3 2 1 1 0 2 1 1 0

Addenbrookes 39 50 6 10 4 7 2 4 2 1 2 4 3 5

Colchester Hospital 18 17 2 5 0 1 1 1 2 2 1 1 0 3

Barts Health/Whipps Cross Hospital

75 Barts Health

82/25 5/3 8/2 3/1 5/1 6/2 10/2 4/3 8/1 7/0 5/5 10/4 5/1

MEHT 12 14 1 1 0 1 2 2 1 0 2 1 2 1



APPENDIX 4: North Essex Table and Graphs

Clostridium difficile YEAR TO DATE FIGURES

Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14

MEHT 1 2 2 3 5 7 8 8 10 11 13 14

Mid CCG 8 12 13 17 23 28 35 37 42 48 53 57

CHUFT 2 7 7 8 9 9 11 11 13 14 14 17

NE CCG 3 9 12 14 15 16 20 22 25 28 28 30

PAH 3 4 7 10 12 13 14 14 16 17 18 18

West CCG 4 7 10 13 20 32 40 42 44 46 48 51

MEHT trajectory 1 3 4 5 7 7 8 8 9 10 11 12

Mid CCG trajectory 4 8 14 19 24 30 35 39 44 49 53 57

CHUFT trajectory 2 4 5 7 8 9 11 13 14 16 17 18

NEE CCG trajectory 5 7 14 20 25 31 36 41 43 46 51 55

West CCG trajectory 5 11 13 20 23 25 32 36 40 43 46 51

PAH trajectory 1 2 2 3 3 3 4 5 6 7 8 9

MRSA bacteraemia YEAR TO DATE FIGURES

Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14

MEHT 0 0 0 0 0 1 1 1 1 2* 2 2

Mid CCG 2 2 2 2 2 2 2 2 2 4** 4 4

CHUFT 0 0 0 0 0 0 0 0 0 1 0 0

NEE CCG 2 2 2 3 3 4 4 4 4 6 6 7

PAH 0 0 0 0 0 0 0 0 0 0 0 0



APPENDIX 5: C difficile Appeals Process paper & Scrutiny Panel Terms of Reference

C DIFFICILE APPEALS PROCESS

Introduction:

Acute Trust organisations are required, under national contract, to maintain C difficile case numbers

within annual ceiling which is set nationally and requires percentage reduction on previous year.

Failure to remain within this ceiling at year end requires imposition of financial penalty.

North Essex CCGs recognise that this infection may happen even where all appropriate policies have

been correctly followed. The CCGs also recognise the infection may at times be diagnosed in the

absence of actual C difficile disease or may be diagnosed more than 72 hours after admission to an

Acute Trust where there is strong evidence of infection pre-admission.

The appeals process is designed to allow due consideration of such circumstances and, where

approved, removal of cases from trajectories used to calculate financial penalties. The process is an

extenuation of existing scrutiny processes implemented in North Essex which utilise all available

expertise. A process map is attached to this paper at Appendix 2.

Approval for an appeals process is being sought from NHS England Area Team.

RCA and Appeals Process:

Where a case is deemed Trust attributed (i.e. sample taken 72 hours post admission as per HPA

guidance) the Acute Trust specialist team stand as lead investigator. Information from in-patient

episode (current and recent), Primary Medical Care and any other relevant provider e.g. Community

Hospital, is collated and studied. Once the investigation is considered complete the case is

presented to the North Essex Scrutiny panel for consideration. Terms of reference for this group are

attached to this paper at Appendix 1. Panel determines whether all required questions have been

asked and answered and whether appropriate actions are being implemented and sufficiently

monitored before the case is considered closed.

Where an Acute Trust deems a case suitable for appeal this will be presented to scrutiny panel for

consideration. Panel may:-

Reject appeal

Request further information

Approve appeal


If appeal is approved by the Scrutiny panel the relevant Acute Trust will prepare appeal

documentation for presentation at North Essex Serious Incident and Never Event(SINE) Panel . SINE

panel may:

Reject appeal

Request further information

Approve appeal

It is suggested the appeal is presented by Director of Infection Prevention & Control, Lead Infection

Prevention Nurse and appropriate Executive Director, for example Director of Nursing.

The CCG Director of Nursing for the locality of the appeal may offer an opinion on the strength or

weakness of the appeal but may not vote.

SINE panel discussions and decisions will be minuted and formally reported to the Acute Trust

appeal team. The decision will also be reported at monthly Clinical Quality review meetings.

CCG performance reports to NHS England Area Team will include information on appeals made and

decisions taken.


HCAI Scrutiny Panel

Function To review all HCAIs that are subject to mandatory reporting and/or investigation requirements.

To fully scrutinise such incidents and investigations.

To review Root Cause Analysis reports from all and request additional information where appropriate?

To agree closure of incident investigations.

To consider avoidability/non avoidability of cases.

To explore potential risk reduction opportunities identified by incident investigation

Constitution North East Essex IPCC which is a sub-committee of Mid, West and North East CCG Quality Committees

Membership is :- CCG Lead IPN (Chair) CCG IPN (Deputy Chair) CHUFT } PAH }DIPC + Lead IPN or nominated Deputy MEHT }

Community Provider Lead IPNs ad hoc

Quoracy = Chair or Deputy Chair + At least 1 DIPC } + 1 Lead IPN } from different Trusts

Purpose To provide a second line of assurance, with expert oversight of the quality of investigations of relevant HCAIs, across NHS North Essex locality, and to ensure sharing of the learning identified from such investigation, providing assurance to the CCGs and provider organisations.

Level of Authority

The Panel will :

Receive monthly reports of all newly declared relevant HCAIs across the NHS North Essex locality

Receive reports of HCAI investigations

Request additional information as required to ensure thorough and robust investigation and analysis

Recommend avoidable/unavoidable determination

To identify and report trends of root causes and contributory factors

To review and advise on delivery of action plans

Receive, review and scrutinise Acute Trust HCAI trajectory appeals and make recommendation to North Essex Serious Incident and Never Event (SINE) panel.


APPEALS PROCESS MAP:

Acute Trust RCA

Multidisciplinary panel review involving relevant clinical staff investigation

Incorporating relevant information from other providers e,g, primary care

Evidence of policy compliance/non compliance

N Essex Scrutiny Panel

RCA investigation and findings discussed with peer specialist group

Addiitonal information sought as required

Reason for appeal described with evidence to support

N Essex SINE Panel

Acute Trust IP&C leads and DoN present case for appeal

Additonal information provided if required

Decision by SINE panel

CCG/Acute Trust

Decision communicated by Lead IPN to CCG Contract leads

Appeal process and decision reported in CCGs via IP&C reports to Quality Committees

Appeal decision recorded at contract reveiw meetings

Documents

INFECTION PREVENTION & CONTROL ANNUAL REPORT …