Staphylococcus aureus C.difficile

BOARD OFFICIAL

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NHS Greater Glasgow & Clyde

Paper No. 68

Meeting: Board Meeting

Date of Meeting: 22nd December 2020

Purpose of Paper: For Noting

Classification: Board Official

Sponsoring Director: Prof Angela Wallace Interim Director of Infection Prevention and Control

Paper Title The Healthcare Associated Infection Reporting Template (HAIRT)

Recommendation: The NHS Board is asked to:

Note the HAIRT report. Note the performance in respect of the Annual Operational Plan (AOP) Standards for SAB, CDI & ECB. Note the detailed activity in support of the prevention and control of Healthcare Associated

Infection. Note contribution of IPCT to GGC response to COVID-19.

Executive Summary The Healthcare Associated Infection Reporting Template (HAIRT) is a mandatory reporting tool for the Board to have oversight of the Healthcare Associated targets (Staphylococcus aureus bacteraemias (SAB), Clostridioides difficile infections (CDI), E. coli bacteraemias (ECB), incidents and outbreaks and all other HCAI activities across NHS Greater Glasgow & Clyde (NHSGGC).

Key Issues to be considered:

AOP targets set for 2019-2022 for SAB, CDI and ECB are presented in this report. Board SAB rate remains within limits. Actions to address HCAI SAB reduction are included in the report. CDI remain within normal control limits for the period of the report. ECB remain within normal control limits. There were 2 deaths in October and 1 in November where C.difficile was recorded on a death

certificate and 1 death in October where MRSA was recorded on a death certification. Each has been added to Datix and a clinical review by the clinical team has been requested.

Surgical Site Infection (SSI) surveillance has paused nationally from April to date as part of the COVID-19 surveillance response, however GGC continues with local SSI surveillance programme.

The HAIRT report continues to be reviewed and consultation process to develop the presentation of HCAI performance.

An update on the proposed IPC Quality Improvement Network - Better, Safe, Clean and Clinical Environment has been included for information.

COVID-19 activity has significantly increased from mid- September. The IPCT continue to review every case and are currently assisting with ‘Test and Protect’ as directed by the Public Health Protection Unit. The IPCT are also participating in the review of nursing homes as directed by the Board Nurse Director.

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Financial Implications None Workforce Implications None Risk Assessment Work is ongoing to continually reduce all reducible SAB, CDI and ECB across NHSGGC. Relevance to Strategic Priorities Annual Operating Plan (AOP) Standards in respect of SAB, CDI & ECB.

The HAIRT report is currently under review.

Equality Declaration The author can confirm that due regard has been given to the Equality Act 2010 and compliance with the three aims of the Equality Duty as part of the decision making process. Further to an evaluation it is noted that:

The paper is not relevant to Equality and Diversity.

Consultation Process Infection Prevention and Control Team (IPCT), Board Infection Control Committee, Acute Infection Control Committee, Partnerships Infection Control Support group and Board Clinical Governance Forum.

Author: Interim Infection Control Manager Tel No: 0141 451 6750 Date: 11 December 2020

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Healthcare Associated Infection Reporting Template For Assurance

Executive Sponsor: Prof Angela Wallace, Interim Director IPC. Authors: Mrs Sandra Devine, Interim Infection Control Manager & Professor

Angela Wallace, Interim Director Infection Prevention and Control.

Healthcare Associated Infection Summary – October/November 2020

The HAIRT Report is the national mandatory reporting tool and is presented bi-monthly to the NHS Board. This is a requirement by the Scottish Government HAI Task Force and informs NHSGGC of activity and performance against Healthcare Associated Infection Standards and performance measures. This section of the report focuses on NHSGGC Board-wide prevention and control activity and actions. SUMMARY FOR THIS PERIOD

The Board’s cleaning compliance is 96% and Estates compliance is 97% for this period. SSI surveillance recommenced locally in June. National SSI surveillance remains paused. SAB - HCAI standard aim is 70 cases or less per quarter by 2022. NHSGGC are on aim for the period

July-September 2020 with 70 HCAI SAB cases. The IPCT are supporting the organisation response to COVID-19. The IPCT continue to provide assurance to HPS in accordance with the National Support Framework

in relation to PICU. All required evidence has been submitted by GGC (final additional documents submitted 14 December) and we await feedback from HPS/HFS.

Close communication with Health Protection Scotland (HPS) and other external organisations continues with contributions from several members of the IPCT to National Groups.

All of the above actions continue to support the organisations Safe and Effective Care Objective.

Performance at a glance relates only to the two months reported and should be viewed in the context of the overall trend in the following pages.

Performance at a glance

Oct Nov RAG status toward AOP target (based on trajectory to March

2022)

Healthcare Associated Staphylococcus aureus bacteraemia (SAB). Both months below mean. RAG status RED when assessed against the 2022 trajectory.

28 25

RED↓

Healthcare Associated Clostridioides difficile infection (CDI) RAG status GREEN when assessed against the 2022 trajectory.

23 19

GREEN ↑

Healthcare Associated Escherichia coli bacteraemia (ECB). RAG status RED when assessed against the 2022 trajectory.

49 60

RED ↓

Hospital acquired IV access device associated SAB 8 5

Hand Hygiene 98 97

National Cleaning compliance (Board wide) 95.5 95.5

National Estates compliance (Board wide) 96.2 97.1

Key infection control challenges (relating to performance) Staphylococcus aureus bacteraemia There were 28 healthcare associated SAB in October and 25 in November. Aim is 23 or less per

month. Clostridioides difficile infection There were 23 healthcare associated CDI in October and 19 in November. Aim is 17 or less per month

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Escherichia coli bacteraemia There were 49 healthcare associated ECB in October and 60 in November. Aim is 38 or less per

month. SAB, CDI and ECB case numbers remain within control limits this month

Surgical site infection surveillance Surveillance paused nationally (CNO letter 25th March 2020)

Local SSI surveillance commenced on 1st June and continues throughout the second wave.

Glossary of abbreviations Following feedback from stakeholders, below is a list of abbreviations used within this report: HAI - Hospital acquired infection (not present or incubating on admission to hospital and arising ≥ 48 hours

after admission). Please note this excludes COVID-19 cases (hospital onset currently thought to be >14 days)

HCAI - Healthcare associated infection SAB - Staphylococcus aureus bacteraemia IVAD - Intravenous access device CDI - Clostridioides difficile infection AOP - Annual Operational Plan NES - National Education for Scotland IPCT - Infection Prevention & Control Team HEI - Healthcare Environment Inspectorate SSI - Surgical Site Infection SICPs - Standard Infection Control Precautions PVC - Peripheral Vascular Catheter Definitions used for S. aureus and E.coli bacteraemias Definition of a bacteraemia Bacteraemia is the presence of bacteria in the blood. Blood is normally a sterile environment, so the detection of bacteria in the blood (most commonly accomplished by blood cultures) is always abnormal. It is distinct from sepsis, which is the host response to the bacteria. Bacteria can enter the bloodstream as a severe complication of infection (like pneumonia, meningitis, urinary tract infections etc.), during surgery, or due to invasive devices such as PVCs, Hickman lines, urinary catheters etc. Transient bacteraemias can result after dental procedures or even brushing of teeth although this poses little or no threat to the person in normal situations. Bacteraemia can have several important health consequences. The immune response to the bacteria can cause sepsis and septic shock which has a high mortality rate. Bacteria can also spread via the blood to other parts of the body (haematogenous spread), causing infections away from the original site of infection, such as endocarditis (infection of the heart valves) or osteomyelitis (infection of the bones). Treatment for bacteraemia is with antibiotics for many weeks in some circumstances however cases such as Staph aureus bacteraemia, usually 14 days of antibiotic therapy is required.

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Origin definitions for bacteraemia surveillance

https://www.hps.scot.nhs.uk/web-resources-container/protocol-for-national-enhanced-surveillance-of-bacteraemia

Healthcare Associated Infection

Hospital Acquired Infection

Positive blood culture obtained from a patient who has been hospitalised for ≥48 hours. If the patient was transferred from another hospital, the duration of in-patient stay is calculated from the date of the first hospital admission.

If the patient was a neonate / baby who has never left hospital since being born.

OR The patient was discharged from hospital in the 48 hours prior to the

positive blood culture being taken. OR

A patient who receives regular haemodialysis as an out-patient. OR

Contaminant if the blood aspirated in hospital. OR

If infection source / entry point is surgical site infection (SSI). [This will be attributed to hospital of surgical procedure]

Healthcare Associated Infection

Positive blood culture obtained from a patient within 48 hours of admission to hospital and fulfils one or more of the following criteria:

Was hospitalised overnight in the 30 days prior to the positive blood culture being taken.

OR Resides in a nursing, long-term care facility or residential home.

OR IV, or intra-articular medication in the 30 days prior to the positive

blood culture being taken, but excluding IV illicit drug use. OR

Had the use of a registered medical device in the 30 days prior to the positive blood culture being taken, e.g. intermittent self-

catheterisation or percutaneous endoscopic gastrostomy (PEG) tube with or without the direct involvement of a healthcare worker

(excludes haemodialysis lines see HAI). OR

Underwent any medical procedure which broke mucous or skin barrier, i.e. biopsies or dental extraction in the 30 days prior to the

positive blood culture being taken. OR

Underwent care for a medical condition by a healthcare worker in the community which involved contact with non-intact skin, mucous

membranes or the use of an invasive device in the 30 days prior to the positive blood culture being taken, e.g. podiatry or dressing of chronic

ulcers, catheter change or insertion.

Community Acquired Infection

Positive blood culture obtained from a patient within 48 hours of admission to hospital who does not fulfil any of the criteria for healthcare associated bloodstream infection.

https://www.hps.scot.nhs.uk/web-resources-container/protocol-for-national-enhanced-surveillance-of-bacteraemia

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HCAI Surveillance NHSGGC has systems in place to monitor key targets and areas for delivery. The surveillance and HCAI systems and ways of working allow early detection and indication of areas of concern or deteriorating performance. The IPCT undertake formal ward audits (IPCAT) in addition to regular weekly ward visits by the IPC Nurse; infection investigation is also a significant function within the team as part of the AOP target reporting. This activity provides robust intelligence of how infection prevention is maintained across all areas and is reported on a monthly basis to all appropriate stakeholders.

Staphylococcus aureus bacteraemia (SAB) All blood cultures that grow bacteria are reported nationally and it was found that S. aureus became the most common bacteria isolated from blood culture. As S. aureus is an organism that is found commonly on skin it was assumed (nationally) that bacteraemias occurred because of the presence of a device such as a peripheral vascular catheter (PVC) and as such a national reduction strategy was initiated and became part of the then HEAT targets in 2006. The target was a national reduction rather than a board-specific reduction however, the latest target set for 2019-2022 are Board-specific, based on current infection rates.

NHSGGC’s approach to SAB prevention and reduction All Staph aureus bacteraemia are monitored and reported by the IPCT. Investigations to the cause of infection consist of examining the patients notes, microbiology, biochemistry and haematology reports to identify potential causes of the infection; from this, in most cases, a provisional cause is identified however if necessary, this is discussed further with the clinical team responsible for the management of the patient to assist further with the investigation. Any issues identified during the investigations, such as incomplete bundle* etc., is highlighted at this time and where appropriate a DATIX report is generated. Once a conclusion has been agreed, the information is discussed with the Infection Control Doctor and outcomes agreed. This information is part of mandatory reporting and is submitted to HPS quarterly. *Care “bundles” are simple sets of evidence-based practices that when implemented collectively, improve the reliability of their delivery and improve patient outcomes. There are several care bundles in use within GGC, i.e. PVC, CVC, SSI and Urinary Catheter Care (UCC). Compliance with these bundles are monitored via the IPC audit IPCAT and if there is an incident or outbreak. Information on patients with SABs and any follow-up actions are reported to the Directorate/Division in two ways; in their monthly summary reports, and quarterly in a SAB specific report. A monthly GGC acute operating division report is also produced and circulated and this is presented as a summary at the Acute Clinical Governance Committee. All SABs associated with an IV access device are followed-up by an audit of PVC/CVC practice in the ward or clinical area of origin, and the results are returned to the Chief Nurse for the Sector/Directorate. The analysis of the data and subsequent SAB reports enables the IPCT to identify trends in particular sources of infections such as Hickman line infections etc., and it also enables us to identify areas requiring further support. The data also influences the elements contained in the IPCT annual work plan.

A SAB and ECB reduction group has been re-established (previously SAB group) to further progress actions to reduce healthcare associated cases. This is a multi-disciplinary group and includes clinicians and nurse specialists from across NHSGGC. The first meeting via MS Teams is scheduled for 17th December. Actions and progress from the group will be included in subsequent issues of the HAIRT. This group may become one of the work streams in the IPC Improvement Collaborative.

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RAG Status - GREEN denotes monthly case numbers are less than the mean monthly SAB totals. AMBER denotes when monthly case numbers are above the mean monthly SAB totals but less than three standard deviations from the mean. RED denotes monthly case numbers are above three standard deviations from the monthly mean. Healthcare associated S. aureus bacteraemia total: December 2019 to date = 291

Oct 2020 Nov 2020

Total 34 Green 32 Green

Hospital 24 16

Healthcare 4 9

Community 6 7

Comment: Overall SAB numbers have been stable since May 2020, however the aim is to drive down rates over time. NB not a representative time period due to COVID 19 Still remains below the mean (average).

Comment: Number of cases has been variable since June 2020. November is below the mean (average).

Comment: Case numbers remain within control limits with stable variability.

Breakdown of Healthcare SAB entry point

October

Hospital acquired No of Cases

= 24

Source not identified 8

LIGHT SURVEILLANCE1 6

CVC tunnelled 4

PVC 3

Dialysis line - tunnelled 1

Ulcer 1 Surgical site infection (superficial)- Mediastinum 1

Healthcare associated No of Cases = 4

Chest drain 1

CVC tunnelled 1



November

Hospital acquired No of Cases

=16



PICC/Midline 2

CVC tunnelled 1

CVC non tunnelled 1

Surgical site infection (deep) 1

PVC 1

Respiratory infection 1

Healthcare associated No of Cases

= 9

CVC tunnelled 2



PICC/Midline 1

Cellulitis 1

Skin break 1

1Light surveillance – enhanced surveillance not undertaken on some cases due to IPC COVID response requirements. HPS (ARHAI) currently only require origin of infection for SAB & ECB.

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IV access device (IVAD) associated SABs In addition to the nationally set targets, infections from an IV access device caused by S. aureus are investigated fully and reported.

NHSGGC’s approach to SAB prevention and reduction

Continual monitoring and analysis of local surveillance data, enables the IPCT and managers to identify and work towards ways to reduce infections associated with IV access devices. All SABs are reviewed and investigated fully and highlighted to the patients’ clinicians, nursing staff and management. Where appropriate, a DATIX is generated to enable infections that require learning is shared and discussed at local clinical governance meetings.

In addition, the IPCT assess bundle compliance of three invasive devices (PVCs, urinary catheters, CVCs etc.) as part of their IPCAT audit programme and this is reported in the monthly Directorate Reports. There is also a multi-disciplinary GGC SAB Group which comprises clinicians from many areas in order to review information and devise strategies to reduce SABs.

October & November 2020

Enhanced bacteraemia surveillance temporarily switched to light methodology as directed by SG because of the acknowledged increased workload of IPCTs responding to the challenges of COVID-19. No data on source of SAB collected in April/May but recommenced again in June 2020.

Location of IV access device related SABs

October

Stobhill ACH Renal Dialysis – 3 SABS1

QEUH Ward 5C IDU

QEUH Ward 8D

IRH Renal Dialysis Unit1

GRI – NGS2

NVACH Renal Clinic1

1 Renal cases reviewed by senior clinician. All unavoidable harm.

2 Unable to assign HAI to a single ward due to patient transfers

November

GRI Ward 64

IRH – Clyde2

IRH HDU

QEUH Renal Dialysis Centre

QEUH Ward 9C

Comment: Above chart mean in October 2020 with 8 hospital acquired cases. Ward audits of device care plan undertaken by IPCT and results prospectively fed back to nursing team. Common themes were the failure to complete the care plan and consequently the care bundle. Five IV access device related cases reported in November.

Healthcare Associated Infection Standards – local reduction aims

0123456789

1011121314151617181920

GGC : Hospital acquired IVAD related SABs

HAI IVAD related SABs CL (6.2) UCL UWL

Source of SABnot investigated

in April 2020 due to IPC COVID-19 surveillance response

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S. aureus bacteraemia – reduction of 10% from 2019 to 2022.

Local quarterly reduction aim charts have been produced for GGC as a whole and for the five Acute sectors.

Comment: HCAI standard aim is 70 cases or less per quarter by 2022. NHSGGC are on aim for the current quarter.

Comment: South Glasgow Sector aim is 22 cases or less per quarter. On aim for the quarter.

Comment: North Glasgow are on HCAI aim for the quarter.

Comment: Clyde sector are on aim for this quarter.

Comment: Regional Services are one patient case above aim for the quarter. Improvement group lead by the Chief of Nursing continue to review cases.

Comment: Women and Children’s are below aim for the quarter.

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S.aureus bacteraemia - 2019-2022 HCAI standard NHSGGC - local aim

Please note this chart contains local case numbers and may differ from nationally published HPS data

GGC HCAI SAB HCAI Standard (n=70)

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S.aureus bacteraemia - 2019-2022 HCAI standard South Glasgow sector - local aim

GGC HCAI SAB HCAI Standard (n=70) South Glasgow Actual South Glasgow Aim (n=22)

Chart comment: Quarter 4, 2019 - introduction of revised HCAI standard by CNO.10% reduction in HCAI SAB cases by YE March 2022.South Glasgow are on aim for July- September 2020.

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S.aureus bacteraemia - 2019-2022 HCAI standard North Glasgow sector - local aim

GGC HCAI SAB HCAI Standard (n=70) North Glasgow Actual North Glasgow Aim (n=17)

Chart comment: Quarter 4, 2019 - introduction of revised HCAI standard by CNO.10% reduction in HCAI SAB cases by YE March 2022.North Glasgow are on aim for July - September 2020.

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S.aureus bacteraemia - 2019-2022 HCAI standard Clyde sector - local aim

GGC HCAI SAB HCAI Standard (n=70) Clyde Actual Clyde Aim (n=14)

Chart comment: Quarter 4, 2019 - introduction of revised HCAI standard by CNO.10% reduction in HCAI SAB cases by YE March 2022.Clyde are below aim for July-September 2020

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S.aureus bacteraemia - 2019-2022 HCAI standard Regional services - local aim

GGC HCAI SAB HCAI Standard (n=70) Regional Actual Regional Aim (n=13)

Chart comment: Quarter 4, 2019 - introduction of revised HCAI standard by CNO.10% reduction in HCAI SAB cases by YE March 2022.Regional services areone patinet case above aim for July - September 2020

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S.aureus bacteraemia - 2019-2022 HCAI standard Women and Children's services - local aim

GGC HCAI SAB HCAI Standard (n=70) W&C Actual W&C Aim (n=4)

Chart comment: Quarter 4, 2019 - introduction of revised HCAI standard by CNO.10% reduction in HCAI SAB cases by YE March 2022.Women's and Children services are below aim for July-September 2020

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Escherichia coli bacteraemia (ECB)

NHSGGC’s approach to ECB prevention and reduction E. coli is one of the most predominant organism of the gut flora, and for the last several years the incidence of E. coli isolated from blood cultures, i.e. causing sepsis, has increased to the point that it is the most frequently isolated organism in the UK. As a result of this, the HAI Policy Unit has now included E. coli as part of the AOP targets. The most common cause of E. coli bacteraemia (ECB) is from complications arising from urinary tract infections (UTIs), hepato-biliary infections (gall bladder infections) and infections associated with urinary catheters. Daily case totals for all three HCAI standards are reported to the IPC senior management team to provide a prospective update on the current situation within the Board.

RAG Status - GREEN denotes monthly case numbers are less than the mean monthly total. AMBER denotes when monthly case numbers are above the monthly mean but less than three standard deviations from the monthly mean. RED denotes monthly case numbers are above three standard deviations from the monthly mean.

Healthcare associated E. coli bacteraemia total: December 2019 to date = 554

Oct 2020 Nov 2020 Total 76 Green 89 Green

Hospital 21 34

Healthcare 28 26

Community 27 29

Comment: SPC chart for all E. coli bacteraemia had demonstrated a downward trend in the last six months to April. There was an increase in May and again in June. July to August plateaued, however cases decreased again in September and October. There was an increase associated with urinary catheters and this was reported to the CN with the advice to ensure that wards were using the CAUTI care bundle to prevent avoidable CAUTIs. CAUTIs can increase in the warmer months as people can become dehydrated.

Comment: There is some variability in recent months however remains below chart upper control limit.

Comment: There has been a decrease in community onset cases since July.

Breakdown of Healthcare ECB entry point

October

Hospital acquired No of Cases =21


Lower urinary tract infection 6

Urinary Catheter 5

CVC non tunnelled 1

Urinary tract abnormalities 1

PICC/Midline 1

Pyelonephritis 1

November

Hospital acquired No of Cases = 34


Urinary Catheter 6

Hepatobiliary 5


Intra abdominal infection 3

PICC/Midline 1

PVC 1

Dialysis fistula 1

Neutropenic sepsis 1

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70

80

90

100

Jan

-18

Feb

-18

Ma

r-18

Ap

r-1

8

Ma

y-1

8

Jun

-18

Jul-

18

Au

g-1

8

Sep

-18

Oct

-18

No

v-1

8

De

c-18

Jan

-19

Feb

-19

Ma

r-19

Ap

r-1

9

Ma

y-1

9

Jun

-19

Jul-

19

Au

g-1

9

Sep

-19

Oct

-19

No

v-1

9

De

c-19

Jan

-20

Feb

-20

Ma

r-20

Ap

r-2

0

Ma

y-2

0

Jun

-20

Jul-

20

Au

g-2

0

Sep

-20

Oct

-20

No

v-2

0

Healthcare associated ECB cases SPC(includes HAI and HCAI)

HCAI ECB cases Mean (n=50) UCL UWL0

10

20

30

40

50

60

70

80

90

100

Jan

-18

Feb

-18

Ma

r-18

Ap

r-1

8

Ma

y-1

8

Jun

-18

Jul-

18

Au

g-1

8

Sep

-18

Oct

-18

No

v-1

8

De

c-18

Jan

-19

Feb

-19

Ma

r-19

Ap

r-1

9

Ma

y-1

9

Jun

-19

Jul-

19

Au

g-1

9

Sep

-19

Oct

-19

No

v-1

9

De

c-19

Jan

-20

Feb

-20

Ma

r-20

Ap

r-2

0

Ma

y-2

0

Jun

-20

Jul-

20

Au

g-2

0

Sep

-20

Oct

-20

No

v-2

0

Community acquired ECB cases SPC

Community ECB cases Mean (n=46) UCL UWL

BOARD OFFICIAL

11



Hepatobiliary 8


Urinary Catheter 3

Suprapubic catheter 1



Urinary Catheter 3

Hepatobiliary 3


Pyelonephritis 1

Nephrostomy 1

PICC/Midline 1

Prostate biopsy 1

Intra abdominal infection 1


LIGHT SURVEILLANCE 1

Dialysis line - non tunnelled 1

CVC tunnelled 1

Urinary catheters were associated with % of all healthcare associated cases in the past two months. The nurse consultant IPC is currently undertaking a review of measures to reduce avoidable harm in cases associated with invasive devices including urinary catheters. ICM has contacted CN(s) to raise this as an issue and encourage the use of the CAUTI bundles for all patients who have or require a urinary catheter.

Healthcare Associated Infection Standards – local reduction aims E.coli bacteraemia – initial reduction of 25% by 2021/22

Local reduction aim charts have been produced for GGC as a whole and for the five Acute sectors. The IPC Work Plan for 2020/2021 includes the development of tools to assist clinical teams to improve the incidence of E. coli bacteraemia.

Comment: There has been a reduction in HCAI ECB cases in the previous two quarters, however a very slight increase this quarter.

Comment: South Glasgow are above aim for the quarter. The IPC Work Plan for 2020/2021 includes the development of tools to assist clinical teams to improve the incidence of E. coli bacteraemia.

149

176

152 154

164

174

152

123 125

142

0

20

40

60

80

100

120

140

160

180

200

Apr 18-Jun18

Jul 18-Sep18

Oct 18-Dec18

Jan 19-Mar19

Apr 19-Jun19

Jul 19-Sep19

Oct 19-Dec19

Jan 20-Mar20

Apr 20-Jun20

Jul 20-Sep20

Oct 20-Dec20

Jan 21-Mar21

Apr 21-Jun21

Jul 21-Sep21

Oct 21-Dec21

Jan 22-Mar22

E.coli bacteraemia - 2019-2022 HCAI standardNHSGGC - local aim


GGC HCAI ECB HCAI Standard (n=113)

4852

4348

3944

38 3734

47

0

20

40

60

80

100

120

140

160

180

200

Apr 18-Jun18

Jul 18-Sep 18 Oct 18-Dec18

Jan 19-Mar19

Apr 19-Jun19


Jan 20-Mar20

Apr 20-Jun20


Jan 21-Mar21

Apr 21-Jun21


Jan 22-Mar22

E.coli bacteraemia - 2019-2022 HCAI standard South Glasgow sector - local aim

GGC HCAI ECB HCAI Standard (n=113) South Glasgow Actual South Glasgow Aim (n=35)

Chart comment: Quarter 4, 2019 - introduction of revised HCAI standard by CNO.25% reduction in HCAI ECB cases by YE March 2022.South Glasgow are above aim for July-September 2020.

BOARD OFFICIAL

12

Comment: North Glasgow remain 4 patient cases above aim. The IPC Work Plan for 2020/2021 includes the development of tools to assist clinical teams to improve the incidence of E. coli bacteraemia.

Comment: Clyde are 6 patient cases above aim. The IPC Work Plan for 2020/2021 includes the development of tools to assist clinical teams to improve the incidence of E. coli bacteraemia.

Comment: Regional Services are 2 patient cases below aim.

Comment: Women and Children’s are 9 patient cases above aim. The IPC Work Plan for 2020/2021 includes the development of tools to assist clinical teams to improve the incidence of E. coli bacteraemia.

53

70

3736

46

61

48

3439 39

0

20

40

60

80

100

120

140

160

180

200

Apr 18-Jun18

Jul 18-Sep18

Oct 18-Dec18

Jan 19-Mar19

Apr 19-Jun19

Jul 19-Sep19

Oct 19-Dec19

Jan 20-Mar20

Apr 20-Jun20

Jul 20-Sep20

Oct 20-Dec20

Jan 21-Mar21

Apr 21-Jun21

Jul 21-Sep21

Oct 21-Dec21

Jan 22-Mar22

E.coli bacteraemia - 2019-2022 HCAI standard North Glasgow sector - local aim

GGC HCAI ECB HCAI Standard (n=113) North Glasgow Actual North Glasgow Aim (n=35)

Chart comment: Quarter 4, 2019 - introduction of revised HCAI standard by CNO.25% reduction in HCAI ECB cases by YE March 2022.North Glasgow remain 4 patient cases above aim for July-September 2020.

33 32

43 42

4945

40

32 34 33

0

20

40

60

80

100

120

140

160

180

200

Apr 18-Jun18

Jul 18-Sep18

Oct 18-Dec18

Jan 19-Mar19

Apr 19-Jun19

Jul 19-Sep19

Oct 19-Dec19

Jan 20-Mar20

Apr 20-Jun20

Jul 20-Sep20

Oct 20-Dec20

Jan 21-Mar21

Apr 21-Jun21

Jul 21-Sep21

Oct 21-Dec21

Jan 22-Mar22

E.coli bacteraemia - 2019-2022 HCAI standard Clyde sector - local aim

GGC HCAI ECB HCAI Standard (n=113) Clyde Actual Clyde Aim (n=27)

Chart comment: Quarter 4, 2019 - introduction of revised HCAI standard by CNO.25% reduction in HCAI ECB cases by YE March 2022.Clyde are 7 above aim for July-September 2020.

914

2319

22

1319

16 1410

0

20

40

60

80

100

120

140

160

180

200

Apr 18-Jun18

Jul 18-Sep18

Oct 18-Dec18

Jan 19-Mar19

Apr 19-Jun19

Jul 19-Sep19

Oct 19-Dec19

Jan 20-Mar20

Apr 20-Jun20

Jul 20-Sep20

Oct 20-Dec20

Jan 21-Mar21

Apr 21-Jun21

Jul 21-Sep21

Oct 21-Dec21

Jan 22-Mar22

E.coli bacteraemia - 2019-2022 HCAI standard Regional services - local aim

GGC HCAI ECB HCAI Standard (n=113) Regional Actual Regional Aim (n=12)

Chart comment: Quarter 4, 2019 - introduction of revised HCAI standard by CNO.25% reduction in HCAI ECB cases by YE March 2022.Regional services are below aim for July-September 2020.

47

6 7 610

6 4 4

13

0

20

40

60

80

100

120

140

160

180

200

Apr 18-Jun18

Jul 18-Sep18

Oct 18-Dec18

Jan 19-Mar19

Apr 19-Jun19

Jul 19-Sep19

Oct 19-Dec19

Jan 20-Mar20

Apr 20-Jun20

Jul 20-Sep20

Oct 20-Dec20

Jan 21-Mar21

Apr 21-Jun21

Jul 21-Sep21

Oct 21-Dec21

Jan 22-Mar22

E.coli bacteraemia - 2019-2022 HCAI standard Women's and Children services - local aim

GGC HCAI ECB HCAI Standard (n=113) W&C Actual W&C Aim (n=4)

Chart comment: Quarter 4, 2019 - introduction of revised HCAI standard by CNO.25% reduction in HCAI ECB cases by YE March 2022.Women's and Children services are above aim for July-September 2020.

BOARD OFFICIAL

13

Clostridioides difficile infection (CDI) Reporting to HPS of C. difficle infections has been mandatory for several years in NHS Scotland. NHSGGC has met its targets over the years and has maintained a low rate of infection. Similar to the SAB target, the new target set for 2019-2022 is based on our Board’s rate rather than an overall national rate.

C. difficile can be part of the normal gut flora and can occur when patients receive broad-spectrum antibiotics which eliminate other gut flora, allowing C. difficile to proliferate and cause infection. This is the predominant source of infection in GGC. C. difficile in the environment can form resilient spores which enable the organism to survive in the environment for many months, and poor environmental cleaning or poor hand hygiene can lead to the organism transferring to other patients leading to infection. Another route of infection is when a patient receives treatment to regulate stomach acid which affects the overall pH of the gut allowing the organism to proliferate and cause infection. Origin definitions for Clostridioides difficile infections

NHSGGC’s approach to CDI prevention and reduction

Similar to our SAB and ECB investigation, patient history is gathered including any antibiotics prescribed over the last several months. Discussion with the clinical teams and microbiologists assist in the determination and conclusion of the significance of the organism, as occasionally the isolation of the organism can be an incidental finding and not the cause of infection. Data is shared with the antimicrobial pharmacist and cases are discussed at the Antimicrobial Management Group to identify inappropriate antimicrobial prescribing. Daily case totals for all three HCAI standards are reported to the IPC senior management team to provide a prospective update on the current situation within our Board.

RAG Status - GREEN denotes monthly case numbers are less than the mean monthly CDI totals. AMBER denotes when monthly case numbers are above the monthly mean but less than three standard deviations from the monthly mean. RED denotes monthly case numbers are above three standard deviations from the monthly mean.

Oct 2020 Nov 2020

Total 32 Amber 22 Green

Hospital 9 9

Healthcare 9 9

Indeterminate 5 1

Community 9 3

Comments: Case numbers remain within control limits.

0

10

20

30

40

50

60

70

Jan

-18

Feb

-18

Ma

r-18

Ap

r-1

8

Ma

y-1

8

Jun

-18

Jul-

18

Au

g-1

8

Sep

-18

Oct

-18

No

v-1

8

De

c-18

Jan

-19

Feb

-19

Ma

r-19

Ap

r-1

9

Ma

y-1

9

Jun

-19

Jul-

19

Au

g-1

9

Sep

-19

Oct

-19

No

v-1

9

De

c-19

Jan

-20

Feb

-20

Ma

r-20

Ap

r-2

0

Ma

y-2

0

Jun

-20

Jul-

20

Au

g-2

0

Sep

-20

Oct

-20

No

v-2

0

All CDI cases SPCCDI cases

Mean (n=28)

UCL

UWL

BOARD OFFICIAL

14

Healthcare associated Clostridioides difficile total:

December 2019 to date = 227



October – hospital acquired cases

Ward Number of HAI CDI =9

BOC Ward B5 1

GRI Ward 35 1

Leverndale Ward 3A 1

QEUH Ward 6B 1

QEUH Ward 7B 1

QEUH Ward 9A 1

RAH Ward 27 1

RAH Ward 4 1

RAH Ward 8 1

November – hospital acquired cases

Ward Number of HAI CDI=9

GRI Ward 61 1

IRH K North 1

IRH Larkfield Unit Wd 2 1

QEUH PDRU 1

QEUH Ward 4D 1

QEUH Ward 6A 1

QEUH Ward 8B 1

RAH Ward 18 1

RAH Ward 5 1

Action Taken Cases in hospital: All patients are reviewed by the IPCT and advice is given regarding antimicrobial prescribing, isolation and transmission based precautions.

ICNs visit patient and discuss the infection and what this means for them.

Any ward with two cases of HAI in two weeks is automatically visited daily and the SCN is assisted with the completion of the HPS Trigger Tool.

Any clusters (2) are sent to the Reference Lab for testing.

Each ward receives an updated CDI SPC each month.

0

10

20

30

40

50

Jan

-18

Feb

-18

Ma

r-18

Ap

r-1

8

Ma

y-1

8

Jun

-18

Jul-

18

Au

g-1

8

Sep

-18

Oct

-18

No

v-1

8

De

c-18

Jan

-19

Feb

-19

Ma

r-19

Ap

r-1

9

Ma

y-1

9

Jun

-19

Jul-

19

Au

g-1

9

Sep

-19

Oct

-19

No

v-1

9

De

c-19

Jan

-20

Feb

-20

Ma

r-20

Ap

r-2

0

Ma

y-2

0

Jun

-20

Jul-

20

Au

g-2

0

Sep

-20

Oct

-20

No

v-2

0

Healthcare associated CDI cases SPC(includes HAI and HCAI)

HCAI CDI cases Mean (n=21) UCL UWL 0

10

20

30

40

50

Jan

-18

Feb

-18

Ma

r-18

Ap

r-1

8

Ma

y-1

8

Jun

-18

Jul-

18

Au

g-1

8

Sep

-18

Oct

-18

No

v-1

8

De

c-18

Jan

-19

Feb

-19

Ma

r-19

Ap

r-1

9

Ma

y-1

9

Jun

-19

Jul-

19

Au

g-1

9

Sep

-19

Oct

-19

No

v-1

9

De

c-19

Jan

-20

Feb

-20

Ma

r-20

Ap

r-2

0

Ma

y-2

0

Jun

-20

Jul-

20

Au

g-2

0

Sep

-20

Oct

-20

No

v-2

0

Community acquired CDI cases SPC

Community CDI cases Mean (n=7) UCL UWL

BOARD OFFICIAL

15

Healthcare Associated Infection Standards – local reduction aims C. difficile – reduction of 10% from 2019 to 2022

Comment: the chart above excludes HCAI specimen from GPs, Hospices. There has been an increase this quarter and GGC is slightly above 2022 aim.

Comment: South Glasgow is above aim this quarter. Each case has been investigated and there are no common links that would imply these were anything other than isolated occurrences.

Comment: North Glasgow is slightly above aim this quarter. Each case has been investigated and there are no common links that would imply these were anything other than isolated occurrences.

Comment: Clyde are below aim.

Comment: Regional Services are slightly above aim.

Comment: On aim for the quarter.

64

86

55

53

63

49

58

52

32

56

0

10

20

30

40

50

60

70

80

90

100

Apr 18-Jun18

Jul 18-Sep18

Oct 18-Dec18

Jan 19-Mar19

Apr 19-Jun19

Jul 19-Sep19

Oct 19-Dec19

Jan 20-Mar20

Apr 20-Jun20

Jul 20-Sep20

Oct 20-Dec20

Jan 21-Mar21

Apr 21-Jun21

Jul 21-Sep21

Oct 21-Dec21

Jan 22-Mar22

C.difficile - 2019-2022 HCAI standard NHSGGC - local aim


GGC HCAI CDI (in-patient only) HCAI Standard (n=51)

19

24

20

14 15 13

21 22

7

19

0

10

20

30

40

50

60

70

80

90

100

Apr 18-Jun18

Jul 18-Sep18

Oct 18-Dec18

Jan 19-Mar19

Apr 19-Jun19

Jul 19-Sep19

Oct 19-Dec19

Jan 20-Mar20

Apr 20-Jun20

Jul 20-Sep20

Oct 20-Dec20

Jan 21-Mar21

Apr 21-Jun21

Jul 21-Sep21

Oct 21-Dec21

Jan 22-Mar22

C.difficile - 2019-2022 HCAI standard South Glasgow sector - local aim

GGC HCAI CDI (in-patient only) HCAI Standard (n=51) South Glasgow Actual South Glasgow Aim (n=15)

Chart comment: Quarter 4, 2019 - introduction of revised HCAI standard by CNO.10% reduction in HCAI CDI cases by YE March 2022.South Glasgow are above aim for July-September 2020.

20

25

17 1619

17

12

7

17 17

0

10

20

30

40

50

60

70

80

90

100

Apr 18-Jun18

Jul 18-Sep18

Oct 18-Dec18

Jan 19-Mar19

Apr 19-Jun19

Jul 19-Sep19

Oct 19-Dec19

Jan 20-Mar20

Apr 20-Jun20

Jul 20-Sep20

Oct 20-Dec20

Jan 21-Mar21

Apr 21-Jun21

Jul 21-Sep21

Oct 21-Dec21

Jan 22-Mar22

C.difficile - 2019-2022 HCAI standard North Glasgow sector - local aim

GGC HCAI CDI (in-patient only) HCAI Standard (n=51) North Glasgow Actual North Glasgow Aim (n=15)

Chart comment: Quarter 4, 2019 - introduction of revised HCAI standard by CNO.10% reduction in HCAI CDI cases by YE March 2022.North Glasgow are 2 patient cases above aim for July-September 2020.

19

25

13

18

15

10

1512 4

13

0

10

20

30

40

50

60

70

80

90

100

Apr 18-Jun18

Jul 18-Sep18

Oct 18-Dec18

Jan 19-Mar19

Apr 19-Jun19

Jul 19-Sep19

Oct 19-Dec19

Jan 20-Mar20

Apr 20-Jun20

Jul 20-Sep20

Oct 20-Dec20

Jan 21-Mar21

Apr 21-Jun21

Jul 21-Sep21

Oct 21-Dec21

Jan 22-Mar22

C.difficile - 2019-2022 HCAI standard Clyde sector - local aim

GGC HCAI CDI (in-patient only) HCAI Standard (n=51) Clyde Actual Clyde Aim (n=15)

Chart comment: Quarter 4, 2019 - introduction of revised HCAI standard by CNO.10% reduction in HCAI CDI cases by YE March 2022.Clyde are below aim for July-September 2020.

6

10

5 4

13

9 10 10

47

0

10

20

30

40

50

60

70

80

90

100

Apr 18-Jun18

Jul 18-Sep18

Oct 18-Dec18

Jan 19-Mar19

Apr 19-Jun19

Jul 19-Sep19

Oct 19-Dec19

Jan 20-Mar20

Apr 20-Jun20

Jul 20-Sep20

Oct 20-Dec20

Jan 21-Mar21

Apr 21-Jun21

Jul 21-Sep21

Oct 21-Dec21

Jan 22-Mar22

C.difficile - 2019-2022 HCAI standard Regional services - local aim

GGC HCAI CDI (in-patient only) HCAI Standard (n=51) Regional Actual Regional Aim (n=5)

Chart comment: Quarter 4, 2019 - introduction of revised HCAI standard by CNO.10% reduction in HCAI CDI cases by YE March 2022.Regional services are above aim for July-September 2020.

0

2

0 1 1 0 0 1 0 0

0

10

20

30

40

50

60

70

80

90

100

Apr 18-Jun18

Jul 18-Sep18

Oct 18-Dec18

Jan 19-Mar19

Apr 19-Jun19

Jul 19-Sep19

Oct 19-Dec19

Jan 20-Mar20

Apr 20-Jun20

Jul 20-Sep20

Oct 20-Dec20

Jan 21-Mar21

Apr 21-Jun21

Jul 21-Sep21

Oct 21-Dec21

Jan 22-Mar22

C.difficile - 2019-2022 HCAI standard Women's and Children services - local aim

Age 15 & over

GGC HCAI CDI (in-patient only) HCAI Standard (n=51) W&C Actual W&C Aim (n=1)

Chart comment: Quarter 4, 2019 - introduction of revised HCAI standard by CNO.10% reduction in HCAI CDI cases by YE March 2022.Women's and Children services are on aim forJuly-September 2020.

BOARD OFFICIAL

16

HAI AOP targets for 2019-2022 On 10 October 2019 a letter was sent to all Health Board Chief Executives highlighting our new HCAI targets. These targets are based on our (NHSGGC) current rates of infection and a percentage reduction has been set to be achieved by March 2022. This target is different from our previous targets and includes the reduction in hospital acquired and healthcare associated infections and does not include community acquired. Hospital acquired and healthcare associated infections are now grouped together for reporting and classified as healthcare associated infections as it is thought nationally that these are all reducible. In addition to SAB and CDI targets, Escherichia coli bacteraemia (ECB) is now included in our targets. Please see table below for our targets:

2018/19 Rate (base line) per 100,000 total

bed days

No of HCAI cases

(per annum)

Reduction %

Date for reduction

Target HCAI rate per

100,000 total bed days

Target HCAI cases per

annum

Target HCAI cases per

month

SAB 19.3 324 10 2022 17.4 280 23

ECB 38.1 638 25 2022 28.6 452 38

CDI 19.0 318 10 2022 17.1 204 17

AOP target progress to date- published HPS data

NB: Q3-2020 data will be published in early January 2021

Comments: Reduction is just above aim.

Comments: Reduction is above aim.

Comments: Reduction is below aim.

Quarter ending June 2020

Target RAG Status

SAB ↓ RED

ECB ↓RED

CDI ↑GREEN

Comments CDI rate continues to be below aim. Work is continuing to reduce avoidable harm SABs related to IV access devices. ECB reduction aim of 25% is more challenging as many of these infections are related to urinary or hepatobiliary sources.

19.3 19.020.5

19.2 19.1 19.6

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

45.0

50.0

Mar-19 Jun-19 Sep-19 Dec-19 Mar-20 Jun-20 Sep-20 Dec-20 Mar-21 Jun-21 Sep-21 Dec-21 Mar-22

Hea

lthc

are

asso

ciat

ed r

ate

per

100,

000

bed

days

Reporting year end

S.aureus bacteraemia - GGC reduction aimYear end rates of Healthcare associated cases per 100,000 bed days

GGC Healthcare associated rate Scotland Healthcare associated rate GGC 10% reduction aim (17.4)

GGC year end rate March 2019 : 19.3

38.0 38.9

38.3 38.036.3 36.5

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

45.0

50.0


Hea

lthc

are

asso

ciat

ed r

ate

per

100,

000

bed

days

Reporting year end

E.coli bacteraemia - GGC reduction aim

Year end rates of Healthcare associated cases per 100,000 bed days



19.017.9

15.4 15.6 15.8 15.7

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

45.0

50.0


Hea

lthc

are

asso

cia

ted

rate

per

100

,000

bed

day

s

Reporting year end

C.difficile - GGC reduction aimYear end rates of Healthcare associated cases per 100,000 bed days



BOARD OFFICIAL

17

Surgical Site Infection Surveillance (SSIS)

Surgical site infection surveillance is the monitoring and detection of infections associated with a surgical procedure. In GGC the procedures include hip arthroplasty, Caesarean-section, major vascular surgery and large bowel surgery. These are all mandatory procedure categories for national reporting. In addition IPCT undertake surveillance on knee arthroplasty, repair of fractured neck of femur and in the Institute of Neurological Sciences (QEUH campus), spinal and cranial surgery. The IPCT monitor patients for 30 days post surgery and for those procedures with implants, up to 90 days post surgery including any microbiological investigations from the ward for potential infections and also hospital re-admissions relating to their surgery. Any mandatory procedure category infection associated with a surgical procedure is reported nationally to enable board to board comparison. GGC infection rates are comparable to national infection rates.

NHSGGC’s approach to SSI prevention and reduction Surgical site infection criteria is determined using the European Centre for Disease Control (ECDC) definitions. Any infection identified is investigated fully and information gathered including the patients’ weight, duration of surgery, grade of surgeon, prophylactic antibiotics given, theatre room, elective or emergency, primary theatre dressing etc. can provide additional intelligence in reduction strategies. The IPCT closely monitor infection rates, and any increased incidence of SSIs are reported to management and clinical teams, and IMTs are held.

October /November procedures

SSI surveillance was temporarily paused in April & May due to COVID-19 response. Local surveillance recommenced on 1st June Please note graphs are for SSIs detected as in-patient and up to 30 day readmission only. Surveillance is currently ongoing for November 2020 procedures.

Caesarean-section

Comments: case numbers remain within control limits.

Hip Arthroplasty

Comments: case numbers remain within control limits. Elective surgery paused in April 2020.

Knee Arthroplasty

Comments: case numbers remain within control limits. Elective surgery paused in April 2020.

BOARD OFFICIAL

18

Repair of NOF


Large Bowel Surgery


Major Vascular

Comments: there was an increased incidence of SSI in procedures undertaken in September. An IMT was held in early November – HIIAT green. The IPCT continue to work collaboratively with clinical colleagues to identify areas for quality improvement measures, however it should be noted that many of this patient group has existing co-morbidities which may prove difficult to impact upon.

Cranial Surgery


Spinal Surgery- INS only

Comments: There was an increased incidence of SSI in May and June procedures. IMTs held in July and the start of August. No SSI reported for August procedures and SSIs within expected limits for September to November procedures.

BOARD OFFICIAL

19

IPCAT – audit programme - Due to COVID-19 the audit schedule has been paused There were 2 acute IPCAT audits undertaken in October 2020 Both audits scored green

There were 3 acute IPCAT audits undertaken in November 2020 1 audit scored gold 2 audits scored green Results are fed back prospectively via the Synbiotix platform to the chief nurse, senior management and nursing staff. All critical non-compliance are completed within 24 hours by the responsible person for each clinical area. Areas who score red in any section undertake repeat audits with the assistance of the IPCT in order to identify any areas for improvement or any barriers to clinical areas being able to do the right thing. This is a supported improvement process which will hopefully maintain sustained improvement over time. October 2020 IPCAT

November 2020 IPCAT

Action Taken During each audit the IPCT look at the compliance with standard infection control precautions (SICPs). These include Patient Placement, Hand Hygiene, PPE, Managing Patient Care Equipment, Control of the Environment, Safe Management of Linen and Safe Disposal of Waste, Transmission Based Precaution (TBPs), Compliance with PVC, CVC and CAUTI bundles and compliance with requirement re clinical risk assessment for MRSA and CPE screening. Critical non-compliances are required to be rectified within 24 hours. The action plan is electronically returned to the SCN to be completed in one month. Any sections that score RED are followed-up with a joint re-audit with the IPCN and SCN to try and support staff in this process and determine any barriers that make the application of IPC standards difficult to implement. Audit results are included in the monthly activity reports to directorates and sectors but SCN, LN and Chief Nurses all have access to the audit dashboard and can view the results and action plans in real time.

Infection Prevention & Control Audits Undertaken (IPCAT 20)

Hospital Site Ward/Dept Date of audit

SICP QA Overall score

Re-audit period

Sector

RAH 5 06/10/20 90 80 89 12 Months Clyde

GGH Theatre

Recovery and Transfer

06/10/20 88 50 86 12 Months South

Glasgow

Infection Prevention & Control Audits Undertaken (IPCAT 20)

Hospital Site Ward/Dept Date of audit

SICP QA Overall score

Re-audit period

Sector

QEUH Ward 6A(RHC

2A) 17/11/20 92 71 90 12 Months W&C

RHC Ward 1D 25/11/20 94 86 93 12 Months W&C

RHC Ward 1E 10/11/20 92 67 90 12 Months W&C

BOARD OFFICIAL

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Meticillin resistant Staphylococcus aureus (MRSA) & Clostridioides difficile recorded deaths

The National Records of Scotland monitor and report on a variety of deaths recorded on the death certificate. Two organisms are monitored and reported, MRSA and C. difficile. Please click on the link below for further information:

https://www.nrscotland.gov.uk/statistics-and-data/statistics/statistics-by-theme/vital-events/deaths

There were two deaths in October and one in November where hospital acquired Clostridioides difficile was recorded on the death certificate. There was one death in October due to hospital acquired MRSA.

Hand Hygiene Monitoring Compliance

NHS GGC Board Dec

2019 Jan

2020 Feb 2020

Mar 2020

Apr 2020

May 2020

June 2020

July 2020

Aug 2020

Sept 2020

Oct 2020

Nov 2020

Board Total

98 97 97 97 99 99 98 98 97 98 98 97

Hospital site Oct 2020 Nov 2020

Glasgow Royal Infirmary/Princess Royal Maternity 98 98

Gartnavel General Hospital/Beaton Oncology Centre 99 98

Inverclyde Royal Hospital 99 99

Queen Elizabeth University Hospital 98 97

Royal Alexandra Hospital 97 96

Royal Hospital for Children 97 98

Vale of Leven Hospital 98 100

NHSGGC Total 98 97

Better Safe, Clean and Clinical Environment Quality Improvement Network Proposal

NHS Scotland Quality Strategy ambitions states “there will be no avoidable harm to people from the

healthcare they receive.” Healthcare associated infection is estimated to affect 5% of all patient who receive

care. One of NHS Greater Glasgow and Clyde’s ambitions is to strive for excellence in the prevention of

avoidable infections. This proposed ambition aims to embed quality improvement and quality management

within our systems and processes for Infection Control and Prevention throughout NHSGGC by shaping the

future whilst building on the experiences, learning and positive outcomes to date. This will be taken forward

through the work of the Quality Strategy as one of the three key priorities, thus providing the structure,

methodology and expertise required. The “Quality Improvement Network” needs to deliver the key aim of

creating an Infection Control renewal programme that strives to be a world leader in its approach and

measurable outcomes. This designated priority work stream of the Quality Strategy will:

Align with the other key priorities areas of tissue viability & person centred care

Utilise & build on organisational quality improvement capacity and capability expertise at all levels

within the organisation

Teams & staff will lead on the improvement continuum of prevention of avoidable infections to

embed sustained improvement

Refresh Infection Control & Preventions Teams integration within patient facing services to achieve

agreed outcomes

Ultimately improve both patient safety & their care experience in line with organisational objectives An update on the work of the collaborative will be included in future HAIRTS.

https://www.nrscotland.gov.uk/statistics-and-data/statistics/statistics-by-theme/vital-events/deaths

BOARD OFFICIAL

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Estate and Cleaning Compliance (per hospital)

The data is collected through audit by the Domestic Services Team using the Domestic Monitoring National Tool, and areas chosen within each hospital is randomly selected by the audit tool. Any issues such as inadequate cleaning is scored appropriately and if the score is less than 80% then a re-audit is scheduled. Estates compliance assesses whether the environment can be effectively cleaned; this can be a combination of minor non-compliances such as missing screwcaps, damaged sanitary sealant, scratches to woodwork etc. The results of these findings are shared with Serco/Estates for repair. Similar to the cleaning audit, scores below 80% triggers a re-audit.

Cleaning Compliance Estates Compliance

The charts above show Estate and cleaning compliance data for October, the chart below shows compliance for November.

Cleaning Compliance Estates Compliance

Board Total 95.5%

GRI

95.4%

RAH

95.5%

IRH 95.7%

VOL

96.4%

GGH

95.5%

QEUH

95.3%

Langlands 94.1%

RHC 96.3%

Board Total

96.2%

GRI

90.9%

RAH

94.5%

IRH 93.2%

VOL

98.8%

GGH

99.3%

QEUH

95.5%

RHC 96.9%

Board Total 95.5%

GRI

95.8%

RAH

95.5%

IRH 95.8%

VOL

96.2%

GGH

96.3%

QEUH

95.0%

Langlands 94.2%

RHC 95.7%

Board Total

97.1%

GRI

92.3%

RAH

95.6%

IRH 92.1%

VOL

98.8%

GGH

99.9%

QEUH

96.1%

RHC 98.0%

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COVID-19 update There has been an increase in new positive cases since mid-September. To date in NHSGGC there have been over 8700 confirmed positive cases however many people do not require admission to our hospitals. As well as the IPCNs providing advice and expertise to the local clinical teams, the IPCT monitor all COVID-19 positive cases to assist with the provision of overall case numbers, ITU admissions and deaths. The first bar graph displays the number of in-patients across all GGC hospital who are positive for COVID-19. In orange are the number of people in intensive care areas. During the summer months the number of new cases decreased, and the methodology of counting in-patient cases was no longer viable for the reporting of recent onset of first positive COVID cases. A national review was undertaken and a revised reporting format as described in the document below was adopted from 15th September.

HSCA - COVID-19 -

hospital inpatients data - blog on definition.docx

REVISED REPORTING – from 15/09/2020 to date

Daily reporting now includes only those in-patients who have had a first positive COVID-19 test within the previous 28 days. As Lighthouse test results are not imported into the GGC virology lab, there are limitations with daily reporting, however GGC Business Intelligence are working with Infection Prevention & Control to identify how these results can be incorporated.

0

100

200

300

400

500

600

700

NHSGGC Number of In-patients with Positive COVID-19 test (excluding Lighthouse)

(status at 08:00 each day)

Positive in-patients (non ITU) Positive in-patients (ITU) In-patient (highest-16/04/2020 ) Wave 2 In-patient (highest- 02/11/2020)

Data at 9th December

11/09/20revised national reporting

0

100

200

300

400

500

600

NHSGGC Number of In-patients with first positive COVID-19 test within the previous 28 days (Excluding Lighthouse)

(status at 08:00 each day)

Positive in-patients (non ITU) Positive in-patients (ITU)

data at 09/12/2020

BOARD OFFICIAL

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Public Health Scotland now publish weekly reports on the incidence of COVID-19 in Scotland. These are available at: https://beta.isdscotland.org/find-publications-and-data/population-health/covid-19/covid-19-statistical-report/

Further information on Coronavirus (COVID-19) data, intelligence and guidance is available at: https://www.publichealthscotland.scot/our-areas-of-work/sharing-our-data-and-intelligence/coronavirus-covid-19-data-and-guidance

Ward closures due to COVID-19 There were 44 ward closures due to COVID-19 in October, 19 of which didn’t reopen till November. There were 37 ward closures due to COVID-19 in November, 12 of which didn’t reopen till December and 11 of which are still closed as of 09/12/2020.

Month Mar -20

Apr -20

May-20

Jun-20

Jul-20

Aug-20

Sept-20

Oct-20

Nov-20

Ward Closures

6 16 5 1 0 1 9 44 37

Bed Days Lost

597 1270 184 35 0 38 310 3583 3992

Below is a extract from ARHAI Scotland’s Report on the incidence of COVID 19 in Scotland – Validated data up until 15 November 2020 published 9 December 2020.

https://beta.isdscotland.org/find-publications-and-data/population-health/covid-19/covid-19-statistical-report/

https://beta.isdscotland.org/find-publications-and-data/population-health/covid-19/covid-19-statistical-report/

https://www.publichealthscotland.scot/our-areas-of-work/sharing-our-data-and-intelligence/coronavirus-covid-19-data-and-guidance

https://www.publichealthscotland.scot/our-areas-of-work/sharing-our-data-and-intelligence/coronavirus-covid-19-data-and-guidance

BOARD OFFICIAL

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Incidents/Outbreaks Incidence and outbreaks across NHSGGC are identified primarily through ICNet, microbiology or from the ward. ICNet is the IPCT data management system that automatically identifies clusters of infections and specific organisms such as MRSA, admission of patients with known infections etc. to enable timely patient management to prevent any possible spread of infection. The identification of outbreaks is determined following discussion with the microbiologist. In the event of a declared outbreak a Problem Assessment Group (PAG) or Incident Management Team (IMT) meeting is held with staff from the area concerned, and actions are implemented to control further infection and transmission. All outbreaks are notified to HPS and Scottish Government. Healthcare Infection Incident Assessment Tool (HIIAT)

The HIIAT is a tool used by boards to assess the impact of an incident or outbreak. The tool is a risk assessment and allows boards to rate the incident/outbreak as a RED, AMBER, or GREEN. The tool also directs boards whether to inform HPS/SGHD of the incident (if AMBER or RED), release a media statement etc.

HIIAT GREEN - Seven reported for October, Seven for November HIIAT AMBER - Four in October, Twelve in November HIIAT RED - Twenty-one in October, Twenty-two in November

Incidents/Outbreaks (HIIAT assessed as Amber or Red) QEUH – Isolation of Burkholderia stabilis in blood cultures. Assessed as HIIAT Green on 9 September then Amber 1 & 16 October 2020 then Green on the 22 October. An IMT was held on 01/10/20 following identification of 3 patients with Burkholderia stabilis isolated from blood cultures from 02/06/20 to 02/09/20 now identified as a typing match (SERN07B5-2). Burkholderia is a gram-negative bacteria, with isolates identified from a variety of environments. Outbreaks have been associated with contaminated medical devices, e.g. gloves and some antibacterial solutions. Focus of the IMT is to try to identify possible sources in the environment. Actions

Water sampling in all 3 wards has been undertaken; this includes all outlets in affected patient

rooms and the additional support rooms. All specimens reported as negative. Drain sampling also

negative.

Specimens of nitrile gloves and ABHR sent to laboratories for testing for Burkholderia stabilis. All

specimens reported as negative.

Blood bottles collected for all 3 wards were sampled and were negative.

Hand Hygiene and Infection Prevention and Control (IPCAT) audits have been completed, no

significant issues were identified.

Review of line insertion by vascular access team was completed with no issues identified.

Shared equipment was identified, sampled and were negative.

No commonality with theatre dressings used.

Conductive gel used for bladder scanning was tested and was negative.

Pharmacy Team conducted a medication review to establish if any of the patients were on the

same medications and if there are any significant links; none were identified.

Organism added to IC net as an alert. If any further cases occur the IMT will reconvene.

All actions are now complete and monitoring for further cases is ongoing.

BOARD OFFICIAL

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GRI - 2 cases of MDRO Pseudomonas aeruginosa which had matching VNTR profiles in ICU. HIIAT assessed as red on 3 November 2020, then Green on 4 November. Index patient had pseudomonas with an increasing resistance pattern over time. Another patient became positive with the same type of pseudomonas so the hypothesis was that this was due to cross transmission on the unit. One patient sadly passed away. This patient had other serious underlying conditions which had required ITU care. Actions

HPS Water use checklist was carried out 31/8/20 and 1/10/20. Results were fed back to unit and action taken (cleaning issue with the ice machine although it was noted that neither patient had received ice).

Hand hygiene audit was carried out on the 1/10/20 compliance was 90%. Immediate action was taken with the one area of non-compliance.

IPCAT audit carried out in July and the score was 100%.

Water sampling was carried out and was negative for pseudomonas.

Patient placement advice was given to the clinical team. All actions are now complete and monitoring for further cases is ongoing. COVID 19 Incidents September assessed as either HIIAT Amber or Red Number of incidents reported. The HIIAT assessment below indicates the highest rating. This is based on

an assessment of:

Severity of Illness

Impact on Services

Risk of transmission

Public anxiety

Number RED/AMBER/GREEN HIIATs in second wave (highest score recorded).

Red Amber Green Total

48 27 15 90

Number still open as of 10/12/2020 and current HIIAT status

Red Amber Green Total

7 15 10 32

Approach and Action

NHS GGC in learning from the first wave of COVID 19 have taken an extremely proactive approach to safely managing patients, maintaining services and reducing possible nosocomial transmission.

Wards have been closed if there is one hospital onset patient if the IPCT are unable to hypothesise how the patients became positive or if the patient is in some way cognitively impaired and may had significant contact with other patients/staff.

Where possible positive patients are being moved from the closed wards to the COVID 19 HUBs. The wards remain closed but this is to reduce continuing exposure from positive patients. Contacts are left on the ward until 14 days have elapsed or until all the patients have been discharged.

IPCT have frequent meeting with HPS to update incident reports and review approach.

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Screening Patients/Staff – IPCT have undertaken screening of all patients and all staff or staff groups where indicated throughout the second wave of the pandemic, e.g., when IPCT were unable to hypothesise how COVID 19 appeared in unexpected areas.

Increased and dedicated Infection Control Team visibility and leadership is in place including ICDs and ICNs and members of the IPCT SMT providing a service over weekends to provide advice and support to sectors. This is in addition to the normal microbiology on call rota.

IPCT meet three times per week to share lessons and experiences across the sites.

Healthcare Environment Inspectorate (HEI) There have been no Inspections undertaken since the last report. All HEI reports and action plans can be viewed by clicking on the link below. http://www.healthcareimprovementscotland.org/our_work/inspecting_and_regulating_care/nhshospitals_and_services/hei_inspections/all_hei_reports.aspx

Multi-drug resistant organism screening (no update since last report) As part of the national mandatory requirements, each board is expected to screen specific patients for resistant organisms. These are Carbapenemase producing Enterobacteriaceae (CPE) and Meticillin resistant Staphylococcus aureus (MRSA). Assessment to screen depends on a clinical risk assessment performed on all admissions to indicate whether the patient requires to be screened. On a quarterly basis we assess compliance of completing this risk assessment to provide assurance of effective screening and report this nationally. The national expectation of compliance is 90%. NHSGGC has met both measures.

Last validated quarter (April to June 2020)

NHSGGC 94% compliance rate for CPE screening Scotland 80%

NHSGGC 93% compliance rate for MRSA screening Scotland 84%

Current quarter (July to September 2020)

NHSGGC 94% compliance rate for CPE screening Scotland tbc

NHSGGC 93% compliance rate for MRSA screening Scotland tbc

HPS Validated Data (no update since last report) Quarter 3 2020 data will be available early January 2021

HPS Validated Data Quarter 1 January-March

Validated Health Protection Scotland (HPS) data : Quarter 1 2020 (January-March)

Healthcare Associated

Rate per 100 000 bed days Community Associated

Rate per 100 000 population

GGC National GGC National

S. aureus bacteraemia 98 18.2 16.3 7.8 11.0

C. difficile in age 15+ 72 15.3 13.5 3.1 3.5

E.coli bacteraemia 218 29.8 36.4 32.3 37.8

Quarter 2 April - June

Validated Health Protection Scotland (HPS) data : Quarter 2 2020 (April-June)

Healthcare Associated

Rate per 100 000 bed days Community Associated

Rate per 100 000 population

GGC National GGC National

S. aureus bacteraemia 83 22.6 20.3 4.8 9.7

C. difficile in age 15+ 61 15.7 15.4 4.4 5.9

E.coli bacteraemia 236 41.0 39.7 37.7 35.9

http://www.healthcareimprovementscotland.org/our_work/inspecting_and_regulating_care/nhshospitals_and_services/hei_inspections/all_hei_reports.aspx

http://www.healthcareimprovementscotland.org/our_work/inspecting_and_regulating_care/nhshospitals_and_services/hei_inspections/all_hei_reports.aspx

BOARD OFFICIAL

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In conclusion the NHS Board is asked to:

Note the HAIRT report Note the performance in respect of the AOP Standards for SAB, ECB and CDI Note the detailed activity in support of the prevention and control of Healthcare Associated

Infection

Documents

Staphylococcus aureus C.difficile