Please note any items relating to

Board business are embargoed and

should not be made public until after
the meeting

Item 11.1

BOARD58/2016
Tayside NHS Board
23 June 2016
HEALTHCARE ASSOCIATED INFECTION (HAI) CONTROL IN TAYSIDE FOR MARCH
AND APRIL 2016
1. SITUATION AND BACKGROUND
Infections contracted while receiving healthcare are a significant cause of ill health.
Members of the public reasonably expect that all practicable measures are being taken to
reduce the opportunity for acquiring an infection as a result of their treatment and care.
HAI is a priority patient safety issue for both the SGHD and NHS Tayside, being one of
the most important events that can adversely impact on patients when they receive care
Dr Gabby Phillips is the Lead Doctor Infection Control and Dawn Weir is the General
Manager Infection Control. They are the lead officers for the HAI Strategy and annual
programme of work.
Professor D Nathwani was the lead for antimicrobial prescribing.
Attached to this report is the summary position for March and April 2016.
2. ASSESSMENT
To provide an update on progress with Healthcare Associated Infection (HAI) in Tayside
using the standard reporting template as mandated by the Scottish Government Health
Directorate (SGHD).
NHS Tayside
i.)
is currently above the HEAT target for SABs.
ii.)
is currently above CDI HEAT target
3. RECOMMENDATIONS
For information
4. REPORT SIGN OFF
Ms Lesley McLay, Chief Executive
Dr G Phillips
Lead Infection Control Doctor

Ms L McLay
Chief Executive

Professor D Nathwani
Consultant Physician, Infection Unit/Lead Clinician for the AMT
May 2016

Page 1 of 18

Healthcare Associated Infection Reporting Template (HAIRT)

Section 1 Board Wide Issues
This section of the HAIRT covers Board wide infection prevention and control activity and
actions. For reports on individual hospitals, please refer to the Healthcare Associated
Infection Report Cards in Section 2.
A report card summarising Board wide statistics can be found at the end of section 1

Key Healthcare Associated Infection Headlines for March and April 2016

CDI rate is above target

NHS Tayside is in line with the 3 antibiotic prescribing targets that support the
CDI HEAT target, compliance with the target for surgical prophylaxis is showing a
high level of reliability.
SAB target is above target and stable

Staphylococcus aureus (including MRSA)

Staphylococcus aureus is an organism which is responsible for a large number of healthcare
associated infections, although it can also cause infections in people who have not had any
recent contact with the healthcare system. The most common form of this is Meticillin
Sensitive Staphylococcus Aureus (MSSA), but the more well known is MRSA (Meticillin
Resistant Staphylococcus Aureus), which is a specific type of the organism which is resistant
to certain antibiotics and is therefore more difficult to treat. More information on these
organisms can be found at:
Staphylococcus aureus : http://www.nhs24.com/content/default.asp?page=s5_4&articleID=346
MRSA:http://www.nhs24.com/content/default.asp?page=s5_4&articleID=252
NHS Boards carry out surveillance of Staphylococcus aureus blood stream infections, known
as bacteraemias. These are a serious form of infection and there is a national target to
reduce them. The number of patients with MSSA and MRSA bacteraemias for the Board
can be found at the end of section 1 and for each hospital in section 2. Information on the
national surveillance programme for Staphylococcus aureus bacteraemias can be found at:
http://www.hps.scot.nhs.uk/haiic/sshaip/publicationsdetail.aspx?id=30248

Clostridium difficile
Clostridium difficile is an organism which is responsible for a large number of healthcare
associated infections, although it can also cause infections in people who have not had any
recent contact with the healthcare system. More information can be found at:
http://www.nhs.uk/conditions/Clostridium-difficile/Pages/Introduction.aspx

NHS Boards carry out surveillance of Clostridium difficile infections (CDI), and there is a
national target to reduce these. The number of patients with CDI for the Board can be found
at the end of section 1 and for each hospital in section 2. Information on the national
surveillance programme for Clostridium difficile infections can be found at:
http://www.hps.scot.nhs.uk/haiic/sshaip/ssdetail.aspx?id=277

Page 2 of 18

Hand Hygiene (HH)

Good hand hygiene by staff, patients and visitors is a key way to prevent the spread of
infections. More information on the importance of good hand hygiene can be found at:
http://www.washyourhandsofthem.com/

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

Cleaning and the Healthcare Environment

Keeping the healthcare environment clean is essential to prevent the spread of infections.
NHS Boards monitor the cleanliness of hospitals and there is a national target to maintain
compliance with standards above 90%.The cleaning compliance score for the Board can be
found at the end of section 1 and for each hospital in section 2. Information on national
cleanliness compliance monitoring can be found at:
http://www.hfs.scot.nhs.uk/online-services/publications/hai/

Healthcare environment standards are also independently inspected by the Healthcare

Environment Inspectorate. More details can be found at:
http://www.nhshealthquality.org/nhsqis/6710.140.1366.html

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

A small outbreak of Staph aureus (NOT MRSA) infections was declared in Ward 40
in April 2016. The outbreak was detected because the antibiotic sensitivity pattern
showed resistance to gentamicin antibiotic. This single resistance was different to our
standard pattern: however this did not affect antibiotic choice, make the infection
anymore difficult to treat or the strain more invasive (infections were superficial). A
small number of other babies were screened for carriage and no new cases were
found. Health Protection Scotland and the Scottish Government were informed.
There have been no new cases since the middle of April 2016. This antibiotic profile
has been added to our alert list to allow for early detection. Neither the source nor
route of transmission could be confirmed, but audits and observations identified
some areas for general improvement and have been implemented such as
replacement trolleys and some changes to practices.

Page 3 of 18

Other HAI Related Activity

See Appendices as below
Appendix 1
MRSA
Appendix 2
Vancomycin-resistant Enterococcus (VRE)
Appendix 3
SAB Data
Appendix 4
CDI Data
Appendix 5
ESBLs and other multi-drug resistant Gram-negative
bacteria
Appendix 6
Antimicrobial Prescribing data
Appendix 7
Surgical Site Infection (SSI) data
Appendix 8
Hot Topics / Horizon Scanning
Appendix 9
HAI and Medical Certificate of Death
Appendix 10
Status of HEI Action Plans
Appendix 11
Glossary

Page(s)
10
11
11
12
12-13
13-14
15
15
16
17
18

Page 4 of 18

Healthcare Associated Infection Reporting Template (HAIRT)

Section 2 Healthcare Associated Infection Report Cards
The following section is a series of Report Cards that provide information, for each acute hospital and key
community hospitals in the Board, on the number of cases of Staphylococcus aureus blood stream infections
(also broken down into MSSA and MRSA) and Clostridium difficile infections, as well as hand hygiene and
cleaning compliance. In addition, there is a single report card which covers all community hospitals [which
do not have individual cards], and a report which covers infections identified as having been contracted from
outwith hospital. The information in the report cards is provisional local data, and may differ from the
national surveillance reports carried out by Health Protection Scotland and Health Facilities Scotland. The
national reports are official statistics which undergo rigorous validation, which means final national figures
may differ from those reported here. However, these reports aim to provide more detailed and up to date
information on HAI activities at local level than is possible to provide through the national statistics.
Understanding the Report Cards Infection Case Numbers
Clostridium difficile infections (CDI) and Staphylococcus aureus bacteraemia (SAB) cases are presented for
each hospital, broken down by month. Staphylococcus aureus bacteraemia (SAB) cases are further broken
down into Meticillin Sensitive Staphylococcus aureus (MSSA) and Meticillin Resistant Staphylococcus
aureus (MRSA). More information on these organisms can be found on the NHS24 website:
Clostridium difficile: http://www.nhs24.com/content/default.asp?page=s5_4&articleID=2139&sectionID=1
Staphylococcus aureus: http://www.nhs24.com/content/default.asp?page=s5_4&articleID=346
MRSA: http://www.nhs24.com/content/default.asp?page=s5_4&articleID=252&sectionID=1
For each hospital the total number of cases for each month are those which have been reported as positive
from a laboratory report on samples taken more than 48 hours after admission. For the purposes of these
reports, positive samples taken from patients within 48 hours of admission will be considered to be
confirmation that the infection was contracted prior to hospital admission and will be shown in the out of
hospital report card.
Targets
There are national targets associated with reductions in C.difficile and SABs. More information on these can
be found on the Scotland Performs website:
http://www.scotland.gov.uk/About/Performance/scotPerforms/partnerstories/NHSScotlandperformance
Understanding the Report Cards Hand Hygiene Compliance
Monthly audits are carried out by nursing teams in a wide range of clinical settings across NHS Tayside. The
compliance figure from this date onwards represents the score derived from measuring the combined
compliance of opportunity and technique.This means that we start from a new baseline.
Understanding the Report Cards Cleaning Compliance
Hospitals strive to keep the care environment as clean as possible. This is monitored through cleaning and
estates compliance audits. More information on how hospitals carry out these audits can be found on the
Health Facilities Scotland website:
http://www.hfs.scot.nhs.uk/online-services/publications/hai/
Understanding the Report Cards Out of Hospital Infections
Clostridium difficile infections and Staphylococcus aureus (including MRSA) bacteraemia cases are all
associated with being treated in hospitals. However, this is not the only place a patient may contract an
infection. This total will also include infection from community sources such as GP surgeries and care
homes and. The final Report Card report in this section covers Out of Hospital Infections and reports on
SAB and CDI cases reported to a Health Board which are not attributable to a hospital.

Page 5 of 18

NHS TAYSIDE BOARD REPORT CARD

Staphylococcus aureus bacteraemia monthly case numbers
May
Jun
July
2015 2015 2015
MRSA
0
0
0
MSSA
8
9*
13
Total SABs
8
9*
13
* One source outwith Tayside
Within the natural variation parameters

Aug
2015
0
13
13

Sept
2015
2
11
13

Oct
2015
2
11
13

Nov
2015
0
9
9

Dec
2015
0
14
14

Jan
2016
0
12
12

Feb
2016
1
18
19

Mar
2016
0
13
13

Apr
2016
1
11
12

May
Jun
July
Aug
Sept
Oct
Nov
Dec
Jan
Feb
Mar
2015 2015 2015 2015 2015 2015 2015 2015 2016 2016 2016
1
3
4
Ages 15-64
2
4
4
2
7
6
3
4
9
5
7
Ages 65 plus
9*
10
9
7
6
9
10
9
10
8
11
Total CDI
11
14
13
9
13
15
13
13
* 1 case indeterminate as to which hospital to allocate against, counted in Tayside total only.
Within natural variation parameters

Apr
2016
1
7
8

Clostridium difficile infection monthly case numbers

See Appendix 3 for related SAB information and Appendix 4 for CDI information

Hand Hygiene (HH) Monitoring Compliance (%)

Support from the Infection
control team is provided to
those areas where results are
suboptimal. The figure now
reflects the combined
opportunity and technique
score. Variation is noted as
different sites are audited on
different.

Sept
2015

Oct
2015

Nov
2015

Dec
2015

Jan
2016

Feb
2016

Mar
2016

Apr
2016

AHP
Ancillary
Medical
Nurse

100
89
92
99

99
93
94
97

95
93
97
97

95
86
95
97

98
98
91
98

93
81
90
96

98
84
92
97

94
87
89
97

Combined

95

96

95

93

96

90

93

92

Aug
2015
94

Sept
2015
94

Oct
2015
95

Nov
2015
95

Dec
2015
95

Jan
2016
95

Feb
2016
94

Mar
2016
94

Apr
2016
94

Sept
2015
96

Oct
2015
95

Nov
2015
95

Dec
2015
96

Jan
2016
95

Feb
2016
96

Mar
2016
97

Apr
2016
95

Cleaning Compliance (%)

Board Total

May
2015
95

Jun
2015
94

July
2015
94

Estates Monitoring Compliance (%)

Board Total

May
2015
95

Jun
2015
95

July
2015
96

Aug
2015
94

Page 6 of 18

NHS TAYSIDE
NINEWELLS HOSPITAL REPORT CARD
Staphylococcus aureus bacteraemia monthly case numbers

MRSA
MSSA
Total SABs*

May
2015
0
2
2

Jun
2015
0
0
0

July
2015
0
4
4

Aug
2015
0
6
6

Sept
2015
1
4
5

Oct
2015
0
4
4

Nov
2015
0
6
6

Dec
2015
0
4
4

Jan
2016
0
4
4

Feb
2016
1
8
9

Mar
2016
0
4
4

Apr
2016
0
1
1

Clostridium difficile infection monthly case numbers

Ages 15-64
Ages 65 plus

Total CDI*

May
2015
1
5
6

Jun
2015
0
3
3

July
2015
1
3
4

Aug
2015
1
2
3

Sept
2015
2
3
5

Oct
2015
3
7
10

Nov
2015
2
5
7

Dec
2015
0
4
4

Jan
2016
1
4
5

Feb
2016
2
1
3

Mar
2016
2
3
5

Apr
2016
1
1
2

Aug
2015
94

Sept
2015
94

Oct
2015
94

Nov
2015
94

Dec
2015
94

Jan
2016
94

Feb
2016
93

Mar
2016
94

Apr
2016
93

Sept
2015
92

Oct
2015
93

Nov
2015
93

Dec
2015
94

Jan
2016
94

Feb
2016
95

Mar
2016
94

Apr
2016
93

Cleaning Compliance (%)

Board Total

May
2015
94

Jun
2015
94

July
2015
94

Estates Monitoring Compliance (%)

Board Total

May
2015
91

Jun
2015
92

July
2015
93

Aug
2015
92

PERTH ROYAL INFIRMARY REPORT CARD

Staphylococcus aureus bacteraemia monthly case numbers

MRSA
MSSA
Total SABs*

May
2015
0
0
0

Jun
2015
0
0
0

July
2015
0
1
1

Aug
2015
0
1
1

Sept
2015
0
0
0

Oct
2015
1
1
2

Nov
2015
0
0
0

Dec
2015
0
0
0

Jan
2016
0
0
0

Feb
2016
0
2
2

Mar
2016
0
1
1

Apr
2016
0
0
0

Clostridium difficile infection monthly case numbers

Ages 15-64
Ages 65 plus

Total CDI*

May
2015
0
1
1

Jun
2015
0
1
1

July
2015
1
2
3

Aug
2015
0
1
1

Sept
2015
0
0
0

Oct
2015
0
0
0

Nov
2015
0
0
0

Dec
2015
0
1
1

Jan
2016
0
1
1

Feb
2016
0
1
1

Mar
2016
0
0
0

Apr
2016
0
1
1

Aug
2015
92

Sept
2015
94

Oct
2015
94

Nov
2015
94

Dec
2015
96

Jan
2016
96

Feb
2016
92

Mar
2016
89

Apr
2016
96

Sept
2015
100

Oct
2015
100

Nov
2015
100

Dec
2015
100

Jan
2016
98

Feb
2016
99

Mar
2016
97

Apr
2016
100

Cleaning Compliance (%)

Board Total

May
2015
93

Jun
2015
92

July
2015
93

Estates Monitoring Compliance (%)

Board Total

May
2015
100

Jun
2015
99

July
2015
99

Aug
2015
100

* See Appendix 3 for related SAB information and Appendix 4 for CDI information.

Page 7 of 18

NHS TAYSIDE
ROYAL VICTORIA HOSPITAL REPORT CARD
Staphylococcus aureus bacteraemia monthly case numbers

MRSA
MSSA
Total SABs*

May
2015
0
0
0

Jun
2015
0
0
0

July
2015
0
0
0

Aug
2015
0
0
0

Sept
2015
0
0
0

Oct
2015
0
1
1

Nov
2015
0
0
0

Dec
2015
0
0
0

Jan
2016
0
1
1

Feb
2016
0
1
1

Mar
2016
0
0
0

Apr
2016
0
1
1

Clostridium difficile infection monthly case numbers

Ages 15-64
Ages 65 plus

Total CDI*

May
2015
0
1
1

Jun
2015
0
0
0

July
2015
0
1
1

Aug
2015
0
2
2

Sept
2015
0
0
0

Oct
2015
0
0
0

Nov
2015
0
0
0

Dec
2015
0
2
2

Jan
2016
0
0
0

Feb
2016
0
0
0

Mar
2016
0
1
1

Apr
2016
0
0
0

Aug
2015
98

Sept
2015
94

Oct
2015
96

Nov
2015
95

Dec
2015
96

Jan
2016
97

Feb
2016
95

Mar
2016
95

Apr
2016
96

Sept
2015
99

Oct
2015
100

Nov
2015
97

Dec
2015
99

Jan
2016
100

Feb
2016
100

Mar
2016
99

Apr
2016
100

Cleaning Compliance (%)

Board Total

May
2015
96

Jun
2015
97

July
2015
97

Estates Monitoring Compliance (%)

Board Total

May
2015
100

Jun
2015
99

July
2015
99

Aug
2015
100

STRACATHRO HOSPITAL REPORT CARD

Staphylococcus aureus bacteraemia monthly case numbers

MRSA
MSSA
Total SABs*

May
2015
0
0
0

Jun
2015
0
0
0

July
2015
0
0
0

Aug
2015
0
0
0

Sept
2015
0
0
0

Oct
2015
0
0
0

Nov
2015
0
0
0

Dec
2015
0
0
0

Jan
2016
0
0
0

Feb
2016
0
0
0

Mar
2016
0
0
0

Apr
2016
0
1
1

Clostridium difficile infection monthly case numbers

Ages 15-64
Ages 65 plus

Total CDI*

May
2015
0
0
0

Jun
2015
0
0
0

July
2015
0
0
0

Aug
2015
0
0
0

Sept
2015
0
0
0

Oct
2015
0
0
0

Nov
2015
0
0
0

Dec
2015
0
0
0

Jan
2016
0
0
0

Feb
2016
0
0
0

Mar
2016
0
0
0

Apr
2016
0
0
0

Aug
2015
95

Sept
2015
96

Oct
2015
96

Nov
2015
94

Dec
2015
92

Jan
2016
92

Feb
2016
96

Mar
2016
95

Apr
2016
92

Sept
2015
99

Oct
2015
99

Nov
2015
96

Dec
2015
100

Jan
2016
97

Feb
2016
99

Mar
2016
99

Apr
2016
98

Cleaning Compliance (%)

Board Total

May
2015
95

Jun
2015
96

July
2015
96

Estates Monitoring Compliance (%)

Board Total

May
2015
99

Jun
2015
98

July
2015
98

Aug
2015
97

* See Appendix 3 for related SAB information and Appendix 4 for CDI information.

Page 8 of 18

NHS TAYSIDE COMMUNITY HOSPITALS REPORT CARD

The community hospitals covered in this report card include:

Royal Dundee Liff Hospital

Strathmartine Hospital
Dudhope Young Persons Unit
Arbroath Infirmary
Aberfeldy Community Hospital
Blairgowrie Community Hospital
Murray Royal Hospital
St Margarets Hospital, Auchterarder

Brechin Infirmary
Little Cairnie
Montrose Royal Infirmary
Crieff Community Hospital
Carseview Centre
Whitehills Health & Community Care Centre
Pitlochry Community Hospital

Staphylococcus aureus bacteraemia monthly case numbers

MRSA
MSSA
Total SABs

May
2015
0
0
0

Jun
2015
0
0
0

July
2015
0
0
0

Aug
2015
0
0
0

Sept
2015
0
0
0

Oct
2015
0
2
2

Nov
2015
0
1
1

Dec
2015
0
0
0

Jan
2016
0
0
0

Feb
2016
0
0
0

Mar
2016
0
0
0

Apr
2016
0
0
0

Dec
2015
0
0
0

Jan
2016
0
0
0

Feb
2016
0
0
0

Mar
2016
0
0
0

Apr
2016
0
0
0

Clostridium difficile infection monthly case numbers

Ages 15-64
Ages 65 plus

Total CDI

May
2015
1
0
1

Jun
2015
0
0
0

July
2015
0
1
1

Aug
2015
0
0
0

Sept
2015
0
0
0

Oct
2015
0
0
0

Nov
2015
0
1
1

See Appendix 3 for related SAB information and Appendix 4 for CDI information

NHS OUT OF HOSPITAL REPORT CARD

Staphylococcus aureus bacteraemia monthly case numbers
MRSA
MSSA
Total SABS

May
2015
0
6
6

Jun
2015
0
8
8

July
2015
0
8
8

Aug
2015
0
6
6

Sept
2015
1
7
8

Oct
2015
1
3
4

Nov
2015
0
2
2

Dec
2015
0
9
9

Jan
2016
0
7
7

Feb
2016
0
7
7

Mar
2016
0
8
8

Apr
2016
1
8
9

Dec
2015
4
2
6

Jan
2016
0
4
4

Feb
2016
1
3
4

Mar
2016
2
2
4

Apr
2016
0
4
4

Clostridium difficile infection monthly case numbers

Ages 15-64
Ages 65 plus

Total CDI

May
2015
0
1
1

Jun
2015
4
6
10

July
2015
2
2
4

Aug
2015
1
2
3

Sept
2015
5
3
8

Oct
2015
3
2
5

Nov
2015
1
4
5

Page 9 of 18

MRSA
Appendix 1
MRSA KPIs: The compliance figure for NHS Tayside for the 4th quarter 2015-16 (Jan-March) is 79%
which is on a par with other areas but a reduction from the previous quarter at 89% despite awareness
sessions being delivered, target is 90%. The main challenge is the documentation (especially if patients
are subsequently transferred to a high risk area) of the fact the swabs have been taken though in the
vast majority of instances the swabs are being taken. For compliance both elements are required.
Sampling of screening sites tends to have better compliance than sampling of additional sites such as
wounds or catheters. No outbreaks were reported and the figure for MRSA is stable.
c-chart for Number of New MRSA Acquired in Ninewells Hospital
January 2012 - Apr 2016
15
14
13
12

Mean and Control Limits

recalculated at June 2013

11

No. of New MRSA

10
9
8
7
6
5
4
3
2
1

Jan-12
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan-13
Feb
Mar
Apr
May
June
July
Aug
Sep
Oct
Nov
Dec
Jan-14
Feb
March
April
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan-15
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan-16
Feb
Mar
Apr

Month

c-chart for Number of New MRSA Acquired in Perth Royal Infirmary

January 2012 - April 2016

No. of New MRSA

Jan-12
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan-13
Feb
Mar
Apr
May
June
July
Aug
Sep
Oct
Nov
Dec
Jan-14
Feb
March
April
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan-15
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan-16
Feb
Mar
Apr

Month

c-chart for Number of New MRSA Acquired in Royal Victoria Hospital

January 2012 - April 2016

No. of New MRSA

Jan-12
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan-13
Feb
Mar
Apr
May
June
July
Aug
Sep
Oct
Nov
Dec
Jan-14
Feb
March
April
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan-15
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan-16
Feb
Mar
Apr

Month
No. of New MRSA

Mean

UCL

UWL

6 per. Mov. Avg. (No. of New MRSA)

Page 10 of 18

Vancomycin-resistant Enterococcus (VRE)

Nil to report. Clinical isolates remain stable with few invasive isolates from sterile sites (e.g. blood
cultures)
Appendix 2
Run Chart Number of New VRE Positive Samples NHS Tayside,
New Isolates from Clinical Samples
(Includes Community and Hospital Acquired)
January 2014 - April 2016
12

Routine screening stopped

March 2016 (wards screening
as appropriate)

Note - Chart changed May 2016 to

show only new clinical isolates (routine
screening stopped March 2016)

10

Clinical Sample

Median - Clinical Samples (From March 2016)

Staph aureus bacteraemias (SABs)

Appendix 3

HEAT target is 24 episodes per 100 000 Acute Occupied Bed Days
Number of S. aureus Bacteraemias/1000 AOBD taken in NHS Tayside (NOT all Hospital
Acquired) Annual Rolling Total in Line with HEAT Target
0.38
Denominator data revised October
2014 - December 2015
(Incorrect inclusion of Mental
Health OBD previously artificially
inflating denominator and reducing
rate)

0.36

Annual Rate/1000 AOBD

0.34

0.32

0.30
April 16 rate calculated
using AOBD for March
2016

0.28

0.26

0.24

0.20

Jan-12
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan-13
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan-14
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan-15
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan-16
Feb
Mar
Apr

0.22

Month
Rolling total

HEAT Target

We remain above target with significant numbers still being associated with community acquisition.
Where infections are hospital acquired, the single biggest group is associated with vascular access
devices though often the source of infection is difficult to identify. Most patients have underlying
risk factors .

Page 11 of 18

C.difficile Infection (CDI) HEAT target is 32 over the age of 15 years

per 100 000 Occupied Bed Days.
NHS Tayside HEAT Target

Appendix 4

Number of C. Diff Cases/1000 TOBD in NHS Tayside (NOT all Hospital Acquired) for Patients
> 15 years Annual Rolling Total in Line with HEAT Target
0.60
Figures include all patients aged > =16 years f rom April 2013

0.50
January 2016 - March 2016 rate calculated
using HPS AOBD for Q4 2015

Annual Rate/1000 AOBD

0.40

0.30

0.20
01.06.2013
National testing algorithm adopted

0.00

Jan-12
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan-13
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan-14
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan-15
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan-16
Feb
Mar
Apr

0.10

Month
Rolling total

HEAT Target

CDI rate is stable with no outbreaks but above the target.

ESBLs and other multi-drug resistant Gram-negative bacteria

Appendix 5

No significant change or triggers breached in any single ward, though there continues to be small
numbers of new cases detected. Allocating place of acquisition is difficult, as there is a mixture of
hospital and community acquired cases. The place of detection is not necessarily the place of
acquisition.
Number of New ESBL Patients per Month January 2012 onwards
Location of Samples Taken
40

35

25

20

15

10

Jan-12
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan-13
Feb
Mar
Apr
May
June
July
Aug
Sept
Oct
Nov
Dec
Jan-14
Feb
March
April
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan-15
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan-16
Feb
Mar
Apr

Number of Patients

30

Month

NW

PRI

STX

Dundee CHP

P & K CHP

Angus CHP

Community

Page 12 of 18

Carbapenemase Producing Enterobacteriaceae (CPE)

NHS Tayside is progressing with the requirement to screen for CPE in line with National
recommendations and in addition has locally enhanced surveillance. Screening will be included in
the Clinical Risk Assessment documentation and education and awareness raising continues.
These can arise in the community as well as in hospital settings. No new cases identified in these
months
Antimicrobial Prescribing

Appendix 6

Secondary Care Audit Process

For 2015/16 the SAPG national antimicrobial prescribing indicator requires data to be collected to
provide the following information for 2 downstream wards on each site (Ninewells Wards 6 & 8 and
PRI Wards1 & 6):
missed doses of antibiotics
duration/review date of antibiotic documented
indication documented in notes
antibiotic compliance with local guidance.
To ensure monthly data is inputted to the national system for NHS Tayside, the data collection
process is currently under review. The Antimicrobial Management Team (AMT) provide support
around all areas of this data collection and review results monthly to identify any issues of concern
which are fed back to the clinical teams for education and improvement.
The required target for each element detailed above is 95% compliance. Figure 1 shows the NHS
Tayside data up to February 2016.
Work is ongoing to highlight the need for clear documentation of indication and review in medical
notes and on medicine charts through education sessions and the AMG 5 key messages issued
after each meeting.
Figure 1: Combined % Compliance with nationally required target

Data collection for audit within NHS Tayside has been reviewed by the AMT and will be reported
quarterly to clinical teams in selected wards. Other areas will carry on auditing antimicrobial
prescribing according to local needs. The AMT continue to provide support and guidance around
all aspects of antimicrobial prescribing within NHS Tayside. SAPG and the NHS Scotland HAI
Standards require that AMTs are confident that the levels of antibiotic compliance are maintained.

Page 13 of 18

The inappropriate and excessive use of prescribing carbapenem antibiotics (e.g. meropenem) has
been recognised nationally as a serious threat to our ability to treat multi-resistant pathogens. To
address this ward based pharmacy staff identify patients prescribed meropenem and alert the
antibiotic pharmacy team of these patients. Patients prescribed meropenem are then reviewed by
microbiologists or the infectious diseases medical staff to ensure use is appropriate. Meropenem
use is reviewed at each AMG meeting.
Primary Care
The primary care National Therapeutic Indicators (NTI) for 2015-16 continues to include an
indicator for overall use of antibiotics. The aim of reducing total antibiotic prescribing is likely to
prove to be challenging and practices have been signposted to supporting resources such as audit
templates and educational packages as well as individual support from AMG members. Figure 2
outlines the spread of antibiotic prescribing in general practice within NHS Tayside.
Whilst the 4-C antibiotic groups which have the highest risk of contributing to CDI are no longer
formally measured as a HEAT target, it remains a priority to monitor and follow up outlying
prescribing patterns of these agents in primary care. Overall however the level of prescribing of
these antibiotics remains low, relative to overall antibiotic prescribing, see Figure 3.
Figure 2: NHS Tayside and Scotland: - Antibiotic Items per 1000 patients per day for each practice in
NHS Tayside during October 2015 December 2015.
Antibiotic Items per 1000
Patients per Day

3.00
2.50
2.00
1.50
1.00
0.50

Items per 1000 patients per day

13369

13891

11363

13091

11414

13706

12281

13975

10751

13049

14501

10361

10799

13848

13481

11166

11486

14291

13941

13195

14037

10017

14569

10002

10553

11171

10036

10835

10125

13231

14342

10708

11005

13335

10498

12210

11128

10322

13496

13142

11823

13660

10182

13571

10407

10286

12901

14249

10233

11861

13284

12991

13532

11096

10106

11645

13621

11650

11382

11289

10638

11058

11931

11306

12831

10445

0.00
Target

In this quarter, 91% of practices have met the required target or shift (62% reaching the target
and 29% achieving the shift); with only 9% not meeting either the target or shift.

NHS Tayside

Scotland

Linear (NHS Tayside)

Dec 2015

Nov 2015

Oct 2015

Sep 2015

Aug 2015

Jul 2015

Jun 2015

May 2015

Apr 2015

Mar 2015

Feb 2015

Jan 2015

Dec 2014

Nov 2014

8.0%
7.5%
7.0%
6.5%
6.0%
5.5%
5.0%
4.5%
4.0%
Oct 2014

% 'c-diffogenic' antibacterials

Figure 3: NHS Tayside and Scotland: - C-diffogenic antibacterials as a % of all antibacterials during
the period: October 2014 December 2015.

Linear (Scotland)

The sustained low level in c-diffogenic antibiotic prescribing has been very encouraging.
The very slight upward trend will continue to be monitored.

Page 14 of 18

Surgical Site Infection Surveillance (SSI)

Appendix 7

Surveillance continues as per National requirements.

Local surveillance figures including 30 day post discharge figures where appropriate.
NOF = neck of femur
Knee = total knee replacement
Month

Jan-14
Feb
Mar
Apr
May
June
July
Aug
Sept.
Oct.
Nov
Dec
Jan 15
Feb
Mar
Apr
May
June
July
Aug
Sept
Oct
Nov
Dec
Jan 16
Feb
March

Hip = Total hip replacement

C section no.
(% infection)

NOF no.

Hip no.

Knee no.

(% infection)

(% infection)

(% infection)

117 (4)
98 (5)
95 (3)
114 (3)
101 (1)
111 (3)
117 (0)
119 (2)
118 (2)
106 (0)
94 (2)
88 (0)
87 (2)
84 (2)
117 (3)
103 (4)
112 (2)
140 (3)
122 (2)
116 (4)
109 (3)
103 (6)
81 (1)
89 (7)
91 (3)
84 (2)
92 (3)

69 (0)
47 (2)
47 (4)
56 (0)
60 (0)
49 (2)
48 (0)
44 (0)
51 (2)
46 (0)
40 (0)
53 (0)
43 (2)
34 (0)
29 (0)
49 (0)
44 (0)
25 (0)
52 (0)
46 (2)
46 (4)
41 (0)
49 (0)
55 (0)
48 (2)
36 (0)
42 (0)

51 (6)
47 (6)
73 (4)
43 (0)
63 (0)
56 (5)
63 (0)
48 (4)
73 (4)
52 (2)
66 (0)
62 (0)
64 (6)
53 (6)
70 (4)
52 (0)
51 (2)
61 (3)
60 (0)
61 (0)
61 (0)
62 (3)
70 (0)
58 (0)
68 (0)
88 (2)
64 (0)

44 (0)
45 (0)
53 (0)
48 (2)
54 (2)
51 (2)
52 (4)
55 (2)
66 (5)
40 (2.5)
51 (4)
47 (0)
35 (3)
35 (0)
39 (3)
38 (0)
37 (0)
44 (2)
32 (3)
45 (0)
50 (0)
47 (0)
38 (0)
45 (0)
34 (0)
51 (0)
46 (0)

Colorectal no.
(% infection)

24 (4)
42 (2)
35 (11)
27 (4)
24 (4)
30 (13)
30 (23)
22 (14)
20 (0)
19 (0)
20 (10)
20 (10)
22 (18)
23 (4)
24 (25)
18 (11)
13 (15)
28 (14)
17 (6)
29 (10)
34 (21)
14 (7)
27 (0)
19 (21)
26 (15)
17 (29)
19 (21)

No exceptions to report for SSI this report

Hot Topics/ Horizon Scanning

Appendix 8

Single room provision: limited single rooms entered as a risk for the organisation.
Increase in negative pressure rooms required in level 2/3 areas: entered as a risk for the
organisation in relation to the ability to deliver care for patients with possible or confirmed
MERS-CoV or Avian influenza.
Multi-resistant gram-negative bacteria for which antibiotic treatment is severely restricted. We
are seeing a small increase in the number of these bacteria being identified in the laboratory.
Staff awareness on the need to screen for these in high risk groups is increasing.

Page 15 of 18

HAI and Medical Certification of Death: MRSA and CDI

Appendix 9

Number of HAI Deaths (for C. difficile) Recorded on any line on the MCCD for
NHS Tayside per Month, January 2013 - April 2016
4

Number of C. Difficile deaths

NB: Deaths on chart include: 1. Patients dying in NHST, but resident in other Health Boards
and NHST residents dying elsewhere
2. Both underlying cause and contributory factors (ie any
mention)
3. The infection may not have been acquired in the Board of
Residence
4.All deaths in NHST (hospital and community recorded)

Month

Number of HAI Deaths (for MRSA) Recorded on any line on the MCCD for
NHS Tayside per Month January 2013 - April 2016
2

Number of MRSA deaths

NB: Deaths on chart include: 1. Patients dying in NHST, but resident in other Health
Boards and NHST residents dying elsewhere
2. Both underlying cause and contributory factors (ie any
mention)
3. The inf ection may not have been acquired in the Board
of Residence
4.All deaths in NHST (hospital and community recorded)

Month

Page 16 of 18

Appendix 10

HEI Inspections
Update May 2016
Previous Inspections to NHS Tayside by HEI:Announced

Ninewells Hospital - November 2009 (Complete)

Perth Royal Infirmary - May 2010 (Complete)
Stracathro Hospital May 2012 (Complete)
Arbroath Infirmary March 2016

Unannounced

Ninewells Hospital November 2010 (Complete)

Ninewells Hospital April 2011 (Complete)
Stracathro Hospital May 2011 (Complete)
Ninewells Hospital November 2011 (Complete)
Perth Royal Infirmary February 2012 (Complete)
Ninewells Hospital October 2012 (Complete)
Stracathro April 2013 (Complete)
Perth Royal Infirmary December 2013 (Complete)
Ninewells Hospital March 2014 (Complete)
Stracathro July 2015 (Complete)
Perth Royal Infirmary November 2015
Ninewells Hospital January 2016

Arbroath, March 2016

An announced inspection took place to Arbroath Infirmary on 2nd March 2016. This was the first
inspection to a community facility within NHS Tayside and resulted in 2 requirements related to
decontamination of patient equipment and a small number of non-compliances with infection
control policies. The report and improvement action plan were published on Tuesday 17th May
2016.
Ninewells, January 2016
An unannounced inspection took place to Ninewells Hospital on 12th and 13th January 2016. The
Report was published on 22nd March 2016 with one requirement in relation to compliance with
Health Protection Scotland (HPS) guidance on the use of personal protective equipment . It is
welcome to note that NHS Tayside was commended on significant improvement since the last
inspection in March 2014.
Perth Royal Infirmary, November 2015
An unannounced inspection to PRI took place on 17th and 18th November 2015, resulting in three
requirements linked to compliance with the Healthcare Improvement Scotland HAI Standards.
Requirements relate to decontamination of patient equipment, hand hygiene and laundering
arrangements. The report and improvement action plan were published on 3rd February 2016. 16
week follow-up improvement action plan submitted 22nd March 2016.

Page 17 of 18

Appendix 11
AOBD Acute Occupied Bed Days
'Alert' organisms- The microbiology department supply the clinical groups with daily reports of alert
organisms that are likely to cause outbreaks of infection and /or are multi drug resistant.
Antimicrobials- An antimicrobial is a substance that kills or inhibits the growth of microbes such as bacteria
(antibacterial activity), fungi (antifungal activity), viruses (antiviral activity), or parasites (anti-parasitic activity).
Bacteraemia- Bacteraemia is the presence of bacteria in the blood. It is the principal means by which local
infections spread to distant organs.
Carbapenemase Producing Enterobacteriaceae (CPE). Coliforms (bowel bacteria) producing enzymes
that break down a wide range of antibiotics. National guidelines for screening and isolation. Found mainly
outwith Scotland at this time in certain parts of the UK but is more common in Asia, Southern Europe and
other parts of the world. Considered to have the potential to be one of the most significant threats to public
health
C difficile- Clostridium difficile is a species of bacteria called Clostridium, which are anaerobic spore-forming
rods. It causes a range of symptoms from diarrhoea through to a severe inflammation of the large bowel
pseudomembranous colitis. Although part of the normal gut flora in about 5% of the adult population,
infection can occur after normal gut flora is altered by the use of antibiotics. Treatment is by stopping
antibiotics and commencing specific anti-clostridial antibiotics, e.g. metronidazole. CDI is short for
Clostridium difficile Infection.
Cohorting. The grouping together of patients with the same infection/symptoms to reduce risk of spread to
unaffected individuals: so for instance there may be a bay of patients with symptoms of diarrhoea and a
separate bay where patients are not symptomatic. It can be done by bay (or rarely by ward). It would be
started when the capacity to care for such affected patients exceeds the number of single rooms. It
preferably should include dedicated facilities for positive (affected) or negative (not affected) cohort patients
and may or may not be managed with cohort nursing staff.
DDD. Defined daily dose. The DDD is the assumed average maintenance dose per day for a drug used in its
main indication in adults.
ESBLs. Extended spectrum beta-lactamase enzyme producers. These are bacteria like E coli which cause a
range of infections such as urinary tract infections or blood poisoning and have acquired the ability to
produce the ESBL enzymes. This means these germs are able to destroy all antibiotics in the penicillin and
cephalosporin classes. Often these bacteria are resistant to other types of antibiotic and this leaves a very
restricted choice for treatment and often the patient needs intravenous treatment. Mostly seen in community
settings at the moment.
HEAT- HEAT targets are a core set of Ministerial objectives, targets and measures for the NHS. HEAT
targets are set for a 3-year period and progress towards them is measured through the Local Delivery Plan
process.
MRSA - Meticillin-resistant Staphylococcus aureus, (MRSA) is a specific strain of the Staphylococcus aureus
bacterium that has developed antibiotic resistance, first to penicillin since 1947, and later to meticillin and
related anti-staphylococcal drugs (such as flucloxacillin). Popularly termed a "superbug", it was first
discovered in Britain in 1961 and is now widespread throughout the UK. There are still antibiotics left that
can deal with this infection. More often than not it colonises (i.e. lives as part of the normal flora of the
individual) rather than infects, but if the normal defence systems are breached for instance following an
operation or if a line is put into a vein, infection can result.
Norovirus - A group of related viruses, including Norwalk and Norwalk-like viruses that can cause stomach
pain, diarrhoea, and vomiting in humans.
PVL - Panton Valentine Leucocidin. A potent toxin (poison) produced by staphylococci (MRSA and MSSA)
which attacks white blood cells. Most frequently seen in community isolates and often in children. It can
cause a range of effects from simple but recurrent abscess through to a serious infection like pneumonia.
Quinolone antibiotics- The quinolones are a family of broad-spectrum antibiotics.
Surgical prophylaxis- Surgical prophylaxis is the use of antibiotics usually a singe dose at the time of the
operation to prevent infections at the surgical site.
Vancomycin resistant enterococci. Enterococci are a normal part of human bowel flora. They rarely cause
infection and if they do tend to be UTIs. Can cause bacteraemia in at risk patients. The ALERT antibiotic
sensitivity pattern (vancomycin resistance) is readily traceable. These usually colonise rather than infect.
Other antibiotic choices are available if treatment is required.

Page 18 of 18