5.8 Infection Control Report - NHS Highland€¦ · INFECTION PREVENTION & CONTROL REPORT Report by...

Highland NHS Board12 August 2014

Item 5.8

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INFECTION PREVENTION & CONTROL REPORT

Report by Catherine Stokoe, Infection Control Manager and Dr Jonty Mills, ConsultantMicrobiologist/Infection Control Doctor, on behalf of Heidi May, Board Nurse Director& Executive Lead for Infection Control

The Board is asked to:

Note the performance position for the Board. Note the progress to keep infection under control.

1. Aim

The purpose of this paper is to update Board members of the current status of HealthcareAssociated Infections (HAI) and Infection Control measures in NHS Highland.

2. Contribution to Board Objectives

One of the Board key objectives is “to reduce to an absolute minimum the chance ofacquiring an infection whilst receiving healthcare and to ensure our hospitals are clean”.This report presents a comprehensive view of HAI data and activities for scrutiny andfeedback from the Board.

3. Summary

Table 1 shows NHS Highland Infection Prevention & Control targets and performance data

Group Target NHSScotland

NHS Highland

Clostridiumdifficile

Age 15 and over New Target32.0 (100,000OBDs) to beachieved by03/15

34.1Jan-Mar2014

30.2 Jan-Mar 2014

Green

39.8 Apr-Jun 2014(not yetHPSvalidateddata)

Red (not yetvalidated)

Staphylococcus aureusbacteraemia

Age 15 and over 24.0(100,000)AOBDs

28.4 Jan-Mar2014

22.8Jan-Mar2014

Green

19.7Apr-Jun2014 (notyet HPSvalidateddata)

Green (notyetvalidated)

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Group Target NHSScotland

NHS Highland

HandHygiene

95% 95% 98% Green

Cleaning 90% 95% 95% Green

Estates 90% 97% 96% Green

Antimicrobialprescribing(includesdata to theend of June2014)

Hospital-basedEmpiricprescribing

95% AMAU94%

Green

Ward 4A95%

Green

Duration oftherapy

95% RaigmoreWard 7C

Amber

Surgicalantibioticprophylaxis

95% Compliant Green

(includes datato the end ofSeptember2013)

Primary Careempiricalprescribing

Less than 5% 4.1% Green

Total antibioticprescribingmeasure

50% of GPpractices at ormovedtowards target

61% Green

Source: – Health Protection Scotland/ISD/Local data.

NHS Highland Clostridium difficile case data (not yet validated by HPS) identifies our positionas of 21 July 2014 as, 30 cases against target of 78 by end of March 2015.NHS Highland SAB case data (not yet validated by HPS) identifies our position as of 21 July2014 as, 17 cases against target of 60 by end of March 2015.

The Board need to note that if the same number of cases/rates occur within 2014/15,as were reported within the previous year we are at a high risk of not meeting the SABor CDI HEAT targets come March 2015.

4. Achievements

The Highland C. diff/SAB Working Group formed in December has successfullyestablished a formal process for the review of infection prevention and controlpractices, and a review of surveillance findings relating to SAB and C. diff cases. Thework of this group alongside the work within the Operational units has enabled thedata collected to be utilised more robustly; and to identify trends and the earlyidentification of any necessary actions which may lead to a reduction in the number ofcases. Work is also ongoing to lessen the reliance on human data input andestablish a data system to allow this to occur automatically, through the review of theInfection Prevention and Control Teams current data systems and the provision of adata analyst.

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The roll-out of the new Infection Prevention & Control Risk Assessment tool isunderway. This document includes a multi-drug resistant risk assessment processwhich will provide a patients assessment, against the risk factors forCarbapenemase-Producing Enterobacteriaceae (CPEs).

Three persons have been appointed to the 75hrs, Healthcare Acquired InfectionQuality Improvement Facilitator (HAI QIF) posts, funded by Scottish Government.They will all be in post by the beginning of August.

5. Challenges

To support all clinical staff in the prevention and reduction of Clostridium difficileinfections.

To reduce MSSA bacteraemias by engaging all clinical staff in hospitals and thecommunity in initiatives to prevent and reduce invasive device/healthcare relatedinfections.

The Scottish Government and Health Protection Scotland recognise the challengesfaced by NHS Boards in achieving the SAB targets. On the 21st of May 2014representatives from the Infection Control and Prevention team attended a nationalStaphylococcus aureus bacteraemia (SAB) summit held in Edinburgh. The addressfrom the CNO acknowledged the work being undertaken across NHS Scotland toreduce the incidence of SAB, but also highlighted the expectation that many NHSBoards are unlikely to reach their SAB HEAT targets. The CNO asked Boards toremain focused, and use the event to learn from other areas. A key learning point thatemerged from the day for NHS Highland was the need for executive support in theactual surveillance case feedback process. Boards which had adopted this method, orhad escalated all HAI SAB cases to a severe adverse event, were achieving muchhigher clinical engagement.

To engage all clinical staff to use the new Infection Prevention & Control RiskAssessment tool and screen for Multi-Drug Resistant bacteria (Carbapenemaseproducers) as per recent Interim Guidance from Health Protection Scotland, andCMO/SGHD (2013)14 letter.

The Infection Prevention and Control team and surveillance team within Raigmorehospital are currently short staffed due to sickness and vacancies. To mitigate anysignificant risk, a six month secondment to the surveillance team has commenced intopost; a six month secondment to the Infection prevention and Control team is currentlybeing recruited too, whilst the vacant Band 8a Highland wide post is being reviewed.

Obtaining accurate data from Microbiology laboratory systems remains a challenge.To target interventions effectively, the Infection Prevention and Control team needssignificant amounts of data, which must be retrieved from the Laboratory InformationManagement System, Medipath. This year searches of Medipath have not beenpermitted at the request of Information Technology (IT) colleagues, in order to preventsystem malfunctions that jeopardise the functioning of the laboratories. As aconsequence we have been unable to run searches again. The business continuityplan within Microbiology acknowledges this risk, and ensures that the reporting resultswould be paper based. In the longer term the system needs replacing to ensure itremains fit for purpose.

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6. Risks

Achieving the Clostridium difficile and SAB HEAT targets.

The Infection Prevention and Control team within Raigmore are facing workloadprioritisation issues due to the current staffing situation and annual leave. Although theteam has appointed a part time secondment nurse they do not commence into postuntil 4 September, and will require an induction period. The reactive clinical workremains a priority against the proactive work such as educational sessions outside ofmandatory training. Time delays for the completion of work may well occur.

Catherine Stokoe – Infection Control ManagerJonty Mills– Consultant Microbiologist & Lead Infection Control Doctor

1 August 2014

NHS Highland Healthcare Associated Infection Report

Key Healthcare Associated Infection Headlines

1. Staphylococcus aureus (including MRSA)

Staphylococcus aureus is an organism which is responsible for a large number of healthcareassociated infections, although it can also cause infections in people who have not had anyrecent contact with the healthcare system. The most common form of this is MeticillinSensitive Staphylococcus Aureus (MSSA), but the more well known is MRSA (MeticillinResistant Staphylococcus Aureus), which is a specific type of the organism which is resistantto certain antibiotics and is therefore more difficult to treat. More information on theseorganisms 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, knownas bacteraemias. These are a serious form of infection and there is a national target to reducethem. The number of patients with MSSA and MRSA bacteraemias for the Board can befound at the end of section 1 and for each hospital in section 2. Information on the nationalsurveillance programme for Staphylococcus aureus bacteraemias can be found at:

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1.1 Staphylococcus aureus bacteraemia targetFrom April 2013, NHS Boards are required to further reduce healthcare associated infectionsso that by year ending March 2015, Staphylococcus aureus bacteraemia (including MRSA)cases are 24.0 cases or less per 100,000 acute bed days. For NHS Highland this means nomore than approximately 60 cases in year ending 2015.

1.2 TrendsNational data published by Health Protection Scotland identifies that NHS ScotlandStaphylococcus aureus bacteraemia rate January to March 2014 was 28.4 per 100,000acute occupied bed days (AOBDs). NHS Highland’s rate for the same period was 22.8 per100,000 AOBDs.

Based on annual data, NHS Highland remains the second best performing Board in Scotlandfor Staphylococcus Aureus bactereamias against comparable Boards (excluding NationalWaiting Times Centre and non-mainland Boards).

http://www.hps.scot.nhs.uk/haiic/sshaip/publicationsdetail.aspx?id=30248

http://www.nhs24.com/content/default.asp?page=s5_4&articleID=346


http://www.hps.scot.nhs.uk/haiic/sshaip/publicationsdetail.aspx?id=30248

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Figure 1: Funnel plot of Staphylococcus bacteraemia rates for all NHS Boards in Scotlandagainst acute occupied bed days(x 100,000), January – March 2014. Note that NHS Orkneyand NHS Western Isles overlap in the figure below.

HG =HighlandApril-June 2014, there were 13 Staphylococcus aureus bacteraemia cases, (11 MSSA & 2MRSA) with a rate of 24.0 per 100,000 acute bed days (not yet validated by HPS).

Since April 2013, the main sources of the potentially preventable Staphylococcus aureusbacteraemia cases have been vascular devices, contamination of blood cultures andCatheter associated Urinary Tract Infections. Work is ongoing to address all of these issues.

Figure 2: NHS Highland Staphylococcus aureus bacteraemia Cumulative Case numbersyear on year since 2009.

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70

April May June July Aug Sept Oct Nov Dec Jan Feb March

Cumulative

Case

Numbers

2010-11 2011-12 2012-13 2013-14 2014-2015 Heat Target to 31-3-15

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Figure 3: Quarterly rolling year Staphylococcus aureus rates per 100,000 Acute OccupiedBed Days for HEAT Target Measurement

Apr 12 -Mar 13

Jul 12 -Jun 13

Oct 12 -Sept 13

Jan 13 -Dec 13

Apr 113-Mar 14

Jul 13 -Jun 14P

Oct 13 -Sept 14

Jan 14 -Dec 14

Apr 14 -Mar 15

ActualPerformance

21.8 21.4 25.0 25.1 25.4 23.2

Trajectory 26.0 24.0 24.0 24.0 24.0 24.0 24.0 24.0 24.0Target 26.0 24.0 24.0 24.0 24.0 24.0 24.0 24.0 24.0

1.3 Current Initiatives

Current initiatives are concentrating on infections associated with vascular devices (lines), aswell as working to reduce blood culture contamination rate.

The Vascular Access group in conjunction with the Scottish Patient Safety team arereviewing current documentation, compliance and levels of spread of the CVC Insertion andMaintenance Bundle and the PVC Maintenance Bundle. They also continue to monitorprogress in order to achieve 95% or > compliance with these bundles in all relevantapplicable patient population areas, as well as the additional aim of achieving 0 or 60 daysbetween invasive device related SAB’s (50% Reduction in SABS) by end September 2014.This group are initially focussing their work within Raigmore Hospital before extending acrossHighland, as due to the nature of our healthcare processes most line-related SABs occurwithin Raigmore hospital. A new PVC Insertion Bundle has been developed and is beingtrialled.

1.4 HAI Quality Improvement Facilitator (HAI QIF) posts

The two full-time hours NHS Highland HAI Quality Improvement Facilitator (HAI QIF) posts,funded by Scottish Government, have been appointed too. By the beginning of August 2014,three persons will be in post (1 person appointed to 22.5hrs; 1 person appointed to 15hrs;and 1 person appointed to 37.5hrs). They will work closely between the Infection Preventionand Control team and the Scottish Patient Safety team to deliver assurance across Highlandwith the compliance with care bundles, and the implementation of the catheter associatedurinary tract infection (CAUTI) bundle.

2. Clostridium difficile

Clostridium difficile is an organism which is responsible for a large number of healthcareassociated infections, although it can also cause infections in people who have not hadany 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 anational target to reduce these. The number of patients with CDI for the Board can befound at the end of section 1 and for each hospital in section 2. Information on thenational surveillance programme for Clostridium difficile infections can be found at:

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2.1 Clostridium difficile HEAT Target

From April 2013, NHS Boards are required to further reduce healthcare associated infectionsso that by year ending March 2015, the rate of Clostridium difficile infections (CDI) in patientsaged 15 and over is 32.0 cases or less per 100,000 total occupied bed days. For NHSHighland that means no more than approximately 78 cases in the year ending March 2015.

2.2 Trends

National data published by Health Protection Scotland identifies that NHS ScotlandClostridium difficile infection (CDI) in patients aged 15 and over Jan – March 2014 was 34.1per 100,000 bed days. NHS Highland’s rate for the same period was 30.2 per 100,000 beddays (15 cases of which there were 9 cases in over 65 and 6 cases 15 - 64 years).

Based on annual data, overall since April 2009, rates of Clostridium difficile in NHS Highlandhave reduced from approximately 56 cases per 100,000 total occupied bed days (April 2009-March 2010) to approximately 30 cases per 100,00 total occupied bed days (April 2013-March 2014). This has been a 46% reduction.

Figure 4: Funnel plot of CDI incidence rates in patients aged over 65 years for all NHSBoards in Scotland, January – March 2014. HS Borders and NHS Dumfries & Gallowayoverlap, as do NHS Highland and NHS Forth Valley.

HG = Highland

http://www.hps.scot.nhs.uk/haiic/sshaip/ssdetail.aspx?id=277

http://www.nhs.uk/conditions/Clostridium-difficile/Pages/Introduction.aspx

http://www.hps.scot.nhs.uk/haiic/sshaip/ssdetail.aspx?id=277

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Figure 5: Funnel plot of CDI incidence rates in patients aged 15 – 64 years for all NHSBoards in Scotland, Jan – March 2014.

HG = Highland

Apr - Jun 2014, there were 24 cases of Clostridium difficile infection in patients aged 15 andover with a rate of 39.8 per 100,000 bed days (not yet validated by HPS).

Figure 6: NHS Highland Clostridium difficile infection cumulative case numbers age 15 yearsand over year on year since 2009.

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120

CumulativeCaseNumbers

2010-2011 2011-2012 2012-2013 2013-2014 2014-2015 Heat Target to 31-3-15

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Figure 7: Quarterly rolling year Clostridium difficile Infection Cases per 100,000 totaloccupied bed days for HEAT Target Measurement

Apr 12 -Mar 13

Jul 12 -Jun 13

Oct 12 -Sept 13

Jan 13 -Dec 13

Apr 113-Mar 14

Jul 13 -Jun 14P

Oct 13 -Sept 14

Jan 14 -Dec 14

Apr 14 -Mar 15

ActualPerformance

31.9 27.3 28.7 28.8 30.2 33.5

Trajectory N/A 37.0 37.0 37.0 37.0 37.0 37.0 34.0 32.0Target N/A 32.0 32.0 32.0 32.0 32.0 32.0 32.0 32.0

2.3 Current Initiatives

A Highland-wide C difficile Working Group was established in December 2013 and ischaired by Lead Infection Control Doctor. This group provides guidance, support andoversight to the local SAB/CDI groups established in each Operational Unit. Thisgroup scrutinises surveillance data from the individual patient case reviews in order toidentify learning points, and trend analysis. Antimicrobial prescribing data is reviewedto ensure appropriate prescribing is occurring within the hospital and communitysettings.

Work is underway to develop a standardised data management system for thecollation and integration of surveillance data. This system will enable the InfectionControl and Prevention team to scrutinise epidemiological data and provide robustreal-time data to NHS Highland staff. The provision of a data analyst to the InfectionControl and Prevention team is key to the success of this work.

2.4 Antimicrobial Management

Table 2: shows NHS Highland progress against the 3 national indicators.

Antimicrobial Indicator NHS Highland progressHospital-based empirical prescribingIn acute admission areas, antibioticprescriptions are compliant with the localantimicrobial policy or specialist advice andthe rationale for treatment is recorded in theclinical case note in above 95% of sampledcases.From April 2011, learning points from casesof non-compliance are shared throughoutthe clinical teams to improve practice.Two areas are monitored, as required, inRaigmore Hospital, AMAU and Ward 4A.

Data April 2011 to June 2014

Ward AMAU – Non-CompliantMedian compliance with guidelines stands at 94%with data for May and June dipping below thetarget at 92% and 93% respectively. A number ofkey themes have been identified and raised at thePhysicians meeting in May. Documentation ofindication remains good, at 100%.

Ward 4A - CompliantThe clinical teams in the surgical admissions unitcontinue to meet the target of 95% mediancompliance with data for May and June being

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95% and 97% respectively. Documentation of theindication remains variable at 95% in May butdropping to 86% in June.

Duration of therapyIn a medical continuing care ward, data iscollected from at least 5 patients per weekon oral antibiotics and the followingmeasures are assessed: indicationdocumented; antibiotic choice in line withguidance; duration of therapy specified inthe notes/Kardex; duration is in line withguidance or specialist advice, with reasonsfor variations documented. The target is ≥ 95% for each measure. Data is currentlycollected in ward 7C.

Data from April to June 2014

Ward 7C Non-compliantData collection for month 3 of this audit showsvariability from 75% to 100%. Monthly summariesare circulated to the teams in 7C. It is likely totake some time to establish any patterns andareas for improvement, but at present the clinicalteams have been encouraged to use the antibioticstickers on ward rounds when changes in therapyare made.

Surgical antibiotic prophylaxisDuration of surgical antibiotic prophylaxis isless than 24 hours and compliant with localantimicrobial prescribing policy in above95% of sampled elective colorectal surgicalcases.Elective urological procedures added to theaudit following achievement of compliancewith elective colorectal.

CompliantData to end of April 2014 show 100% compliancewith surgical prophylaxis in elective colorectalprocedures using the more stringent audit criteriaas previously detailed.

Primary Care Empirical PrescribingSeasonal variation in QuinoloneUse in summer months vs. winter months isless than 5%.

CompliantThe final measure to March 2014 shows NHSHighland remaining compliant with this indicatorwith prescribing at 4.1%

Total antibiotic prescribingTotal antibiotic prescribing rate is 1.8 itemsper 1000 patients per day or less.Target 50% of GP practices to meet ormove towards the target.

CompliantData from Jan to Mar 14 shows 43 of practices attarget with a further 18 making an accepted movetowards the target giving a total of 61 out of 100.

Management of Infection GuidanceThe guidelines for urinary tract infection and treatment of intra-abdominal sepsis haverecently been reviewed by the Antimicrobial Management Team and ratified by theFormulary Sub Group. The main changes to the urinary tract section are inclusion of oralstep down recommendations for urosepsis, changes to penicillin allergy option and additionaladvice on self-management options for UTI. For intra-abdominal sepsis, data from a reviewof prescribing in surgical admissions was presented at a recent audit afternoon to the generalsurgical teams. Changes to the management of intra-abdominal include a switch away fromhigher risk CDI agents to a 3 drug combination with lower risk, aligned to guidelines in otherboards in Scotland. These changes will be circulated and introduced at the beginning ofAugust with the new junior medical staff.

The guidance is reviewed on a rolling sectional basis every 2 years which allows for newevidence or national guidance to be incorporated in a timely manner.

3. Hand Hygiene

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Good hand hygiene by staff, patients and visitors is a key way to prevent the spread ofinfections. 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 noncompliance. The hand hygiene compliance score for the Board can be found at the endof section 1 and for each hospital in section 2. Information on national hand hygienemonitoring can be found at:

.1 Hand Hygiene Reporting

ach Board is now responsible for monitoring and reporting hand hygiene compliance data.ith effect from April 2014, percentage compliance of each staff group will be reported in the

imonthly report to the Board. The Infection Control and Prevention team in conjunction withe Scottish Patient Safety team are developing a combined electronic system to remove the

eed for NHS Highland staff to duplicate data collection, and make it easier to produce datar the Board.

ead Nurses within the Operational Units are in discussion with members of the Patientouncil to conduct hand hygiene audits in their areas. This will complement the work of NHSighland staff in promoting the importance of hand hygiene compliance, as well as providessurance to the Board and public.

.2 Trends

HS Highland Hand Hygiene Rolling Monthly Audit Programme continues across all clinicalreas sustaining 98% compliance in May and 99% in June 2014.

. Cleaning and the Healthcare Environment

.1heem7%

http://www.hps.scot.nhs.uk/haiic/ic/nationalhandhygienecampaign.aspx

Keeping the healthcare environment clean is essential to prevent the spread ofinfections. NHS Boards monitor the cleanliness of hospitals and there is a nationaltarget to maintain compliance with standards above 90%. The cleaning compliancescore for the Board can be found at the end of section 1 and for each hospital insection 2. Information on national cleanliness compliance monitoring can be foundat:

http://www.hfs.scot.nhs.uk/online-services/publications/hai/

Healthcare environment standards are also independently inspected by theHealthcare Environment Inspectorate. More details can be found at:

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Current Ratesmonthly cleaning and estates audits as per the National Cleaning Services Specificationonstrated 96% compliance in May and 95% in June 2014 for domestic monitoring andfor estates monitoring in May and 96% in June 2014.

http://www.nhshealthquality.org/nhsqis/6710.140.1366.html

http://www.washyourhandsofthem.com/

http://www.hps.scot.nhs.uk/haiic/ic/nationalhandhygienecampaign.aspx


http://www.nhshealthquality.org/nhsqis/6710.140.1366.html

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4.2 HEI Inspections

Healthcare Environment Inspectors made unannounced visits to Caithness General hospitalon the 6 and 7 May 2014, and to Raigmore Hospital on 13, 14 and 20 May 2014.

The visit to Caithness General Hospital was a follow-up visit for the inspection carried out onthe 10 and 11 September 2013. The HEI inspectors identified no requirements orrecommendations and were satisfied that all previous issues had been addressed. This istestament to the hard work of staff at Caithness General; this is only the second timenationally that a HEI visit has resulted in no requirements being issued.

The visit to Raigmore hospital was an unannounced inspection on 13 and 14 May 2014, anddue to the identification of issues relating to waste handling and cleanliness in the A/Edepartment, a follow-up visit occurred on 20 May 2014.

An action plan was developed following the visit and report; good progress has been made toaddress all the requirements and recommendations.

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Table 3 shows the requirements and recommendations for Raigmore alongside the actions.

Requirement/Recommendation Action Planned Action taken to date CompletionDate

NHS Highland must ensure that allstaff adhere to the NHSScotlanddress code policy and NHSHighland’s standards of dress policy(HAI criterion 1a.2)

Reinforce compliance with the Dresscode policy including ‘bare below theelbow’.

All Divisional managers have reinforced ‘Dress Code’ during staffmeetings/daily huddle.Reinforcement continues as part of the regular HAI walk round andDivisional walk rounds.A memorandum was circulated to advise staff of the removal oflanyards when delivering direct patient care.Health Protection Scotland have clarified there is no risk from the‘wearing of stethoscopes around the neck’, as long as these itemsare cleaned in between patient use. A reminder has been sentround to all staff on this.Dress code policy is currently under review and will incorporate thedress code issues identified during the HEI inspection.

August 2014

NHS Highland must ensure staffadhere to the World HealthOrganization (WHO) Your 5 keymoments for hand hygiene. This willreduce the risk of infection topatients, staff and visitors. (HAIcriterion 1a.2)

Reiterate requirements of HHcompliance at all planned infectionprevention and control educationsessions.

Throughout June specific awarenessraising will be made to all staff groupsthrough staff meetings to addresscompliance when observingopportunities during HH audit activity.

Deliver staff awareness sessions inJune to promote compliance

Emphasis has been placed on hand hygiene compliance during allinfection prevention and control education sessions.Staff meetings and forums have been used to disseminateawareness of hand hygiene compliance.Representatives from the main supplier of the hand hygieneproducts have attended Raigmore Hospital to deliver supportiveeducation and raise awareness around hand hygiene.

June 2014

NHS Highland must ensure that staffimplement standard infection controlprecautions for the management ofsharps. This will ensure that the riskof infection to patients, visitors andstaff is minimised (HAI criterion 3a.3)

Reiterate need for compliance withsharps management throughspecifically targeting areas visitedduring inspection to provide additionalsupport in achieving immediatecompliance.

Deliver staff awareness sessions topromote compliance with sharpsmanagement

Areas where visited by the IPCNs and Divisional managers toaddress compliance issues immediately following the inspection.Emphasis has been placed on sharps management during allinfection prevention and control education sessions.The Sharps Awareness NESS module is now mandatory for all staffconducting exposure prone procedures.A representative from the main supplier of the Sharps Disposalunits has attended Raigmore Hospital to deliver supportiveeducation and raise awareness around the management of sharps.

June 2014

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NHS Highland must ensure that allstaff are aware of the correct dilutionstrength of chlorine releasingdisinfectant and detergent for themanagement of blood and body fluidspillages. This will reduce therisk of infection to staff, patients andvisitors (HAI criterion 3a.3)

Re-emphasis the need for complianceto correctly dilute the chlorine-releasing disinfectant/detergent tomanage spillages of blood byspecifically targeting the areas visitedduring inspection to provide additionalsupport in achieving compliance.

Deliver staff awareness sessions toreiterate the correct dilution rates whenusing Actichlor-plus for blood/bodilyfluid spillages

Areas where visited by the IPCNs and Divisional managers toaddress compliance issues immediately following the inspection.Dilution posters have been re-issued to ensure areas are displayingthe most up to date information.A representative from the main supplier of Actichlor-plus attendedRaigmore Hospital to deliver supportive education and raiseawareness around the correct use of the product

June 2014

NHS Highland must ensure that theblood gas analyser and surroundingenvironment is clean. This willreduce the risk of potential cross-contamination. (HAI criterion 1a.2)

Produce standard Operating procedurefor cleaning Blood Gas Analyser.

Immediate action occurred to ensure cleanliness of the Blood gasanalyser in A/E.Enforcement of the Standard Operating Procedure (SOP) for thedecontamination of Blood Gas Analyser after each use by theperson using this piece of equipment, has occurredBlood Gas Analysers are now incorporated into the daily 10 pointcheck occurring in A/E.

May 2014

NHS Highland must ensure that thestandard operating procedure formattresses is implemented andadhered to in all wards anddepartments. This will minimise therisk of infection to patients andprovide a greater degree ofassurance that mattresses are cleanand fit for purpose. (HAI criterion1a.2)

The SOP for Mattresscleaning/decontamination is beingreviewed, and will be relaunched withthe ward and departmental staff, toensure compliance.

Provide reassurance that the auditingof static mattresses is robust

Existing mattress SOP currently under review.Mattress audit tool has been reviewed and aligned to SOP forcleaning.Immediate audit of all static mattresses occurred following the HEIinspection.Spot checks on mattresses increased.Six monthly audit of all static mattresses initiated May 2014.New trolley mattresses have been purchased for A/E and areinspected as part of the daily checks. A trial of A/E trolleys is alsooccurring to identify if they are more suitable to our cleaning regime.

August 2014

NHS Highland must ensure thatpatient equipment is clean and thatthe procedure for the cleaning ofpatient equipment is understood bystaff and fully implemented. This willprovide assurance that patientequipment and bed spaces are cleanand ready for use. (HAI criterion4a.3)

Implement a system of spot checks toprovide assurance that patientequipment is clean and ready for use.

Reiterate with staff the procedure forthe cleaning of patient equipment andthe need for providing assurance.

Daily 5 point check has been increased to a daily 10 pointcleanliness check list and now includes areas under theresponsibility of both domestic and nursing staff. Cleaningschedules in A/E have been reviewedDomestic establishments are being reviewed following revision ofcleaning schedules in A/E to code B.

June 2014

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NHS Highland must ensure that HAIinformation is effectivelydisseminated to patients, relativesand carers. This will ensure that allpatients are fully informed about theprevention and control of infection(HAI criterion 2a.2)

The use of laminated HAI informationwas introduced across the hospital in2012. However following thisinspection a review will be undertakento ensure HAI information is availableand accessible to patients and thepublic across all areas in a formatsuitable to their needs.

A review is underway of the current provision and location of thelaminated HAI leaflets to establish suitability for our patient groups.

December2014

NHS Highland should ensure thattoiletries available for use for patientcare are single person use only. Thiswill reduce the risk of cross-contamination.

Re-emphasis the correct managementof single person use toiletries.

Areas identified during the inspection were actioned immediately.Communication was issued to all SCNs to reiterate themanagement of single person use equipment

May 2014

NHS Highland must ensure there aresystems in place to demonstrate thatsenior charge nurses are responsiblefor the cleanliness of patientequipment

Reiterate roles and responsibilities ofSenior Charge Nurse in relation tocleanliness

SCN in A/E briefed immediatelySCNs throughout organisation briefed via SCN forums

May 2014

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5. Outbreaks

Norovirus

12.06.2014 Mains House, Newtonmore reported residents affected with Norovirus like symptoms.Precautions were adopted and the home re-opened on the 14/07/2014.In total 12 residents and 7 staff reported symptoms, 2 confirmed cases of Norovirus were reported.

27.6.14 Ward 6C reported a number of patients affected with Norovirus like symptoms. Outbreakmeasures were adopted and the ward underwent cleaning, and re-opened on 07.07.2014.In total 14 patients were affected, of which 6 were confirmed Norovirus positive, and 5 staffaffected, of which 1 was confirmed Norovirus positive.

6. Surgical Site Infections (SSI)

Colorectal Surgical Site InfectionThe Colorectal and Infection Prevention & Control Teams continue to review all aspects of care toreduce the number of avoidable infections. Root cause analysis is carried out on all elective SSIs.Sep - Nov 2013, 39 elective procedures were carried out with 8 infections, a rate of 20.5%. Dec 13– Feb 14, 38 elective procedures were carried out with 4 infections, a rate of 10.52% and March14-May 14, 46 elective procedures were carried out with 3 infections, a rate of 6.52% which is asignificantly improved position to the previous quarters.

Figure 8: Monthly SSI rate following elective colorectal surgery June 2011 – May 2014

NHSH Monthly SSI rate following elective colorectal surgery

June 2011 to May 2014

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on

s

SSI%

median

Orthopaedic Surgical Site InfectionsThere was only 1 orthopaedic infection since July 2013. The cases shown in table 5 have beendiscussed and reviewed with the Orthopaedic team.

18

Figure 9: Monthly SSI rate for Total Hip Replacement January 2010 – May 2014

NHSH Monthly SSI rate for Total Hip Replacement

Jan 2010 to May 2014

0

1

2

3

4

5

6

Jan-

10

Mar

-10

May

-10

Jul-1

0

Sep-1

0

Nov-10

Jan-

11

Mar

-11

May

-11

Jul-1

1

Sep-1

1

Nov-11

Jan-

12

Mar

-12

May

-12

Jul-1

2

Sep-1

2

Nov-12

Jan-

13

Mar

-13

May

-13

Jul-1

3

Sep-1

3

Nov-13

Jan-

14

Mar

-14

May

-14

Date

%o

fin

fecti

on

SSI%

Figure10: Monthly SSI rate for Hemiarthroplasty January 2010 – May 2014

NHSH Monthly SSI rate for Hemiarthroplasty Jan 2010 to May 2014

0

2

4

6

8

10

12

14

16

18

Jan-

10

Mar

-10

May

-10

Jul-1

0

Sep-1

0

Nov-10

Jan-

11

Mar

-11

May

-11

Jul-1

1

Sep-1

1

Nov-11

Jan-

12

Mar

-12

May

-12

Jul-1

2

Sep-1

2

Nov-12

Jan-

13

Mar

-13

May

-13

Jul-1

3

Sep-1

3

Nov-13

Jan-

14

Mar

-14

May

-14

%o

fin

fec

tio

n

SSI%

19

Figure 11: Monthly SSI rate for #NOF January 2010 – May 2014

NHSH Monthly SSI rate for #NOF Jan 2010 to May 2014

(excluding Hemi arthroplasty)

0

2

4

6

8

10

12

Jan-1

0

Apr-10

Jul-10

Oct-10

Jan-1

1

Apr-11

Jul-11

Oct-11

Jan-1

2

Apr-12

Jul-12

Oct-12

Jan-1

3

Apr-13

Jul-13

Oct-13

Jan-1

4

Apr-14

Date

%ofin

fections

SSI %

Surveillance

suspended

July 2011-Jan2012

Table 4 shows the number of orthopaedic procedures with the number and rate of infections Sep2013 – May 2014.

Procedure Number ofProcedures

Number ofinfections

Rate %

Total Hip Replacement 289 1 0.3Hemi – arthroplasty 105 0Other Neck of Femur 106 0

Caesarean Section Infections

Figure 12: SSI rate for elective C Sections for January 2010 - May 2014

NHSH SSI rate for elective C Sections Jan 2010 to May

2014

0

2

4

6

8

10

12

14

16

18

01/01/201

0

01/05/201

0

01/09/201

0

01/01/201

1

01/05/201

1

01/09/201

1

01/01/201

2

01/05/201

2

01/09/201

2

01/01/201

3

01/05/201

3

01/09/201

3

01/01/201

4

01/05/201

4

Date

%ofin

fections

%

20

Figure 13: SSI rate for emergency C Sections January 2010 - May 2014

January – May 2014, 130 emergency caesarean section procedures have been carried out with 4infections, a rate of 3.1, and 114 elective caesarean procedures with 2 infections, a rate of 1.7%.The rise in cases of infection has been noted and works is underway to the processes involved,one of the focuses will be to review antibiotic prophylaxis timing ‘knife to skin’ for emergency c-sections.

NHSH SSI rate for emergency C Sections Jan 2010 to March 2014

0

2

4

6

8

10

12

14

16

18

01/01/

2010

01/04/

2010

01/07/

2010

01/10/

2010

01/01/

2011

01/04/

2011

01/07/

2011

01/10/

2011

01/01/

2012

01/04/

2012

01/07/

2012

01/10/

2012

01/01/

2013

01/04/

2013

01/07/

2013

01/10/

2013

01/01/

2014

01/04/

2014

date

%ofin

fections

%

7. Antimicrobial Resistance

Growing numbers of bacterial and viral infections are resistant to antimicrobial drugs, but no newclasses of antibiotics have come on the market for more than 25 years. Around 25,000 people dieeach year from infections resistant to antibiotic drugs in Europe alone and the lack of new drugswhich are capable of fighting bacteria has been described by the World Health Organisation as oneof the most significant global risks facing modern medicine.

Antimicrobial resistance was chosen by the public as the winner of the £10 million Longitude prize,with a focus on creating a cheap accurate and easy to use test for bacterial infections that willallow healthcare staff to better target antibiotic use and prevent over use.

Extensive spread of organisms resistant to carbapenems (antibiotics usually of last resort) hasoccurred within a number of European countries, with some countries moving to an endemicsituation. The number of Carbapenemase-Producing Enterobacteriaceae (CPEs) detected withinthe UK has also risen, with over 70 Trusts in England having isolated a Carbapenemase producingorganism. In Scotland there has been an increase in CPE detection, with 25 cases detected in2012.

The CPE Working Group, set up to ensure the Board is compliant with the actions as described inthe CMO/SGHD (2013)14 letter, has developed an infection prevention & control risk assessmentwhich has been tested in Raigmore and Belford hospitals. The focus will now switch to the roll-outinto routine use of this document, and the best way to incorporate it into existing patient-caredocumentation. The Microbiology laboratory has developed a new Standard Operating Procedurefor dealing with the screening samples that will be received as a result. European AntibioticsAwareness day will take place in November, and planning is underway to evaluate whatmethods should be used to raise awareness with the public and healthcare staff.

21

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 hospitaland key community hospitals in the Board, on the number of cases of Staphylococcus aureusblood stream infections (also broken down into MSSA and MRSA) and Clostridium difficileinfections, as well as hand hygiene and cleaning compliance. In addition, there is a single reportcard which covers all community hospitals [which do not have individual cards], and a report whichcovers infections identified as having been contracted from outwith hospital. The information in thereport cards is provisional local data, and may differ from the national surveillance reports carriedout by Health Protection Scotland and Health Facilities Scotland. The national reports are officialstatistics which undergo rigorous validation, which means final national figures may differ fromthose reported here. However, these reports aim to provide more detailed and up to dateinformation on HAI activities at local level than is possible to provide through the national statistics.

Understanding the Report Cards – Infection Case NumbersClostridium difficile infections (CDI) and Staphylococcus aureus bacteraemia (SAB) cases arepresented for each hospital, broken down by month. Staphylococcus aureus bacteraemia (SAB)cases are further broken down into Meticillin Sensitive Staphylococcus aureus (MSSA) andMeticillin Resistant Staphylococcus aureus (MRSA). More information on these organisms can befound 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 aspositive from a laboratory report on samples taken more than 48 hours after admission. For thepurposes of these reports, positive samples taken from patients within 48 hours of admission willbe considered to be confirmation that the infection was contracted prior to hospital admission andwill be shown in the “out of hospital” report card.

TargetsThere are national targets associated with reductions in C.diff and SABs. More information onthese can be found on the Scotland Performs website:

http://www.scotland.gov.uk/About/Performance/scotPerforms/partnerstories/NHSScotlandperformance

Understanding the Report Cards – Hand Hygiene ComplianceHospitals carry out regular audits of how well their staff are complying with hand hygiene. Eachhospital report card presents the combined percentage of hand hygiene compliance with bothopportunity taken and technique used broken down by staff group.

http://www.nhs24.com/content/default.asp?page=s5_4&articleID=2139&sectionID=1


http://www.nhs24.com/content/default.asp?page=s5_4&articleID=252&sectionID=1



22

Understanding the Report Cards – Cleaning ComplianceHospitals strive to keep the care environment as clean as possible. This is monitored throughcleaning and estates compliance audits. More information on how hospitals carry out these auditscan 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 casesare all associated with being treated in hospitals. However, this is not the only place a patient maycontract an infection. This total will also include infection from community sources such as GPsurgeries and care homes and. The final Report Card report in this section covers ‘Out of HospitalInfections’ and reports on SAB and CDI cases reported to a Health Board which are notattributable to a hospital.


23

NHS HIGHLAND REPORT CARD

NHS Highland Staphylococcus aureus bacteraemia (SABs) monthly casenumbers

Jul2013

Aug2013

Sep2013

Oct2013

Nov2013

Dec2013

Jan2014

Feb2014

Mar2014

Apr2014

May2014

Jun2014

MRSA 1 0 1 0 0 0 0 0 1 1 0 1

MSSA 5 6 4 6 3 6 5 4 5 3 3 5

TotalSABS

6 6 5 6 3 6 5 4 6 4 3 6

NHS Highland Clostridium difficile infection monthly case numbers

Jul2013

Aug2013

Sep2013

Oct2013

Nov2013

Dec2013

Jan2014

Feb2014

Mar2014

Apr2014

May2014

June2014

Ages 15-64 1 1 3 1 4 1 2 2 2 0 2 4Ages 65

plus4 11 7 7 4 1 3 2 5 10 3 5

Ages 15

plus5 12 10 8 8 2 5 4 7 10 5 9

24

Hand Hygiene Monitoring Compliance (%)

Jul2013

Aug2013

Sep2013

Oct2013

Nov2013

Dec2013

Jan2014

Feb2014

Mar2014

Apr2014

May2014

June2014

BoardTotal

98 99 99 98 98 99 98 97 98 98

AHP 99 97 99 100 99 99

Ancillary 97 98 97 99 97 98

Medical 96 94 96 94 97 99

Nurse 99 99 99 99 98 99

Cleaning Compliance (%)

Jul2013

Aug2013

Sep2013

Oct2013

Nov2013

Dec2013

Jan2014

Feb2014

Mar2014

Apr2014

May2014

June2014

BoardTotal

96 96 95 96 96 96 96 96 96 96 96 95

Estates Monitoring Compliance (%)

Jul2013

Aug2013

Sep2013

Oct2013

Nov2013

Dec2013

Jan2014

Feb2014

Mar2014

Apr2014

May2014

June2014

BoardTotal

97 97 97 97 96 97 97 97 96 98 97 96

25

NHS HIGHLAND RAIGMORE HOSPITAL REPORT CARD

Staphylococcus aureus bacteraemia (SABs) monthly case numbers

Jul2013

Aug2013

Sep2013

Oct2013

Nov2013

Dec2013

Jan2014

Feb2014

Mar2014

Apr2014

May2014

Jun2014

MRSA 0 0 0 0 0 0 0 0 1 0 0 0MSSA 1 0 1 0 0 1 0 2 0 0 2 2TotalSABS

1 0 1 0 0 1 0 2 1 0 2 2

Clostridium difficile infection monthly case numbers

Jul2013

Aug2013

Sep2013

Oct2013

Nov2013

Dec2013

Jan2014

Feb2014

Mar2014

Apr2014

May2014

Jun2014

Ages 15-64 0 0 1 0 3 0 0 0 2 0 0 0Ages 65

plus1 1 1 1 2 0 0 0 1 2 0 0

Ages15

plus1 1 2 1 5 0 0 0 3 2 0 0


Jul2013

Aug2013

Sep2013

Oct2013

Nov2013

Dec2013

Jan2014

Feb2014

Mar2014

Apr2014

May2014

Jun2014

Total 97 98 99 99 99 99 99 98 98 100

AHP 100 97 100 100 100 100

Ancillary 99 98 96 100 97 96

Medical 98 98 97 99 97 98

Nurse 100 99 100 100 99 99


Jul2013

Aug2013

Sep2013

Oct2013

Nov2013

Dec2013

Jan2014

Feb2014

Mar2014

Apr2014

May2014

Jun2014

Total 96 96 95 96 96 96 97 97 96 96 95 95


Jul2013

Aug2013

Sep2013

Oct2013

Nov2013

Dec2013

Jan2014

Feb2014

Mar2014

Apr2014

May2014

Jun2014

Total 98 96 96 97 97 97 96 98 95 98 96 95

26

NHS HIGHLAND CAITHNESS GENERAL HOSPITAL REPORTCARD


Jul2013

Aug2013

Sep2013

Oct2013

Nov2013

Dec2013

Jan2014

Feb2014

Mar2014

Apr2014

May2014

Jun2014


0 0 0 0 0 0 0 0 0 0 0 1


Jul2013

Aug2013

Sep2013

Oct2013

Nov2013

Dec2013

Jan2014

Feb2014

Mar2014

Apr2014

May2014

Jun2014

Ages 15-64 0 0 0 0 0 0 0 0 0 0 0 0Ages 65

plus1 2 0 1 0 0 0 0 0 0 0 0

Ages 15

plus1 2 0 1 0 0 0 0 0 0 0 0


Jul2013

Aug2013

Sep2013

Oct2013

Nov2013

Dec2013

Jan2014

Feb2014

Mar2014

Apr2014

May2014

Jun2014

Total 99 100 99 99 98 100 99 99 100 97

AHP 100 100 100 100 100 100

Ancillary 100 100 100 100 100 100

Medical 100 97 100 88 100 100

Nurse 97 100 100 100 100 100


Jul2013

Aug2013

Sep2013

Oct2013

Nov2013

Dec2013

Jan2014

Feb2014

Mar2014

Apr2014

May2014

Jun2014

Total 97 98 96 96 97 96 96 96 96 97 96 94


Jul2013

Aug2013

Sep2013

Oct2013

Nov2013

Dec2013

Jan2014

Feb2014

Mar2014

Apr2014

May2014

Jun2014

Total 96 98 97 96 100 96 99 98 95 97 97 94

27

NHS HIGHLAND BELFORD HOSPITAL REPORT CARD


Jul2013

Aug2013

Sep2013

Oct2013

Nov2013

Dec2013

Jan2014

Feb2014

Mar2014

Apr2014

May2014

Jun2014


1 0 0 0 0 0 0 0 0 0 0 0


Jul2013

Aug2013

Sep2013

Oct2013

Nov2013

Dec2013

Jan2014

Feb2014

Mar2014

Apr2014

May2014

Jun2014

Ages 15-64 0 0 0 0 0 0 0 0 0 0 0 0Ages 65

plus0 0 0 0 0 0 0 0 0 0 1 1

Ages 15

plus0 0 0 0 0 0 0 0 0 0 1 1


Jul2013

Aug2013

Sep2013

Oct2013

Nov2013

Dec2013

Jan2014

Feb2014

Mar2014

Apr2014

May2014

Jun2014

Total 95 99 100 100 96 100 99 99 98 99

AHP 100 100 100 100 100 100

Ancillary 100 100 100 100 100 100

Medical 95 100 95 100 100 94

Nurse 100 98 98 97 98 100


Jul2013

Aug2013

Sep2013

Oct2013

Nov2013

Dec2013

Jan2014

Feb2014

Mar2014

Apr2014

May2014

Jun2014

Total 95 96 91 95 96 97 95 97 96 97 97 92


Jul2013

Aug2013

Sep2013

Oct2013

Nov2013

Dec2013

Jan2014

Feb2014

Mar2014

Apr2014

May2014

Jun2014

Total 99 98 99 98 99 99 95 97 99 98 98 97

28

NHS HIGHLAND LORN & ISLANDS HOSPITAL REPORT CARD


Jul2013

Aug2013

Sep2013

Oct2013

Nov2013

Dec2013

Jan2014

Feb2014

Mar2014

Apr2014

May2014

Jun2014


0 0 0 0 0 0 0 1 0 0 0 0


Jul2013

Aug2013

Sep2013

Oct2013

Nov2013

Dec2013

Jan2014

Feb2014

Mar2014

Apr2014

May2014

Jun2014

Ages 15-64 0 0 0 0 0 0 0 0 0 0 0 0Ages 65

plus0 0 1 0 0 0 0 0 0 0 0 0

Ages 15

plus0 0 1 0 0 0 0 0 0 0 0 0


Jul2013

Aug2013

Sep2013

Oct2013

Nov2013

Dec2013

Jan2014

Feb2014

Mar2014

Apr2014

May2014

Jun2014

Total 100 100 100 100 99 100 99 99 96 96

AHP 100 100 100 100 100 100

Ancillary 100 100 100 100 100 100

Medical 95 96 86 85 97 100

Nurse 100 100 100 100 100 100


Jul2013

Aug2013

Sep2013

Oct2013

Nov2013

Dec2013

Jan2014

Feb2014

Mar2014

Apr2014

May2014

Jun2014

Total 97 96 96 98 98 94 95 95


Jul2013

Aug2013

Sep2013

Oct2013

Nov2013

Dec2013

Jan2014

Feb2014

Mar2014

Apr2014

May2014

Jun2014

Total 95 93 92 91 91 91 96 95

29

NHS HIGHLAND NORTH & WEST OPERATIONAL UNITCOMMUNITY HOSPITALS REPORT CARD

The community hospitals covered in this report card include: Dunbar Hospital, Thurso Town & County Hospital, Wick Lawson Memorial Hospital Golspie Migdale Hospital, Bonar Bridge MacKinnon Memorial Hospital, Broadford Portree Hospital, Isle of Skye

Staphylococcus aureus bacteraemia monthly case numbers

Jul2013

Aug2013

Sep2013

Oct2013

Nov2013

Dec2013

Jan2014

Feb2014

Mar2014

Apr2014

May2014

Jun2014


0 0 0 0 0 0 0 0 0 0 0 0


Jul2013

Aug2013

Sep2013

Oct2013

Nov2013

Dec2013

Jan2014

Feb2014

Mar2014

Apr2014

May2014

Jun2014

Ages 15-64 0 0 0 0 0 0 0 0 0 0 0 0Ages 65plus 0 0 0 0 0 0 0 0 1 0 0 0

Ages 15plus 0 0 0 0 0 0 0 0 1 0 0 0


Jul2013

Aug2013

Sep2013

Oct2013

Nov2013

Dec2013

Jan2014

Feb2014

Mar2014

Apr2014

May2014

Jun2014

Total 99 97 99 97 98 100 97 94 98 100

AHP 100 100 100 100 100 100

Ancillary 89 100 94 100 86 100

Medical 100 80 100 100 100 100

Nurse 100 96 98 100 100 100


Jul2013

Aug2013

Sep2013

Oct2013

Nov2013

Dec2013

Jan2014

Feb2014

Mar2014

Apr2014

May2014

Jun2014

Total 97 95 94 96 96 96 95 95 95 94 97 94


Jul2013

Aug2013

Sep2013

Oct2013

Nov2013

Dec2013

Jan2014

Feb2014

Mar2014

Apr2014

May2014

Jun2014

Total 99 99 96 94 95 96 96 95 97 97 97 95

30

NHS HIGHLAND SOUTH & MID OPERATIONAL UNITCOMMUNITY HOSPITALS REPORT CARD

The community hospitals covered in this report card include: Ross Memorial Hospital, Dingwall County Community Hospital, Invergordon Royal Northern Infirmary Community Hospital, Inverness Town & County Hospital, Nairn Ian Charles Hospital, Grantown on Spey St Vincent’s Hospital, Kingussie For the purposes of monitoring New Craigs Psychiatric Hospital is

included in this report card.


Jul2013

Aug2013

Sep2013

Oct2013

Nov2013

Dec2013

Jan2014

Feb2014

Mar2014

Apr2014

May2014

Jun2014


0 0 0 0 0 0 0 0 0 0 0 0


Jul2013

Aug2013

Sep2013

Oct2013

Nov2013

Dec2013

Jan2014

Feb2014

Mar2014

Apr2014

May2014

Jun2014

Ages 15-64 0 0 0 0 0 0 0 0 0 0 0 0Ages 65plus 0 1 1 1 0 0 1 0 0 0 0 0

Ages 15plus 0 1 1 1 0 0 1 0 0 0 0 0


Jul2013

Aug2013

Sep2013

Oct2013

Nov2013

Dec2013

Jan2014

Feb2014

Mar2014

Apr2014

May2014

Jun2014

Total 99 98 97 98 97 95 98 98 97 97

AHP 98 98 100 100 100 100

Ancillary 98 98 99 100 100 96

Medical 95 97 91 92 94 100

Nurse 98 99 98 95 94 96


Jul2013

Aug2013

Sep2013

Oct2013

Nov2013

Dec2013

Jan2014

Feb2014

Mar2014

Apr2014

May2014

Jun2014

Total 95 95 95 95 96 95 96 96 95 96 96 95


Jul2013

Aug2013

Sep2013

Oct2013

Nov2013

Dec2013

Jan2014

Feb2014

Mar2014

Apr2014

May2014

Jun2014

Total 97 97 93 97 97 99 97 97 97 98 97 98

31

NHS HIGHLAND ARGYLL & BUTE CHP COMMUNITY HOSPITALSREPORT CARD

The community hospitals covered in this report card include: Argyll & Bute Hospital Lochgilphead Campbeltown Hospital Cowal Community Hospital, Dunoon, Dunaros Community Hospital, Isle of Mull Islay Hospital Mid Argyll Community Hospital & Integrated Care Centre, Lochgilphead Victoria Hospital & Annex, Rothesay


Jul2013

Aug2013

Sep2013

Oct2013

Nov2013

Dec2013

Jan2014

Feb2014

Mar2014

Apr2014

May2014

Jun2014


0 0 0 0 0 0 0 0 0 0 0 0


Jul2013

Aug2013

Sep2013

Oct2013

Nov2013

Dec2013

Jan2014

Feb2014

Mar2014

Apr2014

May2014

Jun2014

Ages 15-64 0 0 1 0 0 0 0 0 0 0 0 0Ages 65plus 0 0 0 0 0 0 0 0 0 0 0 0

Ages 15plus 0 0 1 0 0 0 0 0 0 0 0 0


Jul2013

Aug2013

Sep2013

Oct2013

Nov2013

Dec2013

Jan2014

Feb2014

Mar2014

Apr2014

May2014

Jun2014

Total 98 99 98 96 98 96 94 93 96 97

AHP 97 86 96 100 96 96

Ancillary 92 93 90 94 95 94

Medical 90 94 100 95 92 100

Nurse 99 99 98 98 99 99


Jul2013

Aug2013

Sep2013

Oct2013

Nov2013

Dec2013

Jan2014

Feb2014

Mar2014

Apr2014

May2014

Jun2014

Total 95 97 96 97 96 96 97 97 96 96 96 96


Jul2013

Aug2013

Sep2013

Oct2013

Nov2013

Dec2013

Jan2014

Feb2014

Mar2014

Apr2014

May2014

Jun2014

Total 98 97 98 98 97 97 98 97 98 99 96 97

32

NHS HIGHLAND OUT OF HOSPITAL REPORT CARD

Staphylococcus aureus bacteraemia monthly case numbers

Jul2013

Aug2013

Sep2013

Oct2013

Nov2013

Dec2013

Jan2014

Feb2014

Mar2014

Apr2014

May2014

Jun2014


4 6 4 6 3 5 5 1 5 4 1 3


Jul2013

Aug2013

Sep2013

Oct2013

Nov2013

Dec2013

Jan2014

Feb2014

Mar2014

Apr2014

May2014

Jun2014

Ages 15-64 1 1 1 1 1 1 2 2 0 0 2 4Ages 65plus 2 7 4 4 2 1 2 2 3 8 2 4

Ages 15plus 3 8 5 5 3 2 4 4 3 8 4 8

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