26.11.09-12.infection prevention and control - presentation

8/2/2019 26.11.09-12.Infection Prevention and Control - Presentation

1/30

1

Infection Control

Progress Report

Trust Board

Nizam Damani

Clinical Director: Infection Prevention & Control

26th November 2009


2/30

Priorities for Action Target 2009

BASELINE

2007-08

TARGET

2009-10

No. of

cases per

month

Apr May Jun Jul Aug Sept Oct 25th

Nov

MRSA 14 20

(+6)

1.70 1 2 1 3 0 1 1 2

MSSA 46 33

(-13)

2.8 2 4 4 6 3 3 6 3

C difficile 134 99

(-35)

8.25 6 5 3 2 2 5 6 6


3/30

33

Southern Trust

C difficile Cumulative Total

April 2009

25 Nov.2009

0

20

40

60

80

100

120

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

65

Target


4/30

44

Southern Trust

C difficile Jan 2008 25 Nov 2009

05

10152025303540

Jan Mar May Jul Sept Nov Jan March May July

September

November

C A HD H HLu rg anOthersSouthern TrustLinear (SouthernTru s t )


5/30

C Diff CDSC Data September 2009


6/30

C difficile: Pre and post intervention

Pre intervention period

May 08 - Jan 09

( 9 months)

Post intervention period

Feb Oct 09

( 9 months)

Difference

No of patients 183 40 143

fewer cases

Cost saving : 143 x 4000 * = Total saving of 572,000 achieved

No. of bed days : 143 x 21* days = Total of3,003 bed days released

*Dept of Health, 2007


7/30

77

0

5

10

15

20

25


2 Days

Target

Southern Trust

MRSA Cumulative Total

April 2009 25 Nov2009


8/30

MRSA CDSC Data September 2009

0.00

0.05

0.10

0.15

0.20

0.25

0.30

0.35

0.40

Quarter1

Quarter2

Quarter3

Quarter4

Quarter1

Quarter2

Quarter3

Quarter1

Quarter2

Quarter3

Quarter4

Quarter1

Quarter2

Quarter3

Quarter1

Quarter2

Quarter3

Quarter4

Quarter1

Quarter2

Quarter3

Quarter1

Quarter2

Quarter3

Quarter4

Quarter1

Quarter2

Quarter3

Quarter1

Quarter2

Quarter3

Quarter4

Quarter1

Quarter2

Quarter3

2008 2009 2008 2009 2008 2009 2008 2009 2008 2009

Belfast Northern SouthEastern Southern Western

MRSApatientepisodesper1,000episo

dicoccupiedbeddays

2008 Trust annual MRSA rate

Belfast Trust Quarterly RatesNorthern Trust Quarterly Rates

South Eastern Trust Quarterly Rates

Southern Trust Quarterly Rates

Western Trust Quarterly Rates


9/30

99

0

5

10

15

20

25

30

35


2 Days

Target

Southern Trust

MSSA Cumulative Total

Apr 2009 25 November2009


10/30

MSSA CDSC Data September 2009

0.00

0.05

0.10

0.15

0.20

0.25

0.30

0.35

0.40

Quarter1

Quarter2

Quarter3

Quarter4

Quarter1

Quarter2

Quarter3

Quarter1

Quarter2

Quarter3

Quarter4

Quarter1

Quarter2

Quarter3

Quarter1

Quarter2

Quarter3

Quarter4

Quarter1

Quarter2

Quarter3

Quarter1

Quarter2

Quarter3

Quarter4

Quarter1

Quarter2

Quarter3

Quarter1

Quarter2

Quarter3

Quarter4

Quarter1

Quarter2

Quarter3

2008 2009 2008 2009 2008 2009 2008 2009 2008 2009

Belfast Northern SouthEastern Southern Western

MSSApatientepisodesper1,000episodicoccupiedbeddays

2008 Trust annual MSSA rate

Belfast Trust Quarterly Rates

Northern Trust Quarterly RatesSouth Eastern Trust Quarterly Rates

Southern Trust Quarterly Rates

Western Trust Quarterly Rates


11/30

RCA for MRSA and MSSA

April

Oct 09 : Total no : 37

No ofpatients

RCA carriedout

Preventable

Infections

MRSA 9 9 6

MSSA 28 24 11

Total 37 33 (89%) 17 (46%)


12/30

Age Distribution of RCA Returns (n=33)

0

2

4

6

8

10

12

14

< 1 Month 1 to 5 11 to 20 31 to 40 41 to 50 51 to 60 6 to 10 61 to 70 71 to 80 81 to 90

MSSA

MRSA


13/30

Preventable Infections

IV Cannula

59%

Other

41%

IV Cannula

Other

No. =17

10 : IV related infections

7 Other


14/30

MSSA/MRSA bacteraemia reduction action plan

Protocol for insertion of peripheral IV line to

reduce unnecessary insertion

Introduction of IV line monitoring form (formsare with the printer)

Introduction of competence based training

both for medical and nursing staff


15/30

MSSA/MRSA bacteraemia reduction action plan

Introduce standardized IV line pack

Pilot sites: One medical and one surgical ward in

Craigavon and Daisy Hill Hospital


16/30

Introduce NEW RCA Forms


17/30

NEW RCA Forms


18/30


19/30


20/30


21/30

Antimicrobial Stewardship


22/30

22

Antibiotic StewardshipCompliance with antibiotic guidelines in the Southern Trust

84%

90% 90%93% 92%

95% 96%96%95%94%

0%

20%

40%

60%

80%

100%

Jan 09

(n=556)

Feb 09

(n=348)

Mar 09

(n=384)

Apr 09

(n=303)

May 09

(n=335)

Jun 09

(n=315)

Jul 09

(n=332)

Aug 09

(n=269)

Sep 09

(n=232)

Oct 09

(n=259)

PercentageComplianc

e


23/30

Expenditure on Antibiotics

Antibioitic expenditure in the Southern Trust

0

20000

40000

60000

80000

100000

120000

JULY

AUGUST

SEPTEMBER

OCTOBER

NOVEMBER

DECEMBER

JANUARY

FEBRUARY

MARCH

APRIL

MAY

JUNE

JULY

AUGUST

SEPTEMBER

OCTOBER

2008 2009

MEDIUM

LOW

HIGH

HOSPITAL SOUTHERN TRUST DIRECTORATE (All)

Sum of COST

YEAR MONTH

RISK GROUP

Estimated annual saving: 300,000


24/30

Antibiotics Consumption

Antibiotic Consumption in the Southern Trust

0

10

20

30

40

50

60

JANUARY FEBRUARY MARCH APRIL MAY JUNE JULY AUGUST

HIGH

LOW

MEDIUM

HOSPITAL SOUTHERN TRUST

Sum of DDD PER 100 OCCUPIED BED DAYS

MONTH

RISK GROUP


25/30

Antibiotic Stewardship

Feedback to individual consultants oncompliance and antibiotic ward rounds

Continue antibiotic ward rounds to Medical &

Surgical wards Resource issues: medical, microbiologists &

pharmacist

December 2009: Establish Trust wideAntibiotic Management Team

2010: Revised antibiotic guidelines both fortreatment and prophylaxis


26/30

Zero tolerance toCatheter-related Bloodstream Infections

(CR-BSI)


27/30

0

20

40

60

80

100

120

140

Oct-06

Nov-06

Dec-06

Jan-07

Feb-07

Mar-07

Apr-07

May-07

Jun-07

Jul-07

Aug-07

Sep-07

Oct-07

Nov-07

Dec-07

Jan-08

Feb-08

Mar-08

Apr-08

May-08

Jun-08

Jul-08

Aug-08

Sep-08

Oct-08

Nov-08

Dec-08

Jan-09

Feb-09

Mar-09

Apr-09

May-09

Jun-09

Jul-09

Aug-09

Sep-09

Oct-09

No.

ofinfectionsper1

000lineday

27

Central Venous Catheterassociated

Blood Stream Infections

Craigavon & Daisy Hill Hospital

ICU: No CR-BSI since

Jan 2009


28/30

28

Help develop Regional Guidelines on theInsertion and Management of Central line

infections in Paediatrics

Nizam Damani (chair) and Christine Armstrong


29/30

Infection Control Workshop

Patients and Client Council


30/30

Thank you

26.11.09-12.infection prevention and control - presentation

Documents