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University Hospitalsof Morecambe BayNHS© David Telford 2007
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Methicillin Sensitive
Methicillin Resistant
National Reports of MRSA Bacteraemias
University Hospitalsof Morecambe BayNHS© David Telford 2007
EMBARGOED UNTIL THE MORNING OF 25 JULY
Table 5. Annual counts and rates of MRSA bacteraemia April 2001 to March 2007
These tables contain data received prior to the submission deadline for this publication. Data are provisional. Late submissions of data corrections will be incorporated in future publications.
Alphabetical order
April 2001 - March 2002
Trust
code
Trust category
Trust type
Region Name of NHS TrustMRSA
bacteraemia reports
Estimated MRSA
bacteraemia rate per 10,000
bed days
Total 7,291 1.70
RJE L - West Midlands University Hospital of North Staffordshire 83 2.14
RKB T - West Midlands University Hospitals Coventry and Warwickshire 74 1.92
RWE T - East Midlands University Hospitals of Leicester 163 2.24
RTX L - North West University Hospitals of Morecambe Bay 33 1.02
RM2 T FT North West University Hospitals of South Manchester 30 0.95
RBK M - West Midlands Walsall Hospitals 15 0.66
RET Sp - North West Walton Centre for Neurology and Neurosurgery 5 1.14
University Hospitalsof Morecambe BayNHS© David Telford 2007
UHMB Bacteraemias
Year Total Rate
2001 - 2002 33 1.06
2002 – 2003 24 2.18
2003 – 2004 30 1.52
2004 – 2005 30 2.24
2005 - 2006 33 2.15
2006 – 2007 24 1.36
2007 – 2008
(projected)10/5*12
=24
Target is 60% reduction on 2004 level by March 2008 (12 cases)
University Hospitalsof Morecambe BayNHS© David Telford 2007
MRSA Bacteraemia Rate vs Occupied Beds per Day
0
0.5
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1.5
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2.5
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4.5
0 500 1000 1500 2000
Occupied Beds per Day
MR
SA
Bac
tera
emia
Rat
e
UHMB
University Hospitalsof Morecambe BayNHS© David Telford 2007
National MRSA Bacteraemia Rates 2001-2007
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0 1 2 3 4 5 6 7 82001- 02 2002- 03 2003- 04 2004- 05 2005- 06 2006- 07 0
1
2
3
4
5
6R
ate
per
10,
000
bed
day
s
All Trusts
Target Target
Average
UHMB
University Hospitalsof Morecambe BayNHS© David Telford 2007
National MRSA Bacteraemia Rates 2001-2007
0
1
2
3
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6
0 1 2 3 4 5 6 7
2001- 02 2002- 03 003- 04 2004- 05 2005- 06 2006- 07
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0
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Rat
e p
er 1
0,00
0 b
ed d
ays
Teaching Hospitals
Target Target
Average
UHMB
University Hospitalsof Morecambe BayNHS© David Telford 2007
MRSA Bacteraemia Reduction vs Starting Point
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20
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60
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-100% 0% 100% 200%
Percentage change
20
03
- 2
00
4 R
ep
ort
s
UHMB
University Hospitalsof Morecambe BayNHS© David Telford 2007
National MRSA Bacteraemia Rates 2001-2007
0
1
2
3
4
5
6
0 1 2 3 4 5 6 7 8
Blackpool, Fylde and Wyre Hospitals East Lancashire Hospitals Lancashire Teaching Hospitals North Cumbria Acute Hospitals University Hospitals of Morecambe Bay National AverageNational Target
2001- 02 2002- 03 2003- 04 2004- 05 2005- 06 2006- 07
0
1
2
3
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5
6
Rat
e p
er 1
0,00
0 b
ed d
ays
Critical Care Network
University Hospitalsof Morecambe BayNHS© David Telford 2007
Date Ward Narrative Source Outcome Lesson
1 01/09/06 M58 R34 Septic Knee. Nursing home Comm
2 02/09/06 M85 W8 Admission sample. Chest infection. Non-contributory. No abx Comm
3 12/09/06 F45 W2 Admission sample. ALD Comm
4 03/10/06 M75 FONC Myeloma, Cytopenic Hosp IV care
5 16/10/06 M85 W11 Admission sample. Same patient as no 2 Comm ? Treat
6 26/12/06 M82 FICU Diabetic. Cancer. Complicated abdominal surgery. Wound, line, lung, Hosp Died Causative
7 26/12/06 M81 F6 Myeloma, Chest infection Hosp
8 13/01/07 M78 RITU Cholecystectomy Dec 06. Slow mobilisation & jaundice. Died 3 weeks post op. Hosp Died Irrelevant
9 23/01/07 M75 FICU Multiple problems. Very dependent. Longstanding positive. Multiple resistance Comm Died Marginal Catheter Care
10 12/02/07 M76 F5 Bladder Cancer. Cystectomy. Hosp
11 16/02/07 F85 W8 Residential Home. Diabetes, COPD, IHD OA. Admitted with C diff. Hosp Died Marginal
12 17/02/07 M81 F8 Diabetes. Leukaemia. Hosp Died Marginal
13 01/03/07 M80 F6 Diabetic foot ulcer. CVA. Catheter. Longstanding MRSA. Comm
14 13/03/07 F79 W3 Dementia, Diabetes, Anaemia. 2 hospitalisations. Bronchopneumonia. Hosp Died Causative
15 21/03/07 F68 F8 Diabetic. COPD. C diff. Longstanding MRSA Comm
16 01/04/07 F71 FITU Post arrest. Short stay Hosp Resp Care
17 08/04/07 F43 RMAU IVDU. Admission sample. Sensitive strain Comm
18 02/05/07 M91 FA&E Nursing home. Catheter infection Comm Catheter Care
19 08/05/07 M44 FHDU Varices. Short stay, Hosp
20 02/06/07 M65 F7 Alcoholic liver disease. Line infection. Hosp IV care
21 03/06/07 F57 RMAU Admission Sample. Diabetic foot ulcer. Poor compliance Comm
22 04/06/07 M71 R33 Trauma case. MRSA isolated after 4 days on ITU. Hosp IV care
23 02/07/07 M44 RMAU Admission Sample. Diabetic foot ulcer. Poor compliance Comm
24 27/07/07 M91 FA&E Indwelling catheter. MRSA in urine Comm Catheter Care
25 08/08/07 M86 R33 Arteriopathic. Multiple amputations. Prolonged hospital stay. Hosp Died Irrelevant Hand hygiene
UHMB MRSA Bacteraemias 2006-2007
University Hospitalsof Morecambe BayNHS© David Telford 2007
“Community” cases 12
Total cases 24
Deaths 7
UHMB MRSA Bacteraemias 2006-2007
DependentMultiple interventionsHeavy antimicrobial use
“INEVITABLE”
13
“AVOIDABLE”
Short staySingle episodeLittle antimicrobial useAcute care
7 (No deaths)
University Hospitalsof Morecambe BayNHS© David Telford 2007
Actions
Hand hygieneIntravenous accessWound care
SAVING LIVES
ANTIMICROBIALS PoliciesMedicines ManagementHigh profile microbiology
HOSPITAL HYGIENE Internal auditsExternal reviews
ISOLATION Need more
RESOURCES Trust investment - Nurse ConsultantCentral allocations - £500,000+
University Hospitalsof Morecambe BayNHS© David Telford 2007
MRSA bacteraemi
a
Pre 48 hr
Post 48 hr
RCA within acute
setting
Acute Trust to telephone confidential patient details to PCT ICN; Email confirmation to all of above that details have been conveyedIf no-one available to speak to, Acute Trust to send urgent email alert to all of above to state that information is available; all of above to attempt to call Acute Trust to receive information and send email to each of above to confirm receipt of information; whoever receives information, pass information to PCT ICN for investigation
Acute Trust input into RCA tool PCT ICN to investigate
within non-acute setting
Acute Trust to input all individual cases into SHA reporting template, including any supporting evidence,
e.g. If unavoidable, state how
10th each month Acute Trust to forward Summary Sheet, with email confirmation of sign-off by Acute DIPC, to PCT
for sign off by PCT DIPC
Following formal sign off by PCT, on 15th each month PCT to forward Summary Sheet to SHA,
PCT ICN to liaise with Acute Trust; Acute
Trust to input into RCA tool
PCT ICN to inform PCT
DIPC