Dr Eleri Davies, Director Infection Prevention and Control

Last update to QSE committee December 2015

HCAI Update Overview of last 9 months. Current position against WG Reduction Expectations

set for 2016/17 Review of current priorities

Antimicrobial Delivery Plan C. difficile disease and Staph. aureus blood stream

infections Multi-Drug Resistant Gram negative organisms.

July 2015

Cases of Acinetobacter baumanni noted in May, June, July (one per month)

August 2015 Further cases presented - screening found

colonisation of several babies. 25th August linked cases of Enterobacter cloacae

also detected on the unit. 26th August full closure of the NNU.

OLD NNU

Interim NNU Facilities - T1 :

28th October 2015!

November 2015 27th November 2015

Blood cultures positive on baby admitted to the unit 8th November confirmed positive for ABAUM

28th November 2015 (Saturday) ET secretions positive on a second baby

30th November 2015 Blood cultures positive from second baby ET secretions positive on 3rd Baby

FURTHER CLOSURE OF NNU

NNU re-opened 23rd December 2015. No further cases of Acinetobacter or Enterobacter

detected. Formal closure of outbreak February 2016.

External Review Professor Mike Sharland – Expert opinion /

teleconference 21st December 2015. Full external Review – 5 – 7th September 2016:

Martin Kiernon – former Nurse Consultant IP&C Dr Bharat Patel – Consultant Microbiologist Dr Mark Turner – Neonatologist (Chair)

Winter 2015/16 299 patients had D&V / Diarrhoea or confirmed

Norovirus 47 patients had influenza

17 staff

234 bed days lost March 2016:

30 wards affected across the whole HB. At peak 12 wards affected concurrently.

Other Issues C. difficile outbreak (ribotype 078) E8 UHL August

2016 Legionella – probable hospital acquisition October

2016 Admission of patient with highly resistant E.coli

(Carbapenemase producing E.coli) – not immediately identified / isolated.

Chart 5. Cardiff and Vale University Health Board monthly rates of C. difficile per 100,00 population from Oct 15 to Sep 16, rate for the current 3 month period and

the expected rate for the period Oct 16 to Mar 17

45.96

28.00

0.010.020.030.040.050.060.0

Oct-1

5

Nov-

15

Dec-

15

Jan-

16

Feb-

16

Mar

-16

Apr-1

6

May

-16

Jun-

16

Jul-1

6

Aug-

16

Sep-

16

Oct-1

6

Nov-

16

Dec-

16

Jan -

17

Feb-

17

Mar

-17

C. difficile/100,000 populationCurrent 3 month rate of C. difficile/100,000 populationExpected rate of C. difficile/100,000 population

C. difficile

C. difficile

Interventions to reduce C. difficile Antimicrobial Policy Changes Antimicrobial Stewardship Hand Hygiene! Collaboration with General Practice re Antimicrobial

Prescribing, use of PPIs and learning from RCA. Rapid isolation of symptomatic patients Improved cleaning – commodes etc. Introduction of new treatment to reduce recurrent disease

– Fidaxomicin. Introduction of Faecal Microbiota Transplantation Service

(FMT)

Hand Hygiene & Bare Below the Elbows (BBE) Actions: • Feedback of data at Big Room • Floor signage • Clinical Leads • All Wales procurement of Hand Hygiene Products and support • Consideration of new signage / screen savers.

Staph. aureus bacteraemia Chart 5. Cardiff and Vale University Health Board monthly rates of S. aureus

bacteraemia per 100,00 population from Oct 15 to Sep 16, rate for the current 3 month period and the expected rate for the period Oct 16 to Mar 17

22.16 20.00

0.010.020.030.040.050.0

Oct-1

5

Nov-

15

Dec-

15

Jan-

16

Feb-

16

Mar

-16

Apr-1

6

May

-16

Jun-

16

Jul-1

6

Aug-

16

Sep-

16

Oct-1

6

Nov-

16

Dec-

16

Jan-

17

Feb-

17

Mar

-17

MRSA bacteraemia/100,000 populationMSSA bacteraemia/100,000 populationCurrent 3 month rate of S. aureus bacteraemia/100,000 populationExpected rate of S. aureus bacteraemia/100,000 population

0

20

40

60

80

100

120

07/0

4/20

14

23/0

4/20

14

29/0

4/20

14

10/0

5/20

14

12/0

5/20

14

03/0

6/20

14

18/0

6/20

14

11/0

8/20

14

19/0

8/20

14

01/0

9/20

14

11/0

9/20

14

05/1

0/20

14

28/1

0/20

14

04/1

1/20

14

14/1

1/20

14

15/1

2/20

14

28/1

2/20

14

27/0

1/20

15

03/0

2/20

15

25/0

2/20

15

14/0

3/20

15

19/0

3/20

15

18/0

4/20

15

06/0

7/20

15

02/0

8/20

15

12/0

8/20

15

24/0

9/20

15

17/1

0/20

15

09/0

1/20

16

20/0

4/20

16

13/0

7/20

16

25/0

8/20

16

Number of days between MRSA bacteraemia cases Cardiff & Vale UHB April 2014 - October 2016

Number of days between cases Mean number of days between cases

13.10.167 days since

last case(06/10/16)

Interventions to reduce Staph. aureus blood stream infections MRSA / MSSA screening

Revised MRSA procedure. MSSA screening introduced in Renal Medicine, consideration

being given to broader MSSA screening. Improving line care (central and peripheral)

Evidence Based Practice Cannulation packs IV access team (Specialist Clinical Board)

Improving Aseptic Technique Roll out of Aseptic Non-Touch Technique (ANTT) across the

Health Board.

Current Priorities Antimicrobial Delivery Plan

Delivery Theme 1 – Improving Infection Prevention and Control

Challenge of Multi-Drug Resistant Gram negative organisms: Acinetobacter outbreak on NNU Carbapenem Resistant Organisms MDRO procedure including screening of patients on

admission to ensure early isolation. Continuing to reduce C. difficile and Staph. aureus BSI Working to prevent Winter Season outbreaks.