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NHS Highland

Meeting: Board Meeting

Meeting date: 31 March 2020

Title: Infection Prevention and Control

Responsible Executive/Non-Executive: Ms Heidi May, Board Nurse Director/HAI Executive Lead

Report Author: Mrs Catherine Stokoe, Infection Control Manager

1 Purpose To inform members of the position of the board against the national standards on healthcare associated infections and indicators for antibiotic use

This is presented to the Board for: • AwarenessThis report relates to a:• Annual Operation Plan• Emerging issue• Government policy/directive• Local policy• NHS Board/Integration Joint Board Strategy or Direction

This aligns to the following NHSScotland quality ambition(s): • Safe• Effective• Person Centred

2 Report summary

2.1 Situation The current position against the national standards on healthcare associated infections and indicators on antibiotic use, as well as the other key performance indicators ( MRSA screening, mandatory training, and surgical site infection).

NHSH Board 31 March 20, Item 11

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2.2 Background There is a requirement to provide pertinent information relating to the national standards and indicators.

2.3 Assessment

The position against the local NHS Highland Board target for Staphylococcus aureus bacteraemia (SAB) reduction will not be met at the end of March 2020. However we remain within expected limits. All staff continue to ensure preparedness is in place for suspected and confirmed cases of Coronavirus COVID19.

2.3.1 Quality/ Patient Care The impact on services and quality of cares remains unchanged.

2.3.2 Workforce

In light of the preparedness occurring for potential COVID19 cases the Infection Prevention and Control staff are prioritising work and providing additional support across the Operational Units. It is a very challenging time.

2.3.3 Financial

In relation to COVID19 the board does face additional funding pressures due to the need to allocate extra staffing and equipment resources to meet clinical demand.

2.3.4 Risk Assessment/Management

The Infection Prevention and Control team following national guidance at all times. 2.3.5 Equality and Diversity, including health inequalities

An impact assessment has not been completed for this report

2.3.6 Communication, involvement, engagement and consultation The Board has carried out its duties to involve and engage external stakeholders where appropriate: State how his has been carried out and note any meetings that have taken place. • Stakeholder/Group Name, date written as 1 January 2019 • Stakeholder/Group Name, date written as 1 January 2019

2.4 Recommendation

Members are asked to note the report.

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The Infection Prevention and Control team will focus on the management of invasive vascular devices and blood culture contamination to reduce the incidence of healthcare associated infections. • Awareness – For Members’ information only.

2 List of appendices

The following appendices are included with this report:

• Infection, Prevention and Control Board report

1

Highland NHS Board 31 March 2020

Item 12 INFECTION PREVENTION & CONTROL REPORT Report by Catherine Stokoe, Infection Control Manager and Dr Vanda Plecko, Consultant Microbiologist/Infection Control Doctor, on behalf of Heidi May, Board Nurse Director & Executive Lead for Infection Control The Board is asked to: • Note the position for the Board. • Note the update on the current status of Healthcare Associated Infections (HCAI)

and Infection Control measures in NHS Highland. 1. Background The Board remains committed to reducing to an absolute minimum the chance of acquiring an infection whilst receiving healthcare and to ensure our hospitals are clean. This report presents an overview of infection prevention and control data and activities. 2. Summary The table below shows NHS Highland Infection Prevention and Control targets and performance data.

Local Target NHS Highland rate

Clostridium difficile

HEAT rate of 32.0 cases per 100,000 OBDs to be achieved by year ending 03/20

Annual performance April – Dec 2019/2020 19.9

Green (NHSH data)

Staphylococcus aureus bacteraemia

HEAT rate of 24.0 cases per 100,000 AOBDs to be achieved by year ending 03/20

Annual performance April – Dec 2019/2020 26.6

Red ( NHSH data)

Clinical Risk assessment Compliance

90% screening target Oct-Dec 2019 (last data received from HPS) Meticillin resistant Staph. Aureus (MRSA) 93% Carbapenemase-producing Enterbacteriaceae (CPE) 93%

Green (validated data)

C-Section Surgical site infection

Target rate of 2% or below Jan-Dec2019 combined rate of 1.8%

Green (NHSH data)

Orthopaedic Surgical site infection

Target rate of 2% or below Jan-Dec 2019 combined rate of 0.9%

Green (NHSH data)

Colorectal Surgical site infection

Target rate of 10% or below

Jan-Dec 2019 rate of 6.9% Green (NHSH data)

Hand Hygiene 95% Annual performance Jan-Dec 2019 rate of 97%

Green (NHSH data)

Cleaning 92% Annual performance Jan-Dec 2019 rate of 96%

Green (NHSH data)

Estates 95% Annual performance Jan-Dec 2019 rate of 96%

Green (NHSH data)

Source: - Health Protection Scotland/ISD/Local data

Outbreaks/Clusters and multidrug resistant isolates associated with NHS Highland

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At the time of writing (28/02/20202) Ward 5C Raigmore was closed on 19/02/2020; Ward 6C Raigmore was closed on 20/02/2020 and Ward 7A Raigmore was closed on 25/02/2020 due to confirmed cases of Norovirus. Outbreak control measures remain in place, and it is envisaged that the wards will reopen first week of March following cleaning; if symptoms remain resolved as they currently are. The Board has to date (28/02/2020) tested 35 persons for suspected Coronavirus (COVID19); so far, all people have tested negative. Mask face fit testing continues to occur as part of preparedness. It should be noted that whilst stock of masks and powered hoods is not a concern at the moment, along with other Boards national capacity may become an issue and Health Protection Scotland are aware of this and working to resolve. Pandemic flu plans are being updated as part of the Boards preparedness. Healthcare Environment Inspections (HEI) There have been no HEI inspections carried out within NHS Highland since the last report. General Data Protection Principles Compliance There are no risks to compliance with Data Protection Legislation.

3. Issues for Consideration • As discussed at the last Board meeting, the local NHS Highland Board target for

Staphylococcus aureus bacteraemia (SAB) reduction will not be met at the end of March 2020. However we remain within expected limits (see 6.2).

• We will continue to report on the position against the local NHS Highland Board targets for Staphylococcus aureus bacteraemia and Clostridium difficile infection until April 2020. Following this, we will then report against the NHS Scotland standards, as detailed in the last report to the Board.

• The Infection Prevention and Control team are dealing with an exceptionally high level of work at present, which is resulting in the prioritisation of existing workloads.

4. Contribution to Board Objectives • The Infection Prevention and Control team along with colleagues across the organisation

continue to promote best infection control practice to reduce the potential for norovirus and influenza outbreaks.

• The Infection Prevention and Control team along with colleagues from Health Protection are working together with other members of NHS Highland to ensure resilience and preparedness for suspected and confirmed COVID19 cases.

• We are still aiming to run the Infection Prevention and Control Annual Conference on the 23rd April 2020.

5. New Standards on Healthcare Associated Infections and Indicators on Antibiotic Use

On 10th October 2019 the Chief Nursing Officer published new standards and indicators for healthcare associated infections and antibiotic use. The antibiotics indicators must be achieved by 2022 and the first local data was released to boards on the NSS Discovery platform in January 2020. NHS Highlands position against the new indicators is reassuring and outlined in the table below. Whilst the current position of antibiotic use against the new indicators is reassuring we acknowledge that this position needs to be maintained and continually improved over the next two years. The Antimicrobial Management Team will continue to work with frontline clinical teams to promote optimal antibiotic use and welcomes the support of Control of

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Infection Committee members to achieve these aims. An update will be provided every year or sooner if any concerns are raised. The antibiotic use indicators are: 1. A 10% reduction of antibiotic use in Primary Care (excluding dental) by 2022, using 2015/16 data as the baseline (items/1000/day). The target for NHS Highland is 1.71 items/1000/day. 2. Use of intravenous antibiotics in secondary care defined as DDD / 1000 population / day will be no higher in 2022 than it was in 2018. The target for NHS Highland is a rate of 0.66 DDDs/1000pts/day. 3. Use of WHO Access antibiotics (NHSE list) ≥60% of total antibiotic use in acute hospitals by 2022. WHO Access antibiotics (NHSE list) are commonly used first line antibiotics, mainly narrow spectrum and include flucloxacillin, doxycycline, trimethoprim and phenoxymethylpenicillin. Current NHS Highland position in relation to new antibiotic indicators Data on NSS Discovery platform to the end of quarter 2, 2019 shows the following position.

Indicator Target Current position at Q2 2019 and comment RAG rating

Primary care (excluding dental) 10% reduction from 2015/16

1.71 or lower items per 1000 patients per day

1.74 items/1000patients/day. Current position equates to 8.4% reduction with downward trajectory

AMBER

Secondary Care – use of IV antibiotics Use no more in 2022 than in 2018 (rate of 0.66)

Maximum of 0.66 DDDs per 1000 population per day

0.655. Awaiting publication of national resources focussing on 3 day review of IV antibiotics

GREEN

Acute hospital use of WHO Access antibiotics At least 60% of all antibiotic use is from Access list

60% or more of all antibiotic use is from Access list

65% Last 6 data points all above 60% target GREEN

Prescribers are to be commended for implementing the best practice guidance and advice on infection management. Strategies for maintaining and improving these positions are in place and include a focus on timely intravenous to oral switch, changing the default duration in primary care for many indications to 5 or 3 days in line with guidance and continuing to promote first line antibiotics in all guidance as much as possible. 6. Healthcare Associated Infection Standards 6.1 Clostridioides difficile infection (CDI)

Scientific literature and Health Protection Scotland now refer to Clostridioides difficile infection. This brings the terminology in line with European Centre for Disease Prevention and Control. For the purpose of board reporting CDI will be used. Figure 1: NHS Highland Clostridioides difficile Infection age 15 and over, case numbers year on year since 2014, based on NHS Highland case number data

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NHS Highlands position showing actual case numbers as of 31st January 2020 (data not yet validated by HPS) is tabled below 1st April 2019 to 31st January 2020

Total CDI Cases aged 15 and over = 49 Re-occurrence (within 8 weeks of previous episode) =1

Previous CDI (out with 8weeks of previous episode = 5

Aged 15-64 = 17 Aged 65+ = 32

Healthcare Associated = 30 Community Acquired = 17 Unknown = 2 Under Investigation = 0 For definitions of above classifications please see section 2

The position against the new standards on Healthcare Associated Infections for CDI will be tabled in the next Board Paper. The new standard is tabled below.

CDI 2018/19 NHS baseline rate is 16.6 (approximately 78 cases)

NHS Highland new standard rate to achieve by 2022. Is a rate of 14.9 (approximately 44 cases) by 2022

6.2 Staphylococcus aureus (including MRSA) Figure 2: NHS Highland Staphylococcus aureus bacteraemia Cumulative Case numbers year on year since 2014, based on NHS Highland case number data.

0

20

40

60

80

100

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

Cum

ulat

ive

Case

Num

bers

NHS Highland Cumulative Toxin Positive Cdifficile age 15 and over

2017-18 2018-19 2019-20 Heat Target to 31-3-20

0

10

20

30

40

50

60

70

80

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

Cum

ulat

ive

Case

Num

bers

NHS Highland Cumulative staph aureus Bacteraemia

2017-18 2018-19 2019-20 Heat Target to 31-3-20

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The Board need to note that the local NHS Highland Staphylococcus aureus bacteraemia target will not be met. We are at 60 cases against an estimated target of 60 cases by 31st March 2020, however we remain with our predicted limit of 78 cases by 31st March 2020. NHS Highlands position showing actual verified case numbers as of 31st January 2020 is tabled below. 1st April 2019 – 31st January 2020

MSSA = 57 MRSA = 3 Total SABs = 60 Cases

Preventable = 10 Not preventable = 39 Unknown = 8 Under Investigation = 3 Hospital Acquired Cases = 15 Community Acquired Cases = 30 Healthcare Associated Cases = 15 Undergoing Investigation = 0 For definitions of above classifications please see section 2

The position against the new standards on Healthcare Associated Infections for SAB will be tabled in the next Board Paper. The new standard is tabled below.

SAB 2018/19 NHS baseline rate 17.0 (approximately 60 cases)

NHS Highland new standard rate to achieve by 2022 is 15.3 (approximately 44 cases).

6.3 Escherichia coli (E.Coli) Bacteraemia surveillance NHS Highlands position showing actual case numbers as of 31st January 2020 (data not yet validated by HPS) is tabled below. 1st April 2018 to 31st January 2020

Total Cases = 176 Hospital Acquired = 25 Healthcare Associated = 35 Community Associated = 110 Not Known = 6 Under Investigation = 0 For definitions of above classifications please see section 2

The position against the new standards on Healthcare Associated Infections for SAB will be tabled in the next Board Paper. The new standard is tabled below.

EColi 2018/19 NHS baseline rate is 22.8 (approximately 67 cases)

NHS Highland new standard rate to achieve by 2022 is 17.1 (approximately 50 cases)

NHS Highland new standard rate to achieve by 2024 is 11.4 (approximately 34 cases)

7 SURGICAL SITE SURVEILLANCE (SSI)

NHS Highland continues to monitor SSI rates through mandatory surveillance. The clinical teams alongside the Infection Prevention & Control Surveillance team and the Scottish Patient Safety Programme team (Acute adult workstream: SSI) are working jointly to review incidents of infection, and ensure that care practices are evidence based and maintained.

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RAIGMORE 30 DAYS READMISSION ELECTIVE COLORECTAL SSI January to December 2019, 160 procedures performed, 11 infections reported, an annual rate of 6.9%. In 2018 160 procedures were undertaken and 7 SSIs recorded, giving a rate of 4.4%. 2017 Colorectal SSI rate was 9.4% achieved with 159 procedures with 15 infections. Figure 3: Monthly SSI rate in elective colorectal surgery, Jan 2016 to December 2019

RAIGMORE 30 DAYS READMISSION ORTHOPAEDIC SSI Total Hip replacement (THR) surgery continues to have a low rate of SSI. January to December 2019, 395 procedures performed, 4 infections reported; an annual rate of 1%. 2017 the rate was 0%, 0 infections, and in 2018 there was 1 THR infection in August giving an SSI rate of 0.3%.

Figure 4: Monthly SSI rate for Total Hip Replacement January 2016 – December 2019

Whilst the previous orthopaedic surgical site surveillance graph denotes points above the upper control level, it should be acknowledged that this has been triggered as the actual case numbers are very low and following case review no learning was identified. This applies to the graph below in relation to Hemi-arthroplasty. Hemi-arthroplasty surgery continues to have a low rate of SSI. January to December 2019, 166 procedures performed, 1 infection reported; an annual rate of 0.6%. In 2017 a rate of 0.5% 1 infection reported. In 2018 0.6% with one hemi-arthroplasty infection reported.

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Figure 5: Monthly SSI rate for Hemi arthroplasty surgery Jan 2016 to December 2019

NHSH 10 DAYS POST DISCHARGE CAESAREAN SECTION SSI Elective C-Section January to December 2019, 368 procedures performed, 6 infections reported, an annual rate of 1.6%. The SSI rate for 2017 was 1.1%, which was a reduction from 2.7% in 2016. For 2018 the SSI rate was 1.7%, 347 procedures with 6 infections identified.

Figure 6: Monthly SSI rate for Elective C-Sections, Jan 2016 to December 2019

Emergency C-Section January to December 2019, 368 procedures performed, 7 infections reported; an annual rate of 1.9%. The SSI rate for 2018 is 3.0% (this is the same rate as 2017), 334 procedures carried out with 10 infections identified.

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Figure 7: Monthly SSI rate for Emergency C-Section, January 2016 to December 2019

RAIGMORE 30 DAYS READMISSION ELECTIVE VASCULAR SSI January to December 2019, 137 procedures performed, 4 infections reported; an annual rate of 3%. The SSI rate for 2018 was 4%, 124 procedures performed and 5 infections identified. Figure 8: Monthly SSI rate following Vascular Surgery April 2017 –December 2019

It should be noted that the increase at the end of 2019 in relation to the upper control limit reflects the increase in actual operations performed.

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Section 2 – Healthcare Associated Infection Report Cards - Healthcare Associated Infection Reporting Template (HAIRT)

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 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. 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. SAB cases are further broken down into Meticillin Sensitive Staphylococcus aureus (MSSA) and Meticillin Resistant Staphylococcus aureus (MRSA). For each hospital the total number of cases for each month, been reported as positive from a laboratory report, on samples taken more than 48 hours after admission. Understanding the Report Cards – Hand Hygiene Compliance Hospitals carry out regular audits of how well their staff are complying with hand hygiene. Each hospital report card presents the combined percentage of hand hygiene compliance with both opportunity taken and technique used broken down by staff group. 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. Understanding the Report Cards – ‘Out of Hospital Infections’ CDI and SAB (including MRSA) bacteraemia cases are presented as ‘‘Out of Hospital Infections’ and are not attributable to a hospital. This section identifies those infections from community sources such as GP surgeries and care homes, and those from positive samples taken from patients within 48 hours. Abbreviations

SAB Definitions Definitions: Hospital acquired infection (HAI): Positive blood culture obtained from a patient who has been hospitalised for ≥48 hours. OR patient was transferred from another hospital, the duration of in-patient stay is calculated from the date of the first hospital admission. OR If the patient was a neonate/baby who has never left hospital since being born. OR The patient was discharged from hospital in the 48hr prior to the positive blood culture being taken. OR A patient who receives regular haemodialysis as an out-patient. OR Contaminant if the blood aspirated in hospital Healthcare associated infection (HCAI): Positive blood culture obtained from a patient within 48 hours of admission to hospital and fulfils one or more of the following criteria: 1. Was hospitalised overnight in the 30 days prior to the positive blood culture being taken. 2. Resides in a nursing, long term care facility or residential home. 3. IV, or intra-articular medication in the 30 days prior to the positive blood culture being taken, but excluding IV illicit drug use. 4. Regular user of a registered medical device e.g. intermittent self-catheterisation, home CPD or PEG tube with or without the direct involvement of a healthcare worker (excludes haemodialysis lines see HAI). 5. Underwent any medical procedure which broke mucous or skin barrier i.e. biopsies or dental extraction in the 30 days prior to the positive blood culture being taken. 6. Underwent care for a medical condition by a healthcare worker in the community which involved contact with non-intact skin, mucous membranes or the use of an invasive device in the 30 days prior to the positive blood culture being taken e.g. podiatry or dressing of chronic ulcers, catheter change or insertion. Community infection: Positive blood culture obtained from a patient within 48 hours of admission to hospital who does not fulfil any of the criteria for healthcare associated bloodstream infection. Not known: Only to be used if the SAB is not an HAI, and unable to determine if Community or HCAI. CDI definitions Definitions: Healthcare-associated CDI: a case with onset of symptoms on day three or later, following admission to a healthcare facility on day one, OR in the community within four weeks of discharge from any healthcare facility. This may apply to the current hospital or a previous stay in another healthcare facility, e.g. in another hospital, a long-term care facility or other healthcare facilities (e.g. outpatient departments etc.) Community-associated CDI: a case with [onset outside of healthcare facilities, AND without discharge from a healthcare facility within the previous 12 weeks] OR [onset on the day of admission to a healthcare facility or on the following day AND not resident in a healthcare facility within the previous 12 weeks]

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Unknown association: a case who was discharged from a healthcare facility 4–12 weeks before symptom onset

ADTC Area Drugs & Therapeutics Committee AMT Antimicrobial ManagementTeam

AMAU Acute Medical Admissions Unit CHP Community Health Partnership

CDI Clostridioides difficile Infection CMO Chief Medical Officer

CNO Chief Nursing Officer CVC Central Venous Catheter

HEAT Health Improvement, Efficiency, Access, Treatment ECDC European Centre for Disease Prevention & Control

GDP General Dental Practitioner HAI Healthcare Associated Infection

HAI QIF Healthcare Associated Infection

Quality Improvement Facilitator

HAIRT Healthcare Associated Infection

Reporting Template

HPS Health Protection Scotland HSE Health and Safety Executive

JAG Joint Advisory Group HFS Health Facilities Scotland

CPE Carbapenemase-producing Enterobacteriaceae MRSA Meticillin Resistant Staphylococcus Aureus

PICC Peripherally Inserted Central Catheter MSSA Meticillin Sensitive Staphylococcus Aureus

PVC Peripheral Venous Catheter SAB Staphylococcus aureus Bacteraemia

PPI Proton Pump Inhibitor SPC Statistical Process Chart

RIDDOR Reporting of Injuries, Diseases & Dangerous Occurrences

Regulations 1995

Hemiarthroplasty: Operation to treat fractured hip (only involves half

of hip)

SHPN Scottish Health Planning Note SHTM Scottish Health Technical Memoranda

SICPs Standard Infection Control Precautions SAPG Scottish Antimicrobial Prescribing Group

IPCT Infection prevention & control team SPSP Scottish Patient Safety Programme

NHS HIGHLAND REPORT CARD

NHS Highland Staphylococcus aureus bacteraemia (SABs) monthly case numbers

Feb 2019

March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

MRSA 1 0 0 0 1 0 0 2 0 0 0 0 MSSA 7 4 4 8 3 9 6 3 10 4 6 4 Total SABS

8 4 4 8 4 9 6 5 10 4 6 4

-4

1

6

11

16SAB's NHS Highland

MRSA MSSA Total SABS

11

NHS Highland Clostridium difficile infection monthly case numbers

Feb

2019 March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

Ages 15-64

0 1 2 2 0 2 4 2 2 2 1 2

Ages 65 plus

4 3 5 0 4 4 4 4 2 2 2 3

Ages 15 plus

4 4 7 2 4 6 8 6 4 4 3 5

Hand Hygiene Monitoring Compliance (%) Feb

2019 March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

Board Total

99

97

97

96

97

97

98

96

99

99

97

98

AHP 100 97 95 93 97 97 96 97 100 98 100 99 Ancillary 100 98 96 98 100 98 99 92 99 99 92 100 Medical 95 93 98 96 95 95 97 96 98 98 98 95 Nurse 99 99 99 97 97 99 98 97 99 99 98 99 Cleaning Compliance (%)

Feb 2019

March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

Board Total

96

96

95

96

96

96

96

96

97

96

96

97

Estates Monitoring Compliance (%)

Feb 2019

March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

Board Total

96

96

96

97

96

96

97

93

98

97

96

96

-4

1

6

11

16

C.difficile NHS Highland

Ages 15-64 Ages 65 plus Ages 15 plus

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NHS HIGHLAND RAIGMORE HOSPITAL REPORT CARD

Staphylococcus aureus bacteraemia (SABs) monthly case numbers

Feb 2019

March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2019


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

Clostridium difficile infection monthly case numbers

Feb 2019

March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2019

Ages 15-64

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

Ages 65 plus

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

Ages 15 plus

2 0 0 0 2 3 1 1 2 2 0 3

Hand Hygiene Monitoring Compliance (%)

Feb 2019

March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

Total 97 99 95 99 95 95 93 94 98 100 85 / AHP 100 100 100 100 100 100 80 100 100 100 100 / Ancillary 97 100 90 100 100 93 100 90 95 100 60 / Medical 95 96 93 97 85 89 92 93 97 100 86 / Nurse 97 100 97 98 94 98 100 93 98 100 93 /

Cleaning Compliance (%)

Feb 2019

March 2019

April 2019

May 2019

June 2019

July 2019

August

2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

Total 93 95 95 96 95 95 94 94 93 96 95 96 Estates Monitoring Compliance (%)

Feb 2019

March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

Total 92 91 95 100 95 95 95 96 96 96 97 98

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NHS HIGHLAND CAITHNESS GENERAL HOSPITAL REPORT CARD


Feb 2019

March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020


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


Feb 2019

March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

Ages 15-64

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

Ages 65 plus

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

Ages 15 plus

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


Feb 2019

March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

Total 98 100 100 96 97 97 97 99 99 99 100 97

AHP 100 100 100 100 100 100 100 100 100 100 100 100 Ancillary 100 100 100 100 100 100 100 100 100 100 100 100 Medical 91 100 100 84 86 86 89 96 96 95 100 86 Nurse 100 100 100 100 100 100 98 98 99 100 100 100


Feb 2019

March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020


Feb 2019

March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

Total 93 93 95 93 89 92 92 95 95 94 92 93

NHS HIGHLAND BELFORD HOSPITAL REPORT CARD


Feb 2019

March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

MRSA 0 0 0 0 0 0 0 0 0 0 0 0

14

MSSA 0 0 0 0 0 0 0 1 0 1 0 0 Total SABS

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


Feb 2019

March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

Ages 15-64

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

Ages 65 plus

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

Ages 15 plus

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


Feb 2019

March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

Total 98 92 92 98 92 86 98 98 99 98 100 100 AHP 100 90 75 100 80 100 100 100 100 100 100 100 Ancillary 100 100 100 100 100 100 100 100 100 100 100 100 Medical 95 79 92 100 100 100 100 91 100 100 100 100 Nurse 97 97 100 93 88 97 93 100 97 93 100 98


Feb

2019 March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020


Feb 2019

March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

Total 99 100 99 100 100 99 97 98 96 96 98 99 NHS HIGHLAND LORN & ISLANDS HOSPITAL REPORT CARD


Feb 2019

March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020


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

15


Feb 2019

March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

Ages 15-64

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

Ages 65 plus

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

Ages 15 plus

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


Feb

2019 March 2019

April 2019

May 2019

June 2019

June 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

Total 97 99 100 98 99 97 100 98 99 100 100 95 AHP 100 100 100 100 100 96 / 96 100 100 100 96 Ancillary 100 100 100 100 100 100 100 100 100 100 100 100 Medical 88 95 100 94 95 92 100 95 96 100 100 85 Nurse 100 100 100 98 100 99 100 100 99 100 98 100


Feb 2019

March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

99 99 100 100 100 99 99 99 98 99 98 98 Estates Monitoring Compliance (%)

Feb

2019 March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

Total 96 94 93 100 92 94 93 95 93 93 92 93 NHS HIGHLAND NORTH & WEST DIVISION COMMUNITY 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

16

Staphylococcus aureus bacteraemia monthly case numbers Feb

2019 March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020


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

0 Clostridium difficile infection monthly case numbers Feb

2019 March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

Ages 15-64

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

Ages 65 plus

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

Ages 15 plus

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


Feb 2019

March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

Total 100 96 97 100 100 100 100 100 100 100 100 100 AHP 100 100 88 100 100 100 100 100 100 100 100 100 Ancillary 100 100 100 100 100 100 100 100 100 100 100 100 Medical 100 80 100 100 100 100 100 100 100 100 100 100 Nurse 100 96 98 100 100 99 98 98 100 99 98 98


Feb

2019 March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020


Feb 2019

March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

Total 98 98 97 97 97 97 98 98 97 97 98 97 NHS HIGHLAND SOUTH & MID DIVISION COMMUNITY HOSPITALS REPORT CARD


• 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.

17

Staphylococcus aureus bacteraemia (SABs) monthly case numbers Feb

2019 March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020


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

0 Clostridium difficile infection monthly case numbers Feb

2019 March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

Ages 15-64

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

Ages 65 plus

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

Ages 15 plus

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


Feb 2019

March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

Total 99 99 97 98 100 99 97 98 99 98 100 100 AHP 100 97 100 98 100 100 98 100 98 98 100 100 Ancillary 100 100 88 96 100 96 95 95 96 96 100 100 Medical 96 100 100 100 100 100

96 100 100 96 100 100

Nurse 99 98 100 99 100 100 100 98 100 100 98 100 Cleaning Compliance (%)

Feb 2019

March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020


Feb 2019

March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

Total 99 97 97 98 99 98 99 98 98 98 99 97 NHS HIGHLAND ARGYLL & BUTE IJB COMMUNITY HOSPITALS REPORT CARD


• 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, Rothesay

18

Staphylococcus aureus bacteraemia (SABs) monthly case numbers Feb

2019 March 2019

April 2019

May 2019

June 2019

June 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020


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

Clostridium difficile infection monthly case numbers Feb

2019 March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

Ages 15-64

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

Ages 65 plus

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

Ages 15 plus

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


Feb 2019

March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

Total 100 95 98 83 99 94 100 85 99 96 96 97 AHP 100 90 100 50 96 83 100 83 100 90 100 95 Ancillary 100 88 93 91 100 94 100 62 100 100 82 100 Medical 100 100 100 100 100 100 100 100 96 95 100 95 Nurse 100 100 100 89 99 100 100 95 99 100 100 98 Cleaning Compliance (%)

Feb 2019

March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020


Feb 2019

March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

Total 96 95 98 94 95 97 95 95 98 97 97 96

NHS HIGHLAND OUT OF HOSPITAL REPORT CARD Staphylococcus aureus bacteraemia monthly case numbers Feb

2019 March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020


6 3 3 8 2 9 5 4 8 2 5 4

19

Clostridium difficile infection monthly case numbers Feb

2019 March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

Ages 15-64

0 1 2 2 0 1 4 1 2 0 1 1

Ages 65 plus

2 3 4 0 2 1 1 2 0 2 1 1

Ages 15 plus

2 4 6 2 2 2 5 3 2 2 2 2

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