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1
Infection Control
Progress Report
Trust Board
Nizam Damani
Clinical Director: Infection Prevention & Control
26th November 2009
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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
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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
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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 )
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C Diff CDSC Data September 2009
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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
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77
0
5
10
15
20
25
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
2 Days
Target
Southern Trust
MRSA Cumulative Total
April 2009 25 Nov2009
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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
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99
0
5
10
15
20
25
30
35
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
2 Days
Target
Southern Trust
MSSA Cumulative Total
Apr 2009 25 November2009
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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
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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%)
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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
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Preventable Infections
IV Cannula
59%
Other
41%
IV Cannula
Other
No. =17
10 : IV related infections
7 Other
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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
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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
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Introduce NEW RCA Forms
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NEW RCA Forms
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Antimicrobial Stewardship
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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
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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
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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
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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
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Zero tolerance toCatheter-related Bloodstream Infections
(CR-BSI)
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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
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28
Help develop Regional Guidelines on theInsertion and Management of Central line
infections in Paediatrics
Nizam Damani (chair) and Christine Armstrong
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Infection Control Workshop
Patients and Client Council
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Thank you
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