Healthcare Associated Infection

Prevention of Healthcare Associated Infection (HAI) is a major priority in NHS Forth Valley.

Tackling HAI is a complex issue, including:

• surveillance
• antimicrobial management
• outbreak management
• evidence based infection control practice

Examples of the work carried out by the Infection Control Team are shown below.

Surveillance

Clostridium Difficile Infection Surveillance

Clostridium Difficile Infection (CDI) is primarily associated with antibiotic treatment. Clostridium difficile is part of the normal gut flora of many normal health individuals and causes no harm at all; but certain antibiotic therapies can upset the gut flora balance which results in the Clostridium difficile causing infection. Symptoms include mild to severe diarrhoea, fever and stomach pains.

NHS Forth Valley has been set a target by the Scottish Government Health Department (SGHD) to reduce the CDI rate by 50%, compared to the baseline rate from 2007, by March 2011. To date we have achieved a 79% rate reduction and is currently one of the lowest rates of CDI in Scotland.

• For further information please refer to the HAI Annual report 2009 to 2010.

Staphylococcus Aureus Bacteraemia Surveillance

Staphylococcus Aureus Bacteraemia (SAB) surveillance is a Scottish Government initiative to reduce bacterial infections of the blood (bacteraemia) associated with devices which penetrate the skin such as catheters inserted into blood vessels for drips.In 2008 the Scottish Government set a target reduction of SABS across the whole of NHS Scotland by March 2011.The target reduction is relative to the SAB rate submitted to the Scottish Government in 2005-06.

Unfortunately NHS Forth Valley, in common with a number of other Boards across NHS Scotland, failed to meet this target.

Not all SABs are associated with medical invasive devices and some patients acquire a SAB outwith the hospital environment.It is critical that every patient who has a SAB is assessed fully by the dedicated surveillance team, to accurately diagnose the root cause of the SAB.This surveillance enables the NHS Forth Valley Infection Control Team to concentrate resources to specific areas where it is needed to help reduce SAB numbers.

Surgical Site Infection Surveillance

Surgical Site Infection Surveillance (SSIS) has continued within NHS Forth Valley since January 2003. It is a national requirement to report on two groups of procedures, caesarean sections and hip arthroplasty. In Forth Valley five procedures are monitored and it is intended to increase surveillance to cover other procedures.

The annual surveillance of HAI report Jan-Dec 2010 published by Health Protection Scotland shows that the NHS Forth Valley surgical site infection rate is lower than the national rate.

MRSA (Meticillin Resistant Staphylococcus Aureus) Screening in NHS Forth Valley

In Scotland, all hospitals that treat emergency patients and carry out operations have introduced MRSA screening. MRSA screening involves testing patients who are admitted to hospital so we can identify those patients who are already carrying this bacterium.

The MRSA bacterium is more likely to cause an infection in people who are unwell, which is why its so important to identify people in our hospitals who have MRSA on their body before it can cause harm or spread to others.

By asking a few simple questions to every patient admitted to hospital we can identify those who have the potential of having MRSA on their body, we can then make sure that they receive the best and most appropriate care to minimise the risk of other patients acquiring the bacterium and causing harm to them.

Healthcare Environment Inspectorate Inspection

In April 2009 the Scottish Government announced that the Healthcare Environment Inspectorate (HEI) would be inspecting all acute hospitals throughout NHS Scotland.Their focus would be to reduce healthcare associated infection risk to patients and to provide assurance to the public that they are as safe as possible from HAIs and their consequences.

Stirling Royal Infirmary had an unannounced inspection in February 2011. The HEI made twelve requirements and three recommendations following their visit. All actions are hoped to be closed by the end of May 2011.

• The HEI report and action plan can be seen on the Healthcare Improvement Scotland web site.

Other areas

Other areas covered by the Healthcare Associated Infections (HAI) Annual Report include:

• audit
• education and training
• NHS Scotland national hand hygiene campaign.

Regular reports to NHS Forth Valley NHS Board are made as part of Performance Management. These reports are called the Healthcare Associated Infection (HAI) Reporting Templates known as HAIRTS.

Other Useful Documents & Web Sites

NHS Forth Valley:

• HAI Annual Report 2011 to March 2012
• HAI Annual Report April 2009 to March 2011
• HAI Annual Report April 2009 to March 2010 (PDF 243 kb - 27 pages)
• Healthcare Associated Infection Reporting Templates

National:

• The Annual Surveillance of Healthcare Associated Infection Report January - December 2009 (PDF 2.21 mb - 36 pages)
  This report contains information on HAI and provides information at Board level.

• Healthcare Environment Inspectorate Reports
  HEI inspection reports for NHS Forth Valley are available on the Healthcare Improvement Scotland website.

* Please note that NHS Forth Valley Directorate of Public Health takes no responsibility for the accuracy or quality of external websites linked to from this page. If you have a query, please contact the Infection Prevention and Control Team.