Our ref: CD/rr/ew
29 February 2008
Mr Hugh Farren
Committee Clerk
Committee for Health Social Services and Public Safety
Room 412
Parliament Buildings
BELFAST
BT4 3XX
Dear Hugh
Further to your request, please find attached a briefing paper outlining the practices in place in the Southern Trust to tackle Clostridium difficile together with the most up to date figures available on the number of cases of C difficile infection and the number of deaths where C difficile was recorded on the death certificate.
Please note validated figures are only available up to September 2007. The figures for the final quarter of 2007 and 2008 to date have been obtained from the Trust’s monitoring arrangements. These figures are provisional and a small variation can be expected following the validation process conducted by the Communicable Disease Surveillance Centre.
I hope you find this helpful.
Yours sincerely
Colm Donaghy
Chief Executive
Management of Clostridium Difficile in the Southern Health and Social Care Trust Area
Briefing Paper for the Assembly Health Committee
29 February 2008
Practices in place in the Southern Trust area to address the issue of Clostridium Difficile
The Southern Health and Social Care Trust is committed to the highest standard of infection prevention and control practice.
Strict protocols are in place to ensure that practices throughout the Trust are of the highest clinical standards and we are confident that these robust procedures create a safe environment for patients.
The Trust has an on going and rigorous infection prevention and control programme. Staff are routinely educated about infection control processes; regular reviews of hospital cleaning are carried out and we have taken part in a number of independent audits. There is an infection control link person in each ward and department.
The Trust has rigorous laboratory testing processes and any patient suspected of having C difficile is immediately isolated with additional infection control precautions in place.
Full surveillance is carried out to ensure accurate and timely monitoring of cases which further informs our infection prevention programme. Audits in infection control practices are carried out on a regular basis.
The following 10 point action plan summarises the Trust’s approach to controlling C difficile.
Controlling C Difficile – 10 point action plan
1. Education of staff in infection control including mandatory training for all nursing, medical and pharmacy staff in control of C difficile
2. Same day diagnosis
3. Prompt treatment and management of all symptomatic patients
4. Prompt isolation of all symptomatic patients with contact precautions
5. Hand washing with soap and water
6. Antibiotic stewardship: narrow spectrum, minimum no. of antibiotics prescribed and minimum duration. Avoid use of cephalosporins, quinolones and clindamycin. A pilot antibiotic ward round by the Infection Control Doctor has been introduced in Lurgan and Craigavon (Med 1 and 2)
7. Environmental cleaning: Detergent and hypochlorite and good house keeping for all clinical areas
8. Continuous Surveillance to detect outbreaks and regular audits to monitor compliance & effectiveness of interventions
9. Root cause analysis for all positive cases
10. Trust acute hospital visiting policy launched by the Health Minister, December 07
Southern Trust Lab reports New C difficile cases (Age ≥ 65 yrs)
Jan 07- 14 Feb 08 (includes provisional figures Oct – Feb)
| Jan -March totals | April - Jun totals | Jul - Sept totals | Oct - Dec totals | Jan | 14 Feb | |
| CRAIGAVON | 26 | 18 | 17 | 18 | 13 | 4 |
| DAISY HILL | 2 | 2 | 2 | 2 | 3 | 0 |
| LURGAN | 3 | 5 | 7 | 9 | 2 | 3 |
| SOUTH TYRONE | 0 | 0 | 1 | 0 | 0 | 0 |
| MULLINURE * | 2 | 1 | 1 | 0 | 1 | 0 |
| ST LUKES | 0 | 0 | 0 | 0 | 0 | 0 |
| TOTAL | 33 | 26 | 28 | 29 | 19 | 7 |
* Mullinure figures to be included in the updated CDSC which will be released early March (not in current CDSC data)
The figures for the first three quarters of 2007 have been validated by the Communicable Diseases Surveillance Centre.
Deaths where C difficile is recorded on a death certificate
Information from the recent NISRA exercise indicates that during 2007 there have been 7 deaths where C difficile was mentioned on the death certificate in hospitals in the Southern Trust’s area.
Between 1 January and 14 February 2008 there has been 1 death in the Southern Trust area where c difficile has been recorded on the death certificate. (Please note figures for this period have not been validated by the General Registrar’s Office.