NMH

NMH | 2024 175 Quality & Safety Services T he Infection Prevention and Control (IPC) team work alongside other healthcare staff to ensure that all measures are taken to reduce and prevent healthcare associated infection through education, audit, surveillance, consultation, posters, leaflets and the development of policies/ guidelines. Antimicrobial stewardship and minimising development of antimicrobial resistance is a key goal of the IPC team. The team contributes to multi- disciplinary committees including Infection Prevention and Control Committee, Drug & Therapeutics Committee, Quality Risk & Patient Safety Committee, Decontamination Steering Group, Hygiene Committee, Sepsis & IMEWS Committee, NMH Audit Steering committee, and Clinical Governance Executive. Clinical Outcomes Sepsis and Septic Shock (Maternity and Gynaecology) • Eight women developed maternal sepsis in 2024 (1.21 per 1000 mothers delivered compared to 0.89 in 2023, 1.03 in 2022, 0.52 in 2021 and 0.83 in 2020). • One woman developed septic shock and seven had sepsis. • Two sepsis were intrapartum term deliveries. Six were following deliveries at 12, 33, 37, 38, 39 and 40 weeks. All women survived. • No gynaecology patient developed sepsis. • The organisms identified were E. coli (4) and one each of Staphylococcus aureus, S. lugdunensis, polymicrobial infection and no organism identified. Only two were associated with blood stream infection. Blood Stream Infection (BSI) and Meningitis: (Neonates) • The rate of neonatal early onset group B streptococcal (GBS) disease was Infection Surveillance, Prevention and Control zero per 1000 births in 2024 compared to 0.87 in 2023, zero in 2022, 0.38 in 2021, and 0.27 in 2020. • The rate of neonatal laboratory confirmed early-onset sepsis was per 0.44 per 1000 births in 2024, compared to a rate of 1.45 in 2023, 0.57 in 2022, 0.64 in 2021 and 0.27 in 2020. • There were 12 neonatal healthcare associated, late-onset blood stream infections in 2024; Four coagulase negative Staphylococcus, 7 gram negative bacilli and 1 Bacillus cereus. • Two infants were diagnosed with meningitis in 2024. Both were late onset; 1 Enterovirus and 1 VAD- associated CONS. Adults: There were 24 BSI in 2024, 4 of which occurred during the antenatal period, 6 intrapartum, 13 postnatal and 1 gynaecology patient. Causative organisms were E.coli (10), Streptococcus species (4), E.faecalis (3), Group B Streptococcus (2), Anaerobe (2) and one each of Klebsiella pneumoniae, P. mirabilis and polymicrobial. Nine (37.5%) were healthcare associated infections (HCAI). Device Associated Infection, Surgical Site Infection and Clostridium difficile • The central line associated blood stream infection (CLA-BSI) rate in the NICU was 1.04 per 1000 catheter days in 2024 compared to 2.02 in 2023, 2.14 in 2022, 5.37 in 2021 and 2.9 in 2020. • The ventilator associated pneumonia rate in the NICU was 4.65 per 1000 ventilator days in 2024 compared to a rate of 1.5 in 2023, 1.93 in 2022, 3.45 in 2021 and zero in 2020. (increase possibly due to two chronically extremely premature babies who required a more prolonged period of ventilation) • The CS-SSI was 6.09% in 2024; 5.15% following elective CS and 6.93% following emergency CS. This compares to 5.57% in 2023; 4.95% following elective CS and 6.12% following emergency CS. • There was 1 case of Clostridium difficile infection in 2024, which was a community acquired case. Multi-Drug Resistant Organisms (MDRO) • There were no MRSA bloodstream infections (BSI) in 2024. - MRSA was detected in 9 infants. Of these 9 infants, 2 were acquired from the mother; two were acquired in the NICU and 5 were colonised on admission to NICU. - MRSA was detected in 55 adult patients. Eight developed an MRSA infection and 47 patients were colonised. Forty-nine were community-acquired MRSA, 1 was from an undetermined source and 5 were HCAI from other hospitals. • There were 2,855 CPE screens in 2024. There were 2 CPE cases identified in 2024, 1 in an adult and 1 in a neonate, both of which were colonisation. • There was no vancomycin-resistant Enterococcus (VRE) BSI in 2024. There was no VRE detected in neonatal patients. • In the neonatal unit, 8 infants were colonised with gentamicin resistant gram negative bacilli, 19 with ESBL and four with gram negative bacilli that were both ESBL and gentamicin resistant. Respiratory viruses • There were 47 cases of Influenza in 2024; 37 Influenza A and 10 Influenza B, all in adult patients. One case of Influenza A was a co-infection with SARS-CoV-2 and one was a co- infection with RSV • There were 4 cases of RSV in 2024; all in adult patients; one was a co- infection with Influenza A. • Twenty-one patients tested positive for SARS-CoV-2 in 2024; one was a co-infection with influenza A. All cases were in adults. Three were HCAI.

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