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Tackling hospital infections
02/07/2008
New figures on Healthcare Associated Infections (HAI) serve as an important reminder of why it's important for hand hygiene to stay at the top of the Scottish Government's HAI agenda, Health Secretary Nicola Sturgeon said today.
Two reports published by Health Protection Scotland (HPS) reveal how Health Boards performed over the last quarter (January - March 2008) in their efforts to tackle Clostridium difficile Associated Disease (CDAD) and Staph. aureus bacteraemia (MRSA and MSSA). A third report published by HPS shows hand hygiene compliance by healthcare staff for this audit period (May 2008).
On Clostridium difficile:
- New national figures for CDAD show the number of cases increased to 1861, an increase of 16 per cent on the previous quarter, and a 4.8 per cent increase on the same quarter for the previous year. In total 26 per cent of these patients had no history of hospital stays in the previous 12 weeks, while 74 per cent had been in hospital within 12 weeks before the onset of the disease
- The average rate was 1.24 per 1000 total occupied bed days (OCBD), an increase of 6 per cent on the last quarter, but a 4.6 per cent decrease on the same quarter in the previous year. Many NHS Boards areas show little change or increases which may be caused by seasonal factors
On Staph. aureus bacteraemia:
- The Staph. aureus bacteraemia report records the lowest number and rate of MRSA bacteraemia of any quarter reported since this surveillance began. It also shows the fourth consecutive quarterly decrease in Staph. aureus bacteraemia, the second lowest number since surveillance began in 2005
On hand hygiene:
- The Compliance with Hand Hygiene (Audit Report) shows the rate of compliance in Scotland has increased from 68 per cent in the first audit in February 2007 to 88 per cent this May
Commenting on the reports, Nicola Sturgeon said:
"The data published today give a clear picture of the incidence of and response to Healthcare Acquired Infections across NHS Scotland. NHS Boards use this information to manage the situation in their local area and monitor progress.
"Tackling HAI is a priority for the Scottish Government. Scotland has one of the most comprehensive sets of policies and procedures to manage HAI in Europe. However, recent events at the Vale of Leven show how vital it is for Boards to ensure that these policies and procedures are applied to a high standard. Indeed I challenged NHS Board Chairs at my meeting with them on Monday (30 June) to ensure that this is the case, and I intend to raise the issue with every Board during this summer's Annual Reviews.
"The report on rates of Staph. aureus bacteraemia reveals that these infections are at the second lowest level since national reporting began, and that MRSA bacteraemias are at their lowest rate since 2003. This, coupled with a high level of progress towards compliance on our 90 per cent hand hygiene target and other interventions led by the HAI Task Force, indicates that the actions we are taking are beginning to take effect.
"We now have a mandatory national surveillance programme for reporting the incidence of Clostridium difficile Associated Disease and it is vital that Boards analyse and act on this information with targeted action to improve the prevention and control of infection.
It is also important that HPS monitor rates over the coming months so that we can better understand what might lie behind any increases.
"We need to tackle HAIs on all fronts. We know that good hand hygiene is one of the most effective ways to prevent and reduce infections which is why we will continue with the national Hand Hygiene Campaign and reinforce this message. I hope that we may also strengthen prevention further through Scotland's MRSA Screening Programme. The only UK pilot of such a programme, it is currently being trialled across three NHS Board areas and I eagerly await the results of this next year."
*HEAT targets (Health Improvement, Efficiency, Access and Treatment) are a core set of Ministerial objectives, targets and measures for NHS performance in Scotland. HEAT targets are set for a three year period and progress towards them is measured through the Local Delivery Plan process. A Health Improvement, Efficiency, Access and Treatment (HEAT) target for monitoring NHS Scotland performance requires a 30 per cent reduction in Staph. aureus bacteraemia by 2010.
A mandatory surveillance programme for recording cases of CDAD in patients aged 65 and over was introduced in Scotland in September 2006.
Good hand hygiene by everyone in the NHS is key to ensuring patients do not contract a variety of infections, including CDAD and SAB. In November 2007, Ms Sturgeon announced a challenging target for NHS staff in Scotland to achieve at least 90 per cent hand hygiene compliance by November this year.
The data for the CDAD report are taken from laboratory confirmed reports (e.g. each patient tested for C.diff has been confirmed by the hospital lab as a positive result). HPS quality check this data and return their findings back to the microbiologists at each lab for them to cross check that each lab agrees that the data is an accurate reflection of the position.
The Scottish Government is investing £54 million over the next three years to tackle HAI. This is a 260 per cent increase on spend on HAI under the previous administration.