FIFTH MEETING OF THE HEALTHCARE ASSOCIATED INFECTION (HAI) TASK FORCE, HELD AT 11.00AM ON TUESDAY 26 JUNE 2007, IN CONFERENCE ROOM 3, VICTORIA QUAY, EDINBURGH

Present:

Scottish Executive Health Department

Mr Paul Martin, Chief Nursing Officer (Chair) (attended after lunch)

Mrs Margaret Tannahill, Nursing Adviser HAI and Communicable Disease (Acting Chair)

Dr Peter Christie, Senior Medical Officer

Mrs Linda Middleton, HAI Team

Dr Mini Mishra, Senior Medical Officer

Mr John Mullet, Health Workforce Directorate

Mrs Anne Williams, HAI Team

NHSScotland and other representatives

Mr Tim Brett, Director, Health Protection Scotland

Mr David Bedwell, Assistant Director, Health Facilities Scotland (deputising for

Paul Kingsmore)

Mr Robin Creelman, Chair of HAI Task Force Public Involvement Communications Team

Mrs Liz Gillies, Director of HAI Initiative, NHS Education for Scotland

Miss Shona Halley, Infection Control Nurses Association, (Co-ordinator Scottish Branch)

Mr Robert Howe, Head of Environmental Services, South Lanarkshire Council

Mrs Heather Kelman, General Manager, Community Health Partnership, NHS Grampian

Mr John McMeekin, Public Involvement Representative and PICT member

Dr Jacqui Reilly, Consultant Nurse Epidemiologist/Head of Group, Health Protection Scotland

Dr David Steel, Chief Executive, NHS Quality Improvement Scotland

Mr Tom Walsh, Infection Control Manager, NHS Greater Glasgow and Clyde

Mr Tony Wigram, Health and Safety Manager, Scottish Ambulance Service (deputising for Adrian Lucas)

The following apologies were noted:

Mrs Susan Brimelow, Director of Healthcare Regulation, Care Commission

Dr Harry Burns, Chief Medical Officer (Deputy Chair)

Mr John Glennie, Chief Executive, NHS Borders

Dr Mary Hanson, Microbiologist, Joint Chair Scottish Microbiology Forum

Mrs Bridget Hunter, Scottish Partnership Forum

Mr Paul Kingsmore, Director, Health Facilities Scotland (David Bedwell deputising)

Mr Adrian Lucas, Chief Executive, Scottish Ambulance Service (Tony Wigram deputising)

Dr Bob Masterton, Medical Director, NHS Ayrshire and Arran

Dr Ken Oates, Consultant in Public Health Medicine, NHS Highland

Mr Callum Percy, HAI Policy Lead, SEHD

Ms Lorna Renwick, NHS Programme Manager, NHS Health Scotland

Mrs Midge Rotherham, Hotel Services Manager/National Chair, Association of

Domestic Services Management

Dr Charles Saunders, Scottish Joint Consultants Committee

Mr Ross Scott, Head of Health Finance Policy Implementation and Development Branch

(including decontamination policy), SEHD

Miss Margie Taylor, Chief Dental Officer, SEHD

Dr Eugene Waclawski, Director of Occupational Health, NHS Greater Glasgow and Clyde

Mr Paul Wilson, Executive Director for AHPs, Nursing & Midwifery, NHS Lanarkshire

1. Welcome and Apologies

Margaret Tannahill welcomed everyone to the meeting and apologised for the change of time. Apologies were noted as above. She introduced Tom Walsh, Infection Control Manager NHS Greater Glasgow and Clyde replacing Dr Bill Anderson at this meeting; Dr Jacqui Reilly Consultant Nurse Epidemiologist/Head of Group, Health Protection Scotland replacing Professor Mary Henry; Tony Wigram, Health and Safety Manager, Scottish Ambulance Service deputising for Adrian Lucas; David Bedwell, Assistant Director, Health Facilities Scotland (deputising for Paul Kingsmore); John Mullet, Health Workforce Directorate and Miss Sally Stewart, HAI Prevalence Survey Project Manager, Health Protection Scotland.

2. Matters Arising

2.1 The minutes of the meeting held on 27 February were agreed subject to an amendment to show that Dr Charles Saunders attended.

Action: HAI Task Force Secretariat to amend minutes of last meeting to show that Dr Charles Saunders was in attendance.

• National Uniforms Group

2.2 This national working group is developing a national dress code for all staff, reviewing the potential for national uniform procurement and taking account of the laundry services required to do so. As this item is now the responsibility of Health Workforce Directorate it will be removed from the HAI Task Force Delivery Plan.

Action: HAI Task Force Secretariat to remove the development of National Uniform Code from the HAI Task Force Delivery Plan.

• Communications Strategy

2.3 The communications strategy had been discussed at the last meeting on 27 February 2007 and the comments and suggestion had now been included. The communications strategy was agreed subject to the following amendments:

• The overarching group of the Royal Colleges to be included
• The drafting note on page two to be removed

Action: HAI Task Force Secretariat to amend the communications strategy as noted above.

3. HAI Task Force Delivery Plan: Progress Report

3.1 Members discussed the format of the progress report and it was agreed that, to make it more user friendly, we should return to the narrative style of report, as used in the phase one of the HAI Task Force.

Action: HAI Secretariat to reformat the progress report into narrative style.

Update from Stakeholder Leads

Health Facilities Scotland

Delivery Area 11.3.2 - Drive the adoption throughout NHSScotland of the: Role of the ward housekeeper, including arrangements fro networking and sharing good practice

3.2 Members were advised that the job description and the role have been accepted by domestic managers. The job description (with a suggestion of Band 2 grading) was currently being assessed under Agenda for Change. This delivery area should now show green status.

Action: HAI Task Force Secretariat to amend delivery plan area 11.3.2 to show status of green

Delivery Area 12.2 and 12.3 - Implement HAI Scribe risk control system and define the HAI Task Force role in the implementation and monitoring of Scottish Health Facilities Note 30

3.3 Members were advised that agreement in principle had still to be reached about the need for a Health Department Letter to be issued. Discussions are ongoing between Health Facilities Scotland and Health Finance Directorate (Property and Capital Planning). This delivery area is now heading for amber status.

Action: David Bedwell to ask Geraldine O'Brien to provide an update on HAI Scribe for the next HAI Task Force progress report.

Health Protection Scotland

Delivery Area 14.4 - Develop programmes for the reduction of surgical site infection, C difficile and MRSA - Care Bundles

3.4 Members were advised that a Project Initiation Document had been submitted for Care Bundles and that the first set of project linked care bundles i.e. central line insertion, central line maintenance, ventilator associated pneumonia, peripheral vascular, catheter, surgical site infection C. difficile associated disease and hand hygiene have been initiated for delivery at the end of June 2007. NHS Forth Valley and NHS Greater Glasgow and Clyde are piloting the care bundles at present. NHS Lanarkshire has indicated a desire to pilot in the future. HPS has created a new post to lead the implementation of care bundles across NHSScotland.NHS Education for Scotland

Delivery Area 3.2.1 - Antimicrobial prescribing: Develop antimicrobial prescribing resources for undergraduate medical students

3.5 As this work is now complete request and the progress report should be amended to show the status as green.

Action: HAI Task Force Secretariat to amend the Delivery Plan - Area 3.2.1 to show the Status as green.

Delivery Area 3.7 - Produce proposals for increasing general HAI awareness for NHS Chief Executives

Members were advised that this delivery area had been overtaken by the Scottish Patient Safety Alliance agenda that includes several HAI areas.

Action: HAI Task Force Secretariat to note that delivery area 3.7 has been overtaken by developments in the patient safety agenda.

Delivery Area 11.3.1 - Drive the adoption throughout NHSScotland of the: education and training framework for domestic assistants

3.6 The framework has been well received and is a useful benchmark for organisations. Proposed workshops have been delayed meantime but will be rearranged soon. The revised workbook for domestic assistants has been issued. An additional vignette on needle stick injury for undergraduates to be available soon along with a vascular package for central lines.

3.7 Peter Christie advised that the Department of Health Specialist Advisory Committee on Antimicrobial Resistance (SACAR) and the Health Protection Agency internal HAI committee have now been combined within the Advisory Committee on Antimicrobial Resistance and Healthcare Associated Infection (ARHAI). He further advised that SEHD had obtained observer status at ARHAI and should be attending the inaugural meeting next week.

Action: Peter Christie to provide feedback from the ARHAI meeting at next HAI Task Force meeting.

PICT

Delivery Area 5.5 Develop a national public information strategy in relation to HAI

3.8 Members were advised that a meeting of the PICT sub-group to discuss the development of a national public information strategy had been arranged for 10 July 2007. The sub-group had already identified the need to standardise the provision of information for members of the public across NHSScotland.National hand hygiene campaign

3.9 Robin Creelman advised that he had undergone training as part of the national hand hygiene campaign and is now a "Hand Hygiene Promoter". He also mentioned that the public part of the hand hygiene campaign will be advertised again in January 2008 and that a presentation of this will be arranged for PICT members.

National cleaning monitoring tool

3.10 Robin also advised that cleaning monitoring within hospitals was progressing well however, there is a vast amount of care given outwith hospitals and this raised the question of how to audit primary care premises. Audit should be seen as a measure of success rather than failure and is also seen as an important element of education.

Scottish Patient Safety Alliance

3.11 Robin also advised that he had been invited to join and had accepted an invitation to become a member of the Scottish Patient Safety Alliance (SPSA) Board.

Action: PICT to develop Draft Public Information Strategy for presentation at the next HAI Task Force meeting.

NHS Quality Improvement Scotland

Delivery Area 2.2 - Review of the NHS Quality Improvement Scotland HAI infection control standards

3.12 Members were advised that the NHS Quality Improvement Scotland infection control standards would be issued for consultation in the very near future with final standards ready for issue in January 2008. NHS QIS has organised two open public consultation meetings to be held in September 2007 and piloting of these standards in two Board areas. A decision has still to be made on the timescale for the review of the standards. A baseline may need to be established for NHS Boards by self assessment against the standards.

Delivery Area 7.1 - Develop incident and 'near miss' reporting using HAI as a "tracer" to test methodology developed

3.13 This problematic area is now in red status. The process is proving very difficult to work through and a more realistic date would be December 2007. The Scottish Patient Safety Alliance plans at the moment do not explicitly include reference to adverse incident reporting, though they are clearly related pieces of work.

Delivery Area 7.2 - Develop and pilot HAI incident reporting linked to the HAITF document on risk methodology

3.14 Another area with delivery status red. Members advised that the Risk Assessment document is almost ready for issue.Delivery Area 7.3 - Use HAI as a "pathfinder" theme in implementation of the Australian/New Zealand risk assessment matrix

3.15 This delivery area has been subsumed into delivery area 7.1.

Delivery Area 7.4 - Work with Risk Managers in NHS Boards to raise awareness and implement the risk matrix with specific regard to HAI

3.16 This delivery area has mostly been subsumed into delivery area 7.1.

SEHD

3.17 Members were updated Skills for Health national competencies on infection control and that there were based on the NES Cleanliness Champions programme and the model infection control policies. There will be no formal launch of these competencies but they may be available on the SfH website soon.

Delivery Area 14.1 - Develop and consult on a National MRSA Control Strategy

3.18 Some further work is required on this document which cannot be completed until the Health Technology Assessment on the clinical and cost effectiveness of screening for MRSA has been finalised and published.

Delivery Area 6.1 - Review the existing Antimicrobial Scottish Strategy and Scottish Action Plan and prepare a consultation document

3.19 The final draft of the ScotMARAP document is almost complete. The document which aligns with the Antimicrobial Prescribing Policy and Practice (HAI Task Force 2005) will be passed to the Cabinet Secretary for Health and Wellbeing for approval. It will then be issued for a peer consultation.

Delivery Area 14.2 - Develop and implement standard operating procedures for diagnosis of key organisms (e.g. Clostridium difficile)

3.20 The standardisation of operating procedures for diagnosis and reporting of C. difficile cases is now complete and this delivery area status should be returned to green. The broader agenda is now to look at the recording of other organisms. Information on C.diff data was requested by the media and under the Freedom of Information Act, and had to be released, despite the fact that the data were neither complete nor of good quality. The information was released with caveats and health warnings (largely ignored) but fortunately most media outlets apparently took the view that the story was not worth publishing. It is proposed to publish the finalised data formally at the end of the year as planned.

Action: HAI Task Force Secretariat to amend the Delivery Plan - Area 14.2 to show the Status as green.

Discussion and Feedback

3.21 NHS Boards complete a self assessment each year for the accountability review process. The HAI section should include progress against the new HEAT target for reduction of Staphylococcus aureus bacteraemias. Historically NHS Boards have been requested to provide information and this has been received in many different formats. It has been decided, to ensure that consistent comparable information is received from NHS Boards, that a standardised template be developed. This template could form the basis for a framework for the annual report from NHS Board Infection control Managers.

Action: HAI Task Force Secretariat to develop a standard template for the HAI section of the Accountability Review self assessment form.

3.22 Members were advised that the Scottish Executive Health Department has now been renamed the Scottish Executive Health Directorates. The Cabinet Minister for Health and Wellbeing (as well as being Deputy First minister) is Nicola Sturgeon who has HAI as part of her port-folio. The Minister for Public Health is Shona Robison (some areas are shared between the two). Longer term issues for the HAI programme have still to be discussed and approved.

3.23 Kevin Woods, the Chief Executive of NHSScotland is now also the Director General of Health. Health Department Letters (HDLs) will in future be called Chief Executive Letters (CELs).

Minutes of HAI Task Force Meetings

3.24 As Callum Percy was unable to attend this meeting, it was agreed that this item should be discussed at the next HAI Task Force meeting.

Action: HAI Task Force to include Minutes of HAI Task Force meetings on the agenda for the next HAI Task Force meeting.

4. HAI Improvement Strategy Workshop Update/Patient Safety

4.1 Quality Improvement Programmes and development of care bundles align with the HAI topic areas in the SPSA programme. Cultural change is major issue for the SPSA and our work will align as closely as possible. The Patient Safety Alliance Project advisory board, chaired by CMO, first met in May. Health Protection Scotland has a place on the advisory board. The initial focus of the board will be on hospital safety, but this should write across to primary care at an early stage. An internal stakeholder network within the Health Directorate will include the HAI Team.

5. Presentation: National Point Prevalence Survey

5.1 Jacqui Reilly and Sally Stewart gave a very detailed and informative presentation. Members were reminded that the PPS report was embargoed until 11 July 2007 and that notes should not be taken during the presentation. A copy of the presentation will be issued with the minutes.

Action: HAI Task Force Secretariat to issue copy of presentation along with the minutes of the meeting.

6. Continued HAI Improvement after March 2008

It was intimated at the February meeting that a paper would be prepared for discussion at this meeting. With the advent of the new administration, discussions are ongoing as to the future of a central approach to prevention and control of HAI. This item, therefore, will be included as an agenda item for the next HAI Task Force meeting.

Action: HAI Task Force Secretariat to include an update on agenda for the next HAI Task Force meeting

7. AOCB

7.1 Peter Christie advised members that he had attended a safety Conference in Barcelona co-hosted by IHI. The meeting had included a significant focus on pressure sores, which is often a neglected issue. He further advised that the Scottish Patient Safety Alliance include HAI related tasks as one third of their key topic areas and that pressure sores have been included as a specific issue.

7.2 David Steel from NHS QIS advised members that the Scottish Patient Safety Alliance (SPSA) was launched on 7 March 2007. A technical partner is still being sought. NHS QIS will update HAI Task Force members on the SPSA as soon as possible.

Action: NHS QIS to update Task Force members on the Scottish Patient Safety Alliance at future HAI Task Force meetings.

8. Date of Next Meeting

8.1 The next meeting will take place on 30 October, from 10.00 - 13.00 in Conference Room 3, Victoria Quay, Leith, Edinburgh.

HAI Task Force Secretariat

August 2007