SIXTH MEETING OF THE HEALTHCARE ASSOCIATED INFECTION (HAI) TASK FORCE, HELD AT 10.00AM ON TUESDAY 30 OCTOBER 2007, IN CONFERENCE ROOM 3, VICTORIA QUAY, EDINBURGH

Present:

Scott ish Government Health Department

Mr Paul Martin, Chief Nursing Officer (Chair)

Mrs Margaret Tannahill, Nursing Adviser HAI and Communicable Disease

Dr Peter Christie, Senior Medical Officer

Mrs Shona Colley, HAI Team

Mrs Linda Middleton, HAI Team

Mr Callum Percy, HAI Team

NHSScotland and other representatives

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

Paul Kingsmore)

Ms Hazel Borland, Head of Clinical Governance and Patient Safety, NHS Quality

Improvement Scotland (deputising for Dr David Steel)

Mrs Susan Brimelow, Director of Healthcare Regulation, Care Commission (part meeting)

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

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

Dr Mary Hanson, Microbiologist, Joint Chair Scottish Microbiology Forum

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

Ms A MacKenzie, Infection Control Adviser, Care Commission (deputising for Susan

Brimelow)

Mrs Maggie McCowan, Chair, Infection Control Managers Association

Mr John McMeekin, Public Involvement Representative and PICT member

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

Dr Charles Saunders, Scottish Joint Consultants Committee

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

Mr Tony Wigram, Health and Safety Manager , Scottish Ambulance Service

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

The following apologies were noted:

Dr Harry Burns, Chief Medical Officer (Deputy Chair)

Mr John Glennie, Chief Executive, NHS Borders

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

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

Mrs Bridget Hunter, Scottish Partnership Forum

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

Dr Bob Masterton, Medical Director, NHS Ayrshire and Arran

Dr Mini Mishra, Senior Medical Officer

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

Ms Lorna Renwick, NHS Programme Manager, NHS Health Scotland

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

Domestic Services Management

Dr David Steel, Chief Executive, NHS Quality Improvement Scotland (Hazel Borland

deputising)

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

(including decontamination policy), SEHD

Miss Margie Taylor, Chief Dental Officer, SEHD

1. Welcome and Apologies

Paul Martin welcomed everyone to the meeting and noted apologies as above.

2. Matters Arising

2.1 Paul Martin advised members that Margaret Tannahill would be leaving the Scottish Government at the end of November to take up a post as Lead Consultant Nurse Infection Control at HPS. Paul thanked Margaret for her work with the HAI Task Force and requested that her significant contribution in forwarding the HAI agenda in Scotland and also raising the profile internationally should be recorded. Paul wished Margaret every success in her new post and advised members that the HAI Nurse Adviser post had been advertised and that the closing date was 9 November 2007.

2.2 The minutes of the meeting held on 26 June were agreed.

• Continued HAI Improvement after March 2008 - update (see item 3)

2.2 Paul Martin reminded members that Nicola Sturgeon, Cabinet Secretary for Health and Wellbeing announced, on 11 July 2007, that she was content for the HAI Task Force to continue with a new programme of work focusing on the priority areas highlighted in the Scottish Point Prevalence Survey. The new programme will be discussed separately under Agenda Item 3.

• The Scottish National Point Prevalence Survey

2.3 Margaret Tannahill reminded members that HPS was commissioned to develop and document a methodology for establishing the overall burden of HAI in terms of health service utilisation and costs. The Scottish National Point Prevalence survey was successfully launched by Nicola Sturgeon, Cabinet Secretary on 11 July 2007 at the Southern General Hospital in Glasgow. Margaret expressed thanks to HPS for developing this detailed and complex report. Jacqui Reilly from HPS advised members that there had been international interest in the results and that Belgium, France and some states in America had indicated an interest to carry out a similar survey. Robin Creelman, Chair of PICT was asked for his opinion of the report from a patient and public involvement point of view. Robin advised that initially in his local area, the report did not receive good press as journalists found the report detailed, complex and difficult to understand. Journalists were encouraged to contact HPS to seek clarification of the data, leading to a more positive approach being taken.

• NHS QIS Health Technology Assessment on MRSA screening

2.4 Peter Christie advised members that the NHS QIS Health Technology Assessment on the clinical and cost effectiveness for screening from MRSA was launched on 19 September 2007. It is proposed to run a pilot exercise in 2008-09 to test practicality and establish that the major assumptions in the model were reasonable. There is general agreement that effectiveness will take longer to assess. The aim is to implement MRSA screeningas policy in 2009. Although there is political commitment to provide funding for this initiative, approval depends on the allocations detailed in the spending review, which should be announced by the end of November. A steering group has been set up and a scoping exercise meeting is to be held on 29 November to consider the approach. It has been suggested that for the pilot study Boards could be grouped both geographically rather than looking at a single Board system. As a number of Boards have indicated interest in taking part in the pilot, they may be invited to make a case for being included in the pilot study.

• National Public Information Strategy

2.5 A draft copy of the National Public Information Strategy was tabled at the meeting. Robin Creelman, Chair of PICT advised members that the group had collected public information from NHS Boards for comparison. The consensus was that national leaflets (including local contact information) should be developed. The following points were raised:

• Members of the public should be made more aware of HAI. Members were advised that the new NHS Quality Improvement Scotland HAI Infection Control Standards should help encourage Boards to raise public awareness.
• Challenge of winning public confidence.
• Provide information for use in the community
• Pro-active education of members of the public
• The use of ICMs and Head of Communications to highlight good news stories
• Linking and working with PFPI in each NHS Board

Members were requested to review the document and submit comments to HAITF Secretariat by the end of the November 2007.

Action: Members to submit comments to HAI Task Force Secretariat by end of November 2007.

3. HAI Task Force New Draft Delivery Plan

3.1 Paul Martin reminded members that the draft delivery plan issued on 25 October 2007 was still restricted status, and should not be discussed outwith this meeting. The Cabinet Secretary for Health and Wellbeing requested that a work programme focusing on the priority areas highlighted in the Point Prevalence Survey and aligning with the patient safety agenda should be developed.

• Delivery Area 1: Patient Safety, Practice and Culture.
• Delivery Area 2: Education.
• Delivery Area 3: Surveillance, Information and Audit.
• Delivery Area 4: Guidance and Standards.
• Delivery Area 5: Physical Environment.

An HAI and Patient Safety conference has been arranged for Monday 26 November 2007 for Nursing and Medical Directors and other key stakeholders to enable the Cabinet Secretary for Health and Wellbeing to announce the funding allocations and the new HAI Programme of Work. Members were advised that the Delivery Plan is flexible and can be amended as and when necessary. Stakeholders were reminded that it would be useful to know of completion dates and funding required.

The following points were raised in discussion:

• Clear assessment required for the current use of physical environment for care of the elderly.
• The issue of bed occupancy and the issue that some Boards do not have the resources to put into infection control within care homes.
• Encouraged to note the prescribing of antibiotics highlighted.
• Concern that Cleanliness Champions training programmes not being fully completed. Tracking of the data should be carried out at local level. NES offered support to a number of Boards last year and progress has been made. NES to hold a training day for co-ordinators.
• Focus on national priorities in NHS and provide support for independent and voluntary sector.
• Explore the possibility of carrying out surveillance in care homes.
• A National Food, fluid and nutrition care group has been established. A common assessment tool supported by national education and training and a monitoring tool to be developed by end of June 2008.
• National standards, framework, education/training and monitoring tool for tissue viability nurses association to be developed by NES.

Members were requested to send any comments on the Delivery Plan to HAI Task Force Secretariat by 14 November 2007 and also to advise if they wish to attend the HAI & Patient Safety conference.

Action: HAI Task Force members to submit comments on delivery plan by 14 November 2007.

Action: HAI Task Force members to advise Secretariat if they wish to attend conference.

4. HAI Task Force Delivery Plan: Progress Report

· Update from Stakeholder Leads

Health Facilities Scotland

Delivery Area 12.2: Implement HAI Scribe risk control system

Delivery Area 12.3: Define the HAI Task Force Role in the implementation and monitoring of Scottish Health Facilities Note 30

4.1 David Bedwell advised that an implementation programme had been developed and would be issued shortly along with a CEL. Both these delivery plan areas are now complete.

Health Protection Scotland

4.2 Jacqui Reilly advised that all delivery areas have green status. She further advised that the hand hygiene audit report had been finalised and that two thirds of hospitals are showing red or amber. Although these results are actually good in terms of audit, the media will pick up on the red and amber. Discussions are ongoing about the presentation within the report of these results, including the issue of sustainability and the issue of improving the level of compliance. The report should be published by the end of the year and the possibility of publishing quarterly is still under discussion.

Delivery Area 14.4: Develop programmes fore the reduction of surgical site infection, C difficile and MRSA

4.3 Jacqui Reilly advised that the appointment of a programme manager to progress the implementation of care bundles had been delayed to allow time to align with the patient safety agenda.

NHS Education for Scotland

4.4 Liz Gillies advised that all delivery areas were on track to be completed on time. She expressed concern at staffing levels within NES as extra peripheral work was being carried out along with parallel work on decontamination.

Action: Liz to contact HAI Task Force Secretariat to discuss staffing levels.

NHS Quality Improvement Scotland

4.5 Hazel Borland advised that Risk Management programmes are in alignment with the patient safety agenda.

PICT

4.6 Robin Creelman advised that all strands of work in the current delivery plan are now complete.

SGHD

4.7 Peter Christie advised members that the National MRSA Control Strategy could not be finalised until a decision had been made on the recommendations of the Health Technology Assessment on the effectiveness of screening for MRSA.

· Discussion and Feedback

4.8 Members agreed that the new Delivery Plan focussed on the high priority areas and was what members had expected.

The following points were raised in discussion:

• The question was raised about what can be done about bed occupancy, staffing and the physical environment. Paul Martin advised members that a staffing workforce planning tool was being developed and that this could be beneficial.
• The need to consider how to keep older people out of hospitals.
• Need to look at the HEAT target and consider whether target can be achieved, and if not what needs to be done. SSI rates reducing and MRSA rates remaining stable, focus required on how to reduce rates and meet targets.
• Requirement for a communication strategy within NHS Boards.
• Most of the hand hygiene work has been focused on hospitals. Consider how this could be carried out in care homes. The movement of patients and staff within hospitals without attention to risk assessment was highlighted.

• Minutes of HAI Task Force Meetings

4.9 Callum Percy led the discussion on the possible publication of HAITF minutes. agenda item. The issue is whether the minutes of the meetings should be anonymised or should individual names be attributed to areas discussed. Callum advised members that under the Freedom of Information (Scotland) Act 2002 the HAI Task Force were under no obligation to publish minutes on the HAITF website. This follows consideration of the exemptions offered by section 29(a) of the Act, which relates to the formulation and development of government policy, and section 30(b)(i) and (ii), which relates to disclosure which would or would be likely to inhibit substantially the free and frank provision of advice or the free and frank exchange of views for the purposes of deliberation. Members did not have a problem with the naming of individual within the minutes and agreed for publication on the website. Callum confirmed that minutes would not appear on the website until such time as they had been agreed with HAI members.

5. Presentation: Scottish Patient Safety Alliance

5.1 Jane Murkin gave a detailed and informative presentation. A copy of the presentation will be issued along with the minutes of the meeting.

The following points were raised in discussion:

• The need for a national approach was highlighted with the Scottish Government taking the lead with key contacts in each NHS Board.
• Contacts within each NHS Board would be unique to the Board based on enthusiasm and drive for the project rather than management status.
• Concerns raised about the increasing emphasis on waiting times which could conflict with this work.
• The 'overly American' language needs refinement to ensure that all parties are engaged.
• The question of who owns and leads the IHI branding was raised. Members were advised that HAI Task Force owns; informed and supported by IHI agency and expertise.

Paul Martin emphasised the opportunity of learning; in particular the Cleanliness Champions training programme i.e. what ever the label, evidence based practice should be critical, and methodologies identified to underpin growth and development of practitioners. IHI would be difficult to embed in Primary Care and CHPs as much of their portfolio to date is hospital focused. IHI has been proven in acute hospitals and the programme will eventually be rolled out across the independent contractor/primary care sector - issues such as hand hygiene and community-based care of central lines and urinary catheters are obvious candidates for early rollout.

5.2 It was noted that the slide detailing the key partners involved, omitted to show HPS. Tayside, Dumfries and Galloway and Ayrshire and Arran are piloting the IHI care bundles under existing Health Foundations SPI programme. Hazel Borland advised that these were huge programmes and NHS Boards were "champing at the bit" to get started. The importance of fundamentally different models working was highlighted. It was agreed that a Communication strategy was important; Jason and Jane are embarking on a wide-ranging programme of face-to-face engagement with a variety of groups. Steering group established with Paul Martin, Jacqui Reilly and Robin Creelman as part of the network.

6. Four Country Update

6.1 Margaret updated members as follows:

• Department of Health has updated their HII care bundles relating to blood.
• A new Health Minister has been appointed in Wales
• World Health Organisation advice on Global Patient Safety Challenge - Professor Didier Pittet has continued to support our approach in tackling HAI and feedback from other countries show similar support.

6.2 Peter reminded members that the Specialist Advisory Committee on Antimicrobial Resistance (SACAR) has now been wound up. The new committee ARHAI - Antimicrobial Resistance and Healthcare Associated Infection is the nearest equivalent of our HAI Task Force. He advised that he and Jacqui Reilly would be attending a meeting the following day and that Jacqui would be giving a presentation on the Scottish Point Prevalence Survey. He further advised that Department of Health has announced an intention to go ahead with universal screening for MRSA but no details of funding or approach had been released.

6.3 Peter advised that a review of CJD transmission risks associated with dental procedures was being carried out for submission to SEAC. This may have further implications for the Scottish programme of upgrading local decontamination facilities.

6.4 Peter advised that the national policy on isolation rooms for new builds and refurbishments is progressing, with a likely decision in favour of new build hospitals having at or near 100% single rooms. Northern Ireland and Wales are planning to go with 100% single room provision. It remains unclear what level should be set for major refurbishment of existing properties.

6.5 Paul Martin mentioned the recent publicity in relation to the C.diff outbreaks at Maidstone in Kent. He advised members that he proposed to issue a letter to Chief Executive (copied to Chairs) of NHS Boards reminding them of their responsibilities to minimise and manage risk and to ensure that actions are in place to avoid any similar outbreaks.

7. HAI BURDEN Project

7.1 Peter Christie advised members that Professor Peter Davey from Dundee University is leading this European Union initiatives funded project. The aim of the project is to generate valid and comparable information on the burden of disease and the costs attributable to infections caused by antimicrobial resistant pathogens. Professor Davey is not looking for funding (£14K) but is seeking a statement of support from the HAI Task Force for further investigating potential sources of variability in HAI rates such as bed occupancy and staffing levels. During discussion the question was raised as to the accuracy of the baseline data. Jacqui Reilly confirmed that a validation study had been carried out and that the data are accurate. The importance of understanding the potential variation in bacteraemia rates in particular was highlighted. Members agreed that the work should be progressed through the Scottish Information Research Network (SIRN).

Action: Peter Christie to contact Professor Peter Davey and advise him to progress the BURDEN project though SIRN.

8. AOCB

8.1 Paul Martin reminded members that the Agenda for next meeting will focus on how meeting the MRSA/MSSA bacteraemia HEAT targets can best be supported.

9. Date of Next Meeting

9.1 The next meeting will take place on Tuesday 29 January 2008 from 10.00 - 13.00 in Conference Room 3, Victoria Quay, Leith, Edinburgh.

HAI Task Force Secretariat

December 2007