SEVENTH MEETING OF THE HEALTHCARE ASSOCIATED INFECTION (HAI) TASK FORCE, HELD AT 10.00AM ON TUESDAY 29 JANUARY 2008, IN CONFERENCE ROOM 3, VICTORIA QUAY, EDINBURGH

Present:

Scottish Government Health Directorates

Mr Paul Martin, Chief Nursing Officer (Chair)

Mrs Carol Fraser, Nursing Adviser HAI

Dr Peter Christie, Senior Medical Officer

Mrs Shona Colley, HAI Team

Mr Callum Percy, HAI Team

Mr Gavin Reid, HAI Team

Dr Mini Mishra, Senior Medical Officer (Primary Care)

Miss Margie Taylor, Chief Dental Officer, SEHD

NHSScotland and other representatives

Mr David Bedwell, Assistant Director, Health Facilities Scotland

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

Improvement Scotland

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

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

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

Dr Mary Hanson, Microbiologist, Joint Chair Scottish Microbiology Forum

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

Mr Paul Kingsmore, Director, Health Facilities Scotland

Dr Bob Masterton, Medical Director, NHS Ayrshire and Arran

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

The following apologies were noted:

Dr Harry Burns, Chief Medical Officer (Deputy Chair)

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

Mr John Glennie, Chief Executive, NHS Borders

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

Mrs Bridget Hunter, Scottish Partnership Forum

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 Charles Saunders, Scottish Joint Consultants Committee

Mr Colin Brown, Branch Head, Patients & Quality Division, Scottish Government Health

Directorates

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

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

1. Welcome and Apologies

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

2. Matters Arising

2.1 Paul Martin welcomed Carol Fraser, who will be taking up the new post of HAI Nurse Adviser to the Scottish Government in March, to the group.

2.2 The minutes of the meeting held on 30 October 2007 were agreed subject to some minor alterations.

2.3 Paul Martin set the context of the meeting by reminding members of the importance that the Cabinet Secretary places upon tackling HAIs. He announced that there will be a Scottish Government led Parliamentary Debate on the topic on 26 March 2008.

3. Update on Progress Towards HEAT Target

Jacqui Reilly provided an update on the progress towards the HEAT target for the reduction of MRSA rates by 30% of their 2006 levels by 2010. She commented that it was difficult to establish strong trends due to the limited amount of data available at present. Subject to this, it appears that of the 14 Boards, 7 show a downward trend, 4 show no change, and the remaining are Island Boards where the number of cases is too small to establish any trend. A discussion followed during which the following points were raised:

• Concerns were raised regarding media interpretation of figures, especially in relation to comparison between Scotland and England. It was pointed out that there are considerable differences in the way in which data are collected and presented between the two nations, and this should be emphasised in any queries relating to this.
• Community Associated MRSA (CA - MRSA) is a rising concern and one which will need to be monitored, although the primary focus will remain on the acute setting for the immediate future.
• Boards should ensure that they tackle MRSA through an integrated suite of measures, including hand hygiene, screening, care bundles, cleaning etc and should not become overly focussed upon just one. Boards should all have an Action Plan which details how they will meet the MRSA HEAT Target. It was agreed that a summary of these Action Plans should be presented at the next Taskforce Meeting.

Action: Gavin Reid will compile a report summarising the Health Boards MRSA HEAT Action Plans for presentation at the next Task Force meeting.

4. Review of Cleaning Specification Progress Report

David Bedwell provided an update of the progress of the review of The NHS Scotland National Cleaning Services Specification. He reported that the draft is now complete and requested guidance from the Taskforce as to how to proceed. Following an extensive discussion led by the Chair, the following was agreed:

• The Specification should be deepened, so that a higher standard of cleanliness will be required to achieve the 90% 'Green' pass mark.
• There should be extensive quality assurance of the audit procedures to ensure that all Boards are reporting accurately and consistently.
• It should be ensured that public involvement in the audits should be consistent across Boards.
• It should be emphasised that ownership of ward cleanliness lies with the Charge Nurse, as they are ultimately responsible.

Action: David Bedwell will present a detailed paper for the next Task Force meeting setting out how the above points will be achieved.

5. Presentation: Hand Hygiene Work/Audit Report

Claire Kilpatrick gave a presentation on the Hand Hygiene campaign and the recent Audit which was published on 27 December 2007 - copy attached. A discussion took place after the presentation at which the following points were raised:

• Despite initial scepticism in much of the media when it was launched, the hand hygiene campaign is now seen as having a good influence in increasing the profile of regular hand hygiene.
• There were concerns over the low level of compliance reported in the audit, although the figures are higher than most when compared to international studies. It was agreed that the figures are still unacceptable and need considerable improvement.
• It was noted that the target for 90% compliance by the end of this year, as announced by the Cabinet Secretary for Health and Wellbeing, will be more demanding for some Boards to meet than others.
• Senior management and senior clinical staff have a key role in promoting good practice, especially through acting as role models for junior staff.

6. HAI Task Force Draft Delivery Plan (2008-2011) Progress Report

Paul Martin asked for any final comments or changes for the Draft Delivery Plan (2008-2011) before it is issued to Chief Executives in a CNO letter later in February. The following was noted:

• A point should be included to make involvement of the Primary Care community explicit.
• Point 2.8 in the plan should also include dentistry.

7. HAI Task Force Delivery Plan (2005 - 2008) Progress Report

7.1 Discussion focused on the areas of the delivery plan that remain in red or amber. Hazel Borland provided an update on Action Points 7.2 and 7.4. The final draft of the document "The Risk Management of HAI: A methodology for NHSScotland" is currently under review with Infection Control Managers and Risk Managers. It is anticipated that it will be issued soon, subject to changes to ensure that it links with the Patient Safety Programme and revised QIS HAI Standards.

Action: Peter Christie to present the final draft of "The Risk Management of HAI: A methodology for NHSScotland" at the next Stakeholder meeting in March for final sign off.

7.2 Peter Christie provided an update on the MRSA Strategy Document. This is almost complete, and will be issued for a full consultation by the end of March if possible.

Action: Peter Christie will report to the Task Force on the final MRSA Strategy Document and consultation progress.

8. MRSA Pilot Screening Programme Progress Report

8.1 Jacqui Reilly provided an update on progress with developing the pilot MRSA Screening Programme. The Steering Group for the pilot has been set up, along with the appointment of a project manager and technical steering group. Eight Health Boards have expressed an interest in conducting the pilot and will be invited to complete a tender specification. The Steering Group will then meet to decide on the successful tender. The Project Initiation Document is in draft and will be submitted to the SGHD in early February.

8.2 Queries were raised regarding the purpose of the pilot in light of the apparent commitment to go ahead with the full programme. It was confirmed that the pilot is essentially a feasibility study to validate the Health Technology Assessment and ensure that it's assumptions were correct, as well as to determine potential areas of difficulty. It was also noted that should the pilot highlight any major obstacles then a full programme would not be implemented; although it would require major significant problems to arise before this would be the case.

9. Clostridium difficile First Annual Report

Jacqui Reilly provided an update on the surveillance of Clostridium Difficile Associated Disease (CDAD) (covering the period October 2006-September 2007) which was published on Thursday 20 December 2007. There was press interest, especially with a view to comparing results to other countries. At present this is difficult to do effectively, although HPS is refining methods to allow comparisons between results in Scotland and other EU nations. Following this first surveillance report, results will now be published quarterly, with the next due for publication at the end of February.

10. Care Bundles

Jacqui Reilly provided an update on the progress of the Care Bundle programme. The Institute for Healthcare Improvement (IHI) are assisting and supporting the development and implementation of these across Scotland as part of the Scottish Patient Safety Programme. It was agreed that this will be useful in ensuring a national approach with consistency in implementation between Boards. It was emphasised that there should be genuine uptake for improvement rather than 'change for change's sake', an approach employed by the IHI. It was agreed that it would be useful for the Task Force to have a presentation on the work of the IHI.

Action: Jacqui Reilly and a representative of the Scottish Patient Safety Alliance will give a presentation on the work of the IHI at the next Task Force meeting.

11. AOCB

11.1 Paul Martin made the following announcements:

• Local Health Board Co-ordinators (hand hygiene programme) will have their contracts extended to at least 2010 and Infection Control Managers will become permanent staff from 1 April 2008. Funding for ICMs will be transferred from the HAI budget to NHS Boards from 2008/2009 to 2010/2011, with Boards picking up the funding thereafter.
• There will be a half day event at the Beardmore Hotel on 13 March for ICMs, LHBCs and Higher Education Establishment contacts. The event will be to emphasise the part they will have to play in meeting the Cabinet Secretary's hand hygiene compliance target of 90% and how their roles will adapt over the life of the third HAI Delivery Plan.
• There is a pending case of a 71 year old pensioner who caught MRSA in 2001 and wants to sue Greater Glasgow and Clyde Health Board. If successful, it could open the floodgates for thousands more to take cases forward. Depending on the outcome of the case, an assessment will need to be made of the financial repercussions for the Scottish Government and NHSScotland.

11.2 Paul Martin announced that the next Task Force meeting will:

• focus on the results of the second phase of the Hand Hygiene Campaign which runs for 6 weeks from 14 January;
• invite members to sign off the work of the second Delivery Plan;
• ask for agreement on the shape of the Hand Hygiene Campaign from 2008/2009;
• provide an update on the design of the new HAI Task Force website;
• seek agreement to publishing the HAI Task Force Report for the first and second HAI Delivery Plans (a draft will be issued to members for comment before the end of February);
• keep members informed about the progress of the Pilot MRSA Screening Programme;
• discuss achieving the delivery areas identified in the third HAI Delivery Plan.

12. Date of Next Meeting

12.1 The next meeting will take place on Tuesday 27 May 2008 from 10.00 - 13.00 in Conference Room 3, Victoria Quay, Leith, Edinburgh.

HAI Task Force Secretariat

February 2008