EIGHTH MEETING OF THE HEALTHCARE ASSOCIATED INFECTION (HAI) TASK FORCE, HELD AT 10.00AM ON TUESDAY 27 MAY 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

Mr Callum Percy, HAI Team

Mr Gavin Reid, HAI Team

Mr Colin Brown, Branch Head, Patients & Quality Division

Miss Margie Taylor, Chief Dental Officer

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

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 Prevention Society, (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)

Ms Jane Murkin, Scottish Patient Safety Programme

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

Guest Speakers

Professor Chris Robertson, Statistician, Health Protection Scotland

Ms Clare Falconer, Leith Agency

Ms Evonne Curran, Nurse Consultant, Health Protection Scotland

Dr Anne Eastaway, Health Protection Scotland

The following apologies were noted:

Dr Harry Burns, Chief Medical Officer (Deputy Chair), Scottish Government Health

Directorate

Mrs Susan Brimelow, Director of Healthcare Regulation, Care Commission

Dr Peter Christie, Senior Medical Officer, Scottish Government Health Directorate

Mr John Glennie, Chief Executive, NHS Borders

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

Mrs Bridget Hunter, Scottish Partnership Forum

Mrs Maggie McCowan, Chair, Infection Control Managers' Network

Mr John McMeekin, Public Involvement Representative and PICT member

Dr Mini Mishra, Senior Medical Officer (Primary Care), Scottish Government Health

Directorate

Dr Ken Oates, Consultant in Public Health, Health Protection Scotland

Ms Lorna Renwick, NHS Programme Manager, NHS Health Scotland

Ms Jannette Wheeler, Scottish Branch Chair, Association of Domestic Services Management

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

1. Welcome and Apologies

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

2. Matters Arising

2.1 The minutes to the previous meeting were agreed, subject to some minor amendments.

Action: HAI Task Force secretariat to amend minutes of last meeting and reissue to members.

2.2 Dr Kenneth Oates has resigned from the Task Force as representative for Consultants in Public Health Medicine. Paul Martin expressed thanks for his contribution towards the work of the HAI Task Force and requested that this should be noted in the minutes. It was noted that the Consultants in Public Health Medicine would be nominating a replacement for Dr Oates.

2.3 Carol Fraser provided an update on two Task Force documents. The Risk Management of HAI document has now been completed and will be published in the next few weeks. The MRSA Strategy document has been deferred pending the results of the MRSA Screening Pilot programme. It was suggested that this may be more usefully referred to as a national guidance document rather than a strategy. It was agreed that a CNO letter should be issued to the service indicating the current position in relation to MRSA.

Action: HAI Task Force secretariat to prepare a CNO letter covering the current position in relation to MRSA and issue to NHSScotland.

3. Presentation: Progress Towards the HEAT Target

3.1 Professor Chris Robertson gave a detailed and informative presentation. A copy of the presentation will be issued along with the minutes of the meeting.

3.2 The following points were raised in discussion:

· As the statistics involved are complex, concerns were raised about how the progress towards the target should be presented to the public.

· It was agreed that it would be useful to look at causes and effects in an attempt to determine how interventions are impacting on staphylococcus aureus bacteraemia (SAB) rates. HPS currently has plans to look at this and will report back on progress. Provided this data is supplied to HPS future graphs of SAB rates may be annotated with dates of interventions.

· NHS Greater Glasgow and Clyde was identified as the only Board showing a definite reduction in rates. It was questioned whether this may have been a statistical artefact arising from the merger of NHS Argyll and Clyde with NHS Greater Glasgow. Evidence suggests that this is not the case and the improvement is real resulting from early introduction of interventions such as enhanced surveillance and care bundles.

· The precise accountability of Boards in meeting the HEAT target and how it will be measured requires clarification.

Action: HAI Task Force Secretariat to produce a paper for review, addressing the discussion points on the Performance Management of SABs, for electronic distribution for discussion at the next Task Force meeting.

4. Presentation: Hand Hygiene - Analysis of the Media Campaign

4.1 Clare Falconer of the Leith Agency gave a presentation on a recent survey conducted looking at the impact of the Hand Hygiene media campaign. A copy of the presentation will be issued along with the minutes of the meeting.

4.2 The following points were raised in discussion:

· It was agreed that this was a useful study which indicated the success of the hand hygiene campaign in improving public awareness.

· It was noted that the impact was greatest in groups who already had an interest in hand hygiene with relatively little change in low interest groups. It was agreed that this was likely due to the targeted nature of the campaign and did not necessarily reflect a problem with it.

4.3 Clare Falconer also provided a brief update on a recent study conducted looking at staff attitudes towards the NHS side of the campaign. Results show that staff acknowledge the importance of good hand hygiene but perceive many barriers to compliance, such as time pressure, lack of proper facilities and damage to skin from repeated hand washing. It was noted that existing research confirms this and the information will be used to inform the next stage of the campaign.

5. Presentation: Progress Towards Hand Hygiene Compliance Target

5.1 Professor Chris Robertson gave an informative presentation. A copy of the presentation will be issued along with the minutes of the meeting.

5.2 The following points were raised in discussion:

· Although there is limited data from which to extrapolate trajectories, all but three Boards are on schedule to meet the target.

· The data collected and measured was discussed. Concerns were raised regarding whether the resulting information from the audits reflect genuine compliance across all Boards.

· It was suggested that measuring consumption of hand hygiene products may be a useful method of providing supporting evidence for improvement in hand hygiene compliance.

Various points were raised about the procedures of the present audit process. Members were advised that the audit process was developed prior to the target being set. HPS will conduct a validation study to ascertain if the present audit process is appropriate for target monitoring.

Action: HPS to advise HAI Task Force secretariat of the validation study results in due course.

5.3 Paul Martin advised that a final decision, on the measures needed to assess target achievement, should be made in time for the next Task Force meeting.

6. Presentation: Review of the Cleaning Specification

6.1 David Bedwell presented a paper on the review of the cleaning specification. He informed the meeting that the revised cleaning specification would be out for consultation in June with the aim of issuing the revised specification to the service by end July. A copy of the paper was issued to the HAI Task Force members on 21 May 2008.

6.2 The following points were raised in discussion:

· There are a number of issues regarding the public involvement and perception of estate cleanliness. It was agreed that estate issues were not a key issue for the HAITF. Better mechanisms are required to ensure feedback is acted upon in estates matters. It was noted that the Boards Infection Control Committee's should monitor this area.

· It is important that training is available to members of the public involved in audits/monitoring. Robin Creelman highlighted that there was a good training pack on the HFS website. It was agreed that this should be highlighted to Boards.

· There are issues with the audit process, such as the selection of public involvement members and the amount of warning wards are given for audits. Having a broad selection of people involved and carrying out randomised unannounced audits should be considered.

· It was clarified that external assessors referred to in the paper will be examining the audit process.

6.3 Paul Kingsmore advised that the above concerns are being addresses in the review of the cleaning specification.

6.4 Paul Martin noted that he was supportive of the improvements covered in the paper. It is also important to note that many issues are part of a wider improvement in estates management and not specifically HAI related.

Action: David Bedwell to report back on the implementation of the reviewed Cleaning Specification at the next Task Force meeting.

6.5 Presentation: Clostridium difficile update (C.dif) (Not on the agenda)

6.5.1 Dr Anne Eastaway gave an informative presentation. A copy of the presentation will be issued along with the minutes of the meeting.

6.5.2 The key areas discussed were:

· There are issues regarding the variation in definition of outbreaks between Boards. It was agreed that national guidance on this would be of benefit.

· More information on the ribotypes, antibiotic resistant patterns and the epidemiology of C.dif is required to have a clear understanding of the strains circulating and associated morbidity. This could be achieved through an annual "snap shot" study being carried out.

· HPS have developed a care bundle on the clostridium difficile associated disease (CDAD). Concerns were raised about the possibility of too many bundles being introduced too quickly. However, it was agreed that CDAD was such an important and high profile issue that it is important to introduce the bundle as quickly as possible. It was agreed that this should be co-ordinated with the Scottish Patient Safety Programme to ensure consistency with their care bundle approach.

Action: HAI Task Force secretariat to co-ordinate the development of national guidance on clostridium difficile.

Action: HPS to develop proposals for an annual 'snap shot' study looking at the pattern of antimicrobial resistance and epidemiology of c.diff. Callum Percy to look at the possibility of the Task Force contributing funding to the study.

Action: HPS to liaise with Jane Murkin on the introduction of the CDAD care bundle.

7. Presentation: IHI Approach to Care Bundles

7.1 Evonne Curran and Jane Murkin gave an informative presentation. A copy of the presentation will be issued along with the minutes of the meeting.

7.2 Paul Martin commented on the usefulness of the Task Force receiving an update on the progress on the implementation of care bundles in a ward setting.

Action : Jane Murkin to invite a member of NHS Staff who has implemented care bundles in their ward to speak at the next Task Force Meeting on the benefits and challenges of this approach and what improvements it has lead to.

8. HAI Task Force Summary Report for programme of work 2003 - 2008

Paul Martin asked Task Force members to consider the above document and to submit any proposed changes to Callum Percy.

Action: HAI Task Force members to submit comments to Callum Percy.

9. HAI Task Force Website

Paul Martin asked Task Force members to consider the HAI Task Force Website and to submit any proposed changes to Callum Percy.

Action: HAI Task Force members to submit comments to Callum Percy.

10. HAI Task Force Delivery Plan

10.1 It was agreed to sign off the latest version of the Delivery Plan, subject to a change to point 1.10 to incorporate care homes.

Action: HAI Task Force secretariat to amend delivery plan area 1.10 to incorporate care homes.

10.2 Paul Martin emphasised that the plan is a dynamic document which can be modified in response to new evidence and initiatives.

11. HAI Task Force Progress Report

It was noted that all delivery areas are progressing according to schedule.

12. MRSA Pilot Screening Programme

Jacqui Reilly provided an update on the progress of the MRSA Screening pilot. Despite some slippage arising from slight delays in the selection of the pathfinder Boards, the pilot is now on track and proceeding well. Screening will start to be implemented in the Pathfinders in July 2008, with an interim report published in April 2009 and the final report due December 2009.

13. AOCB

13.1 Paul Martin reminded members that a summary report on Boards' Local Delivery Plans towards the HEAT target as requested in the actions of the previous minutes had been issued prior to the meeting.

13.2 Shona Halley advised that her position as Chair of the Infection Prevention Society had now expired. She proposed that her successor, Gillian Stevenson should attend in her place.

Action: Carol Fraser to liaise with Shone Halley and Gillian Stevenson regarding IPS representation on the Task Force.

14. Date of Next Meeting

The next meeting will take place on Wednesday 3 September 2008 from 10.00 - 13.00 in Conference Room 3, Victoria Quay, Leith, Edinburgh.

HAI Task Force Secretariat

May 2008