The Scottish Government

FIRST MEETING OF THE MODIFIED HEALTHCARE ASSOCIATED INFECTION (HAI) TASK FORCE, HELD AT 10.00AM ON MONDAY 20 MARCH 2006, IN CONFERENCE ROOMS 7 & 8, VICTORIA QUAY, EDINBURGH

Present:

Scottish Executive Health Department

Mr P Martin, Chief Nursing Officer (Chair)

Dr P Christie, Senior Medical Officer

Ms S Ferguson HAI Task Force Policy Lead

Mrs L Middleton, HAI Task Force Secretariat

Dr M Mishra, Senior Medical Officer

Mr R Scott, Head of Policy Implementation and Development Branch

Mrs M Tannahill, Nursing Adviser HAI and Communicable Disease

Mrs A Williams, HAI Task Force Secretariat

NHSScotland and other representatives

Dr W Anderson, Infection Control Manager, NHS Greater Glasgow and Clyde

Mr T Brett, Director, Health Protection Scotland

Mrs S Brimelow, Director of Healthcare Regulation, Care Commission

Ms R Broom, (deputising for Miss S Halley, Infection Control Nurses Association, (Co-ordinator Scottish Branch)

Mr R Creelman, Chair of HAI Task Force Public Involvement Communications Team (PICT)

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

Mr J Glennie Chief Executive, NHS Borders

Dr M Hanson, Microbiologist, Joint Chair Scottish Microbiology Forum

Professor M Henry, Consultant Nurse Epidemiologist/Nurse Director NHS National Services Scotland

Mrs B Hunter Scottish Partnership Forum

Ms H Kelman General Manager, Community Health Partnership NHS Grampian

Mr P Kingsmore, Director, Health Facilities Scotland (formerly Property and Environment Forum)

Ms J Ley (deputising for Mr A Lucas, Chief Executive, Scottish Ambulance Service)

Mr J McMeechin, Public Involvement Representative and PICT member

Dr W Mutch Medical Director, Tayside, (deputising for Dr R Masterton, Medical Director, NHS Ayrshire and Arran)

Mrs M Rotherham, Hotel Services Manager/National Chair, Association of Domestic Services Management

Dr C Saunders, Consultant in Public Health Medicine, NHS Fife

Mrs J Warner, (deputising for Dr D Steele, Chief Executive, NHS Quality Improvement Scotland)

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

1. WELCOME AND APOLOGIES

CNO welcomed the group to the first meeting of the modified HAI Task Force and noted apologies from Dr H Burns, Chief Medical Officer (Deputy Chair), Miss S Halley, Infection Control Nurses Association, (Co-ordinator Scottish Branch) (Ms R Broom deputising), Mr Robert Howe, Head of Environmental Services, South Lanarkshire Council, Mr A Lucas, Chief Executive, Scottish Ambulance Service (Ms J Ley deputising), Dr R Masterton, Medical Director, NHS Ayrshire and Arran (Dr W Mutch Medical Director, Tayside, deputising), Dr K Oates, Consultant in Public Health Medicine, NHS Highland, Dr D Steele, Chief Executive, NHS Quality Improvement Scotland (Mrs J Warner deputising) and Mr R Watkins, Chief Dental Officer, SEHD.

2. MEMBERSHIP, REMIT AND TERMS OF REFERENCE

HAI Task Force members agreed the revised terms of reference.

Remit

The HAI Task Force will meet three times a year to oversee and co-ordinate the development and implementation of the national strategy on HAI, including:

• Increasing public confidence through demonstrating improvements in prevention and control of HAI and cleaning, and ensuing public involvement in the development and implementation of the national HAI strategy;
• The development of policy and best practice for the prevention and control of HAI;
• Acting as a focal point for the exchange of information, experience and best practice between organisations;
• The development of robust monitoring and audit procedures to measure compliance with HAI Task Force and related SEHD requirement;
• The development of robust surveillance data on HAI and actions to address issues identified from surveillance;
• The provision of an annual progress report to Ministers on the HAI national strategy (to be published on the Scottish Executive website).

CNO said that the HAI Task Force's second phase of work would focus on implementation and delivery of existing HAI Task Force outputs and other SEHD requirements. The new programme of work would be detailed in a Delivery Plan.

The following issues were raised during discussion.

• Membership should be extended to include Occupational Health representation
• The importance of public education was highlighted
• The Public Involvement Communication Team (PICT) was encouraged to proceed with exploring ways of engaging with Community Health Partnerships to help embed prevention and control of infection and public engagement at this level.
• A PICT away day was to be held on 21/22 March to discuss the development of public involvement in the area of HAI. The output from this event would be a work programme for PICT which would be included under the heading of a public involvement section of the HAI Task Force Delivery Plan.

Action: HAI Task Force Secretariat to write to Dr Eugene Waclawski to seek an Occupational Health representative.

3. FINAL REPORT ON HAI TASK FORCE PHASE ONE OF PROGRAMME OF WORK

Ms Ferguson reminded HAI Task Force members that HAI Task Force progress and end of year reports had been produced throughout the first three year work programme. A draft report on the HAI Task Force's first phase of work had been provided to HAI Task Force members for comment. Members were requested to send comments to HAI Task Force Secretariat by 3 April 2006. The report would be adjusted and amended as appropriate and then passed to the Minister for Health and Community Care for approval, before being published on SEHD's HAI web pages.

Action: Members to submit comments on the draft final report to HAI Task Force Secretariat by 3 April 2006.

4. HAI TASK FORCE NEW PROGRAMME OF WORK

CNO advised members that the draft Delivery Plan consisted of 19 areas of work. The Delivery Plan included implementation and delivery of existing outputs from the first HAI Task Force programme of work that have already commenced (e.g. development of a national MRSA control strategy commenced in November 2005) as well as new areas of work. The tasks in the Delivery Plan had been developed in consultation key Stakeholders and suggestions had been discussed at the September meeting of the HAI Task Force. The Minister for Health and Community Care was keen to ensure that each task within the new Delivery Plan is underpinned by robust project management and a project initiation template would be developed, which would be used to record key deliverables and milestones, and resources required.

The following points were raised in discussion:-

• The Delivery Plan must clarify what the priority areas are. A lot of what was included could be described as desirable but not essential. All of the areas in the Delivery Plan had previously been agreed by HAI Task Force members and key stakeholders.
• It would be important that the Delivery Plan clarifies outputs.
• Some members expressed concern that the new Delivery Plan may overburden the service. The members were advised that Mrs Tannahill, Nurse Adviser, HAI and Communicable Disease and Dr Christie, Senior Medical Officer, HAI Task Force would visit each NHS Health Board to discuss the Delivery Plan with Chief Executives, Infection Control Managers and Infection Control Teams. This type of HAI Task Force road show was undertaken in 2003 and 2004 and included presentations to, for example, Directors of Nursing, Directors of Public Health, Chairs of NHS Boards, The Board of Care Commission, Local Health Co-operatives etc.
• Concern was expressed that there were no longer any Performance Assessment Framework indicators for HAI as it was felt that Boards may deprioritise HAI in favour of issues with clear targets attached to them. There was some anecdotal evidence that this was already happening. Ms Ferguson advised that the new Health Efficiency Access to Treatment (HEAT) performance management system included key targets, key measures and supporting measures. HAI (i.e. MRSA bacteraemia trends) was currently included in this system as a supporting measure. Discussions were planned with colleagues within SEHD to explore the positioning of an HAI measure within the system and to discuss what form the measure might take.
• The importance of ensuring that HAI was included as a core skill/competency in all healthcare disciplines.
• The need for a tracking and recording system for e-learning packages. NHS Education Scotland had already established this for the Cleanliness Champions programme.
• Delivery plan area 18: independent contractors - it was suggested that this should be amended to read "…in local NHS Boards contracts with non health service contractors."
• What had happened to the existing national working group on uniforms? Does its remit include uniforms in the community e.g. district nurses?
• It was vital that consistent, clear messages were given to the public on HAI and infection control to avoid confusion and promote public confidence.
• The Care Commission regulate private hospitals, which included 36 Healthcare providers in Scotland and was content that any HAI surveillance data requested is provided. The National Surveillance of HAI Steering Group included members from the independent healthcare sector who were already involved in National HAI surveillance.
• To date all HAI Task Force work developed had attempted to ensure that infection control principles applied across all healthcare settings (e.g. the NHSScotland Code of Practice for the Local Management of Hygiene and HAI). Members agreed that this should continue.

Ms Ferguson requested members submit feedback and comments on the Delivery Plan and submit to the HAI Task Force Secretariat as soon as possible.

Action: HAI Task Force Secretariat to develop project initiation document

Action: HAI Task Force Secretariat to arrange visits to NHS Boards for Mrs Tannahill and Dr Christie

Action: HAI Task Force Secretariat to feedback on results of discussions with SEHD colleagues about HEAT at the next HAI Task Force meeting.

Action: HAI Task Force secretariat to check if the existing uniform group's remit included community uniforms.

Action: HAI Task Force Secretariat to consider amending the Delivery Plan at area 18 to read "…in local NHS Boards contracts with non health service contractors."

Action: HAI Task Force members to submit comments and suggestions on the Delivery Plan to HAI Task Force Secretariat as soon as possible

Ms Ferguson advised members that the delivery plan would be amended taking into account any comments received, and would again be discussed with stakeholders to refine timescales and resources required. She further advised that most of the monies were already committed and that only £1 million remained unallocated to support the projects within the Delivery Plan. A final draft of the Delivery Plan would be submitted to the Minister for his approval.

4.1 PRESENTATION: A Review of Cleanliness, Hygiene and Infection Control in Care Homes for Older People 2005

Mrs Susan Brimelow gave a detailed and informative presentation on the Review of Cleanliness, Hygiene and Infection Control in Care Homes for Older People 2005. A copy of her presentation would be circulated with the minutes. Mrs Brimelow had arranged for copies of the report to be delivered to HAI Task Force Secretariat for distribution to members of the group.

The following points were raised in discussion:

• There were two inspections of premises each year, one announced and one unannounced. If concerns were raised, further visits were arranged. Daily visits were arranged if an enforcement order had been issued.
• The Care Commission was notified of all outbreaks of infection.
• HAI surveillance data from care homes was not available.
• The issue of cleaning of equipment was highlighted with clarification of responsibility being raised as an important issue.
• The Cleanliness Champions programme was now available to Care Homes through Scott College.

Mrs Brimelow also advised that a joint study day conference, funded from SEHD's HAI Clean Hospitals budget and facilitated by NHS Education for Scotland was planned for 17 May 2006.

Action: HAI Task Force Secretariat to issue copies of the report to group members.

4.2 Compliance Monitoring

Ms Ferguson provided an overview of the monitoring requirements in relation to the HAI Task Force Delivery Plan.

The following points were raised in discussion:

• The NHSScotland Code of Practice for the Local Management of Hygiene and Healthcare Associated Infection working group had been reconvened to consider monitoring against the Code of Practice. It had been suggested that 4 - 6 key performance indicators should be developed to monitor progress on key issues, such as hand hygiene.
• NHS Quality Improvement Scotland would be reviewing the content of the HAI infection control standards.
• Monitoring in other countries

Wales - Monitoring at local Trust level. Requested by the Welsh Assembly to develop infection reduction plans.

Northern Ireland - Chief Executives of Trusts requested to develop priorities and set local targets

Department of Health - set robust target of 50% reduction in rates of MRSA. Saving Lives toolkit and expert teams created to help those Trusts not performing against this MRSA target.

4.3 Hand Hygiene Campaign

Mrs Tannahill updated the members on the progress towards the World Health Organization's (WHO) Guidelines on Hand Hygiene and the hand hygiene campaign included in the new Delivery Plan. This included the following:

• Media and information campaign to promote of hand hygiene amongst the general public.
• Campaign to improve hand hygiene compliance within the NHS. This would include identification of a way to monitor compliance with hand hygiene nationally. One method in use was to use a measure of the amount of hand hygiene products (e.g. alcohol-based hand rubs) as a proxy measure for hand hygiene compliance.
• Other approaches to influence families and especially children, for example through schools, nurseries and breakfast clubs. The development of a campaign for school children was seen as crucial.

Mrs Tannahill advised that a proposal paper for this campaign was being finalised.

Action: Feedback on progress would be given at the next HAI Task Force meeting.

5. AOCB

Update on national cleaning services

Mr Kingsmore advised members that he NHSScotland National Cleaning Services Specification monitoring tool, launched by The Property and Environment Forum (now Health Facilities Scotland) was currently being rolled across all NHS Boards. NHS Boards are required to monitor cleaning compliance on a regular basis and submit returns to HFS. The first quarterly report (covering the period April to June 2006) would be published in August or September 2006. He also advised that public involvement in peer reviews had been incorporated into the monitoring process.

Cleanliness Champions

Ms Ferguson notified members that CNO had issued a letter on 8 December 2005 offering Boards £200 per head for each member of staff completing the Cleanliness Champions training course during the period November 2005 to March 2006. To date, uptake had been slow. The deadline had been extended to the end of April 2006 (payments will based on anticipated completion figures submitted by Boards). This issue had been raised with Nurse Directors by the CNO.

DATE OF NEXT MEETINGS

Tuesday 27 June 2006, 10.00am-1.00pm, Conference Room 3 Victoria Quay, Edinburgh

Tuesday 31 October 2006, 10.00am-1.00pm, Conference Room 3, Victoria Quay, Edinburgh

HAI Task Force Secretariat

May 2006