FOURTH MEETING OF THE HEALTHCARE ASSOCIATED INFECTION (HAI) TASK FORCE, HELD AT 10.00AM ON TUESDAY 27 FEBRUARY 2007, IN CONFERENCE ROOM G.05/G.06, MERIDIAN COURT, GLASGOW

Present:

Scottish Executive Health Department

Mr Paul Martin, Chief Nursing Officer (Chair)

Dr Peter Christie, Senior Medical Officer

Mrs Linda Middleton, HAI Team

Dr Mini Mishra, Senior Medical Officer

Mrs Margaret Tannahill, Nursing Adviser HAI and Communicable Disease

Mr Len Warmer, HAI Team

NHSScotland and other representatives

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

Mr Tim Brett, Director, Health Protection Scotland

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 Bridget Hunter, Scottish Partnership Forum

Mr Paul Kingsmore, Director, Health Facilities Scotland

Mr John McMeekin, Public Involvement Representative and PICT member

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

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

Domestic Services Management

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

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

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

Professor Mary Henry, Consultant Nurse Epidemiologist/Nurse Director, Health Protection

Scotland

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

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

Mr Adrian Lucas, Chief Executive, Scottish Ambulance Service

Dr Bob Masterton, Medical Director, NHS Ayrshire and Arran

Ms Lorna Renwick, NHS Programme Manager, NHS Health Scotland

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

(including decontamination policy), SEHD

Dr David Steel, Chief Executive, NHS Quality Improvement Scotland

Mr Ray Watkins, Chief Dental Officer

1. WELCOME AND INTRODUCTIONS

Paul Martin welcomed the group to the meeting and noted apologies (as above).

2. MATTERS ARISING

Minutes of the last meeting

The minutes of the last meeting were agreed subject to the following changes:

Page 5 - Paragraph 3.13 First sentence should be amended to read - Mary Hanson advised members that the implementation of standard operating procedures to support surveillance of Clostridium difficile Associated Disease (CDAD) is now complete.

Page 10 - Bullet point one delete 'Control' and insert 'Central'.

National Uniforms Working Group

Claire Brennan from Workforce Directorate, SEHD was unable to attend to give an update. Dr Peter Christie advised that this area of work is now being led by the Workforce Directorate and that the working group set up to progress this work had already established that eight Boards have existing dress/uniform codes that are similar in content. The other NHS Boards did not have a formal dress code.

The following points were raised in discussion:

• A development of a national dress code was not the most challenging part of the work of the national group. The complex issues included provision of additional uniforms, changing facilities and laundering arrangements.
• Changing facilities for health centres outwith hospital settings should also be considered
• The requirements of Practice Nurses with regard to the development of a national uniforms code need to be considered.
• Professional image and appearance is vital in order to increase public confidence as clarity of status and professional grouping.

Members were advised that a consultation dress code is currently being developed based on best practice examples from NHSScotland.

Action: HAI Task Force Secretariat to contact Claire Brennan for more information as to the timescale for issue of the consultation code.

HAI Task Force Communications Strategy

Members were advised that the need for review of the existing HAI Task Force Communications Strategy had been discussed at the last meeting. A revised strategy had been developed and was issued to members along with papers for the meeting. Comments were invited from the members:

• Members were happy with the revised strategy and are keen for information to be issued to NHS Boards for inclusion in local bulletins rather than form new communication flows. Such information should be issued direct to Infection Control Managers (ICMs) for local appropriate dissemination following discussion with relevant colleagues (e.g. infection control colleagues).

Action: HAI Task Force Secretariat to review the HAI Task Force Communication Strategy and amend in light of the above comments.

3. HAI TASK FORCE DELIVERY PLAN: PROGRESS REPORTS

3.1 Members were reminded that the HAI Task Force Stakeholders Group meets six times a year and that the remit of this group includes ongoing review of the progress of the HAI Task Force Delivery Plan.

Verbal report by lead Stakeholders

NHS Education for Scotland

Delivery Area 3.1 - Cleanliness Champions Training Programme

3.2 Some concern was expressed about the completion rates for the Cleanliness Champions programme. NES would continue to support NHS Boards that have not quite met targets for progressing cleanliness champions training programme.

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

3.3 Although this area of work had now been completed, members were advised that the prudent prescribing programme had been made available to all foundation year doctors and that five hundred doctors had completed the programme.

Delivery Area 3.3.2 - Review existing HAI educational programmes and define additional input required

3.4 Members were advised that NES had undertaken a mapping exercise (by questionnaire) to uncover what HAI education was already available at Higher Education Centres. The information received had been incomplete. NES had also spoken directly to Infection Control Specialists. This assisted NES to identify educational programmes that are not available. Work is progressing on addressing the gaps identified.

Public Involvement and Communication Team (PICT)

Delivery Area 5.8 - Hold a PICT induction workshop for new members

3.5 Members were advised that an induction day had now been arranged for Monday 2 April 2007. The day would include a series of speakers outlining the national HAI programme, the roles and responsibilities of infection control professionals and the importance of public involvement and engagement in this area. The event would also be documented so that those who would be unable to attend could receive written copy of the event.

NHS Quality Improvement Scotland

Delivery Area 2.2. Review of the NHS Quality Improvement Scotland HAI Infection control Standards

3.6 Members were advised that the first meeting of the group had been held on 14 February 2007 to discuss the development of outcome focused standards based on the NHSScotland Code of Practice for the Local Management of Hygiene and Healthcare Associated Infection. Consultation of the standards is expected in September 2007 with publication of final standards in December 2007/January 2008.

Delivery Areas 71. and 7.2 - Develop incident and 'near miss' reporting using HAI as a 'tracer' to test methodology developed. Develop and pilot HAI incident reporting linked to HAITF document on risk methodology

3.7 Members were advised that focus on these delivery areas would be on endoscopy decontamination. Parallel work on prescribing errors was also progressing well.

Delivery Areas 7.3 and 7.4 - Use HAI as a 'pathfinder' theme in implementation of the Australian/New Zealand risk assessment matrix. Work with Risk Managers in NHS Boards to raise awareness and implement the risk matrix with specific regard to HAI

3.8 Members were advised that due to a delay from the National Patient Safety Agency (NPSA) the training programme for root cause analysis had been delayed. The training should now be rolled out in April 2007 and the target dates should be reset.

Action: HAI Task Force Secretariat to reset target dates in delivery plan.

Scottish Microbiology Forum

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

3.9 Members were advised that the typing issue was the only outstanding matter to be addressed. The Cardiff reference facility is currently heavily committed and a decision has been made to establish a Scottish C. difficile reference facility. Two reference laboratories had expressed an interest in taking this forward and a decision as to which laboratory is to progress would be made within the next few weeks.

Scottish Executive Health Department

Delivery Area 6

3.10 Members were advised that funding had been allocated for automated sensitivity testing equipment. This means that all laboratories would be measuring antibiotic sensitivity in a standard format. A meeting would be held in March to form an implementation plan and to discuss additional funding for consumables. The implementation plan would be incorporate European standard terms and should be complete by end of March 2007.

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

3.11 Members were advised that the Health Technology Assessment on the clinical and cost effectiveness of MRSA screening had been remodelled after an extended consultation and that data was not yet fully complete. The results should be published on the NHS Quality Improvement Scotland website in July/August 2007 and published in August/September 2007. The National MRSA Control Strategy document could not be finalised as the finding from the HTA on screening would form an integral part of the Strategy. Consultation for the draft strategy would be July/August 2007.

Action: Secretariat to amend delivery plan to show amended completion date of September 2007.

3.12 It was noted that Department of Health issued an MRSA screening best practice document on 15 November 2006 and that it included reference to the Scottish HTA.

Health Protection Scotland

Delivery Area 1.1 - Develop and launch a hand hygiene campaign for Scotland

3.13 Members were advised that the public Hand Hygiene campaign had gone well and that only two NHS Boards still had to appoint Local Health Board Co-ordinators. As well as undertaking audits, local hand hygiene co-ordinators would raise awareness and link into local Infection Control Teams and Community Health Partnerships. The first national compliance audit had taken place at the end of February 2007 and a scoping meeting for progression of this work and a meeting had been arranged for the middle of March 2007.

Action: Mini Misha to feedback to HPS regarding Primary Care settings.

Health Facilities Scotland

Delivery Area 11 - Cleaning and hygiene

3.14 Members were advised that, through the implementation of action plans, all hospitals and all NHS Boards had received a green rating in the latest report of the Cleanliness Monitoring exercise. All NHS Boards now included members of the public in the cleanliness reviews. HFS now want to ensure that the required number of reviews are being carried out and that the appropriate public involvement would be achieved.

3.15 The point was raised about whether to lift the existing green rating by approximately 2% to create a challenge for continuous improvement with the possibility of awarding a green + rating or whether to target certain areas. The issue of tightening the specification would be further discussed but members were happy that reporting system remained unchanged at present.

3.16 HFS would also review the National Cleaning Services Specification.

Public Involvement and Communications Team (PICT)

3.17 Members were advised that a number of new members had joined PICT and that a network of members had been established across Scotland. This increased membership now gives PICT a larger geographical spread across Scotland. A PICT induction day is planned for 2 April 2007. Members were reminded of the importance of disseminating information through Community Health Partnerships.

4. PRESENTATION: NOROVIRUS STUDY IN VICTORIA INFIRMARY, GLASGOW

4.1 Dr Bill Carman gave a very detailed and informative presentation on Norovirus Study in Victoria Infirmary, Glasgow. A copy of his presentation would be issued with the minutes of the meeting.

The following points were raised in discussion:

• Side wards and patient management.
• Suggestion of carrying out a further infection control study on norovirus spread similar to the Glasgow Victoria study.
• Pilot study local PCR; machinery now installed and staff trained.
• The possibility of an analysis of infectious disease units.
• Funding may be available in the next financial year for norovirus study to be carried out again in different hospitals.
• Funding proposal from Victoria Infirmary for monies allocated this year to be used in alternative norovirus/C.difficile studies was approved.

5. HAI ROADSHOW UPDATE

5.1 Margaret Tannahill advised members that she and Peter Christie had visited eleven NHS Boards so far and that dates had been arranged for the remaining visits. She advised that the impact of Infection Control Managers (ICMs) had been positive and that there was a great desire to extend infection control and share good practice.

6. CONTINUED HAI IMPROVEMENT AFTER MARCH 2008

6.1 Paul Martin advised members of the need to develop an exit strategy i.e. managing what we know, thinking about what should be in place, continued improvement after March 2008. He also raised the question of where the work should sit i.e. with individual boards or with NHS Quality Improvement Scotland. A proposal paper would be developed for discussion at the next HAI Task Force meeting.

Action: HAI Task Force Secretariat to develop proposal paper for discussion at next meeting.

7. EVENTS

Infection Control Managers Symposium 20/21 February 2007

7.1 Members were updated of this event for ICMs. It is important that an ICM network is established as the current postholders are a mixture of those with specialist knowledge in infection prevention and control and those without. NES led the educational sessions at the symposium to establish the education and training needs of the ICMs.

Welsh Zero Tolerance Conference on 6/7 March 2007

7.2 Scotland had been asked to present at this conference detailing the national HAI programme of work including the delivery plan. Margaret Tannahill would be presenting at the event.

HAI Improvement Strategy Workshop on 12/13 March 2007

7.3 An HAI Improvement Strategy Workshop had been arranged to progress the HAI improvement strategy as part of the national HAI programme of work. This workshop would include members of the HAI Task Force Stakeholder's Group and additional members including those from HPS, an ICM and representation from the ICNA, a Medical Director, and an intensivist. The main expected output from this workshop is an implementation plan for this strategy that aligns with the overall Scottish approach to patient safety. HAI Task Force members would be updated at the next meeting in June 2007.

Action: HAI Task Forcer Secretariat to arrange for an update to be provided for HAI Task Force members at the next meeting in June 2007.

Patient Safety Agenda

7.4 The Scottish Patient Safety Alliance would likely be launched at the beginning of March. From the beginning of the HAI Task Force programme in 2002/3 improved patient, staff and visitor safety has been a crucial element of the national work programme with the aim of improving overall quality of patient care. The work of the HAI Task Force should align closely with the national patient safety approach.

AOCB

8.1 CNO advised members that Susan Ferguson would leave the Scottish Executive on 14 March 2007 on maternity leave. CNO wished to acknowledge her contribution to the work of the HAI Task Force and especially the Hand Hygiene campaign.

8. DATE OF NEXT MEETING

9.1 The next meeting will take place on Tuesday 26 June 2007 from 10.00 to 1.00 in Conference Room 3, Victoria Quay, Edinburgh.