The Scottish Government

SECOND MEETING OF THE HEALTHCARE ASSOCIATED INFECTION (HAI) TASK FORCE, HELD AT 10.00AM ON MONDAY 27 JUNE 2006, IN CONFERENCE ROOM 3, VICTORIA QUAY, EDINBURGH

Present:

Scottish Executive Health Department

Mr Paul Martin, Chief Nursing Officer (Chair)

Dr Peter Christie, Senior Medical Officer

Ms Susan Ferguson HAI Team

Mrs Linda Middleton, HAI Team

Dr Mini Mishra, Senior Medical Officer

Mrs Margaret Tannahill, Nursing Adviser HAI and Communicable Disease

Mrs Pam Warrington, Deputy Chief Pharmaceutical Officer

NHSScotland and other representatives

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

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

Mr Tim Brett, Director, Health Protection Scotland

Mrs Susan Brimelow, Director of Healthcare Regulation, Care Commission

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

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

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

Dr Mary Hanson, Microbiologist, Joint Chair Scottish Microbiology Forum

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

Mr Paul Kingsmore, Director, Health Facilities Scotland

Ms Jackie Ley (deputising for Mr Adrian Lucas, Chief Executive, Scottish Ambulance Service)

Mr John McMeechin, Public Involvement Representative and PICT member

Dr Bill Mutch, Medical Director, Tayside, (deputising for Dr Bob Masterton, Medical Director, NHS Ayrshire and Arran)

Dr Jacqui Reilly, Consultant Nurse Epidemiologist (deputising for Professor Mary Henry Consultant Nurse Epidemiologist/Nurse Director NHS National Services Scotland)

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

Dr David Steele, Chief Executive, NHS Quality Improvement Scotland

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

Professor Mary Henry, Consultant Nurse Epidemiologist/Nurse Director, NHS National Services Scotland (Dr Jacqui Reilly deputising)

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

Mrs Briget Hunter, Scottish Partnership Forum

Mr Adrian Lucas, Chief Executive, Scottish Ambulance Service (Ms Jackie Ley deputising)

Mrs Cath Krawczyk, Health Improvement Manager, NHS Health Scotland

Dr Bob Masterton, Medical Director, NHS Ayrshire and Arran (Dr Bill Mutch, Medical Director, NHS Tayside deputising)

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

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

Mr Ross Scott, Head of Policy Implementation and Development Branch, SEHD

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

Mr Ray Watkins, Chief Dental Officer, SEHD

1. WELCOME AND APOLOGIES

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

2. MATTERS ARISING

The minutes from the meeting held on 20 March 2006 were agreed.

· Final Report on HAI Task Force phase one programme of work

Ms Ferguson reminded everyone that a draft report had been tabled at the last meeting and she thanked all those who had submitted comments. She advised that the comments had now all been incorporated into the report which would be placed on the Scottish Executive website.

• Project Initiation Documents

This would be covered under item 3 of the agenda

• HAI Road Shows

Mrs Tannahill advised the members that both she and Dr Peter Christie will visit NHS Boards throughout Scotland over the next few months. The purpose of these visits is to discuss the progression and delivery of the new programme of work with Chief Executives, Infection Control Managers and Infection Control Teams. Dates for visits had been confirmed with a number of Boards and arrangements were progressing to confirm dates with the remaining Boards. She advised that she had visited NHS Lanarkshire a few weeks ago and was informed of examples of good practice in areas of prevention and control of HAI, public communication and HAI education.

· Update of discussions on HAI monitoring

Ms Ferguson advised members that hand gels and the "Tops Tips" posters were not being used or were not visible in all areas. This had to be rectified immediately.

Ms Ferguson advised the members that the HAI Task Force Secretariat met with Gerry Marr (Chief Executive, NHS Tayside) and Bob Masterton (Medical Director, NHS Ayrshire and Arran) to discuss HAI monitoring and how the development of Key Performance Indicators (KPIs) should be taken forward. It was agreed that the Code of Practice for the Local Management of Hygiene and HAI should be promoted as good practice that should be implemented by NHS Boards. It should not be used as the basis of a tool to monitor performance as this would be too cumbersome and would not focus on outcomes. A workshop would be held on 21 and 22 August to discuss/recommend HAI KPIs and discuss monitoring more generally. Ms Ferguson also advised that she had met with NHS Quality Improvement Scotland to discuss the review of their HAI Infection control Standards. It was agreed that, following the workshop on 21 and 22 August, a policy steer would be provided to NHS QIS by the end of September 2006. Mrs Tannahill advised that Wales is setting local targets and Department of Health (DH) has set a target of 50% reduction. The documents produced by DH "Going further faster" and "Flowing with the go" details clear lines for Chief Executives. Two Codes of Practices are being developed; one for NHS and one for the private and independent sector. A member from the "Clean Team" - Janice Stevens is to visit with HAI Task Force Secretariat on 8 August 2006.

The members were advised that HAI is now a standing item on the agenda for the annual accountability reviews of NHS Boards.

• Uniforms Group

Mrs Tannahill advised the members that it was intended to review and use NHS Lothian's uniform code as an example of best practice on which to base CNO's uniform code. The code will be based on the importance of professional appearance/standards of professional appearance. She advised that the Department of Health was hoping to develop a code after completion of research of washing of nurses' uniforms and transmission of infection by Thames Valley University. This work would inform an update of HSG(95)18 on laundry and linen decontamination. The laundry review for capacity and types of equipment is nearing completion. The review only looked at practices in this country. The question was raised as to practices in other countries e.g. Australia and America. The HAI Task Force undertook to investigate whether there had been any information gathered on practices in other countries with those leading this work and report back at the next meeting. Work on uniforms procurement, which was underway, had huge capital and revenue implications. Although work on laundries and procurement were linked to HAI, the HAI Team was not leading on this work. Further clarification was being sought in relation to the future direction of both of these pieces of work.

Action: HAI Task Force Secretariat to seek further information on laundry practice in other countries and report back to the next HAI Task Force meeting.

• Hand Hygiene Campaign

Ms Ferguson advised the members that Health Protection Scotland had agreed to lead the campaign, which would have two distinct strands - one aimed at the general public and the other aimed at the NHS. A draft initiation document had been drawn up and the initial work was underway to identify an advertising agency to support the campaign. The HAI Team would meet with HPS for a detailed discussion on progressing the work and setting up a steering group. The campaign launch was planned for January/February 2007. Mrs Tannahill advised that she attended a meeting with the National Patient Safety Association (NPSA) including discussing the World Health Organisation's Global Safety Challenge Programme "Clean care is safer care." She said that there may be an opportunity for the Minister to make a further announcement pledging continued action on HAI and hand hygiene later this year. It was agreed that the campaign should be based around of a simple, recognisable message.

3. HAI TASK FORCE DELIVERY PLAN

CNO advised the members that the Minister for Health and Community Care had now approved the delivery plan. The Minister commented that he appreciated the amount of work going on behind the scenes on HAI and the fact that MRSA rates were stable is an achievement. He acknowledged that this was a challenging programme of work and expects the focus to be on reducing MRSA rates.

The key priorities in the Delivery Plan areas follows:

• Hand Hygiene Campaign
• Monitoring tool
• National MRSA Control Strategy
• Health Technology Assessment on the Clinical and Cost Effectiveness of screening for MRSA
• Antimicrobial Resistance Strategy and Scottish Action Plan
• Continuation of Public Involvement

A draft template for a Project Initiation Document (PID) was attached to the final draft copy of the Delivery Plan. The PID would provide a record of the scope of the task and key milestones, thus communicating key information to the HAI Task Force and wider stakeholder groups that would support the development, implementation and project management of the work. In terms of the next steps, those organisations leading tasks within the Delivery Plan would be asked to draw up and submit PIDs for tasks that were underway or would be started soon. The Delivery Plan would be disseminated widely to Chief Executives and other interested parties in NHS Boards. Members' comments were invited on the final draft, the PID template and the next steps. Members indicated that they were content.

Action: HAI Task Force secretariat to issue PIDs to all members.

Action: HAI Task Force secretariat to issue Delvery Plan to all Chief Executives of NHS Boards.

Action: HAI Task Force secretariat to publish Delivery Plan on the HAI Task force website.

The following points were raised in discussion:

• The messages should be consistent throughout the delivery plan work areas i.e. ownership by everyone.
• The question of measurement by burden area was raised. This area is to be explored with ISD i.e. Patient Management (length of stay/admission rates).
• The remit of the prevalence survey includes looking at length of stay.
• It was emphasised that performance indicators should be structured and process based.
• The CMO takes the lead on patient safety while the CNO takes the lead on patient experience.
• Policies developed for NHSScotland may be adapted and used by the independent sector.
• It was highlighted that the NHS Education for Scotland Cleanliness Champions programme is available for everyone.
• Primary Care - development of roles and responsibilities for independent network?

4. ROLE OF HAI STAKEHOLDERS GROUP

As the role of the Stakeholders group now focuses on taking forward the Delivery Plan and supporting the HAI Task Force a new remit has been drafted for discussion.

REMIT

• To support and advise the HAI Task Force in relation to the project management of the HAI Task Force Delivery Plan by for example:

Ø Reviewing initial project initiation documents (PIDs) for each task and approving on behalf of the HAI Task Force.

Ø Reviewing the progress of PIDS and reporting to the HAI Task Force.

Ø Providing feedback on the review of progress of individual organisations' tasks in the HAI Task Force's Delivery Plan (including issues relating to implementation and funding) and, where appropriate, providing a clear steer (via relevant Stakeholder Group member) to task leads within stakeholder organisations.

• To report on any local issues in relation to the implementation of the Delivery Plan or within respective fields of expertise, and provide a steer where appropriate.

• To ensure unified programme approach to prevention and control of HAI and to avoid duplication of areas of HAI work.

• To share information on national and local HAI initiatives in Scotland, the UK and beyond, (e.g. feedback from HAI related conferences attended by individual members), including highlighting examples of best practice and considering how these could be replicated in Scotland.

• To actively promote prevention and control of infection initiatives during the annual Infection Control Raising Awareness Week facilitated by the Infection Control Nurses' Association,

• To consider and respond to advice from the Public Involvement and Communication Team in relation to public involvement in the Delivery Plan tasks.

Members agreed the new remit for the Stakeholders group. This draft remit will be discussed by the Stakeholders' Group at its next meeting in August.

5. PRESENTATION: NHS QUALITY IMPROVEMENT SCOTLAND HEALTH TECHNOLOGY ASSESSMENT: CLINICAL AND COST EFFECTIVENESS OF SCREENING FOR MRSA

Dr Karen Ritchie gave a detailed and informative presentation on the NHS Quality Improvement Scotland Health Technology Assessment: Clinical and Cost Effectiveness of Screening for MRSA. A copy of her presentation would be issued with the minutes.

CNO advised that initial views of the document were positive and he thanked NHS QIS for preparing the document.

The following points were raised in discussion:

• The HTA only deals with MRSA it does not include any other HAIs. However it does promote good practice which will impact e.g. single rooms.
• The question of MRSA in care homes and the community was raised. Members were advised that research projects have been proposed to look at the prevalence of MRSA in the community.
• The protocol for isolation rooms is a much bigger issue that just HAI. The issue of screening will be integrated into the National MRSA Control Strategy document.
• Policy decisions will be made once the final report on the HTA has been received.

Action: HAI Task Force Secretariat to issue a copy of the presentation with the minutes.

6. PRESENTATION: CLEANING AND DOMESTIC SERVICES

Mr Paul Kingsmore, aided by Mrs Midge Rotherham, gave a detailed and informative presentation on Cleaning and Domestic Services. The presentation included the Monitoring of the National Cleaning Services Specification, the development of a National Framework for Education and Training of Domestic Assistants and the Re-development of the Housekeeper Role. A copy of his presentation would be issued with the minutes.

The following points were raised:

• Monitoring has been very fragmented in the past but progress has now been made to the sharing of best practice.
• Monitoring will be carried out on a quarterly basis. HFS will advise NHS Boards what information will be required to be submitted to the Scottish Executive.
• The report should follow the format of the MRSA bacteraemia report and will be published on the website.
• HFS to develop a communication document for issue to NHS Boards.
• Some fine tuning is needed to give clear clarification of the traffic light system.
• Development of verification and audit returns.
• Clarification required as to who should have responsibility for Housekeepers.

Action: HAI Task Force Secretariat to issue a copy of the presentation with the minutes.

7. FOUR COUNTRIES UPDATE

• "Skills for Health" (SfH) are developing national occupational standards in infection control. Scotland has membership of the SfH national steering group.
• Northern Ireland launched its HAI Action Plan on 13 March 2006 which includes local action plan and hand hygiene campaigns.
• Wales is in the second year of its HAI action plan and is now developing a plan for the community.
• Department of Health - Saving Lives tool kit is a delivery programme to reduce HAIs including MRSA. It includes six high impact interventions (i.e. evidence based tools) that reinforce the practical actions that clinical staff need to undertake every time for key procedures to significantly reduce HAIs.
• The Department of Health is also updating its existing laundry guidance HSG(95)18: Hospital laundry arrangements for used and infected linen.
• The World Health Organisation's (WHO) - "Clean Care is Safer Care Programme" launched in October 2005 is due for completion in October 2007.

8. AOCB

CNO invited the Stakeholders to update on progress on their tasks in the Delivery Plan.

NHS Education for Scotland

• Training of G Grades in the Cleanliness Champions programme is not causing waiting lists in recruiting Cleanliness Champions, although there have been some issues around mentors.
• Undergraduate training has now been integrated into nursing, medical and dental programmes.
• Workshop held in Wales last week for Cleanliness Champions, also to be held in Northern Ireland shortly.
• Prudent prescribing pilot for doctors has been accepted, although there are some issues around capacity.

Health Protection Scotland

• The development of Project Initiation Documents for all areas is progressing.
• Prevalence survey is on target for the end of March 2007.
• New surveillance on antimicrobial resistance is being developed.
• Best Practice on infection control to be linked to model policies.

NHS Quality improvement for Scotland

• Review of HAI Standards is due to begin in October 2006 with draft standards issued for consultation in April 2007. Final Standards to be ready by September 2007.
• Further development of incident and near miss reporting using HAI as a tracer: action plan in response to the Safe Today Safe Tomorrow report on incident reporting systems across NHSScotland currently out for comment. Action plan to be finalised in July 2006.
• Use HAI as a pathfinder to aid implementation of the core risk assessment martricies based on Australia/New Zealand risk management standards. Implementation of the risk matrices is being determined during the peer review of NHS QIS clinical governance and risk management standards.
• Working with risk managers to raise awareness of HAI risks. Collaborative work with infection control managers and nurses is planned in the autumn of 2006.
• Implementation of the "risk management of HAI" document: finalised document awaited
• Health Technology Assessment on the clinical and cost effectiveness of screening from MRSA published for consultation June 2006.

Public Information and Communications Team (PICT)

• Public involvement at ground level is a key factor of the work of this group.
• PICT to discuss the topic of HAI with the Scottish Health council.

Patient Safety

CNO advised the members that the Chief Medical Officer had highlighted Patient Safety as a major issue. A working group has been established to look at the following:

· HAI as a pathfinder.

· Cultural change - what does cultural change look like? How will it happen? (Looking at the model in Tayside at present).

· Benchmarking processes - getting to an average instead of being the best.

· Medical staff must be involved was highlighted

· Tool kit - what might it look like? Process may be novel.

The "Patient Experience" was discussed at the last Chief Executive's meeting. The question was raised as to how information would be gathered and whether we would want to gather this information throughout NHSScotland.

The suggestion was made that a forward calendar should be produced and issued for each HAI Task Force meeting.

9. DATE OF NEXT MEETING

The next meeting will take place on Tuesday 31 October 2006 from 10am to 1pm in conference Room 3, Victoria Quay, Edinburgh.

HAI Task Force Secretariat

September 2006