THIRD MEETING OF THE HEALTHCARE ASSOCIATED INFECTION (HAI) TASK FORCE, HELD AT 10.00AM ON TUESDAY 31 OCTOBER 2006, IN CONFERENCE ROOM 3, VICTORIA QUAY, EDINBURGH

Present:

Scottish Executive Health Department

Mrs Margaret Tannahill, Nursing Adviser HAI and Communicable Disease (Chair)

Dr Peter Christie, Senior Medical Officer

Mr Duncan Clark, HAI Team

Ms Susan Ferguson, HAI Team

Mrs Linda Middleton, HAI Team

Dr Mini Mishra, Senior Medical Officer

Mr Ray Watkins, Chief Dental Officer

NHSScotland and other representatives

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

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

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

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

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

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

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

Dr David Steel, Chief Executive, NHS Quality Improvement Scotland

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:

Mr Paul Martin, Chief Nursing Officer (Chair)

Dr Harry Burns, Chief Medical Officer (Deputy Chair)

Mr John Glennie, Chief Executive, NHS Borders

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

Mrs Bridget Hunter, Scottish Partnership Forum

Mr Adrian Lucas, Chief Executive, Scottish Ambulance Service

Dr Bob Masterton, Medical Director, NHS Ayrshire and Arran

Mr Ross Scott, Head of Health Finance Policy Implementation and Development Branch (including decontamination policy), SEHD

1. WELCOME AND INTRODUCTIONS

1.1 Margaret Tannahill welcomed the group to the meeting and noted apologies (as above). She advised that Paul Martin was attending a Directors of Nursing Conference in Atlanta and that she would be chairing the meeting. Margaret welcomed and introduced Ms Lorna Renwick, NHS Programme Manager, NHS Health Scotland, who has taken over from Cath Krawczyk and Mr Duncan Clark, a new member of the HAI Team.

2. MATTERS ARISING

Minutes of the last meeting

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

• Page 6 - Under Section 5, bullet point 3 "Care home highlighted as increased risk patients". Action: HAI Task Force Secretariat to clarify this point with Karen Ritchie.

• Page 6 - Under Section 6 "Presentation: Cleaning and Domestic Services" bullet points 2 and 4 to be amended from "HPS" to "HFS".

Uniforms Group

2.2 Margaret Tannahill advised members that Thames Valley University had completed a research report on behalf of the Department of Health (DH). The report was commissioned to underpin evidence to enable DH to develop a uniform policy. The report concluded that no link to HAI was found when uniforms were laundered in home washing machines. Other conclusions included; scrub suits should be worn within theatres, ICUs and baby care units; clean uniforms should be provided on a daily basis; changing facilities should be made available; and protective clothing should be worn on top of uniforms. She advised that Northern Ireland were also carrying out similar research in this area of work. Margaret advised that this paper will be disseminated to group members in due course.

Action: HAI Task Force to issue copy of DH research report to members in due course.

2.3 The question was raised as to who would take the lead in driving this area of work forward. Peter Christie advised that there are three strands to this work - Uniform Code (eg badges, jewellery), Uniform Strategy (national uniform specification, uniform procurement) and Facilities(laundry, changing). While this work extended beyond the remit of the HAI Team discussions were being held within the Scottish Executive to identify the way forward and an update will be given at the next HAI Task Force meeting.

Action: Scottish Executive to discuss way forward for this area of work. Members to be updated at the next HAI Task Force meeting.

3. HAI TASK FORCE PROGRESS

Project Initiation Documents (PIDs)

3.1 Margaret Tannahill reminded key stakeholders that PIDs should be submitted to HAI Task Force Secretariat when delivery plan areas of work are about to commence.

Progress Reports

3.2 Margaret Tannahill apologised for tabling the first progress report. In future these would be issued prior to the meeting for members to review. Susan Ferguson explained the new report layout. The status of red, amber and green had been included to highlight project slippage 'at a glance' and provide an early warning to the HAI Task Force who may be able to assist in resolving issues to help the project "get back on track".

Verbal report by lead stakeholder/discussion on key tasks/issues from Delivery Plan

NHS Quality Improvement Scotland

Delivery Area 2.2 - Review of the NHS Quality Improvement Scotland HAI Infection Control Standards

3.3 David Steel advised members that although the existing standards are useful, they are all process orientated. NHS QIS is moving towards developing updated evidence based standards. A workshop was held in August and NHS QIS is in the process of appointing a project adviser and project team. Work on this area should be commenced very soon.

Delivery Area 7.4 - Work with Risk Managers in NHS Boards to raise awareness and implement the risk matrix with specific regard to HAI

3.4 David advised members that the work being carried out by Eunice Muir in this area is almost complete.

Delivery Area 14.3 - Deliver and Consult on the Health Technology Assessment on MRSA Screening

3.5 David advised members that there had been additional work following the consultation. Further evidence had been uncovered and the model used was in the process of being remodelled. The work on this should be complete by early 2007. He advised however that the conclusions should be available soon and a decision on required actions will need to be made by the Scottish Executive.

Health Facilities Scotland

Delivery Area 3.3.7 - Develop an Education and Training Framework for Domestic Services

3.6 Paul Kingsmore advised that a decision had still to be made on the length of consultation for internal and external stakeholders.

Delivery Area 5.3 - Secure Commitment to Public Involvement in Monitoring Compliance with the NHSScotland National Cleaning Specification

3.7 Paul advised that this area of work has been highlighted as amber as it had taken longer than was anticipated to implement. He further advised however, that full public involvement would be implemented in all NHS Boards as from November 2006.

3.8 Robin Creelman, Chairman of the Public Involvement and Communications Team (PICT) advised members that he had been involved in a peer review for Greater Glasgow and Clyde. He highlighted the importance of public involvement. During the review he had taken time to explain the reasons for carrying out the review and the ethos behind it. These reviews could prove to be a helpful way in educating the general public.

Health Protection Scotland

Delivery Area 3.3.3 - Undertake a Training Needs Analysis for Infection Control Specialists and Infection Control Managers

3.9 Tim Brett advised members that a questionnaire had been issued to Infection Control Managers and that a seminar, to identify training needs, was planned for February 2007.

Delivery Area 4.1 - Completion of the National HAI Prevalence Survey

3.10 Tim advised that all visits had now been completed and that the report would be produced by end of March 2007. The report is to be launched after the election in May next year.

3.11 Peter Christie updated the members on the prevalence survey carried out by the Hospital Infection Society (HIS) in England, Wales, Northern Ireland and Southern Ireland. This did not include Jersey. He advised that, except for Wales, participation in this survey was not mandatory; not all wards in all hospitals were included; relatively simple definitions were provided and data was collected by local staff. The overall prevalence for England was 8.2%. Participation in the Scottish Point Prevalence Survey was mandatory and data had been collected by staff employed by HPS and rigorously quality checked. Therefore, there was a risk that the result in Scotland may appear to exceed the English figure due to methodology differences. Although strictly speaking the Scottish data was not comparable with data from the HIS survey there would be some elements of the data that would be open to comparison. Some funding may be made available in future years for NHS Boards to carry out local prevalence surveys.

NHS Education for Scotland

3.12 Liz Gillies advised members that in general terms NES work on the delivery plan was progressing well and updated as follows:

· Promoting the inclusion of Cleanliness Champions in undergraduate programmes.

· Undertaking review of medical programmes - possibly stand alone.

· Mapping of existing training programmes for Scottish Ambulance Service.

· Looking at ways to support NHSScotland in meeting the original PAF targets for Cleanliness Champions.

· Encouraging the uptake of education and training materials for domestic services.

· Extending education and training on antimicrobial prescribing. Programme for foundation year doctors ready very soon. Guest accounts will be circulated to HAI Task Force members.

· Investigation of the provision of training for non medical staff.

· Dundee University, Napier University and Melville College have developed interim curriculum to promote development of prevention and control of infection in higher education.

· NES supporting NHS Boards by sharing good practice to enable G Grade staff to complete the Cleanliness Champions Programme (e.g. Some Boards imposing time limit for completion; some including in individual's development plan).

· Resource issues for G Grades in Primary Care. Provision of training for practice nurses.

Paul Wilson agreed that he would raise the issue of Cleanliness Champions training for G Grade Staff at the next Directors of Nursing meeting.

Action: Liz Gillies to send details of Cleanliness Champion numbers to Paul Wilson.

Action: Paul Wilson to raise the issue of Cleanliness Champions training G Grade Staff at the next Directors of Nursing meeting.

Scottish Microbiology Forum

Delivery Area 14.2 - Develop and Implement Standard Operating Procedures for Diagnosis of Key Organisms (eg C difficile)

3.13 Mary Hanson advised members that the implementation of standard SOPs to support surveillance of CDAD was now complete. Discussions were ongoing with HPS with regards to typing of organisms. Tim Brett would discuss the way forward with Dr Anne Eastaway at HPS and advise members in due course. Mary also advised that a single methodology had been achieved and that funding had been allocated to the laboratories. She highlighted that facilities would be needed to type the "Canadian" strain of C difficile.

Action: Tim Brett to discuss the typing of organisms and the way forward with Dr Anne Eastaway.

Scottish Executive Health Department

Delivery Area 2.1 - Develop and HAI Monitoring Framework, including Key Performance Indicators

3.14 Susan Ferguson advised members that a workshop was held on 21-22 August to discuss monitoring and improvement in relation to HAI, including the development of Key Performance Indicators. The outcome of the workshop would be covered by Dr Peter Christie under item 5 on the agenda.

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

3.15 Peter Christie advised members that the draft Strategy had been developed as guidance for dealing with all incidents of MRSA, as not one method fits all. Screening for MRSA was woven throughout the Strategy, so the draft could not be finalised until the results of the HTA were known. Preliminary results should be available by December and the Strategy document is due to be issued for consultation in January 2007. One of the recommendations in the draft HTA was to screen all patients. This would have a resource implication of approximately £60 million per year for NHSScotland. The question was raised if any guidance would be provided for the independent sector. Peter advised that there is a section in the Strategy specifically dealing with the independent sector.

Public Involvement and Communications Team (PICT)

3.16 Susan Ferguson advised members that at the PICT meeting on 9 October 2006 the group discussed the development of a national public information strategy. Discussions also included exploring patient/public feedback mechanisms, including NHS Boards' implementation of CNO(2005)1 and identifying the role of Community Health Partnerships. A questionnaire would be developed and issued to Infection Control Managers to obtain the necessary information to support these areas of work.

Action: PICT to develop questionnaire for issue to Infection Control Managers.

Delivery Area 5.4 - Explore the Use of HAI as a Topic Area by the Scottish Health Council

3.17 Susan advised that the Scottish Health Council have agreed in principle to include HAI as a performance indicator.

Action: HAI Task Force Secretariat to check with Rosemary Hill, at Scottish Health Council, that HAI performance indicator has been approved and progressed.

3.18 Susan advised that PICT members hoped to establish good relationships with/within Community Health Partnership networks and that PICT members hoped to be involved in the ICNA raising awareness week.

Action: HAI Task Force Secretariat to issue electronic copies of the progress report to members of PICT.

Documents issued since last meeting

NHS HDL(2006)38 - A Revised Framework for National Surveillance of Healthcare Associated Infection in Scotland issued on 10 July 2006

3.19 Margaret Tannahill advised members that the HDL provides details of mandatory surveillance of all Staph aureus bacteraemias, Clostridum difficile, surgical site infections to include hip arthoplasty and caesarean sections, and post discharge surveillance on all orthopaedic surgical cases and caesarean sections.

Cleaning Monitoring Report - issued by HFS on 28 August 2006

3.20 Paul Kingsmore advised members that comments received on the report had been positive. The only NHS Board not to receive a green indicator was the State Hospital at Carstairs. Three acute hospitals received amber indicators: The Royal Infirmary of Edinburgh, Raigmore Hospital in Inverness and The Royal Alexandra Hospital in Paisley. All three hospitals now have action plans in place to address the issues.

MRSA Quarterly Report

3.21 Peter Christie advised members that although the clinical picture had changed across Scotland with more people undergoing more procedures, especially later on in life the MRSA rates in Scotland are still stable against a general rise across Europe. He stressed, however, that there is still room for improvement.

Events

HAI Roadshows

3.22 Margaret Tannahill advised members that she and Peter Christie would be visiting all NHS Boards seeking feedback on issues from the HAI delivery plan. She noted that there was plenty of evidence of good practice being delivered.

Key Performance Indicator Workshops

3.23 This will be covered under item 5 on the agenda.

Nursing Times Live (update on double workshop of Champions)

3.24 Margaret advised that she attended this event on 13 September 2006, which has now been held for 4 years in succession. G Grade Cleanliness Champions were involved in the two workshops explaining the CNO policy and experiences at local levels. These workshops invoked much interest and requests for further information.

ICNA Conference held in Brighton

3.25 Margaret advised members that she had attended this event and that Claire Kilpatrick and Sally Stewart from HPS and Professor Peter Davey, Dundee University, had all given presentations.

Healthcare Infection Society Conference

3.26 Margaret advised that this conference had taken place earlier in October and that Peter Christie had given an update earlier in the meeting. There had been very little press coverage of this event.

ICNA Raising Awareness Week from 6-10 November 2006

3.27 Shona Halley advised members that posters and flyers had been prepared for issue (copies passed round the members for information). The theme this year "Don't let the bugs score" would again be shown on the city screen in Glasgow. Local quizzes with various prizes had also been produced. She also advised that the UK ICNA had been discussing the future of this event. It may be that in future, rather than highlighting one week in the year, raising awareness should be ongoing throughout the year.

Ministerial Visit on 7 November 2006

3.28 Susan Ferguson advised members that Mr Andy Kerr, Minister for Health and Community Care, would visit Hilltop Nursery in Glasgow to see early years hand hygiene education in action.

World Health Organisation (WHO) videoconference on 10 November 2006

3.29 Susan advised that Mr Kerr is to take part in the WHO Global Patient Safety Challenge - Clean Care is Safer Care. This would provide information on progress on HAI issues since last year's videoconference and would contain footage from his visit to Hilltop Nursery.

Community Health Partnership Conference

3.30 Heather Kelman advised members that this conference had specifically been arranged to target general managers and chairs of NHS Boards, however it was attended, in the main, by specialists. She highlighted that networking potential for the future had been identified. Many Public Partnership Forums had not yet been fully established. She stressed, however, that HAI has been recognised as an important area for inclusion. Robin Creelman, Chairman of PICT, and Lynn Pritchard and Karen Craig, Infection Control Nurses, all presented at the Conference. There had also been two workshops on HAI.

Communications

3.31 Susan Ferguson advised members that the HAI Task Force website had been updated and now included the HAI Task Force Delivery Plan. The link to the website would be issued to members. She reminded members that the role of the HAI Task Force was to bring messages to the table, but also take messages out to the wider audience. Members were advised that the issue of the cleaning monitoring report was included in the NHS Bulletin. Susan asked the members for their thoughts on the production of an HAI newsletter ie would they think this would be helpful? Points raised in discussion were as follows:

o suggestion that script be prepared by HAI Task Force Secretariat to be issued to

Boards for inclusion in House Journals

o inclusion in HPS surveillance journal

o possibility of NES newsletter being extended

o suggestion that text should be short but practical

o text must be current ie not to wait for quarterly issue

o use to kick start general awareness.

The members emphasised that that thought should be given to producing an enduring model for dissemination. Susan thanked the members for their initial thoughts and said she would update at the next HAI Task Force meeting.

Action: HAI Task Force Secretariat to email link to Scottish Executive HAI web pages to members.

Action: HAI Task Force Secretariat to develop draft communications strategy for the February Task force meeting.

Feedback from HAI Task Force Members

3.32 Susan Brimelow spoke about the changes in practice for G Grade Nurses i.e. greater involvement in hand hygiene audits for medical staff, involvement with allied health professionals, and taking responsibility of what is happening on the ward. A good practice model has been developed and discussions were underway on the evaluation of the clinical effectiveness of the model.

3.33 Heather Kelman praised the Scottish Medical Consortium guidance on prudent prescribing issued in 2005. She was reassured that pharmacy and primary care interests were included in the Antimicrobial Resistance Strategy and Scottish Action Plan document under development at present.

4. PRESENTATION: NATIONAL HAND HYGIENE CAMPAIGN

4.1 Simon White, Project Manager from HPS gave a detailed and informative presentation on the National Hand Hygiene Campaign. He explained the background to the project, the scope and approach, the public media campaign and the NHSScotland campaign. He also explained the role of the Local Health Board Co-ordinator (LHBC). A CNO letter enclosing the LHBC job description and highlighting the funding for these posts would issue shortly. A copy of Simon's presentation would be issued with the minutes of the meeting.

The following points were raised in discussion:

· The responsibility for ensuring that facilities are available for children washing their hands lies with the local authorities.

· The Leith advertising agency has written to all local authorities inviting contributions to the campaign.

· The hand hygiene campaign will convey a very broad message.

· Care should be taken that the issuing of "logos" is not seen as endorsement of a product.

Action: HAI Task Force Secretariat to give NHSScotland early notice of the hand hygiene campaign message before going public.

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

5. PRESENTATION; MANAGING AND IMPROVING PERFORMANCE

5.1 Peter Christie gave a detailed and informative presentation on Managing and Improving Performance. A copy of Peter's presentation would be issued with the minutes of the meeting.

The following points were raised in discussion:

• The question of primary and community settings was raised.
• Central line infections in hospitals settings to be used as starting point.
• Looking at long line maintenance in the community.
• Identifying what proportion of HAIs are preventable.
• Public perception that all HAIs are avoidable.
• Minister has agreed the HEAT target (i.e. HAI - to reduce all staphylococcus aureus bacteraemia (including MRSA) by 30% by 2010).

Peter will give a full update at the next meeting.

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

6. UPDATE ON INTERIM GUIDANCE ON LEVEL OF PROVISION OF SINGLE ROOM ACCOMMODATION

6.1 Peter Christie advised members that interim guidance on the provision of single room accommodation would be issued to NHSScotland in the very near future.

7. FOUR COUNTRIES UPDATE

7.1 As the meeting had taken longer than was expected it was agreed that an update for this item would be given at the next meeting.

8. DATE OF NEXT MEETING

8.1 The next meeting will take place on Wednesday 28 February from 10am to 1pm in Conference Room 3, Victoria Quay, Edinburgh.

HAI Task Force Secretariat

November 2006