The Scottish Government

Twelfth meeting of the Healthcare Associated Infection (HAI) task force, held at 10.00am on Tuesday 24 February 2009, in the board room, NHS Quality Improvement Scotland, 8 - 10 Hillside Crescent, Edinburgh

Present:

Scottish Government Health Directorates

Mrs Carol Fraser, Nursing Adviser HAI (Chair)

Mr Kevin Hanlon, Head of HAI Policy Unit

Mrs Linda Middleton, HAI Unit

NHSScotland and other representatives

Dr Eleanor Anderson, Consultant in Public Health Medicine, NHS Lanarkshire

Mr David Bedwell, Assistant Director, Health Facilities Scotland (deputising for Paul

Kingsmore)

Mr Colin Brown, Branch Head Patients & Quality Division

Mr Robin Creelman, Chair of HAI Task Force Public Involvement Communications

Team

Dr Mary Hanson, Microbiologist, Joint Chair Scottish Microbiology Forum

Mr Joseph Lynch, Regional Organiser, Scottish Partnership Forum (UNISON)

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

Grampian

Mr John McMeekin, Public Involvement Representative and Public Involvement Communications Team member

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

Directorate

Ms Mary Morgan, Director Health Protection Scotland

Mr Bob Parry, Associate Director, NHS Education Scotland

Dr Jacqui Reilly, Consultant Nurse Epidemiologist/Head of Group, Health Protection

Scotland

Dr Charles Saunders, Scottish Joint Consultants Committee

Mrs Gillian Stevenson, Nurse Consultant (HAI) Care Commission (deputising for

Susan Brimelow)

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

Clyde

Mr Tom Walsh, Infection Control Manager, NHS Greater Glasgow and Clyde

Ms Jan Warner, Director of Patient Safety and Performance Assessment , NHS

Quality Improvement Scotland

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

Management

Ms Susan Wilson, Infection Control Manager Scottish Ambulance Service (deputising for Tony Wigram)

In attendance

Ms Evonne Curran, Nurse Consultant Infection Control, Health Protection Scotland and Ms Helen Maitland Programme Director of HAI, NHS Education Scotland) (deputy for Bob Parry)

The following apologies were noted:

Mrs Susan Brimelow, Director of Healthcare Regulation, Care Commission (Gillian

Stevenson deputising)

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

Directorate

Ms Rose Gallagher, Nursing Advisor Infection Prevention and Control, Royal College

Mr John Glennie, Chief Executive, NHS Borders

Mr Alan Morrison, Operations Manager Environmental Health, Argyll and Bute

Council

Ms Jane Murkin, National Co-ordinator, Scottish Patient Safety Programme

Mr Paul Kingsmore, Director, Health Facilities Scotland (David Bedwell, Assistant

Director Health Facilities Scotland deputising)

Dr Bob Masterton, Medical Director, NHS Ayrshire and Arran

Dr Margaret McGuire, Acting Chief Nursing Officer and Interim Chair

Ms Lorna Renwick, NHS Programme Manager, NHS Health Scotland

Miss Margie Taylor, Chief Dental Officer, Scottish Government Health Directorate

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

Susan Wilson deputising)

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

1. Welcome, introduction and apologies

1.1 Carol Fraser welcomed everyone to the meeting and reminded members that Paul Martin was due to commence his new post at West of Scotland University on 1 March. She advised that Dr Margaret McGuire is acting Chief Nursing Officer and Interim Chair of the HAI Task Force meantime; unfortunately she is on annual leave and cannot attend the meeting today. She advised members that Gillian Stevenson was attending this meeting as deputy for Susan Brimelow from the Care Commission and Sandra McNamee, attending today, has now taken over from Gillian Stevenson as the representative for the Infection Prevention Society.

Apologies

1.2 Carol Fraser noted apologies as above.

2. Minutes of meeting held on 11 December 2008

2.1 Subject to some minor amendments the minutes from the meeting held on 11 December 2008 were agreed.

Action: HAI secretariat to amend the minutes and issue revised version to HAI Task Force members.

3. Matters Arising

3.1 Update on Estates Monitoring

David Bedwell provided an update under paper HAITF(2009)4 which was issued to members on 18 February 2009. He advised that Health Facilities Scotland (HFS) would be contacting various agencies seeking representatives to form part of a group led by Ian Laidlaw to take forward a project of approximately 10 - 11 months

3.2 Independent Care Inspectorate

Carol Fraser advised members that this would be covered under Item 5 on the agenda.

3.3 Update from NES on intravenous access using care bundles

Bob Parry tabled a flyer from the NES HAI Education Virtual Learning Environment about preventing Catheter Related Bloodstream Infections and informed the meeting that Evonne Curran would provide discussion around care bundles in her presentation.

4. Presentation: Lessons From Maidstone in Kent / Care Bundles

4.1 Evonne Curran, Nurse Consultant, Health Protection Scotland gave presentations on Care Bundles and lessons from outbreaks including the Clostridium difficile outbreak at Maidstone Hospital in Kent. Copies of the presentation will be issued along with the minutes of the meeting.

4.2 The following points were raised in discussion following the presentation on care bundles:

• A training course for preventing catheter related blood stream infections has been launched and is available on line on the NES website along with information of CDAD (Clostridium difficle Associated Disease) and prevention of ventilator associated pneumonia infections.
• Not all catheter infections are Staphylococcus aureus related and consideration should be given to other infections to maintain a view of the wider picture.
• The roll out of care bundles needs to move much quicker to be effective.
• Piloting of catheter infection surveillance is underway and care bundles have been introduced to various units.
• The issue of the number of patients who have a intravenous catheter sited was raised. It was agreed that if insertion of intravenous catheters was truly based on patient's clinical needs, there would be potential for infections related to canulations to decline. It was agreed that this was an issue that should be highlighted, in particular in the undergraduate curricula.

4.3 The following points were raised in discussion following the presentation on lessons from outbreaks, including Maidstone, Kent:

• The question was raised about recommending actions when trigger's were reached. Members were advised that a trigger tool is presently being tested and guidance is being prepared. It was noted that no specific guidance was currently being prepared for Care Homes.
• It was highlighted that statistical process control charts are helpful.
• Members were notified that surveillance has been benchmarked on a national level along with exception reports for CDAD.
• The question of where Scottish NHS Boards are at present was raised. Members were advised that CDAD study days have been planned.
• There was general agreement that there needs to be a change in culture across staff disciplines.
• The need for clear accountability at all levels was highlighted.

5. Care Environment Inspectorate

5.1 Jan Warner highlighted the content of the paper circulated prior to the meeting and advised members that she had recently given a presentation to NHS Chairs and Chief Executives to inform them on the proposed function of the Care Environment Inspectorate (CEI); to build public confidence and to enable continuous quality improvement.

5.2 The model for the review of the QIS HAI Standards has been based on the NHS Quality Improvement Scotland nutrition standards model for review against the standards. The proposed assessment tool has been tried and tested with Health Protection Scotland and Infection Control Mangers. The self assessment data will be reported on a web based data base by Boards. Analyses of the data reported will be carried out before a formal visit by NHS QIS. This web base will eventually provide a local tool for monitoring.

5.3 Guidance on the function and the processes the CEI will adopt will be produced and issued for consultation. A series of regional NHS QIS meetings will be arranged and a number of visits to individual boards will also be arranged to discuss the guidance. A steering group is to be set up, chaired by a lay representative and held in public. Discussions are ongoing on how best to feedback information to the HAI Task Force.

5.4 The appointment of the Chief Inspector will be made in April.

5.5 The following points were raised following discussion:

· The issue of safeguards on patient care and how sanctions would be enforced were raised. First and foremost would be improvement depending upon the seriousness of the findings; sanctions would be used only as a last resort. These powers would come from directions of the NHS Scotland Act 1978, the NHS Scotland Reform Act of 2004 and the ultimate sanction from 78(a) of the 1978 Act.

· The importance of public involvement was highlighted.

5.6 This high priority area is to be kept on the agenda for future meetings.

Action: NHS Quality Improvement Scotland to provide updates on the progress being made in establishing the new Care Environment Inspectorate to the HAI Task Force secretariat, for circulation to HAI Task Force members and provide further update at next meeting.

6. Public Involvement

6.1 Carol Fraser advised members she and had met with Patient Focus Public Involvement (PFPI) leads, Infection Control Managers and representatives from Communications Teams from all NHS Boards last year to discuss how best to get public involvement with the HAI agenda and maintain a link with PFPI forum in all Boards. A meeting was then held with Carol Fraser and Callum Percy, with PICT (Public Information and Communication Team) members Robin Creelman and John McMeekin to discuss the requirement of public representation. During discussion it was agreed that the focus for public involvement had moved on and that the way forward would be to communicate through established PFPI forum within the NHS Boards.

6.2 Members were advised that Callum Percy was attending a forum for PFPI Directors today, to discuss how to link HAI into their agenda. Callum Percy to update members at the next meeting.

Action: Callum Percy to provide feedback to HAI Task force members on the outcome of his meeting with PFPI Directors on 24 February 2009.

6.3 Robin Creelman advised members that public involvement across Scotland is sporadic and highlighted it is important that the public are involved and informed.

6.4 The question of full compliance for public involvement during cleaning audits was raised. David Bedwell advised members that there was considerable compliance with public involvement. He further advised that the Greater Glasgow and Clyde model was being discussed as best practice for possible use across Scotland.

7. HAI Reporting Template

7.1 Carol Fraser advised members that the Cabinet Secretary for Health and Wellbeing announced the introduction of a national HAI reporting template which should ensure that clear, standardised and transparent information is available on infection rates in all health board areas by hospital. This information will be publicly available by being posted on NHS Boards websites; and discussed openly at boards bi-monthly NHS Board meetings.

7.2 NHS Greater Glasgow and Clyde and NHS Forth Valley are currently reviewing the information reported on the template to try to ensure the language used is user friendly and can be understood by members of the public.

7.3 The four key areas for reporting are cleaning, hand hygiene, Staphylococcus aureus Bacteraemia's and Clostridim difficle, further topics will be added throughout the coming year. The aim is to ensure consistency of approach in reporting across Boards.

8. HAI Web Portal

8.1 Kevin Hanlon advised members that the Cabinet Secretary for Health and Wellbeing had announced a single access point for HAI information available on the HAI Task Force website. The front page had information about the HAI Task Force and HAI with web links to national sites i.e. Health Protection Scotland, Health Facilities Scotland, General Register Office for Scotland and individual Board sites.

8.2 The Cabinet Secretary, at the NHS Chairs meeting, emphasised that the national HAI reporting template should be completed and discussed at the bi-monthly board meetings. The expectation is that the templates will be used by all Boards by March for reporting progress against the HAI agenda at their Board meetings. As these meetings are open to the public there is a risk that the media running league tables.

9. Vale of Leven Follow up Review

9.1 Members were advised that the Vale of Leven Follow up Review was published on 10 February 2009. A patient representative and a family representative accompanied the original review team on the follow up visit to Vale of Leven. The findings of the report were positive, showed significant progress by NHS Greater Glasgow and Clyde and were endorsed by both family and patient representatives.

10. HAI Task Force Delivery Plan/ Progress Report HAITF(2009)1

10.1 Carol Fraser advised members that she had met with stakeholders on a one to one basis to obtain a better understanding of progress towards their respective delivery plan areas for 2009/2010. The red and amber progress reports were discussed as follows:

Delivery Area 1.8 - Public Involvement Programme

10.2 This area is reported as Red. It was discussed under Item 6.

Delivery Area 2.10 - Implementation of Outbreak Management Programme

Delivery Area 2.11 - Education Programme for Surveillance Nurses

Delivery Area 2.12 - Development of a Neonatal Vascular Access Programme

Delivery Area 2.13 - Development of an educational package on presentation of infectious diseases in the elderly

10.3 Bob Parry advised that all these areas are progressing although still classified as amber. He further advised that NES would send a copy of their literature review on "Central Venous Catheters: placement and management of infants admitted to a Neonatal Intensive Care Unit" to all HAI Task Force members.

Action: NES to issue a copy of their literature review on "Central Venous Catheters: placement and management of infants admitted to a Neonatal Intensive Care Unit" to all HAI Task Force members.

10.4 Mary Hanson pointed out that Delivery Area 2.13 - Development of an educational package on presentation of infectious diseases in the elderly was identified following the prevalence survey. Carol Fraser advised that this area has still to be scoped out and will now be delivered 2010/11.

10.5 Mini Mishra raised the issue of the independent sector. She was advised that guidance should be translated across all care sectors. Jacqui Reilly advised that a pilot on surveillance of HAI was being carried out in a Care Home at present.

Delivery Area 4.3 - Pilot Study of the recommendations in the MRSA Health Technology Assessment

Delivery Area 4.9 - Implementation of SCOTMARAP recommendations, including addressing the educational recommendations

10.6 Jacqui Reilly advised that these areas were progressing and will be reported as green in due course.

11. National Action Plan

11.1 Members were reminded that the National HAI Action Plan was published last August. Progress reports are submitted on a monthly basis and passed to the Cabinet Secretary for Health and Wellbeing. It has become evident recently that not all Boards may be providing totally accurate information. A plea was issued to boards, through the Nurse Directors, for transparency in the completion of progress reports.

12. Greater Glasgow & Clyde Action Plan

12.1 Members were advised that monthly meetings have been held with NHS Greater Glasgow & Clyde. The progress and work carried out by the board has been reflected in the follow up review at the Vale of Leven. Meetings to discuss the sustainability of the Action Plan will be arranged.

13. CEL 54 (2008), CEL 55 (2008) and CEL 5 (2009)

13.1 Carol Fraser highlighted the importance of surveillance and utilisation of funding.

Clostridium difficile surveillance

13.2 From 1 April 2009 surveillance for Clostridium difficile will include collection of data for aged 15 and above. Also, a new Clostridium difficile HEAT target requiring a minimum reduction of 30% by 2011 was also introduced on 1 April 2009. The HEAt target would apply to a reduction in cases in 65 year olds and above.

MRSA surveillance

13.3 The initial data from the MRSA screening programme carried out by the Pathfinder boards will be published in the interim report at the end of March. The Cabinet Secretary will review the findings with a view of announcing the national programme for implementation over the next two years.

13.4 The funding issued to NHS Boards in this financial year is for "start up" costs and is non-recurring. NHS Boards have been asked to submit details on how the funding will be utilised. A further allocation of recurrent funding will be issued in due course to cover the next two year period.

Hand hygiene

13.5 The issue of hand hygiene compliance by practice nurses in GP premises was raised by Robin Creelman. It was agreed that they would be expected to comply with infection prevention and control standards in the same way as for any other healthcare worker and follow national guidance. Bob Parry advised that a practice nurse education package is available on the NES website. Heather Kelman advised that CHPs (Community Health Partnerships) provide support to practices.

14. HAI Topical Issues: Labour Party 15 Points Plan/HAI Debate HAITF(2009)2

14.1 Members were asked to review, in consultation with their relevant representative organisations, the 15 point action plan enclosed with the letter dated 11 February from Cabinet Secretary for Health and Wellbeing. Comments on what is being done, what is not being done and what is missing should be submitted to HAI Task Force Secretariat by 20 March 2009 with a reminder being issued one week before the due date. Jacqui Reilly raised an issue regarding the terminology used in the headings on the paper circulated. Kevin Hanlon agreed to review the paper.

Action: HAI Task Force secretariat to clarify the headings of the Labour 15 point action plan and issue a revised copy to members along with a copy of the letter form Cabinet Secretary for Health and Wellbeing, the HAI delivery Plan and the National Action Plan.

Action: HAI Task Force members to submit comments to HAI Task Force Secretariat by 20 March 2009.

15. AOCB

• HAI Task Force Membership and Terms of Reference HAITF(2009)3

15.1 Carol Fraser informed members that the remit and membership of the HAI Task Force had not been reviewed for a number of years. She asked members to consider the current Terms of Reference and membership. Paper HAITF (2009)3 was issued on 11 February and members have been asked to review and submit comments to HAI Task Force secretariat before the next meeting.

Action: HAI Task force members to review the remit and membership (paper HAITF (2009) 3 refers) and submit comments by 1 May 2009.

15.2 David Bedwell advised members that new hand hygiene campaign materials would be launched on 25 March 2009

16. Date of next meeting

16.1 The next meeting will take place on Wednesday 27 May 2009 from 10.00 - 13.00 in The Board Room, NHS Quality Improvement Scotland, Elliot House, Hillside Crescent, Edinburgh.

HAI Task Force Secretariat

May 2009

ACTION POINTS FROM HAI TASK FORCE MEETING ON 24 FEBRUARY 2009

SGHD ACTIONS

Action: Item 2.1 HAI Task Force secretariat to amend the minutes of the last meeting and issue revised version to members.

Action: Item 4.1 HAI Task Force secretariat to issue a copy of the presentations on Lessons from Maidstone in Kent/Care Bundles

Action: Item 6.2 Callum Percy to provide feedback to the HAI Task force on the outcome of his meeting with PFPI Directors on 24 February 2009.

Action: Item 14.1 Kevin Hanlon to clarify the content of the Labour 15 point action plan paper. HAI Task Force secretariat to issue revised version of paper along with the letter form the Cabinet Secretary for Health and Wellbeing, HAI Task Force Delivery Plan and National Action Plan. Comments to be provided by 20 March 2009; and a reminder to issue one week before comments are due.

MEMBERS' ACTIONS

Action: Item 5.6 NHS Quality Improvement Scotland to provide updates on the progress being made in establishing the new Care Environment Inspectorate to the HAI Task Force Secretariat, for circulation to Task Force members.

Action: Item 10.3 NES to issue a copy of their literature review on "Central Venous Catheters: placement and management of infants admitted to a Neonatal Intensive Care Unit" to all HAI Task Force members.

Action: Item 15.1 HAI Task force members to review the remit and membership (paper HAITF (2009) 3 refers) and submit comments by 1 May 2009.