Dear Colleague
ALCOHOL BASED HANDRUBS AND INFECTION CONTROL
From the
Chief Nursing Officer
Paul Martin RN, RHV, DMS, MBA
______________________________
St. Andrew's House
Edinburgh EH1 3DG
Telephone 0131-244-2314
Fax 0131-244-2042
Paul.Martin@scotland.gsi.gov.uk
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CNO(2005)1
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9 February 2005
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For action
Chief Executives, NHS Boards
Contracting Services, Scottish Healthcare Supplies
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For information
Finance Directors, NHS Boards
Chief Executive, NHS Education for Scotland
Chief Executive, NHS Quality Improvement Scotland
Scottish Ambulance Service
State Hospitals Board for Scotland
Directors of Public Health
Clinical Director, Health Protection Scotland
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Further enquiries
Dr Peter Christie
Senior Medical Officer
Room 2N.07
St Andrew's House
EDINBURGH
EH1 3DG
Telephone: 0131 244 2806
Fax: 0131 244 2030
Peter.Christie@scotland.gsi.gov.uk
1. One of the most important components in improving control of healthcare associated infections (HAIs) is good hand hygiene. Studies have shown that infection rates can be reduced by 10-50% when healthcare staff comply with correct hand hygiene practice. This letter sets out the Executive's proposals for establishing widespread use of alcohol-based handrub as an adjunct to hand washing by 1st April 2005.
2. This aligns with The NHSScotland Code of Practice for the Local Management of Hygiene and HAI ( http://www.scotland.gov.uk/library5/health/lmhhai-00.asp) issued by the HAI Task Force in May 2004. The Code of Practice requires good hand hygiene before and after contact with patients, and sets out the obligation for regular audit. This also meshes with the elements of the hand hygiene policy required by the CSBS/NHS QIS HAI Infection Control Standards (2001) at Standard 15.
3. As Chief Nursing Officer and Deputy Chair of the HAI Task Force, I have been charged with taking forward the implementation phase of the Task Force programme. This letter signals the first element of that process.
4. I should be grateful if Chief Executives would circulate this document to their Divisional Directors, Medical and Nursing Directors, to Infection Control Managers (and thereby to local Infection Control Committees), and to Heads of Procurement. Scottish Healthcare Supplies will be writing separately to coordinate the operational aspects of purchase and implementation, and will be arranging meetings with key personnel including infection control, estates, procurement and pharmacy.
Implementation
5. It is intended that alcohol-based handrubs (also known as 'alcohol gels') should be available to staff as near to each individual patient as possible. In the acute setting this could be a wall-mounted dispenser, or one attached to the end of each bed. For clinical areas where this would not be appropriate from a risk management point of view (e.g. with very young or confused patients) a personal dispenser for staff, carried on the belt or in the pocket, would be appropriate.
6. The initial priority for implementation by April 2005 will be for ensuring that alcohol handrubs are available near every bed in acute, obstetric and geriatric units. However, this should be part of routine good practice across NHSScotland, including primary care and community services, and NHS Boards are asked to implement this programme in all areas as soon as is practicable. A preliminary survey carried out by NHS Quality Improvement Scotland suggests that use of alcohol handrubs is already widespread in some areas.
7. Alcohol-based hand rub causes less irritation to the skin than soap. However, conventional hand washing with soap and water is required when hands are visibly soiled. It is important to emphasise the need for assessing and managing the main risks associated with alcohol-based hand rub (i.e fire, ingestion and skin irritation) whilst recognising the reductions in HAI that can be made by using this product
8. Scottish Healthcare Supplies have negotiated for extra supplies to be made available through existing national contracts, with a view to establishing revised contracts later in the year based on higher levels of use.
9. The economic evaluation carried out in England for their 'Cleanyourhands' programme suggests that use of alcohol handrubs is cost-saving for health services even at very low levels of effectiveness against HAIs. The Executive will, nonetheless, be allocating an extra £150,000 to NHSScotland in the current financial year to assist with startup costs, followed by a further £900,000 in 2005-06.
10. Implementation of use should be accompanied by effective staff training in hand hygiene. NHS Education Scotland has produced a self-directed web-based hand hygiene training module based on the Cleanliness Champions programme, which can be accessed at http://www.nes-hai.info/.
11. Chief Executives are asked to ensure that the appropriate resources are made available for implementation in collaboration with Scottish Healthcare Supplies, and to confirm with Linda Middleton ( Linda.Middleton@scotland.gsi.gov.uk) by the end of April 2005 that this policy has been implemented across the specified clinical areas.
Yours sincerely
PAUL MARTIN
Chief Nursing Officer