Questions and Answers
What are Healthcare Associated Infections (HAIs)?
Healthcare Associated Infections (HAIs) are infections acquired in the hospital or other healthcare setting.
Infections are caused by germs such as bacteria, fungi or viruses entering the body. They can be minor and stay in one area, like a boil or a chest infection or they can spread throughout the body, like 'flu or septicaemia (blood poisoning).
HAI is not unique to hospitals and may affect people in care homes, GP practices or dental practices. Examples of HAIs include MRSA and the winter vomiting bug.
Who is at risk?
Hospitalised patients who are very young, elderly or very sick or who have an open wound or a tube going into their body (such as a urinary catheter or intravenous (IV) catheter.
What is the most common types of infections?
Skin infections, bone infections, pneumonia, salmonella, E.coli, MRSA (Meticillin Resistant Staphylococcus Aureus) and C.diff (clostridium difficile).
Where can I get more information?
NHS24 can provide general information about specific organisms such as MRSA and Clostridium difficile.
What can I do to avoid contracting an infection?
The most important thing you can do is to wash and dry your hands (or use alcohol gel if provided).
Wash your hands when you enter or leave any healthcare establishment, before and after visiting a patient in hospital, after you go to the toilet or before having a meal.
If you think a healthcare worker has forgotten to wash their hands, remind them to do so.
Never touch wounds, dressings, drips or other equipment.
Why not bring back Matrons(as they have in England)?
In Scotland our ward sister/charge nurses fulfil the same role as Matrons - e.g. leadership, acting as a role model for staff, responsibility for a safe clinical environment (including cleanliness and safe visiting rules), and being the first point of contact for complaints about cleaning.
In addition, our sisters/charge nurses all undergo specialised Cleanliness Champions training, which will help them in their role of keeping patients safe from infection. The word "Matron" can have old-fashioned and negative overtones - the days of being bossed or frightened into doing the right thing have gone. Infection Control is everyone's business, and everyone's personal and professional responsibility.
What about screening everyone for MRSA?
Before introducing a national MRSA screening programme, we have decided to carry out a one year pilot study in three 'Pathfinder' Boards Ayrshire and Arran, Grampian and Western Isles during 2008/2009 to test the validity and practically of the NHSQIS Health Technology Assessment modelling. Provided the model is proved successful, a national MRSA screening programme will be implemented in 2009/2010.
Has there been any targets set for reducing Healthcare Associated Infections?
An overall target has been set for Scotland to reduce by 30% bloodstream infections (bacteraemias) caused by Staphylococcus aureus (S. aureus) as a result of healthcare associated infection (HAI) by March 2010 from their 2006 levels. S.aureus bacteraemias includes MRSA as well as strains that are not multi-resistant to antibiotics - MSSA (meticillin sensitive S. aureus).
There is also a target to reduce the rate of clostridium difficile associated disease in patients aged 65 and over in Scotland by 30% of 2007 levels by 2011.
Are there any reports or figures available?
There are a number of different reports and figures available at both national at local level, which can be accessed in the statistics section.
Who do I contact if I have any complaints?
Any complaints about treatment or service delivery should be addressed to the patient liaison officer/complaints officer at the relevant hospital or NHS Board.
Is there any monitoring of cleaning standards in hospitals?
The thoroughness of cleaning standards in NHS Boards is monitored by Health Facilities Scotland (HFS) which provides data on compliance with the requirements set out in the NHSScotland National Cleaning Services Specification.
Who is accountable if cleaning standards fall?
A reinforced system of accountability for NHS Boards is in place with most infection control managers answering directly to the Chief Executive. In addition, a National Education and Training Framework for Domestic Assistants is in place to make sure they get the education and training they need to enable them to carry out their work to the highest standard and there is a new Housekeeper programme which focuses on proactive reporting and communication in relation to cleaning and associated patient care issues.
What about Hand Hygiene?
Good hand hygiene is one of the key elements of preventing the spread of healthcare associated infections. Many of the bacterial which cause HAIs can be spread from patient from patient through the hands of visitors and healthcare workers.
The hand hygiene campaign will continue throughout the next three years. Young school children are also being taught about good hand hygiene through the use of Hand Hygiene packs launched in September 2007. The aim of this is to instil a culture of good hand hygiene in young children that should last through their lives.
Hand hygiene for NHS staff is monitored and compliance reports are available from Health Protection Scotland. A target to achieve 90% compliance against their standards was met in November 2008, and there is now a zero tolerance approcah to non-compliance with hand hygiene procedures.
What is the Scottish Government doing about HAI?
- The Scottish Government is committed to increasing public confidence in the NHS. Healthcare Associated Infection (HAI) is a problem for health services around the world and Scotland is no different.
- The Healthcare Associated Infection (HAI) Task Force developed a new and more comprehensive programme of Healthcare Associated Infection (HAI) work from 1 April 2008. This is the first programme where policies and strategies focus on the findings in the Scottish Point Prevalence Survey (PPS).
- We are focusing on practical and effective solutions to tackling Healthcare Associated Infection (HAI) and have introduced a new sustainable and high quality Healthcare Associated Infection (HAI) programme from 2008/2009. This is being backed with significant funding (£54 million) from the Scottish budget over the next three years to support a new Healthcare Associated Infection (HAI) Delivery Plan and MRSA (pilot and national) screening programme.
- In November 2007 we announced funding of £7 million for a pathfinder screening programme in 2008/2009. The purpose of the pathfinder programme is to shape a planned, structured and deliverable £16 million per year national MRSA screening programme from 2009/2010.
- NHS Boards are required to meet the National HEAT target 'To reduce all S.aureus bacteraemias (including MRSA) by 30% by 2010. Progress towards the target is being regularly monitored.
- NHS Boards are required to meet the National HEAT target 'To reduce Clostridium difficle Associated Disease (CDAD) by 30% in the 65+ age group by March 2011.
- We recognise that a key element of preventing the spread of healthcare associated infections is good hand hygiene. The TV and radio Hand Hygiene campaign will be rerun in January 2009 and a harder hitting campaign in the NHS will begin in March 2009.
- The Scottish Government wants to see hand hygiene compliance rates in our hospitals climb to match the levels achieved in hospital cleaning. NHS Boards were set a target to achieve at least 90% of hand hygiene compliance by November 2008. I have now announced a zero tolerance approach to non compliance from January 2009. Yet another example of our commitment to bring HAI rates down in Scotland.
- The provision of single room accommodation in hospitals is one of a range of factors that will help to minimise the risk of cross infection. The Scottish Government has announced that single rooms for patients will become the norm across Scotland with all new build hospitals - such as the new Southern General Hospital in Glasgow - which will provide 100% single accommodation. Refurbishment projects should also ensure at least 50% of accommodation is single rooms.