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 screeing programmed 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).
Are there any reports or figures available?
Surveillance is carried out by Health Protection Scotland (HPS) for MRSA/MSSA bacteraemia rates, Surgical Site Infections (SSIs), clostridium difficile and all results are published. A surveillance programme is also in place for catheter-associated urinary tract infections, intensive care infections, and HAI outbreaks.
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.
What is the Scottish Government doing about HAI?
- The Scottish HAI Point Prevalence Survey was launched on 11 July 2007 - one of the biggest and most far reaching studies of its kind ever undertaken. It revealed that the rate of infection in Scotland's acute hospitals was 9.5%. This provides an accurate baseline on which to build.
- £54 million from the Scottish Budget has been committed to tackle a far more comprehensive HAI programme of work.
- Funding provided to fund a one year pilot study on MRSA.
- National Hand Hygiene campaign with messages through a wide audience, including the general public (through a national radio and TV campaign and washroom posters); NHS Staff (posters and hand hygiene compliance monitoring); and schoolchildren (all primary schools and nurseries were issued with Hand Hygiene Packs in September 2007.
- Hand Hygiene campaign now refocused with an emphasis on hand hygiene compliance in the NHS sector with a tarter of at least 90% hand hygiene compliance by November 2008.
- Funding has been provided to the Care Commission over the next three years for the employment of a Nurse Consultant for Infection Prevention and Control in Day Care for Children and Care Homes for Older People.
- The Scottish Management of Antimicrobial Resistance Action Plan (ScotMARAP) was launched on 17 March which builds on the recommendations for good antimicrobial practice in acute hospitals in the HAI Task Force's 2005 guidance Antimicrobial Prescribing Policy and Practice (APP&P).