Tackling Healthcare Associated Infection the Scottish Programme

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Tackling Healthcare Associated Infection the
Scottish Programme
Dr Peter Christie Senior Medical Officer Scottish
Government Health Directorate
Better Health, Better Care 24 June 2008
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Scottish Government HAI Task Force

• Established in January 2003 to implement the
  Ministerial Action Plan
• Coherent, comprehensive programme of work
• HAI as a key element of patient, visitor and
  staff safety
• Infection Control is everyones business
• Ensuring firm foundation e.g.
• Code of practice
• Education
• National cleaning services specification
• Surveillance
• Antimicrobial resistance

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HAI Task Force Delivery Plan (2005-2008)
Surveillance
Antimicrobial Prescribing
Hand Hygiene Campaigns
Research
Structure
Effective Infection Prevention and Control
Estates, Facilities and The environment
Implementation and monitoring
Patient safety patient experience
Guidance
Education
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NHS Scotland National HAI Prevalence Survey

• Launched in July 2007
• To provide the Healthcare Associated Infection
  Task Force with
• baseline information on the total prevalence of
  HAI in Scottish hospitals
• its burden in terms of health service utilisation
  and costs
• a consistent methodology which will allow the
  evaluation of measures taken to reduce the burden
  of HAI

• Overall national HAI prevalence of 9.5 for acute
  hospitals and 7.3 community hospitals

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NHS Scotland National HAI Prevalence Survey

• Priority areas for intervention
• Care and maintenance of devices (urinary
  catheters, peripheral and central vascular
  catheters and mechanical ventilation)
• Surgical site infection prevention
• Prudent prescribing of antimicrobials
• Care Bundle Approach
• Continuing improvement of infection prevention
  and control
• SIRN research
• Impact of HAI outbreaks

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NHS Scotland National HAI Prevalence Survey

• Priority areas for surveillance
• Catheter associated urinary tract infection
  (CAUTI)
• Surgical site infection
• Gastrointestinal Infection (specifically
  Clostridium difficile)
• Skin and soft tissue infections
• Central vascular catheters and peripheral
  vascular catheters
• Blood stream infections
• Repeated targeted surveillance for high risk
  specialties

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Superbug screening for all urged BBC September
2007
Doctors want MRSA screening plan BBC March 2006
MRSA checks before patients go in The Guardian
June 2005
Tougher screening in fight against superbugs The
Times October 2007
Patients set for MRSA screen before hospital
entry The Scotsman August 2007
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Issues

• Most HAITF outputs are also aimed at MRSA as part
  of overall infection control prevention
  strategy
• MRSA is special particular unique elements,
  public confidence, political profile
• Dont want a separate strategy for each infection

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UK National Guidance on MRSA
SHFN30 Infection control the built environment
SCRIBE
HAITF Prudent antibiotic prescribing
HAI Education
HR Staff screening policy
HAITF Alcohol-based hand rubs NHS QIS health
technology assessment
HAITF Organisn structures
HAI Model Polices and Procedures including MRSA
NHS QIS HTA on patient screening
MRSA strategy
Hand Hygiene Programme
SAB HEAT target
HAITF Task 12 Risk Management of HAI
SGHD single room provision policy
Scottish Patient Safety Alliance
HAITF best practice visits to Denmark
Netherlands
National Cleaning Services Specification
Mandatory MRSA/MSSA surveillance
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How we got here

• Lack of professional consensus
• National guidance diagnosis, treatment,
  prevention control BSAC/SACAR
• SISS discussion document
• NHS QIS HTA on screening
• Interest in search destroy models

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Run chart of quarterly number of S. aureus
bacteraemia in Scotland, 1st April 2005 to 31st
March 2008 with HEAT target trajectory to 31st
March 2010
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Infection control and management of MRSA
assessing the knowledge of staff in an
acute hospital setting P.M. Easton a,, A. Sarma
b, F.L.R. Williams c, C.A. Marwick d, G. Phillips
e, D. Nathwani f JHI 2007
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Proposed components of MRSA strategy

• Differential approach to prevention control
• high vs low incidence
• search destroy vs manage down
• Screening patients and staff, incl. HR issues
• Management of cases and carriers, prescribing
• Tracking of strains MRSA Ref Lab
• Movement of patients
• Built environment isolation/cohorting
• Environmental controls incl. cleaning
• Community associated CA-MRSA

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Health Technology AssessmentMRSA Screening

• Published September 2007 and assessed the
  clinical and cost effectiveness of various MRSA
  screening strategies
• Concluded that chromogenic agar screening of all
  hospital patients is the only effective and cost
  effective option
• Conclusions should be tested through a 1 yr pilot
  study

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Current MRSA Screening in Scotland

• Survey of IC lead staff all but two Boards
  replied
• 60 units some risk assessment of MRSA
  colonisation
• Risk assessment pre-elective admission and lab
  screen for high risk patients/ procedures
• Lab methods variety to identify MRSA test
  susceptibility
• Turnaround times min 24-72 hours, max 72-120
  hours
• MRSA colonised/infected isolate or cohort (63)

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Key issues in MRSA screening

• Key aspects of a screening programme
• Legal and ethical issues
• Consent
• Balance of harm and benefit
• Legal consequences
• Building and site issues
• 3 isolation rooms per 25 bed unit
• Expansion in MRSA lab testing

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Key Issues contd

• Staff resources and training
• Lab capacity and training
• Pre-admission assessment
• Infection Control Nurse Specialist time
• Demands on infection control team
• Information Management of MRSA screening
• Quality assurance and audit
• CPA
• Risk assessment and swab techniques

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UK National Guidance on Cdiff
SHFN30 Infection control the built environment
SCRIBE
HAITF Prudent antibiotic prescribing
HAI Education
ScotMARAP
HAITF Organisn structures
New Reference Laboratory
HAI Model Polices and Procedures including Cdiff
Patient informn
C.diff
Hand Hygiene Programme
Dress code
HAITF Task 12 Risk Management of HAI
SGHD single room provision policy
Scottish Patient Safety Alliance
HAITF best practice visits to Denmark
Netherlands
National Cleaning Services Specification
Mandatory Cdiff surveillance
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Scottish Patient Safety Alliance Five objectives

• Reduce healthcare associated infection
• Reduce adverse surgical incidents
• Reduce adverse drug events
• Improve critical care outcomes
• Improve the organisational and leadership culture
  on safety

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What are our tools?

• Care bundles
• Local application of local data compliance and
  surveillance
• Staff involvement
• Cultural change toolkit
• Local governance, assurance
• Make it easy to do the right thing

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The new HAI Task Force Programme

• New three year programme starting March 2008
• 54m over the next three years
• Reflects Point Prevalence Survey priority areas,
  incorporates MRSA screening
• New delivery plan covers 5 main areas
• Patient Safety, Practice and Culture
• Education
• Surveillance, Information and Audit
• Guidance and Standards
• Physical Environment

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Delivery Plan 2008 2011

• Patient Safety, Practice and Culture
• Care Bundles development, implementation and
  evaluation
• Public involvement programme and Patient
  Experience
• Community Health Partnerships and Infection
  Control
• Support for decontamination expertise
• Education
• Education programmes for HAI professional
  development
• Educational packages for specific topics (e.g.
  pressure ulcers, care in isolation, Cdiff)
• Continuing development of Hand Hygiene and
  Cleanliness Champions programmes.

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Delivery Plan 2008 2011

• Surveillance, Information and Audit
• Continuing development of existing surveillance
  programmes
• Repeated targeted prevalence surveillance
• Development and implementation of the second
  National Point Prevalence Survey - ? 2011
• Surveillance of antimicrobial resistance and
  antibiotic use
• Guidance and Standards
• Continuing development of Model Policies
• MRSA Screening Pilot leading to full
  implementation
• contd.

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Delivery Plan 2008 2011

• Guidance and Standards (continued)
• Support implementation and review of NHSQIS
  Infection Control Standards (based on HAI CoP)
• Implementation of ScotMARAP recommendations
• Physical Environment
• Further development of the monitoring framework
  for the NHSScotland National Cleaning Services
  Specification
• Development an HAI education/training framework
  for facilities staff
• Promote specification of new builds as fit for
  purpose for HAI prevention

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Some of the challenges

• Sustaining coherence, focus and drive following
  the initial intensive programmes
• Sustaining and increasing improvements
• Meshing with the Scottish Patient Safety alliance
  and the Patient Experience programmes
• Increasing professional awareness and public
  confidence
• Getting better

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Catch on fire with enthusiasm and people will
come for miles to watch you burn.
John Wesley (1703 1791)
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