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A valuable opportunity for delegates to talk freely about some of the difficulties they face in tackling HAI and to learn and share positive initiatives that have been undertaken across NHSScotland.
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Healthcare Associated InfectionsChallenges, Solutions and Future Priorities
Carol Fraser, Nurse Advisor Healthcare Associated Infection & Rona Tatler, Senior Policy Officer, Scottish Government
Healthcare Associated Infection
Vision: to provide the safest healthcare system in the world through creating a zero tolerance approach to avoidable infections, and delivering safe, effective and person centred care through continued improvement in the prevention and control of Healthcare Associated Infections.
Good News!
Great progress
Lowest ever rates of Staphylococcus aureus bacteraemia (SABS)and Clostridium dificile
infection (CDI)
Highest rate of compliance with hand hygiene and environmental cleaning
But – we still have challenges
Continued improvementSustainability
Competing priorities
Healthcare Associated Infections: Challenges, Solutions and Future Priorities
Prof Robert G MastertonChair of the HAI National Advisory Group
HAI Taskforce SPSP
Quality Strategy
3 Quality Ambitions – Mutually beneficial partnerships between patients,
their families and those delivering healthcare services. Partnerships which respect individual needs and values and which demonstrate compassion, continuity, clear communication and shared decision-making.
– No avoidable injury or harm from the healthcare they receive, and that they are cared for in an appropriate, clean and safe environment at all times.
– The most appropriate treatments, interventions, support and services will be provided at the right time to everyone who will benefit, with no wasteful or harmful variation.
Person centred
Safe
Effective
QUALITYMeasurement Framework
Quality Outcome Measures
HEAT
Supporting local and national quality indicators
1 2
4 5
QUALITY INITIATIVES
COST REDUCTION PROGRAMMES
Costs more Cost neutral Improves quality Quality neutral Reduces quality reduces costs
3
Consolidation of Money AND Gap between supply and demand
Diversity between Boards AND Commonality of constraints
Emphasis on Prevention AND Control
Continued dominance of the hospital AND Policy drive for care closer to home
Sustaining the gains AND Getting ready for new threats
Reliance on IPC Experts AND Need to empower
More well-educated, more well-informed and confident patients
AND Many patients lacking information and confidence
Demand for high technical competence and “scientific rationality”
AND Continuing need for “human qualities”
Blurring of role boundaries & team based care
AND Separate occupation/professional traditions, organisations & public expectations
Continuation of old moral certainties AND Moral uncertainties in new environments
Adapted from “Nursing Towards 2015Alternative Scenarios for Healthcare, Nursing and Nurse Education in the UK in 2015”
(Longley, Shaw, Dolan, 2007)NMC Publishing
Challenges
Clear vision & strategy
Leadership PartnershipsClear Accountability Competence Measurement Monitoring Assurance
Challenges
The easy bits are behind us
De - cluttering and Role clarity
Reliable and consistent practice
Wicked issues – culture, people, leadership, choosing not to do the right thing
Solutions Commitment to the cause. Develop capable Boards. Effective execution. Integrate the effort. Set a specific aims. Measure and report performance. Take clinicians, staff, politicians and public
with us.
Future Priorities
Future Priorities
Establish the evidence.Translational research to work out what works best.Cost effectiveness tested and delivered.Find and deliver the right quality improvement measurements.Communication.
HAI CHALLENGES AT WARD LEVEL
PRIMARY DRIVERSHEALTHCARE QUALITY STRATEGY
FOR NHS SCOTLAND(2010)LEADING BETTER CAREPOTENTIAL UNANNOUNCED HEIHAI INSPECTION AUDIT TOOLNHST AUDIT (Jan 2011)
PRIMARY DRIVERSNHS TAYSIDE SCN ANNUAL
OBJECTIVES (2011-2012)
“DEMONSTRATE YOUR PERSONAL CONTRIBUTION IN TERMS OF MANAGING HEI/HAI WITHIN YOUR CLINICAL AREA”
SECONDARY DRIVERSIMPROVE INVOLVEMENT AND WORKING PARTNERSHIP WITHHOTEL SERVICES, ESTATES AND
INFECTION CONTROL NURSE
CLARIFICATION OF CLEANLINESS CHAMPION ROLE
WITHIN WARD
CLARIFICATION OF HEALTH AND SAFETY REPRESENTATIVE ROLE
WITHIN WARD
PATIENT SAFETY INITIAITIVE
SPECIAL PHARMACY LINKS
STRATEGIES- 6 PRIORITIES-CLEAN AND SAFE CAREENVIORNMENT
NHS TAYSIDE- INFECTIONCONTROL POLICY
SECONDARY DRIVER
Improve involvement and working partnership with hotel services, estates and infection control
KEY CHANGES FOR PDSA
In-house audits/walk about using HEI audit tool
Traffic light system to prioritise outcomes
Regular links/visits from IC nurse
SECONDARY DRIVER
Clarification of cleanliness champion role within ward
KEY CHANGES FOR PDSA
Meeting with champions
In-house audits/feedback
Training/supporting role
SECONDARY DRIVER
Clarification of health and safety representative role within ward
KEY CHANGES FOR PDSA
Ward area divided into zones
H & S reps roles
Improvement of facilities
SECONDARY DRIVER
Patient safety
KEY CHANGES FOR PDSA
Hand hygiene monitors
Quality improvement
Scottish patient safety programme
SECONDARY DRIVER
Pharmacy service
KEY CHANGES FOR PDSA
NHS Tayside Antibiotic policy
Staff education
Local protocol for results and reviews
SECONDAY DRIVER
Clean and safe environment
KEY CHANGES FOR PDSA
Releasing time to care
Patient status at a glance
Cleaning schedule/times
MRSA checklist
SECONDARY DRIVER
Infection control policy
KEY CHANGES FOR PDSA
Staff training
Cleaning matrix
Staff involvement
Recording and documentation of cleaning evidence
OBJECTIVE
Demonstrate your personal contribution in terms of
managing HEI/HAI within your clinical area
“Infection control is everyone’s business”
Healthcare Associated Infections: Challenges, Solutions and Future
Priorities The NHS Dumfries and Galloway Story
Hazel BorlandNurse Director
Executive HAI Lead
Overview
• Context
• Successes
• Challenges
• Outcomes
Context
Extensive national policy documents giving explicit guidance
Healthcare Quality Strategy
Healthcare Environment Inspectorate
Promoting public confidence – enabling staff to feel sense of pride
Successes
Commitment at all levels
Single Executive Lead for HAI, Quality and Scottish Patient Safety Programme
Structures, relationships and links between programmes to enable improvement and delivery
Infection Control Manager
Scrutiny
Challenges
Sustainability and reliability
Local V national
Measurement for improvement
Maintaining energy levels
Inspection
Analysing data collected for different purposes
Outcomes
Reduction in C Difficile by 50%
Reduction in SABs:MSSA: 31%
MRSA: 79%
Hand hygiene performance: above 94% since July 2009, above 90% since May 2008
SPSP outcomes
NHS Dumfries and GallowayCDI HEAT Performance by Quarter
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
Apr-Jun Jul-Sep Oct-Dec Jan-Mar Apr-Jun Jul-Sep Oct-Dec Jan-Mar Apr-Jun Jul-Sep Oct-Dec Jan-Mar
2008/09 2009/10 2010/11
CD
I rat
e pe
r 100
0 O
ccup
ied
Bed
Day
s (O
CB
D) >
65
HEAT Target
HEAT Performance
NHS Dumfries and Galloway: CDI HEAT Performance by quarter
NHS Dumfries and Galloway
CDI Incidence by Month for GPs and DGRI (12 Month Moving Average)
0
2
4
6
8
10
12
14F
eb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
No
v
De
c
Jan
Fe
b
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
No
v
De
c
Jan
Fe
b
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
No
v
De
c
Jan
Fe
b
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
No
v
De
c
Jan
Fe
b
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
No
v
De
c
2006/07 2007/08 2008/09 2009/10 2010/11
Inci
den
ce
DGRI CDI cases - 12 month moving average
GP CDI cases - 12 month moving average
NHS Dumfries and GallowayTotal Staphylococcus aureus bacteraemia (SAB) Incidence by Quarter
0
5
10
15
20
25
Apr-Jun Jul-Sep Oct-Dec Jan-Mar Apr-Jun Jul-Sep Oct-Dec Jan-Mar Apr-Jun Jul-Sep Oct-Dec Jan-Mar
2008/09 2009/10 2010/11
To
tal S
AB
Inci
den
ce
MSSA
MRSA
HEAT Target
NHS Dumfries and GallowayHand Hygiene Compliance - Audit Results (2007-2011)
0
10
20
30
40
50
60
70
80
90
100
% H
and
Hyg
iene
Com
plia
nce
HAI Executive Leads
Persistence
Need to challenge practice
Importance of data and interpretation
Culture
Balance and translation of scrutiny and inspection
Thanks
Infection Control and Health Protection Teams
NHS Dumfries and Galloway staff
Patients and the public.
Any questions?
Hazel Borland
Nurse Director
Executive Lead for HAI
NHS Dumfries and Galloway
