Eleventh meeting of the Healthcare Associated Infection (HAI) task force, held at 10.00am on Thursday 11 December 2008, in the Carrington Suite, Health Service Centre, Crewe Road South, Edinburgh
Present:
Scott ish Government Health Directorates
Mr Paul Martin, Chief Nursing Officer (Chair)
Mr Kevin Hanlon, HAI Policy Unit
Mrs Linda Middleton, HAI Unit
NHSScotland and other representatives
Mr Mark Aggleton, Healthcare Policy & Strategy Directorate (deputising for
Mr Colin Brown, Branch Head Patients & Quality Division)
Mrs Margaret Brown, Project Leader HAI, NHS Education for Scotland
Mr Robin Creelman, Chair of HAI Task Force Public Involvement Communications Team
Ms Rose Gallagher, Nursing Advisor Infection prevention and Control, Royal College
of Nursing
Dr Mary Hanson, Microbiologist, Joint Chair Scottish Microbiology Forum
Mr Paul Kingsmore, Director, Health Facilities Scotland
Mr Joseph Lynch, Regional Organiser, Scottish Partnership Forum (UNISON)
Ms Audrey McKenzie, Professional Adviser Infection Control, Care Commission (deputising
for Mrs Susan Brimelow)
Mr John McMeekin, Public Involvement Representative and PICT member
Dr Bob Masterton, Medical Director, NHS Ayrshire and Arran
Ms Sue Neilson, Operations/Development Manager (Health), Care commission (also
deputising for Mrs Susan Brimelow)
Mr Bob Parry, Associate Director, NHS Education Scotland
Dr Jacqui Reilly, Consultant Nurse Epidemiologist/Head of Group, Health Protection
Scotland
Dr Charles Saunders, Scottish Joint Consultants Committee
Mrs Gillian Stevenson, Nurse Consultant (Healthcare Associated Infection), Infection
Prevention Society (Co-ordinator Scottish Branch)
Dr Eugene Waclawski, Director of Occupational Health, NHS Greater Glasgow and Clyde
Mr Tom Walsh, Senior Infection control Manager, NHS Greater Glasgow and Clyde
Ms Jannette Wheeler, Scottish Branch Chair, Association of Domestic Services Management
Ms Susan Wilson, Scottish Ambulance Service (deputising for Tony Wigram)
In attendance
Mr David Bedwell, Assistant Director, Health Facilities Scotland (deputising for Paul
Kingsmore)
The following apologies were noted:
Dr Eleanor Anderson, Consultant in Public Health Medicine, NHS Lanarkshire
Mrs Susan Brimelow, Director of Healthcare Regulation, Care Commission (Audrey Mackenzie and Sue Neilson deputising)
Mr Colin Brown, Branch Head, Patients & Quality Division (Mr Mark Aggleton deputising)
Dr Harry Burns, Chief Medical Officer (Deputy Chair), Scottish Government Health
Directorate
Mrs Carol Fraser, Nursing Adviser HAI, Scottish government Health Department
Mr John Glennie, Chief Executive, NHS Borders
Mrs Heather Kelman, General Manager, Community Health Partnership, NHS Grampian
Dr Mini Mishra, Senior Medical Officer (Primary Care), Scottish Government Health
Directorate
Ms Mary Morgan, Director Health Protection Scotland
Mr Alan Morrison, Operations Manager Environmental Health, Argyll and Bute Council
Ms Jane Murkin, National Co-ordinator, Scottish Patient Safety Programme
Ms Lorna Renwick, NHS Programme Manager, NHS Health Scotland
Miss Margie Taylor, Chief Dental Officer, Scottish Government Health Directorate
Ms Jan Warner, Director of Patient Safety and Performance Assessment , NHS Quality
Improvement Scotland
Mr Tony Wigram, Health and Safety Manager , Scottish Ambulance Service (Ms Susan Wilson deputising)
Mr Paul Wilson, Executive Director for AHPs, Nursing & Midwifery, NHS Lanarkshire
1. Welcome
Paul Martin welcomed everyone to the meeting and introduced the following new members, Kevin Hanlon, Head of HAI Policy Unit; Rose Gallagher, Royal College of Nursing; Alan Morrison, Society of Chief Officers of Environmental Health in Scotland; Mr Bob Parry, NHS Education for Scotland; Mr Tom Walsh, Infection Control Manager, NHS Greater Glasgow and Clyde; and Sue Neilson, Care Commission (in attendance).
2. Apologies
Paul Martin noted apologies as above.
3. Minutes of meeting held on 3 September 2008
3.1 The minutes from the meeting held on 3 September 2008 were agreed.
4. Matters Arising
4.1 There were no matters arising.
5. HFS Presentation: External Audit Report on compliance with Cleaning Monitoring Framework
5.1 David Bedwell of Health Facilities Scotland (HFS) gave a presentation on the External Audit Report on compliance with the cleaning Monitoring Framework. A copy of the presentation will be issued along with the minutes of the meeting.
5.2 David advised members that
- HFS would be working with PFPI to secure the services of public reviewers.
- The issue of training and education for public members would be reviewed.
- HFS would look at the frequencies of national cleaning specification.
- A meeting had been arranged to discuss the monitoring of hard facilities management; and a follow through report would be provided for the next meeting.
- Monitoring of public, and intensive clinical areas needed review.
5.3 David was asked to include more detail in the final slide of his specification.
5.4 Points raised in discussion:
- The point was raised that poorly maintained buildings do not look clean.
- Public perception of clean is visual
- Shabby does not always mean dirty
Action: David Bedwell to provide follow through report on monitoring of hard
facilities management for next meeting.
David Bedwell to amend the final slide of his presentation and submit the
HAI Task Force secretariat.
HAI Task Force secretariat to issue copy of presentation along with
minutes of the meeting.
6. Care Environment Inspectorate
6.1 Paul Martin advised members that the establishment of a Healthcare Associated Infection Independent Inspectorate had been announced by the Cabinet Secretary for Health and Wellbeing on 11 November; that the Inspectorate would carry out inspections that were random and risk based, to ensure robust scrutiny of NHS processes and facilities; eports of these inspections would be published to ensure greater transparency and accountability; and that the consultation on the structure and remit for the Inspectorate would end on 12 December.
6.2 The following points were raised in discussion:
- It was thought the establishment of an Independent Inspectorate should help combat adverse media coverage about HAI;
- Provided the opportunity to highlight the enhanced roles for public and partnership working; and
- Whether the Inspectorate should cover the Care Home sector.
6.3 Members were advised the Inspectorate would report direct to Cabinet Secretary and Parliament and should be in place by April 2009. An update on progress to be given at the next HAI Task Force meeting.
Action: HAI Task Force secretariat to ensure the Independent Care Inspectorate
is included on the agenda for the next meeting.
7. Single Room Provision
7.1 Paul Martin advised members that guidance on single rooms was issued to NHSScotland under CEL 48 (2008) on 11 November 2008. It was noted that the South Glasgow hospital was designed using a tower block model and would comprise of all single room provision.
7.2 Paul Kingsmore advised that Health Facilities Scotland is undertaking a comprehensive review of all current guidance with a view to providing a single best practice document for maintaining a clean care environment. The question of addressing refurbishment in the short as well as long term would also be considered.
7.3 The Estates Department within Health Facilities Scotland is in the process of gathering data on the number of single rooms. Knowing that the percentage numbers of single rooms is low, Estates Departments is also considering on how best to define single rooms. Jacqui Reilly requested that this information be passed to her to inform work on the MRSA screening programme.
Action: Health Facilities Scotland to send single room data, when collected, to
Jacqui Reilly at Health Protection Scotland.
8. Freedom of Information Requests
8.1 Paul Martin advised members that a Scottish Hospital Survey questionnaire had issued to all NHS Boards; and that a Freedom of Information request had been received from BBC Scotland. The Scottish Hospital Survey covered the numbers of hospital beds, staffing, sanitation, bed spacing, infection control and cleaning, budget and policy; and the answers provided by NHS Boards to the FOI request had been used as the basis for the BBC programme "Scotland Investigates - Death on the Wards". It was clear from the programme that some of the information provided by NHS Boards was inaccurate. Paul emphasised that information provided for this type of request must be accurate, vigorous and robust, and make reference to published data where appropriate.
8.2 Paul Martin also confirmed that a Freedom of Information request had been received from The Herald requesting information on Hand Hygiene compliance. Following on from the replies provided for this questionnaire, Paul advised that audit standards may need t be reviewed.
8.3 A further request had also been received from Mary Scanlon seeking information from NHS Boards on figures for patients who were admitted to hospitals from care homes, what percentage of these patients had C.diff and the number of patients who were admitted with a different type of infection. The response was that this data was not collected or held at Board level.
9. HAI Task Force Delivery Plan: Progress Report - Paper HAITF(2008)14 National Action Plan - Paper HAITF(2008)15 and Greater Glasgow and Clyde Action Plan
Delivery Area 1.8: Public Involvement Programme
9.1 Robin Creelman noted that a meeting with Representatives from the Patient Experience Programme and Patient Focus and International Issues Departments is scheduled for 17 December to discuss the way forward. He advised that he had not had notification of this meeting. Paul Martin requested that both Robin Creelman and John McMeekin be invited to the scheduled meeting.
Action: HAI Task Force Secretariat to ensure that both Robin Creelman and
John McMeekin are invited to the Public Involvement meeting scheduled
for 17 December.
Delivery Area 2.7: Further Development of National Hand Hygiene Project
9.2 Members were advised that this programme would be back on track next month. Funding has been secured and the campaign would not include the general public. The importance of when gel and hand washing was most appropriate needed to be clarified. This issue has been addressed and information credit cards have been cascaded to staff.
Delivery Area 2.12: Development of a Neonatal Vascular Access Programme
9.3 Members were advised there had been a delay with the report but that this should now be issued within the next few weeks. Work on intravenous access using the care bundle approach is due to start in January. An update will be provided at the next meeting. A joint presentation with HPS on care bundles will also be given at the next meeting.
Action: NES to provide update on intravenous access using the care bundle
approach at the next HAI Task Force meeting.
NES and HPS to give a presentation on care bundles at the next HAI
Task Force meeting.
Delivery Area 2.13: Development of an educational package on presentation of infectious diseases in the elderly
9.4 Bob Parry advised that he had met with Jacqui Reilly from HPS and that work would be progressing over the next month.
Delivery Area 4.3: Pilot Study of the Recommendations in the MRSA Health Technology Assessment
9.5 Members were advised that the pilot is now in phase 4. All pathfinder Boards are collecting data and one board is in the process of recruiting staff. This delivery area should be back on track and show a green status for the next progress report. An update on the key measures will be given at the next meeting. Bob Masterton from Ayrshire and Arran pilot site advised members that there had been some issues with GPs but that lessons had been learned. He further advised that the cost of the pilot study had been less than anticipated.
9.6 Kevin Hanlon from SGHD advised members that a letter advising additional funding for local surveillance; 2 million for Clostridium difficile and 1 million for MRSA would be issued within the next few weeks.
Action: HAI Secretariat to issue letter to NHS Boards advising additional funding
for local surveillance.
Delivery Area 4.9: Implementation of SCOTMARAP recommendations, including addressing the educational recommendations
9.6 Members were advised that a pharmacist had been appointed to SAPG and that work is now underway. It is expected the next progress report would show green status. Tom Walsh advised that in Greater Glasgow and Clyde three out of four pharmacists have now been appointed. Antimicrobial policies are now seeing results with more appropriate and less inappropriate prescribing with a significant reduction in Clostridium difficile being reported. Jacqui Reilly advised similar stories from other boards but that good infection prevention and control measures are crucial.
Reporting Template for Board Use
9.7 The reporting template for use by NHS boards is a significant and major development. Cabinet Secretary for Health and Wellbeing has viewed this as positive step. It is hoped to issue the template to Boards for comment next week. Once comments are received the template will be finalised and issued to boards in January for completion. The template will build on data already produced and will develop from there including ward by ward data.
Action Plan Greater Glasgow & Clyde
9.8 Paul Martin advised members that officials of the Scottish Government met with the Chief Executive and officials of NHS Greater Glasgow and Clyde every month to discuss progress with the Action Plan.
Action: HAI Task force Secretariat to issue copies of NHS Greater Glasgow and Clyde action plan to HAI Task Force members.
10. Vale of Leven Follow-up Review
10.1 Paul Martin advised members that the Independent Review Team was due to visit the Vale of Leven hospital later this month to follow up on their original report. Their report was due to be submitted to the Cabinet Secretary for Heath & Well Being by the end of December and published shortly thereafter.
10.2 Members were updated on the current investigations at Vale of Leven Hospital. Strathclyde Police and the Health and Safety Executive were in the process of their respective investigations and are due to report in due course to the Area Procurator Fiscal. It will then be for the Area Procurator Fiscal to determine whether any further inquiries are required before his report is submitted for consideration by Crown Counsel. The Cabinet Secretary for Health and Wellbeing has confirmed that she has not ruled out a public inquiry into the deaths at the Vale of Leven. While these investigations are ongoing her view is that there would be a risk of prejudice to any possible criminal proceedings if a Public Inquiry was ordered now. She has stated that once the Area Procurator Fiscal's investigations were complete and the views of Crown Counsel known that she will return to Parliament to make a statement on next steps.
11. AOCB
11.1 Paul Martin reminded members that the work stream initiation document for "Better Health Better Care" was issued on 9 December for comments. All members confirmed their agreement on content.
11.2 Paul Martin advised members that this would be his last meeting with the HAI Task Force as he is moving on to a new post on 1 March 2009. He expressed his personal thanks to the group for their professional and dedicated input towards progressing the Healthcare Associated Infection agenda.
11.3 Bob Masterton thanked Paul, on behalf of the HAI Task Force members, for direction and leadership in the HAI programme.
12. Date of next meeting and meeting dates for 2009
12.1 The next meeting will take place on Tuesday 24 February 2009 from 10.00 - 13.00 in The Board Room, NHS Quality Improvement Scotland, Elliot House, Hillside Crescent, Edinburgh.
12.2 Further dates for 2009 are as follows:
Wednesday 27 May
Wednesday 30 September
Tuesday 8 December.
12.3 Times and venues as above.
HAI Task Force Secretariat
January 2009
ACTION POINTS FROM HAI TASK FORCE MEETING ON 11 DECEMBER 2008
SGHD ACTIONS
Action: Item 5.1 HAI Task Force to issue copy of presentation on the External Audit Report on compliance with the cleaning Monitoring Framework.
Action: Item 6.3 HAI Task Force secretariat to ensure that the Independent Care Inspectorate is included on the agenda for the next meeting.
Action: Item 9.1 HAI Task Force Secretariat to ensure that both Robin Creelman and John McMeekin are invited to the Public Involvement meeting scheduled for 17 December.
Action: Item 9.6 HAI Secretariat to issue letter to NHS Boards advising additional funding for local surveillance
Action: Item 9.8 HAI Task force Secretariat to issue copies of NHS Greater Glasgow and Clyde action plan to HAI Task Force members.
MEMBERS' ACTIONS
Action: Item 5.2 David Bedwell to provide follow through report on monitoring of hard facilities management for next meeting.
Action: Item 5.3 David Bedwell to amend the final slide of his presentation on the External Audit Report on compliance with the cleaning Monitoring Framework and submit to the HAI Task Force secretariat.
Action: Item 7.3 Health Facilities Scotland to send data, when collected, on single room provision across the NHSS estate to Jacqui Reilly at Health Protection Scotland.
Action: Item 9.3 NES to provide update on intravenous access using the care bundle approach at the next HAI Task Force meeting.
Action: Item 9.3 NES and HPS to give a presentation on care bundles at the next HAI
Task Force meeting.