Healthcare Associated Infections: Challenges, Solutions and Future Priorities

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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 Infections: Challenges, Solutions and Future Priorities

  1. 1. Healthcare Associated Infections Challenges, Solutions and Future Priorities Carol Fraser, Nurse Advisor Healthcare Associated Infection & Rona Tatler, Senior Policy Officer, Scottish Government
  2. 2. 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.
  3. 3. 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
  4. 4. But – we still have challenges Continued improvement Sustainability Competing priorities
  5. 5. Healthcare Associated Infections: Challenges, Solutions and Future Priorities Prof Robert G Masterton Chair of the HAI National Advisory Group
  6. 7. HAI Taskforce SPSP Quality Strategy
  7. 8. <ul><li>3 Quality Ambitions </li></ul><ul><ul><li>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. </li></ul></ul><ul><ul><li>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. </li></ul></ul><ul><ul><li>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. </li></ul></ul>Person centred Safe Effective
  8. 9. QUALITY Measurement Framework Quality Outcome Measures HEAT Supporting local and national quality indicators 1 2 3
  9. 10. 1 2 4 5 QUALITY INITIATIVES COST REDUCTION PROGRAMMES Costs more Cost neutral Improves quality Quality neutral Reduces quality reduces costs 3
  10. 11. Adapted from “Nursing Towards 2015 Alternative Scenarios for Healthcare, Nursing and Nurse Education in the UK in 2015” (Longley, Shaw, Dolan, 2007) NMC Publishing 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
  11. 12. Challenges Clear vision & strategy Leadership Partnerships Clear Accountability Competence Measurement Monitoring Assurance
  12. 13. 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
  13. 15. Solutions <ul><li>Commitment to the cause. </li></ul><ul><li>Develop capable Boards. </li></ul><ul><li>Effective execution. </li></ul><ul><li>Integrate the effort. </li></ul><ul><li>Set a specific aims. </li></ul><ul><li>Measure and report performance. </li></ul><ul><li>Take clinicians, staff, politicians and public with us. </li></ul>
  14. 16. Future Priorities
  15. 17. 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.
  16. 19. HAI CHALLENGES AT WARD LEVEL
  17. 20. PRIMARY DRIVERS HEALTHCARE QUALITY STRATEGY FOR NHS SCOTLAND (2010) LEADING BETTER CARE POTENTIAL UNANNOUNCED HEI HAI INSPECTION AUDIT TOOL NHST AUDIT (Jan 2011)
  18. 21. PRIMARY DRIVERS NHS TAYSIDE SCN ANNUAL OBJECTIVES (2011-2012) “DEMONSTRATE YOUR PERSONAL CONTRIBUTION IN TERMS OF MANAGING HEI/HAI WITHIN YOUR CLINICAL AREA”
  19. 23. SECONDARY DRIVERS IMPROVE INVOLVEMENT AND WORKING PARTNERSHIP WITH HOTEL SERVICES, ESTATES AND INFECTION CONTROL NURSE CLARIFICATION OF CLEANLINESS CHAMPION ROLE WITHIN WARD
  20. 24. CLARIFICATION OF HEALTH AND SAFETY REPRESENTATIVE ROLE WITHIN WARD PATIENT SAFETY INITIAITIVE SPECIAL PHARMACY LINKS
  21. 25. STRATEGIES- 6 PRIORITIES- CLEAN AND SAFE CARE ENVIORNMENT NHS TAYSIDE- INFECTION CONTROL POLICY
  22. 26. <ul><li>SECONDARY DRIVER </li></ul><ul><li>Improve involvement and working partnership with hotel services, estates and infection control </li></ul><ul><li>KEY CHANGES FOR PDSA </li></ul><ul><li>In-house audits/walk about using HEI audit tool </li></ul><ul><li>Traffic light system to prioritise outcomes </li></ul><ul><li>Regular links/visits from IC nurse </li></ul>
  23. 27. <ul><li>SECONDARY DRIVER </li></ul><ul><li>Clarification of cleanliness champion role within ward </li></ul><ul><li>KEY CHANGES FOR PDSA </li></ul><ul><li>Meeting with champions </li></ul><ul><li>In-house audits/feedback </li></ul><ul><li>Training/supporting role </li></ul>
  24. 28. <ul><li>SECONDARY DRIVER </li></ul><ul><li>Clarification of health and safety representative role within ward </li></ul><ul><li>KEY CHANGES FOR PDSA </li></ul><ul><li>Ward area divided into zones </li></ul><ul><li>H & S reps roles </li></ul><ul><li>Improvement of facilities </li></ul>
  25. 29. <ul><li>SECONDARY DRIVER </li></ul><ul><li>Patient safety </li></ul><ul><li>KEY CHANGES FOR PDSA </li></ul><ul><li>Hand hygiene monitors </li></ul><ul><li>Quality improvement </li></ul><ul><li>Scottish patient safety programme </li></ul>
  26. 30. <ul><li>SECONDARY DRIVER </li></ul><ul><li>Pharmacy service </li></ul><ul><li>KEY CHANGES FOR PDSA </li></ul><ul><li>NHS Tayside Antibiotic policy </li></ul><ul><li>Staff education </li></ul><ul><li>Local protocol for results and reviews </li></ul>
  27. 31. <ul><li>SECONDAY DRIVER </li></ul><ul><li>Clean and safe environment </li></ul><ul><li>KEY CHANGES FOR PDSA </li></ul><ul><li>Releasing time to care </li></ul><ul><li>Patient status at a glance </li></ul><ul><li>Cleaning schedule/times </li></ul><ul><li>MRSA checklist </li></ul>
  28. 32. <ul><li>SECONDARY DRIVER </li></ul><ul><li>Infection control policy </li></ul><ul><li>KEY CHANGES FOR PDSA </li></ul><ul><li>Staff training </li></ul><ul><li>Cleaning matrix </li></ul><ul><li>Staff involvement </li></ul><ul><li>Recording and documentation of cleaning evidence </li></ul>
  29. 33. OBJECTIVE Demonstrate your personal contribution in terms of managing HEI/HAI within your clinical area
  30. 34. “ Infection control is everyone’s business”
  31. 35. Healthcare Associated Infections: Challenges, Solutions and Future Priorities The NHS Dumfries and Galloway Story Hazel Borland Nurse Director Executive HAI Lead
  32. 36. Overview <ul><li>Context </li></ul><ul><li>Successes </li></ul><ul><li>Challenges </li></ul><ul><li>Outcomes </li></ul>
  33. 37. Context <ul><li>Extensive national policy documents giving explicit guidance </li></ul><ul><li>Healthcare Quality Strategy </li></ul><ul><li>Healthcare Environment Inspectorate </li></ul><ul><li>Promoting public confidence – enabling staff to feel sense of pride </li></ul>
  34. 38. Successes <ul><li>Commitment at all levels </li></ul><ul><li>Single Executive Lead for HAI, Quality and Scottish Patient Safety Programme </li></ul><ul><li>Structures, relationships and links between programmes to enable improvement and delivery </li></ul><ul><li>Infection Control Manager </li></ul><ul><li>Scrutiny </li></ul>
  35. 39. Challenges <ul><li>Sustainability and reliability </li></ul><ul><li>Local V national </li></ul><ul><li>Measurement for improvement </li></ul><ul><li>Maintaining energy levels </li></ul><ul><li>Inspection </li></ul><ul><li>Analysing data collected for different purposes </li></ul>
  36. 40. Outcomes <ul><li>Reduction in C Difficile by 50% </li></ul><ul><li>Reduction in SABs: </li></ul><ul><ul><li>MSSA: 31% </li></ul></ul><ul><ul><li>MRSA: 79% </li></ul></ul><ul><li>Hand hygiene performance: above 94% since July 2009, above 90% since May 2008 </li></ul><ul><li>SPSP outcomes </li></ul>
  37. 41. NHS Dumfries and Galloway: CDI HEAT Performance by quarter
  38. 42. NHS Dumfries and Galloway CDI Incidence by Month for GPs and DGRI (12 Month Moving Average ) 0 2 4 6 8 10 12 14 Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2006/07 2007/08 2008/09 2009/10 2010/11 Incidence DGRI CDI cases - 12 month moving average GP CDI cases - 12 month moving average
  39. 47. HAI Executive Leads <ul><li>Persistence </li></ul><ul><li>Need to challenge practice </li></ul><ul><li>Importance of data and interpretation </li></ul><ul><li>Culture </li></ul><ul><li>Balance and translation of scrutiny and inspection </li></ul>
  40. 48. Thanks <ul><li>Infection Control and Health Protection Teams </li></ul><ul><li>NHS Dumfries and Galloway staff </li></ul><ul><li>Patients and the public. </li></ul>
  41. 49. Any questions ? <ul><li>Hazel Borland </li></ul><ul><li>Nurse Director </li></ul><ul><li>Executive Lead for HAI </li></ul><ul><li>NHS Dumfries and Galloway </li></ul><ul><li>hazelborland@nhs.net </li></ul>

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