Healthcare Associated Infections
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Healthcare Associated Infections Challenges, Solutions and Future Priorities Carol Fraser, Nurse Advisor Healthcare Associated Infection & Rona Tatler, Senior Policy Officer, Scottish Government.

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Healthcare Associated InfectionsChallenges, Solutions and Future PrioritiesCarol Fraser, Nurse Advisor Healthcare Associated Infection & Rona Tatler, Senior Policy Officer, Scottish Government


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Healthcare Associated InfectionVision: 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.


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Good News!Great progressLowest ever rates of Staphylococcus aureus bacteraemia (SABS)and Clostridium dificile infection (CDI)Highest rate of compliance with hand hygiene and environmental cleaning


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But – we still have challengesContinued improvementSustainabilityCompeting priorities


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Healthcare Associated Infections: Challenges, Solutions and Future PrioritiesProf Robert G MastertonChair of the HAI National Advisory Group


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HAI Future Priorities

Taskforce

SPSP

Quality Strategy


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  • 3 Quality Ambitions Future Priorities

    • 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


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1 Future Priorities

Quality Outcome Measures

2

HEAT

3

Supporting local and national quality indicators

QUALITYMeasurement Framework


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QUALITY INITIATIVES Future Priorities

COST REDUCTION PROGRAMMES

1 2

45

3

Costs more Cost neutral Improves qualityQuality neutral Reduces quality

reduces costs


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Adapted from “Nursing Towards 2015 Future Priorities

Alternative Scenarios for Healthcare, Nursing and Nurse Education in the UK in 2015”

(Longley, Shaw, Dolan, 2007)

NMC Publishing


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Challenges Future PrioritiesClear vision & strategy Leadership PartnershipsClear Accountability Competence Measurement Monitoring Assurance


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Challenges Future PrioritiesThe easy bits are behind usDe - cluttering and Role clarity Reliable and consistent practiceWicked issues – culture, people, leadership, choosing not to do the right thing


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Solutions Future Priorities

  • 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.


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Future Priorities Future Priorities


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Future Priorities Future PrioritiesEstablish the evidence.Translational research to work out what works best.Cost effectiveness tested and delivered.Find and deliver the right quality improvement measurements.Communication.


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HAI CHALLENGES AT WARD LEVEL Future Priorities


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PRIMARY DRIVERS Future Priorities HEALTHCARE QUALITY STRATEGY FOR NHS SCOTLAND (2010) LEADING BETTER CARE POTENTIAL UNANNOUNCED HEI HAI INSPECTION AUDIT TOOL NHST AUDIT (Jan 2011)


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PRIMARY DRIVERS Future PrioritiesNHS TAYSIDE SCN ANNUAL OBJECTIVES (2011-2012)“DEMONSTRATE YOUR PERSONAL CONTRIBUTION IN TERMS OF MANAGING HEI/HAI WITHIN YOUR CLINICAL AREA”


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SECONDARY DRIVERS Future PrioritiesIMPROVE INVOLVEMENT AND WORKING PARTNERSHIP WITH HOTEL SERVICES, ESTATES AND INFECTION CONTROL NURSE CLARIFICATION OF CLEANLINESS CHAMPION ROLE WITHIN WARD


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CLARIFICATION OF HEALTH AND SAFETY REPRESENTATIVE ROLE Future Priorities WITHIN WARD PATIENT SAFETY INITIAITIVE SPECIAL PHARMACY LINKS


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STRATEGIES- 6 PRIORITIES- Future Priorities CLEAN AND SAFE CARE ENVIORNMENT NHS TAYSIDE- INFECTION CONTROL POLICY


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SECONDARY DRIVER Future Priorities

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


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SECONDARY DRIVER Future Priorities

Clarification of cleanliness champion role within ward

KEY CHANGES FOR PDSA

Meeting with champions

In-house audits/feedback

Training/supporting role


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SECONDARY DRIVER Future Priorities

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


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SECONDARY DRIVER Future Priorities

Patient safety

KEY CHANGES FOR PDSA

Hand hygiene monitors

Quality improvement

Scottish patient safety programme


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SECONDARY DRIVER Future Priorities

Pharmacy service

KEY CHANGES FOR PDSA

NHS Tayside Antibiotic policy

Staff education

Local protocol for results and reviews


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SECONDAY DRIVER Future Priorities

Clean and safe environment

KEY CHANGES FOR PDSA

Releasing time to care

Patient status at a glance

Cleaning schedule/times

MRSA checklist


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SECONDARY DRIVER Future Priorities

Infection control policy

KEY CHANGES FOR PDSA

Staff training

Cleaning matrix

Staff involvement

Recording and documentation of cleaning evidence


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OBJECTIVE Future Priorities

Demonstrate your personal contribution in terms of managing HEI/HAI within your clinical area



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Healthcare Associated Infections: Challenges, Solutions and Future PrioritiesThe NHS Dumfries and Galloway StoryHazel BorlandNurse DirectorExecutive HAI Lead


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Overview Future Priorities

  • Context

  • Successes

  • Challenges

  • Outcomes


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Context Future Priorities

Extensive national policy documents giving explicit guidance

Healthcare Quality Strategy

Healthcare Environment Inspectorate

Promoting public confidence – enabling staff to feel sense of pride


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Successes Future Priorities

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


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Challenges Future Priorities

Sustainability and reliability

Local V national

Measurement for improvement

Maintaining energy levels

Inspection

Analysing data collected for different purposes


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Outcomes Future Priorities

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



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NHS Dumfries and Galloway Future Priorities

CDI Incidence by Month for GPs and DGRI (12 Month Moving Average)

14

12

10

DGRI CDI cases - 12 month moving average

Incidence

8

6

GP CDI cases - 12 month moving average

4

2

0

May

May

May

May

May

Aug

Aug

Dec

Dec

Aug

Aug

Aug

Mar

Nov

Mar

Dec

Dec

Dec

Nov

Nov

Mar

Nov

Mar

Nov

Mar

Sep

Sep

Sep

Sep

Sep

Feb

Feb

Feb

Feb

Feb

Jan

Jun

Jan

Jun

Apr

Apr

Jan

Jun

Jun

Jan

Jun

Apr

Apr

Apr

Oct

Oct

Oct

Oct

Oct

Jul

Jul

Jul

Jul

Jul

2006/07

2007/08

2008/09

2009/10

2010/11


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HAI Executive Leads Future Priorities

Persistence

Need to challenge practice

Importance of data and interpretation

Culture

Balance and translation of scrutiny and inspection


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Thanks Future Priorities

Infection Control and Health Protection Teams

NHS Dumfries and Galloway staff

Patients and the public.


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Any questions Future Priorities?

Hazel Borland

Nurse Director

Executive Lead for HAI

NHS Dumfries and Galloway

hazelborland@nhs.net