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Healthcare Associated InfectionsChallenges, Solutions and Future PrioritiesCarol Fraser, Nurse Advisor Healthcare Associated Infection & Rona Tatler, Senior Policy Officer, Scottish Government
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.
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
But – we still have challengesContinued improvementSustainabilityCompeting priorities
Healthcare Associated Infections: Challenges, Solutions and Future PrioritiesProf 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
1 Quality Outcome Measures 2 HEAT 3 Supporting local and national quality indicators QUALITYMeasurement Framework
QUALITY INITIATIVES COST REDUCTION PROGRAMMES 1 2 45 3 Costs more Cost neutral Improves qualityQuality neutral Reduces quality reduces costs
Adapted from “Nursing Towards 2015 Alternative Scenarios for Healthcare, Nursing and Nurse Education in the UK in 2015” (Longley, Shaw, Dolan, 2007) NMC Publishing
ChallengesClear vision & strategy Leadership PartnershipsClear Accountability Competence Measurement Monitoring Assurance
ChallengesThe easy bits are behind usDe - cluttering and Role clarity Reliable and consistent practiceWicked 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 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.
PRIMARY DRIVERS HEALTHCARE QUALITY STRATEGY FOR NHS SCOTLAND (2010) LEADING BETTER CARE POTENTIAL UNANNOUNCED HEI HAI INSPECTION AUDIT TOOL NHST 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 WITH HOTEL 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 CARE ENVIORNMENT NHS TAYSIDE- INFECTION CONTROL 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
Healthcare Associated Infections: Challenges, Solutions and Future PrioritiesThe NHS Dumfries and Galloway StoryHazel BorlandNurse DirectorExecutive 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 Galloway 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
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 email@example.com