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.

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

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. 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. But – we still have challenges Continued improvement Sustainability Competing priorities

5. Healthcare Associated Infections: Challenges, Solutions and Future Priorities Prof Robert G Masterton Chair of the HAI National Advisory Group

7. HAI Taskforce SPSP Quality Strategy

9. QUALITY Measurement Framework Quality Outcome Measures HEAT Supporting local and national quality indicators 1 2 3

10. 1 2 4 5 QUALITY INITIATIVES COST REDUCTION PROGRAMMES Costs more Cost neutral Improves quality Quality neutral Reduces quality reduces costs 3

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

12. Challenges Clear vision & strategy Leadership Partnerships Clear Accountability Competence Measurement Monitoring Assurance

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

16. Future Priorities

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.

19. HAI CHALLENGES AT WARD LEVEL

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

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

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

24. CLARIFICATION OF HEALTH AND SAFETY REPRESENTATIVE ROLE WITHIN WARD PATIENT SAFETY INITIAITIVE SPECIAL PHARMACY LINKS

25. STRATEGIES- 6 PRIORITIES- CLEAN AND SAFE CARE ENVIORNMENT NHS TAYSIDE- INFECTION CONTROL POLICY

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

34. “ Infection control is everyone’s business”

35. Healthcare Associated Infections: Challenges, Solutions and Future Priorities The NHS Dumfries and Galloway Story Hazel Borland Nurse Director Executive HAI Lead

41. NHS Dumfries and Galloway: CDI HEAT Performance by quarter

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