HAI Policy Update
Scottish Microbiology and Virology Network
15 November 2012
1. European Antibiotic Awareness Day
EAAD is on Sunday 18 November with the main media activity taking place this week. The focus is around decreasing inappropriate antimicrobial use. Whilst AMTs and SAPG have achieved huge success on what to prescribe, the focus is now shifting towhether to prescribe. In support of this, some activities will be directed towards public partners who have expressed interest in supporting this work.
SAPG have prepared materials to support AMTs; and CNO and chair SAPG wrote to Board AMT leads and Directors Communication on 15 October.
Scottish Medicines Consortium European Antibiotic Awareness Day
2. UK antimicrobial resistance strategy 2013-18
A new five year UK AMR strategy and action plan is being developed to replace the previous 2000 version. The technical engagement exercise has been completed (SMVN included) and the strategy is expected to be launched in the New Year.
In 2011 the EU announced a 12 point Five Year Strategic Action Plan for both human and veterinary sectors. This was followed by Ministers’ adoption on 22 June 2012 of the Council of Europe conclusions - the impact of AMR in the human health sector and in the veterinary sector – a “One Health” perspective - which invited Member States to develop and implement national strategies and action plans.
Development of this UK Strategy and Action Plan will allow the UK to comply with the recent Council Conclusions. The UK strategy will provide an overarching framework under which the Scottish revised action plan can sit. The ScotMARAP five year action plan runs from 2008 -13 and the review of this will link in. SAPG hosted a development day 13 November to consider their next round of priorities.
3. Norovirus
The HPS report on evaluation of preparedness for and management of the 11/12 season demonstrated a vast amount of preparation and innovation which has continued in readiness for this season (season commenced 29 Oct 2012).
A norovirus ‘summit’ was held 28 August with input from key stakeholders including SMVN and ICDs. A report on the key recommendations was taken to the HAITF National Policy Group 13 Sep. This includes the recommendation of the NAG re the establishment of a norovirus reference laboratory that:
- this was unlikely to be of any current public health benefit
- the situation should be kept under review
- intelligence from the HPA molecular surveillance initiative should be assessed, and
- research questions should be pursued by SIRN.
The report also includes the draft recommendations from SMVN/SCVG on testing policies which were welcomed.
The summit discussed potential visiting restrictions and their handling, noting the need for any restrictions to be carefully considered and communicated in advance. NPG requested that Boards this year should aim for excellence in communication and that any visiting restrictions should be carefully evaluated. HPS together with the Network are preparing a checklist of issues Boards should consider.
HPS are developing a communications strategy and will be supporting Boards and nationally in showcasing the vast amount of preparation that has been undertaken. Further national messaging will issue as appropriate.
The SGHSCD annual winter planning letter issued to NHS Boards on 16 Oct 2012.This emphasised the need for intensive annual preparation, noting that many infectious agents may present around the same time, the need for excellence in communication between health protection and IPCTs and a reminder re staff exclusion for 48 hours post last symptom.
Top tips to prevent infection were refreshed for 2012 (new link)
HPS guidance for hospitals was also updated following advice HOAG (chair Martin Connor).
4. HEAT Targets 2013-15
HEAT targets for 2013-15 are due to be announced shortly by the SG. Advice from the HAITF National Advisory Group is that targets for 2013-15 should remain focused on C diff and SAB. The actual rate expected to be achieved will continue the downward trend.
5. HAI priorities
Whilst Staphylococcus aureus and C diff remain HEAT targets and priorities, there will be increased focus on Gram negative organisms, especially Enterobacteriaceae, with the aim that resistance should not significantly increase, and with a particular focus on E coli. This brings UTIs, catheter associated UTIs, and hence the elderly and the community very much into the picture. Potential surveillance and interventions to reduce infections are being considered.
A CAUTI summit was held on 23 August, linking with SPSP and ‘harm free care’.
6. HAI mandatory surveillance short life working group
A Short Life Working Group (chair Anne Maree Wallace) held its first meeting 14 Nov 2012. The terms of reference include to review mandatory surveillance requirements and the voluntary elements of the SSI programme to ensure that surveillance is fit for current purpose for Scotland; and consider the addition of E coli bacteraemia (or similar). The output of this group will be a revision to HDL (2006) 38.
The group includes representation from SMVN (Martin Connor) and ICDs (Gabby Phillips)
7. Water sources and potential infection risk to patients in high risk settings
Many thanks to all who have commented on the NSS draft guidance. Final guidance is expected to be issued by the end of the year. This is to include an annex from SMVN on sampling (noting that sampling will not be conducted on a routine basis).
8. Community subgroup
A small subgroup of the HAI Development & Implementation Group has also recently been established to address community aspects of HAI. The group ischaired by Margaret Tannahill of the Care Inspectorate (Deputy Chair - Jayne Leith).
9. Code of Practice for the Local Management of Hygiene and HAI CNO(2004)9
A review of the Code of Practice is under way, chaired by Hazel Borland. The group’s first meeting on 10 August highlighted cross over with review of HDL(2005)7 Infection Control & Cleaning: Nursing Issues & HDL(2005)8 Infection Control & Organisational Issues. This crossover was discussed at HAI NAGand it was agreed that the review of HDLs should be included in review of Code of Practice. The aim is to have a draft for consultationby December and a final document ready for issue under cover of a CEL by Spring 2013.
10. HEI inspections
AS HEI gets towards the end of its first 3 year cycle of inspections, there have been a number of ‘poor’ inspection reports, mainly unannounced, resulting in enactment of the CNO support framework algorithm.
From October 2012, there is no longer a requirement for HEI to inspect every acute hospital a minimum amount of times over a set period. Instead it will undertake a minimum of 30 inspections per year to acute and community hospitals. It will focus particular attention on NHS boards which intelligence suggests may present a higher risk to patients. Inspections will be unannounced but HEI may carry out some announced inspections, if it feels this is more appropriate.
11. Other policy communications since May meeting
National Infection Prevention and Control Manual update from CNO 17 May 2012
Lorna Willocks, HAI Policy Unit
SGHealth & Social Care Directorate
15 November 2012
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SMVN 15 November 2012 – HAI Policy Unit Briefing Paper