Published: 07/10/2004, Volume II4, No. 5926 Page 46

Keeping infection out of Scotland's hospitals has involved meticulous planning, high levels of involvement and a gradual culture change, as Margaret Tannahill explains

Until recently the subject of healthcare-associated infection - the preferred term in Scotland - registered only on the fringes of public consciousness. But due to media coverage it is now considered an issue of major national importance.

The facts speak for themselves: HAIs are estimated to cost the NHS in Scotland up to£180m per year, or, to put it another way, it keeps up to 1,040 NHS beds continuously occupied.

With the publication of ministerial HAI action plan Preventing Infections Acquired While Receiving Healthcare almost exactly two years ago, the Scottish Executive laid out its commitment to tackling the issue through a comprehensive approach.

The three-year Scottish ministerial HAI taskforce programme, initiated in January 2003, has brought together a broad group of key players - from members of the public to senior executive-level decision-makers from NHS and non-NHS sectors.

The individual taskforce working groups are populated by front-line workers, specialists with direct experience of implementing best practice and members of the public.

The goal is nothing less than a cultural change - the defining principle that 'infection control is everyone's responsibility' underpins every strand of the work. It acknowledges that fundamental changes in the way things are done will not happen overnight - it will take time for new methods of working to bed in and become standard practice in our wards and clinics.

One year on the taskforce's progress has involved consultations, during which the NHS Scotland code of practice for the local management of hygiene and HAI and the national cleaning services specification were issued as interim guidance.

The code of practice - the first of its kind in the UK - outlines guidance on a range of factors, from compliance management to staff education, management of basic ward equipment and guidance on the prevention and control of infection.

Information on how hospitals and other healthcare sites should be cleaned, including how frequently, is set out in the national cleaning services specification. In addition, this document highlights the crucial importance of staff training.

Also now complete is guidance for those involved in media handling during HAI and other outbreaks, and a linked exercise of producing a best-practice statement on urinary catheter management alongside a new national surveillance system for catheter-associated urinary tract infections.

Work is well advanced across a range of other fronts: for instance the development of a framework for mandatory induction training on HAI for all NHS Scotland staff; the development of risk-based methodologies for targeting measures to reduce the risk of HAI; and guidance on the management of HAI outbreaks (including staff screening).

The draft, risk-based methodology paper will be the third formal consultation exercise by the HAI taskforce. What sets it apart is that it will be simultaneously piloted in NHS Scotland for assessment of its efficacy and applicability. This underscores the taskforce's recognition of the problems created by 'advice overload'.

One of the basics of tackling HAI is, of course, staff education.

Both the code of practice and the cleaning services specification, for instance, emphasise it.

Work is currently under way to develop packages for regular ongoing training for all NHS Scotland staff groups.

On a related front, around 750 staff have currently enrolled with the 'cleanliness champions' training programme, with staff groups ranging from nurses and domestic services staff to allied healthcare professionals, consultant clinicians and chief executives. Since its inception, the programme has also attracted wide interest from the non-NHS healthcare sector.

Communicating the risks of HAI is a challenging business.

Opportunities to raise awareness, identify best practice and share information are consistently being pursued with NHS and non-NHS stakeholders, including those leading the HAI agenda in other UK health departments.

But what about communicating key messages to the public at large? Public involvement in raising awareness of HAI is at the heart of the taskforce's working philosophy, hence the participation of public involvement representatives in every one of its working groups.

The public involvement representatives, however, also contribute to the taskforce's communications strategy, to the development, implementation and monitoring of outputs, and act as leaders in their own areas.

Margaret Tannahill is project leader of the Scottish Executive's HAI taskforce.

Further information

HAI action plan, www. scotland. gov. uk/library5/health/ preventinfect. pdf

Report by Scotland's auditor general, www. audit-scotland. gov. uk/ publications/pdf/2003/03pf07ag. pdf

Cleaning Services Specification www. scotland. gov. uk/library5/health/ ncss-00. asp