Anna Walker CB

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INFECTION CONTROL 2006 - IDENTIFYING RISKS,
SHARING KNOWLEDGE
The role of the Regulator in infection control

• Anna Walker CB
• Chief Executive

6 July 2006
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AGENDA

• Healthcare Commissions role in the prevention
  and control of healthcare associated infections
• some key current and planned activities
• future challenges

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Our assessment of current position

• MRSA and other healthcare associated infection
• just one of many risks in healthcare
• not the most significant but of great concern
• prevention and control still problematic
• simple precautions still causing some problems
• hospital cleanliness 2005 snapshot inspection
• high standards in 1/3rd
• many problems, particularly in some NHS mental
  health trusts

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Healthcare Commissions initiatives on
healthcare associated infection

• MRSA target
• core standards
• developmental (improvement) standards
• audits/reports
• hospital cleanliness
• clostridium difficile
• NHS staff/patient surveys
• national study / improvement review
• new healthcare associated infection code of
  practice

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New national target on MRSA

• July 2005 we reintroduced a MRSA indicator as
  part of star ratings
• 2005/2006 the new annual health check - first
  assessments of progress against the new national
  target for 60 reduction by March 2008
• construction of the new target indicator. Trusts
  with less than 12 MRSA cases will meet the
  target others must achieve an annual 20
  reduction based on a statistical test.

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Core standards application across NHS in 2005/06
First domain Safety C1. Systems for patient
safety C4 a) HAI/MRSA b) Medical devices c)
Decontamination d) Medicines e) Waste

• C4. Health care organisations keep patients,
  staff and visitors safe by having systems to
  ensure that
• the risk of healthcare acquired infection to
  patients is reduced, with particular emphasis on
  high standards of hygiene and cleanliness,
  achieving year-on-year reductions in MRSA.
• Assess performance by
• screening (up to 32 data sets) compare with
  trusts own declarations
• follow up visits on declarations that may present
  a risk spot checks inspecting the evidence

October 2006 results across the country
available
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A glimpse at what trusts declarations are
revealing.
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Developmental standard - safety
D1. Health care organisations continuously and
systematically review and improve all aspects of
their activities that directly affect patient
safety and apply best practice in assessing and
managing risks to patients, staff and others,
particularly when patients move from the care of
one organisation to another.
Consultation for 2006/2007 assessments
completed We favour applying this standard
patients would expect this approach to safety
decisions due on this shortly
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• A snapshot of hospital cleanliness
• sample of 100 hospitals, NHS and independent,
  acute and mental health
• July/August 2005 Unannounced visits by
  Healthcare Commission inspectors

• What we found
• high standards in 33 (band 1) both NHS and
  independent
• 43 in band 2
• poorer standards in 22, most markedly in some
  NHS mental health hospitals

• What next on hospital cleanliness?
• follow-up visits to check on progress with action
  plans
• spot check visits for core standards assessment
• further series of unannounced cleanliness audits

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Investigations outbreak of Clostridium difficile

• Stoke Mandeville
• request by Secretary of State
• report with Health Protection Agency in December
  2005 into trusts practice on infection control
  further detail to be published by HPA shortly
• worrying lack of implementation and consistency
• final report (scheduled for mid 2006)
• we will follow up report recommendations

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What else have we learnt?

• What do NHS staff think?
• a new section in the 2005 staff survey
• 61 of staff said that hot water, soap and paper
  towels, or alcohol rubs were available when
  needed
• 52 had received training, learning or
  development in infection control in the previous
  12 months
• What about independent healthcare?
• subject to a very different regime minimum
  standards regulation
• poor systematic evidence of infection outcomes
• cleanliness audit indicated generally high
  standards but still some significant problem
  areas
• hygiene code will apply to sector

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National study on HAI

• Focus on understanding, learning and improving,
  not
• on rating. Link work closely to the Department of
• Health MRSA improvement programme
• Can we help identify better the key relevant
• characteristics that are succeeding in
• reducing infections / MRSA in order to help
• those who are struggling?
• selective data collection from all acute trusts
  (April/May 2006)
• very detailed data analysis currently underway
• follow-up visits to a small proportion of trusts
  to test hypotheses and any emerging conclusions
• national report published (target - September
  2006)

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Statutory Code of Practice on HCAI Health Bill
2006

• Scope
• Management, organisation and the environment of
  care
• duties to establish appropriate systems assess
  and manage risks maintain clean and adequate
  premises and equipment provide effective
  information ensure adequate laboratory support
• Clinical care protocols
• minimum set of written policies programme of
  audit, revision and update
• Healthcare workers
• access to occupational health services,
  induction, training
• NHS organisations annual compliance assessment
  by the Healthcare Commission align with annual
  health check processes?
• Independent sector and care/nursing homes
  extension to the minimum standards regulations
  framework to reflect provisions of the code?
  Compliance as condition of registration/license?
• BUT
• A code of practice issued under section 47A is
  admissible in evidence in any criminal or civil
  proceedings (Health Bill)
• Implications for duty of care complaints
  pressures for reactive inspection?

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Future challenges

• Healthcare organisations record is patchy
• our approach is to-
• embed the basics through
• core standards
• cleanliness audits
• results of investigations
• hygiene code
• encourage improvement through
• stretching developmental standards
• targets
• one off reviews
• monitor and publicise progress through
  publication of results of-
• target
• standards
• survey/audit reports
• regulation can incentivise (but not deliver)
  improvement

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