NHS
HDL(2001) 57

 

Health Department
Directorate of Planning & Performance Management


 



Dear Colleague

A FRAMEWORK FOR NATIONAL SURVEILLANCE OF HOSPITAL ACQUIRED INFECTION IN SCOTLAND

Summary

This letter alerts you to the report of the sub-group of the Health Department's Advisory Group on Infection. It has recommended that a national system of surveillance of Hospital Acquired Infection (HAI) be set up. The Minister for Health and Community Care has accepted the report. NHS Trusts are therefore required to implement the report's recommendations as they apply to them. The contents of this letter should be drawn to the attention of Trust Infection Control Committees and other relevant bodies.

The Executive Summary of the report is attached. The full report is available at the SHOW website: http://www.show.scot.nhs.uk/sehd.

Action

NHS Trusts

1. All Trusts are required to establish mechanisms for collection of data on MRSA bacteraemias by autumn this year, and to make these data available by April 2002.

2. All Trusts are required to implement surveillance of in-patient surgical site infection (SSI) for at least two operative procedures from a specified list including one orthopaedic procedure. Trusts should put structures in place to collect this information by April 2002, with surveillance data to be available from all Trusts by 2003.

3. All Trusts undertaking neurosurgery should have surveillance of HAI following neurosurgical procedures in place by April 2002.

6th July 2001

______________________________

Addresses

For action

Chief Executives, NHS Trusts
Director, Scottish Centre for Infection
and Environmental Health


For information

General Managers/ Chief Executives,
Health Boards
Chief Executive, State Hospital
Chief Executive, Common Services
Agency
Chief Executive, Health Education
Board for Scotland
Chief Executive, Scottish Ambulance
Service

________________________


Enquiries to:

Ms Jenni Brooks
2E (South)
St Andrew's House
EDINBURGH EH1 3DG

Tel: 0131-244 2083
Fax: 0131-244 2051
Email:

Jenni.Brooks@scotland.gsi.gov.uk
______________________________

Additional Information

The Scottish Health Plan, "Our National Health: a plan for action, a plan for change" makes clear that the Executive places particular importance on infection control, hospital cleanliness and the safety of the hospital environment and it expects NHS Trusts to ensure that the recommendations of the Scottish Infection Manual have been put in place. Appropriate surveillance of HAI is a key step in the monitoring and reduction of infection rates.

The sub-group's report sets out a framework for national HAI surveillance in which national data on HAI in Scotland will be compiled from the data generated by standardised surveillance activity in Trusts. It is expected that surveillance data will also be used locally to improve performance in tackling HAI and reducing infection rates. The national system is based on central-local collaboration between the Scottish Centre for Infection and Environmental Health (SCIEH) and NHS Trusts. SCIEH will facilitate and co-ordinate the local surveillance programmes and collate data at a national level on behalf of the Department. SCIEH will also compile national reports with annual reporting of HAI incidence from 2002. SCIEH will help disseminate good practice and is charged with developing and implementing a system for collecting data on incidents/ outbreaks of hospital infection.

As regards resources, the Department expects Trusts to implement the recommendations within the increased allocations made available through Health Boards this year, and within indicative allocations for future years. Increased resources are being made available to support infrastructure and national initiatives relevant to countering HAI. In particular the Department is funding an expanded national training programme for infection control nurses to help increase numbers in response to expected growth in demand for their skills. The Department is also increasing funding available for SCIEH to support its central facilitating and co-ordinating role for the new surveillance system.

A multidisciplinary Steering Group will be set up by SCIEH to oversee and facilitate implementation of and ensure strategic direction for the planned national surveillance system. The HAI Surveillance Steering Group will be asked to develop plans for post-discharge surveillance of SSI by the end of this year.

The Advisory Group on Infection's sub-group is now addressing the issue of anti-microbial resistance surveillance, and will shortly be making recommendations on this.


Yours sincerely

 

 

GERRY MARR
Director of Planning and Performance Management


 

A FRAMEWORK FOR NATIONAL SURVEILLANCE OF HOSPITAL
ACQUIRED INFECTION IN SCOTLAND

Recommendations of the Advisory Group on Infection’s Sub-group on Surveillance
of Antimicrobial Resistance and Hospital Acquired Infection (HAI)



EXECUTIVE SUMMARY

 

  • ‘Our National Health: a plan for action, a plan for change’ emphasises the
    importance of a safe and healthy environment for NHS patients and staff.

  • A commitment is given to taking steps to strengthen and monitor infection
    control in hospitals and to establishing that action is taken by NHS Trusts to
    ensure that the recommendations of the Scottish Infection Control Manual
    have been put into place.

  • One of the main themes of this guidance is that the implementation of
    appropriate surveillance of hospital acquired infection (HAI) is a keystone in
    the reduction and monitoring of infection rates.

  • This report contains the recommendations of a sub-group of the Advisory
    Group on Infection for the development of national surveillance of HAI in
    Scotland.

  • The sub-group recommends a framework for national HAI surveillance based
    on a central-local collaboration between the Scottish Centre for Infection and
    Environmental Health (SCIEH) and NHS Trusts. Engendering local
    ownership is recognised to be the key to success. The emphasis is
    therefore placed on locally based surveillance involving a local team of
    clinicians, infection control teams and managers. Local surveillance data
    must be of use, and be used, locally to improve performance and within the
    Clinical Governance agenda of Trusts. National surveillance data become
    available as a by-product of this activity. The sub-group stresses the need
    for the collection of national data which are comparable with those collected
    elsewhere in the UK. SCIEH’s role will be to facilitate and coordinate the
    local surveillance programmes and to collate data at a national level on
    behalf of the Scottish Executive.

  • For comparability in Trusts over time and between Trusts, surveillance of HAI
    must be carried out according to agreed national protocols, and specified
    core data collected. However, to match local situations and needs, there
    should be flexibility in the detailed implementation of surveillance and options
    available to include additional data, the collection of which is considered
    important at the local level.

  • It is proposed initially that surveillance of in-patient surgical site infection
    should be implemented in all Trusts. In order to obtain robust national data
    the sub-group recommends that Trusts be asked to undertake, as a
    minimum, inpatient surveillance of at least two operative procedures
    selected from the short list of procedures for surveillance in Table 2, including
    one of the orthopaedic procedures on the list. Structures should be in place
    in all Trusts for surveillance of SSI by April 2002 with surveillance data
    available from all Trusts by 2003.

  • Surveillance of HAI following neurosurgical procedures should be in place in
    all Trusts undertaking neurosurgery by April 2002.

  • Surveillance of post-discharge surgical site infection should be added to the
    national programme as soon as a consensus is reached about appropriate
    methodology. Plans for post discharge surveillance should be available from
    the HAI Surveillance Steering Group by the end of 2001.

  • National surveillance of methicillin resistant Staphylococcus aureus (MRSA)
    is a priority and should be developed as soon as possible. Mechanisms
    should be in place in all Trusts to collect MRSA data by Autumn 2001, with
    data available from April 2002.

  • A second report of the sub-group will include recommendations on
    surveillance of HAI and antibiotic resistance in intensive care units.

  • It is recommended that a Hospital Acquired Infection Surveillance Steering
    Group should be appointed by the Scottish Executive to oversee
    implementation, to provide strategic direction and to monitor and report on
    progress in the development of national surveillance of hospital acquired
    infection.

  • The sub-group recommend that SCIEH play a major part in taking forward
    the implementation of national surveillance of HAI in Scotland. They,
    therefore, recommend that the Scottish Executive consider carefully the
    implications for SCIEH and ensure they have sufficient resources to facilitate
    the rapid implementation of their recommendations.

  • The sub-group recognise the significant resource implications at Trust level
    of their recommendations. They, therefore, recommend that the Scottish
    Executive recognise that additional resources will need to be made available
    to Trusts to implement effective surveillance activities.