News - Current
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Ambulance and Pre-Hospital Care Guidelines regarding Antimicrobial Prescribing – draft for consultation
A supplement to the 'Ambulance Guidelines – Reducing infection through effective practice in the pre-hospital environment'.
Following feedback from users of the document Ambulance guidelines – Reducing Infection through effective practice in the pre-hospital environment, the Department of Health has developed this supplement on the use of antimicrobials in the ambulance and pre-hospital setting. It should be referred to in conjunction with the full document, which provides guidance on how the risk of infection can be reduced by adhering to good practice in:
- Hand hygiene
- The use of personal protective equipment
- Aseptic technique
- Working in the pre-hospital environment.
This consultation document seeks to promote prudent antimicrobial use and good stewardship and by doing so reduce the incidence of inappropriate antimicrobial prescribing in ambulance and pre-hospital care.
Click here to review the draft guidelines. Please send all comments and feedback to reducinghcai@dh.gsi.gov.uk
Consultation closing date: Friday, 5th Feb 2010
How can you achieve sustainability of your improvement gains?
Sustainability of change is a problem that some of you will face. Business research suggests that up to 70% of change efforts fail to be sustained (Daft and Noe, 2000) while evidence from health service research has found that 33% of our improvement efforts fail to sustain those improvements (Ham 2002). We might consider congratulating ourselves on this level but just think about it. One in three of your improvement projects will not maintain those improvements that staff have been working so hard to achieve. The money invested in one of three of your improvement projects might have been better used elsewhere. And, some of your patients and carers will not reap the benefit of the improved services that they deserve because one in three of your projects have not maintained the gains.
I know through discussions with many NHS staff who have been striving to achieve safe, clean care that your ambition is to not only achieve those gains but maintain them over time.
How might you do that? First of all you need to think about how you can plan for sustainability as early on in your project as possible. The NHS Sustainability Model provides a useful framework which helps you:
- Assess your improvement initiative against a number of key criterion for sustaining change
- Recognise and understand key barriers to sustainability relating to the specific local context
- Identify your current strengths in sustaining improvement
- Monitor progress over time
The NHS Sustainability Model is a diagnostic scoring model designed to be used by each member of the core project team. The information collected provides the whole team with a really good understanding of areas that need improving in order to maximise the potential of sustainability within the project. An accompanying Sustainability Guide provides a range of practical ideas about how to actually make those improvements.
Teams should think clearly about the task ahead. Your work to provide safe, clean care has not finished just because you have hit your milestone. What are you going to do to maintain the gains?
Dr. Lynne Maher, Interim Director for Innovation , NHS Institute for Innovation and Improvement.
The HCAI and Cleanliness Division has supported some NHS organisations to undertake sustainability assessments. Our work also involved raising awareness of the NHS Sustainability Model and Guide. As a result of this work we found that by making minor adaptations to the language of the NHS Sustainability Model, supported by the NHS Institute for Innovation and Improvement, it specifically reflected the HCAI agenda and organisations were able to use it in relation to projects to improve the delivery of safe, clean care. Although some of the language has been adapted to reflect the HCAI agenda this does not affect the robustness of the tool as the weightings and importance of each element reflects the original tool.
Details of the work we have undertaken with University Hospital North Staffordshire NHS Foundation Trust around testing out the amended tool is being written up as a case study. A case study from Leeds Teaching Hospitals NHS Trust is also being produced. These will shortly be made available via this website.
The NHS Sustainability Model and Guide is free to the NHS and can be accessed by going to www.institute.nhs.uk/sustainability.
The HCAI focused Sustainability Tool is below:
Sustainability Assessment Tool - Question Sheet - 23 October 2009 (PDF, 135.7 KB)
Sustainability Assessment Tool - Scoring Sheet - 23 October 2009 (PDF, 135.8 KB)
Sustainability Tool - Excel Scoring Sheet - 23 October 2009 (XLS, 610.3 KB)
Emergency Admissions MRSA Screening Pathway
There is a commitment in the 2009/10 Operating framework regarding meticillin-resistant Staphylococcus aureus (MRSA) screening of patients.
"From April 2009, all elective admissions must be screened for MRSA in line with Department of Health guidance. This should be extended to cover emergency admissions as soon as possible and definitely no later than 2011".
The following pathway for MRSA screening of emergency admissions is specifically aimed at nominated leads to assist them in establishing policies and processes for MRSA screening of emergency patients. It is acknowledged that many Trusts have already implemented robust systems for the screening of emergency patients, and where assurance is gained on the efficacy of those processes these should continue.
Click here to view the pathway.
MRSA and MRSA Screening
MRSA and MRSA Screening FAQs / Useful Information
The NHS Operating Framework for 2008/09 places cleanliness and HCAIs as one of five national priorities that require particular and sustained attention from PCTs, working with every organisation that provides care to NHS patients. The Framework contains a commitment for screening for MRSA to be in place across the NHS from April 2009:
"Meeting the challenge of HCAI will require additional actions across the system for 2008/9, including: introducing MRSA screening for all elective admissions from 2008/9 and for all emergency admissions as soon as practicable within the next three years."
The following documents outline some of the more commonly asked questions about MRSA screening:
NOTE: These leaflets have been developed as templates for local areas so are for illustrative use only. Local areas will therefore need to adapt text for local use and add in their own trust branding before distributing locally.
Click here for recent MRSA Screening - Operational Guidance 2 letter from David Flory, Director General of NHS Finance, Performance & Operations and Christine Beasley, Chief Nursing Officer:
www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/Dearcolleagueletters/DH_092844
Click here for operational information on screening:
www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/Dearcolleagueletters/DH_086687
Click here for best practice information on Screening for meticillin-resistant Staphylococcus aureus (MRSA) colonisation:
Screening for meticillin-resistant Staphylococcus aureus (MRSA) colonisation A strategy for NHS trusts: a summary of best practice
MRSA Screening Films
From the 1 to 30 April a series of four MRSA screening films were aired in approximately 1500 GP surgeries throughout England. To view the videos click on the links below:
- MRSA screening commercial - produced by the Life Channel for the DH - Annie and Trevor
- MRSA screening commercial - produced by the Life Channel for the DH - Dan
- MRSA screening commercials - produced by the Life Channel for the DH - Saira
- MRSA screening commercial - produced by the Life Channel for the DH - Matron
Revised Healthcare Cleaning Manual
The National Patient Safety Agency has worked jointly with the Association of Healthcare Cleaning Professionals and NHS Purchasing and Supply Agency to review the guidance contained in the NHS Cleaning Manual. The Revised Healthcare Cleaning Manual is designed to be of use across different healthcare settings, including acute care, mental health care, primary care and the ambulance service. This guidance has been brought up to date to reflect the diversity of care settings. There is a new, improved collection of cleaning method statements as well as new advice on the use of emerging cleaning technologies.
The manual is available via the NPSA website – click here
Current Guidance on Infection Control in Non-acute Settings
The new non-acute standard contracts require plans for controlling HCAIs.
Our guidance on infection control in non-acute settings is set out in Essential Steps, and provides useful information for creating and implementing these new plans. Essential Steps is designed as a framework to support local organisations providing and commissioning services outside the acute hospital setting. Its primary focus is health care, but it will also be of interest to those providing social care.
Essential Steps to safe, clean care
Ambulance Guidelines
Clostridium Difficile Infection: How to deal with the problem
The Department of Health has published new expert guidance on the management of C.difficile in hospitals. This brings together expert advice on control of C.difficile to provide a single comprehensive source of scientific guidance for the NHS.
Click here to link to the publication.
Saving Lives High Impact Intervention (HII) No.1 tutorial film - Central venous catheter care bundle
This short 15 minute film has been produced to illustrate correct procedure of the Saving Lives HII No. 1. Central venous catheter insertion. It is a commonly performed procedure and has an associated risk of infection because of the potential for direct microbial entry to the bloodstream. Intravenous cannulae may be contaminated by the patient's skin flora at the insertion site or by the introduction of other organisms via the cannula hub or injection port.
Download Saving Lives High Impact Intervention (HII) No.1 tutorial film - Central venous catheter care bundle
QuickTime Movie - 300kbps
QuickTime Movie - 800kbps
Going Further Faster II: applying the learning to reduce HCAI and improve cleanliness
This guide is a summary of the key interventions that will enable organisations to prioritise efforts and maximise impact. It reflects the accumulated learning, evidence and good practice on the critical actions that NHS trusts can take and aims to help everyone move faster and in a sustainable way towards the goal of zero tolerance toward infection and delivering a clean NHS.
Click here to read more... (PDF 350KB)
Please use the links below to access all tools and documents developed to accompany Going Further Faster II that will help prioritise efforts and maximise impact:
Board to Ward
DIPC Role Profile
Care Pathway Toolkit
The tools and annexes to support Going Further Faster II have been developed by a variety of authors from the NHS and contributors from across the health economy.
The resources are currently presented with the view to have them used and that feedback will shape finished versions to be released later in the summer.
Department of Health content leads for the various pieces is as follows:
- Draft Care Pathway toolkit for CDAD (hospital setting) - Sandra Shannon and Angela Butler
- Root Cause Analysis Process - Yvonne Robertson
- Capacity (side room) Calculator - Brian Reynolds
If you have specific questions, and or suggestions on how any of these may be improved for easier use in the workplace, please email your feedback attentioned to the author to reducinghcai@dh.gsi.gov.uk
Clostridium difficile Care Pathway:
This interactive version of the Clostridium difficile pathway provides a framework of tools for NHS Trusts to use to develop local integrated care pathways and patient care documents. It is not intended to be prescriptive. The pathway includes menus and submenus and professionals can navigate the levels to access the most relevant information. Detailed guidance on using the pathway is included on the first page.
- Please click on the following: interactive Clostridium difficile pathway tool to access
- Guidance on using CDI pathway
Care pathway documents and decision scorecards:
- Decision scorecard to assess for risk of CDAD
- Care pathway for initial assessment of CDAD
- Decision scorecard to identify suspected CDAD
- Care pathway to assess severity of CDAD
- Care pathway to assess complications of CDAD & to eliminate other pathologies
- Decision scorecard to determine severity of CDAD
- Care pathway for treatment and management of CDAD (Day 1)
- Care pathway for initiation of isolation & care of a patient with known or suspected CDAD
- Care pathway for treatment and management of CDAD (Day 2 onwards)
- Care pathway for discharge of patient with CDAD
Guides & posters:
- Guide to best practice: isolation of patients
- Guideline for CDAD treatment medications
- Sample poster: clostridium difficile cleaning schedule - daily cleaning
- Sample poster: clostridium difficile cleaning schedule - terminal deep clean
- Sample poster: infection control department notice to visitors (episodes of diarrhoea)
Additional information and references
Ambulance Guidelines: Reducing infection through effective practice in the pre-hospital environment
In the pre-hospital environment, there are three key high-risk areas for the transfer of infection:
- Direct transfer through the hands of clinical practitioners
- Invasive devices
- The emergency environment
This document explains how the risk of infection can be reduced by adhering to best practice in:
- Hand hygiene
- The use of personal protective equipment
- Aseptic technique
- Working in the pre-hospital environment
Click here to view - Ambulance Guidelines
Additional articles:
Pre 48hr MRSA bacteraemia project - reducing the risk
This project was set up in June 2008 to test approaches for reducing pre 48hr bacteraemia using hypothesis and to make recommendations for a national approach. Based up the results, this project recommends commissioners and providers follow a 3 step approach to reduce the risk of pre 48hr MRSA bacteraemia (i.e. C, D, E):
Step 1
Be assured that the management of urinary CATHETERSout of hospital follows best practice. E.g. Torbay Care Trust's case study:
Step 2
Be assured that the DOMICILIARY Care (health and social) services is providing good infection control (particularly around wound care management, catheter management and hand hygiene). E.g. Southampton City PCT's case study:
Step 3
Effectively EDUCATE patients and carers, community staff and care home staff in infection prevention and control. E.g. Doncaster PCT's case study:
Importantly, these three steps must be underpinned by effective ASSURANCE SYSTEMS between commissioners and providers, from Board to Ward. E.g. Cumbria PCT's case study:
The full project report with data analysis, practical steps to implement the key recommendations and case studies can be viewed on the following link:
If you have any comments, queries or feedback please contact us at: reducinghcai@dh.gsi.gov.uk
A Development Programme for Infection, Prevention & Control Individuals & Teams
A Development Programme for Infection, Prevention & Control Individuals & Teams Following a successful pilot which completed in October 2008, the Department of Health has commissioned Warwick University to deliver a series of leadership development programmes for infection prevention and control practitioners. The programmes are due to commence in September 2009 and are open to teams of practitioners working within infection prevention and control, including nurse, medical microbiologists, directors of infection prevention and control and antimicrobial pharmacists.
Programme Dates
Day 1 - Tuesday 1 September, 2009
Day 2 - Tuesday 6 October, 2009
Day 3 - Tuesday 3 November, 2009
Day 4 - Tuesday 1 December, 2009
Day 5 - Tuesday 12 January, 2010
For further information click here: Development Programme for Infection, Prevention & Control Practitioners - Warwick Medical School (PDF, 237.9 KB)
Supporting PCT Commissioners and Provider Management in the reduction of HCAIs in providing Safe, Clean Care with Privacy and Dignity
Supporting PCT commissioner and provider management in the reduction of HCAIs is an integral part of the Department of Health’s Improvement Programme. During 08/09 a pre 48hr MRSA project tested hypothesis around community MRSA and identified key actions to reduce the risk of pre 48hr MRSA bacteraemia. To read final pre 48hr MRSA report and case studies click here.
‘Supporting PCT Commissioners and Provider Management in the Reduction of HCAIs’ continues during 09/10 with three elements – Primary Care Organisation Reviews, Peer Reviews and the Development Forum.
- Primary Care Organisation diagnostic reviews (Aug 09 to Jan 10): These provide targeted support to a selected number of PCT provider and commissioners, translating the knowledge and learning about preventing HCAIs we have learnt in the acute sector to the PCT agenda and to support the building of capability around the reduction of HCAIs.
- Development Forum - 1 Dec 09: The outcomes of this successful forum are on the website. In response to feedback from delegates on the day and from those unable to attend because the Forum was oversubscribed we have made available:
- Online clinics : Thu 3 Dec 09 - Fri 11 Dec 09
- Online regional sharing and learning events : Thursday 28 Jan 2010 and Friday 29 Jan 2010
- Access to additional advice and support
For more information click here
- Peer Reviews - Following feedback from many PCTs and SHAs asking for support around developing a peer review process, the purpose of this element is to offer PCT commissioners, PCT providers, SHAs and acutes a peer review package that can be adapted for local needs. The peer review mechanism that we will offer to organisations will include principles, a framework for a process and suggested tools being used already by organisations. Some principles and top tips for conducting peer reviews will be available on this website by the end of Dec 09.
Feedback and suggestions for further support is welcome. Feedback can be sent to hcaicentralsupport@dh.gsi.gov.uk.
Director of Infection Prevention and Control (DIPC) Role Profile Document
This new desk top/pocket sized reference card for DIPCs (Director of Infection Prevention and Control) advises as to what their responsibilities should be based on requisites as formed by policy experts and a clinical reference group.
The reference card will soon be printed and distributed through the Improvement Programme and can currently be downloaded here.
Director of Infection Prevention & Control Role Profile (PDF 116k)
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