Transcript Stock take of where we are and what next

Cleanliness Champions:
Evaluation of impact on HAI
in NHSScotland
Professor Jacqui Reilly
HPS
Overview
• How far have we come?
– Uptake of cleanliness champions
• Where are we now?
– Common types and causes of HAI and the
changes in these in the last five years
– Impact on outcome of cleanliness champions
– Evaluation of trends in HAI incidence data in
the context of all national policy interventions
• What next?
– The focus of the role to meet IPC demands in
2013 and beyond
How far have we come?
Historic burden in Scotland
• First PPS (2005):
– 1 in 10 with an HAI at any one time in
acute care
– £183 million a year
• Estimated 5000 deaths/ year
• Recognised public health threat
• HAITF delivery plan built upon the
baseline epidemiology
REF: Reilly J et al (2008) Results from the Scottish National HAI prevalence survey
Journal of Hospital Infection. 69(1):62-8.
Comparisons
HAITF delivery plan
• Multimodal campaign
– Surveillance, Education, Guidance, Audit,
Targets, HEI, SPSP HAI
• Tackling improvement in systems, structures,
processes and practice
• Education at the heart
– Innovative CC programme and topic
specific educational initiatives
Cleanliness Champion Enrolment by Generic Workplace Setting
Number of Enrollments
2011
2012
2013
5000
4500
4000
3500
3000
2500
2000
1500
1000
500
0
Acute Sector
Adult Care
Home Sector
Community
Sector
Other
Workplace Setting
SAS
Not Known
Cleanliness Champion Enrolment by Generic Profession
Number of Enrollments
2011
2012
5000
4500
4000
3500
3000
2500
2000
1500
1000
500
0
Profession
2013
What was the impact?
Approach to evaluating impact
• Uptake of participation in the programme was monitored as each
student registered on line.
• Demographic details were captured on their professional and
location of workplace.
• Healthcare associated infection data were captured using national
PPS data before and after the interventions and MRSA
bacteraemia data as an indicator of HAI for the duration of the
intervention.
• Data were analysed using correlations to demonstrate the
temporal relationships between the intervention and outcome and
times series and join point analyses and were subjected to
multivariable analyses, and trends pre- and post-implementation
of the policy initiatives, with a specific focus on the educational
elements therein
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Number of cleanliness champions
40000
MRSA bacteraemia rates and uptake of cleanliness
champions programme for all Scotland by quarter
35000
30000
0.20
25000
20000
15000
5000
0.15
Cleanliness Champions
MRSA
0.10
10000
R= -0.952
0
0.05
0.00
MRSA rate per 1000 occupied beds
MRSA rates and cleanliness champions by quarter ; Scotland
0.25
Evaluating impact
• It is acknowledged that educational
initiatives do not happen in isolation of
other national policy initiatives thus in
order to identify the contribution
overall in the context of these a time
series analysis was carried out.
Timeline of major HAI policy initiatives to date
Mandatory
HAI training
F/work issued
Cleanliness
champion
training for all
charge
nurses
announced
Code of
Practice
issued
N u m b er o f clean lin ess ch am p io n s
MRSA
bactr
data 1st
issued
HAI TF
launched
QIS standards
out (with visits)
Model TBPs
issued - May
2008
Care bundles
issued
Screening
practices
changed
SPSP launched
AMR action
plan
CEO HAI
responsibilities
outlined
New surv
funding
Model SICP
pols issued Feb 2006
HH campaign
announced
(with funding
and data
collection)
MRSA g/lines
issued (JHI)
0.25
0.2
Revised
HEAT
target
Zero
tolerance
with HH
announced
0.15
Performance m/ment introduced:
ICM funding
HEAT target
ABHR requirement (CNO)
AMR policy doc issued
0.1
0.05
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Detecting the change point
March 2007:
Multimodal
campaign
implemented from
2003
10000 cleanliness
champions were
registered on CC
programme by this
point
Impact on outcome
0.20
0.15
0.10
0.05
Rate per 1000 Occupied Beds
0.25
MRSA Rates, Fitted trends, based upon a model fitted to the data
up to Q1 2006 and Interventions
Q1
Q3
2003
Q1
Q3
2004
Q1
Q3
2005
Q1
Q3
2006
Q1
Q3
2007
Quarter
Q1
Q3
2008
Q1
Q3
2009
Q1
Q3
2010
Q1
There was a temporal association between the initiation of the HAI policy programme and a decline
in MRSA infections,. The reduction reached statistical significance in 2008, although of course this
does not necessarily prove that the policy caused the reduction. However, the decreasing trend
persisted during the period after the introduction of the policies and was associated with other
interventions thereafter .
Where are we now?
Uptake of the CC programme
• 31599 staff
registered
• 16614 completed
Data source: NES August 31st 2013, HPS Annual report HAI 2013
Distribution of HAI types in
Acute Hospitals in Scotland
in 2006 and 2011
100%
•HAI prevalence is lower by
a third
•Distribution of HAI types
has changed
•Higher proportion of
UTI, pneumonia,
laboratory- confirmed
bloodstream infection
•Lower proportion of
gastrointestinal
infection
Percentage of all HAI
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
2006 (n=836)
2011 (n=525)
Year of survey
Urinary tract infection
Pneumonia
Eye, ear, nose, throat and mouth infection
Skin and soft tissue
Surgical site infection
Laboratory-confirmed BSI (including CRI3)
Gastrointestinal tract infection
Other
National HAI Point Prevalence
Survey 2011
• Prevalence was lower, however….
• One in twenty patients had a HAI at the time
of survey
• 31502 HAI in acute care in Scotland every
year
• 318 172 additional bed days
• £137.1 million a year
The challenge of systems and human
behaviour
• Device use is high, HH not
100% compliant, AM use
not optimal, SICPs and
TBPs not well adhered
to...........
– What are the barriers to
the application of IPC and
infection management at a
clinical level?
– How to we make it easy for
staff to do the right thing
and to be sure what the
right thing to do is?
What should we do
next…?
Take account of new challenges
• Populations: patients (more vulnerable) / micro•
•
•
•
organisms (more resistant) / healthcare workers (fewer in
number)
Methods: new ways of working bring new risks but also
reduce old risks
Environments: new healthcare environment, structure
and buildings, fixtures and fittings reduce risks but bring
new ones
Equipment: More complex, more expensive, more
difficult to decontaminate
Epidemiology of HAI: has changed so infection
prevention and control measures need to flex to meet
these changes
Conclusion
• The introduction of the cleanliness champions
programme is temporally associated with a significant
reduction in MRSA bacteraemia
• The decreasing trend persisted during the period after
the introduction of the policy and correlated strongly with
the increasing uptake of the cleanliness champions
(r=0.952).
• This study gives an indication that national policy
investment in educational initiatives in HAI, as part of a
multimodal campaign, can lead to reductions in HAI
• Continued development of the workforce to sustain the
gains to date in reducing HAI and to meet the new
challenges which lie ahead