Reducing healthcare associated infections: An organisational perspective A summary of best practice

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1 Reducing healthcare associated infections: An organisational perspective A summary of best practice Introduction Sustainable reductions in healthcare associated infections (HCAIs) require the proactive involvement of every member of staff across all care settings. All staff, at every level, have a role to play in reducing HCAI. This document summarises the suggested key organisational features required to support the behavioural change needed to reduce HCAI. Implementing these principles can help staff at every level of the organisation be clear about their role and know how to make their contribution to HCAI improvement. Every health and social care organisation have the following responsibilities to: Demonstrate compliance and assurance with the Hygiene Code 1, using local audits to provide assurance of compliance and ensure that quality is central to care delivery. Provide strategic leadership for effective delivery and management of patient safety in relation to infection prevention and control. Ensure infection prevention and control is embedded into strategic planning and therefore service delivery across the organisation. Enable safety to be a priority in all aspects of care. Roles and Responsibilities The following section sets out in a practical way suggested objectives, practices, deliverables and outcomes to help teams at all levels to define roles, responsibilities, outcome measures and performance indicators across their workforce. The roles are applicable for staff working within any health and social care settings, e.g. acute NHS Trusts, care homes and Primary Care Trusts. Each section indicates the specific staff group to whom the guidance applies. 1 The Health and Social Care Act 2008 Code of Practice for the NHS on the prevention and control of healthcare associated infections and related guidance - 1 -

2 Roles and Responsibilities for HCAI The section below outlines the key HCAI objectives and the corresponding actions required by relevant stakeholder in order to meet these. Each objective indicates the relevant health or social care setting to which it applies. Executive Board In order to implement and monitor a registered provider wide HCAI improvement strategy within both the acute settings and primary care/provider services, it is expected Executive Boards will: Establish an HCAI working group to deliver the strategy which is responsible and accountable for delivering resources to areas of greatest risk. Consider an executive lead such as the Managing Director/ Chief Executive or Director of Infection Prevention & Control to chair group and to report monthly to the Executive Board. Ensure non clinical executives, e.g. Chief Executive chairing the HCAI working group works closely with relevant senior clinicians such as Medical Director and Director of Nursing or equivalent. To ensure all staff are accountable for infection prevention and control relevant to their role, Executive Boards working within Health and Social care settings will: Ensure each member of staff has infection prevention & control (IPC) objectives added to their job description and that this is included in individual performance reviews (IPRs). Objective 3. To ensure staff understand the legal requirements of the Hygiene Code and that staff are trained and competent to undertake local audits, and implement action plans to provide assurance of compliance at the point of care, e.g. within a ward, care home setting, client s home and departmental level, Executive Boards within Health and Social care settings will: Devolve responsibility to department/care home and speciality level for HCAI improvement and regularly monitor performance using local audit tools to ensure compliance to the Code of Practice via, for example, a balanced scorecard and other key performance indicators (KPIs). Objective 4. To ensure registered provider wide HCAI/environmental specific data across all care settings is signed off monthly by the Executive board to assure progress, the Executive Board within acute NHS Trusts and Primary care/provider services will: Monitor the use of a range of appropriate clinical audit tools that provide assurance at ward / team level on a monthly basis or more frequently if compliance to practice is falling below the - 2 -

3 organisation s standard. They may use an HCAI surveillance / organisation specific balanced scorecard to monitor specialty / ward / team-based performance on HCAI. Drive HCAI improvement at specialty level and hold key individuals accountable for HCAI rates at department level. Sign-off on monthly compliance reports for key specialties and for risk areas, e.g. using a balanced scorecard to include HCAI across all care settings. Objective 5. To ensure that a robust communication strategy exists that is monitored by the Board for assurance that internal staff awareness is raised and that local public confidence in the registered provider is good and improving, the Executive Board will: Regularly update the board on communications strategies to highlight methods of raising awareness of HCAI matters across all staff groups. Engage external audiences in the organisation s HCAI plan through proactive communications and media management. Executive Leads e.g. Managing Director, Trust Board Director To lead the organisation in delivery of lower rates of infection in line with national targets and local arrangements the Executive Lead working within acute NHS Trusts will: Set up a collaborative approach across the organisation that ensures medical, clinical, estates, finance and other directorates are involved, and make their contribution to continuously improve HCAI. To lead the organisation in delivery of lower rates of infection in line with national targets and local arrangements, the Executive Lead working within acute NHS Trusts and PCT/Provider services will: Make HCAI a top organisational priority and take personal accountability for the delivery of any local audit tools, action plans and compliance with the Code of Practice. Establish a HCAI group that reports to the board monthly on HCAI improvements. To performance manage the organisation and key individuals to deliver HCAI strategy, the Executive leads working within acute Trusts and PCT/Provider services will: Set HCAI related goals for each department/care home and hold key individuals accountable for performance. Establish a set of key performance indicators (KPIs) for the board and manage performance against these

4 Objective 3. To ensure staff awareness on HCAI increases and that public confidence in the organisation improves, the Executive leads working within acute Trusts and PCT/Provider services will: Deliver a communications strategy that reinforces HCAI as a top organisational priority and core business to all staff groups. Use tools such as patient complaints, satisfaction survey, media reporting to assess the effectiveness of the communication strategy. Nurse and Medical Director To demonstrate clinical leadership that places HCAI as a top priority and safety at the centre of registered provider practices and plans, Nurse and Medical Directors within acute NHS Trusts and PCTs/Provider services will: Take accountability for the delivery of local HCAI audit tools and other HCAI related improvement programmes by staff within their directorate. Encourage compliance to organisational policies relating to HCAI by staff in their departments/directorates and enforce these policies where necessary. To ensure consistency of care across all care settings and that evidenced-based practice is applied to reduce HCAIs and achieve high reliability, Nurse and Medical Directors within acute NHS Trusts and PCTs/Provider services will: Monitor the results / outputs of local HCAI audit tools, hand hygiene and environmental audits and other HCAI related improvement programmes and oversee the development of action plans to address issues arising. Objective 3. To collaborate with medical, clinical and other directorates to ensure joined up approach to HCAI improvement, Nurse and Medical Directors within acute NHS Trusts and PCTs/Provider services will: Ensure members of the directorate/department collaborate with RCA and oversee the sharing of information resulting from any RCAs across the organisation. Objective 4. To establish and manage an operational framework which monitors and assures improvement on HCAI, Nurse and Medical Directors within acute NHS Trusts and PCTs/Provider services will: - 4 -

5 Oversee the collation of information by staff within the directorate/department to contribute to a KPI dashboard that informs the organisation s board of risks and issues relating to HCAI Human Resources Director To collaborate with all clinical/care settings, and other department/directorates to ensure joined up approach to HCAI improvement, the Human Resources Director working within Health and Social Care settings will: Maintain records on the current level of training of all organisations staff including compulsory annual training in infection control. Undertake appropriate checks on new starters to assure the organisation of their level of training and competence. Ensure temporary staff members are adequately training in infection prevention and control before starting work in the organisation. To ensure all staff are able to articulate their role and know how to make their contribution to trust wide plan in HCAI, the Human Resources Director working within Health and Social Care settings will: Add HCAI and infection prevention and control to job descriptions of all staff and see that HCAI forms part of progression and appraisal of all staff. Ensure there is a trust wide plan to advise, train and monitor HCAI awareness across all staff groups. Objective 3. To ensure financial impact of HCAIs is understood across the organisation, the Human Resources Director working within Health and Social Care settings will: Include HCAI and infection control improvements in business case submissions. Quantify financial savings from HCAI improvement and promote to key departments/care settings. Approve business cases where HCAI is quantified and supports HCAI improvement plan. Objective 4. To ensure financial impact of HCAIs is understood across the organisation, the Human Resources Director working within acute NHS Trusts and PCT/Provider services will: Quantify financial impact on trust of effective antibiotic use, screening, isolation, outbreak management. Report regularly to the board on potential and actual savings from HCAI improvement

6 Director of Infection Prevention & Control (DIPC) To ensure the requirements of the Health and Social Care Act 2008 is implemented and embedded across the health care provider, the DIPC working within acute NHS Trusts and PCTs/Provider Services will: Take responsibility for the organisation s Infection Prevention & Control Team (ICPT). Oversee local control of infection policies and their implementation. Participate as a full member of the IPCT and attend its infection control meetings regularly. Report directly to the chief executive or equivalent (not through any other officer) and the board or other senior management committee. Challenge inappropriate clinical hygiene practice and inappropriate antibiotic prescribing decisions. Assess the impact of all existing and new policies on HCAI and make recommendations for change. Participate as an integral member of the organisation s clinical governance and patient safety teams and structures. Produce an annual report on the state of HCAI in the organisation and take responsibility for its release into the public domain. Provide advice on service specifications and KPIs to commissioners in order to include adequate assurance elements in relation to HCAIs in provider contracts. To ensure the requirements of the Health and Social Care Act 2008 is implemented and embedded across the health care provider, the DIPC working within acute NHS Trusts and PCTs/Provider Services will: Oversee the delivery of the infection prevention & control programme in commissioning organisations In commissioning organisations provide advice on service specifications and KPIs to commissioners in order to include adequate assurance elements in relation to HCAIs in provider contracts Infection control team To train, support and advise across the organisation to ensure that all staff are aware of the current infection prevention guidance relevant to their role and are equipped to implement and contribute, the Infection Control Team working within acute NHS Trusts and PCTs/Provider services will: - 6 -

7 Deliver (or manage delivery of) the organisation s Infection Prevention & Control Programme. Ensure that the trust HCAI plan: o Is regularly monitored at ward, and directorate level by use of relevant dashboards. o Is accessible by all staff groups- useable and useful. o Uses results from audit to inform HCAI improvement locally specific to wards and teams. o Focuses on high risk areas and all patient / client groups. Advise the DIPC on day-to-day infection control issues. To act as an expert group to provide guidance, interpretation and support on HCAI improvement plan and infection prevention control issues to patients, staff and partners, the Infection Control Team working within acute NHS Trusts and PCTs/Provider services will: Introduce, oversee and advise on the use of HCAI related tools and ensure appropriate action is taken, detailed in an action plan, after instances of non-compliance. Validate weekly/monthly data on HCAI and ensure it is signed off by the Chief Executive. Review risk register monthly on HCAI issues. Audit use of root cause analysis (RCA) and feeding back in timely fashion to departmental heads. Publish quarterly infection control reports on HCAI progress. Audit attendance data on internal Infection Prevention and Control training and act on the results. Clinical directors, general managers/home managers, lead/senior nurses and clinical champions To ensure quality and safety is central to department/directorate plans to deliver clean and safe care, clinical directors, general managers/home managers, lead/senior nurses and clinical champions working within acute NHS Trusts and PCTs/Provider services will: Embed HCAI improvement and infection prevention in all systems and processes at ward /team and directorate level. Ensure each staff member have HCAI in their job descriptions and that HCAI forms part of progression and performance of staff. Ensure that RCAs are undertaken within 5 working days of relevant HCAI cases. Ensure environmental audit results are used to steer departmental/homes action on cleaning. Ensure any local HCAI audit tools are used appropriately and results are fed back to frontline staff and managers directorate/organisation wide and action taken to address instances of non-compliance

8 Clinical directors, general managers/home managers, lead/senior nurses and clinical champions working within acute NHS Trusts and PCTs/Provider services will: Review monthly infection data in specialties and use it to inform action. Medical Consultants To provide clinical leadership which instils a culture of zero tolerance on HCAI across the organisation, and be a champion for HCAI prevention and improvement, the Medical Consultants working within acute NHS Trusts will: Ensure every patient is provided with high standards of infection prevention and control and safety is the primary consideration in delivery of care. Ensure delivery of best practice at all times and use KPIs to instil this culture across the organisation. Use specialty and consultant specific data to improve performance. Ensure RCA is undertaken where necessary and findings are acted upon. Undertake regular infection control training. Review compliance with national policy to ensure high reliability in reducing HCAIs and ensure results are used to inform action, e.g. audit of antibiotic use to amend prescribing practice. Ward/Care home manager To demonstrate high levels of compliance to infection prevention and control policies, clinical protocols and environmental cleanliness, ward and care home managers working within Health and Social Care settings will: Share infection prevention & control data and action plans with clinical/care teams. Implement local HCAI audit tools in line with IPC team advice, audit and monitor compliance to these, as well as environmental and infection prevention and control policies. Report compliance data to ward/care teams and relevant management board. Identify high risk clinical areas, using IP&C data and root cause analysis, and report findings and outcomes to relevant Governance Committee. Develop an Infection Prevention Report to include: - Monthly review of HCAI data. - Successful implementation of Root Cause Analysis (RCAs) on all alert organisms. - Audit of clinical practice (i.e. via local HCAI audit tools)

9 - Local awareness of compliance levels. - Actions plans for HCAI improvement and cleanliness. Other clinical staff: including junior doctors, nurses, healthcare scientists and Allied Health Professionals, Healthcare assistants etc To ensure infection prevention and control measures that are robust and evidence based are embedded in care delivery, all clinical staff, working within Health and Social Care settings will: Co-operate with the IPC team in their task of maintaining high standards in infection prevention and control. Assisting in monitoring of clinical practice and review delivery of care to minimise risk of HCAI. Ensuring consistent adherence to local antibiotic prescribing policy. Ensuring that all equipment and environments are clean. Ensuring infection prevention reports include data on antibiotic use and audit information reflects local and national policy. To understand local HCAI data and ensure relevant IPC policies are adhered to and aseptic technique followed correctly, all clinical staff working within Health and Social Care settings will: Comply to current policies and procedures with respect to HCAI in the delivery of day to day care. Take steps to address omissions in their own practice. Undertake HCAI audits. Be observed undertaking IPC practices as required and take constructive feedback to improve their practice. Have an awareness of current local HCAI data and be aware of recent causes of HCAI outbreaks and any recommendations made as a result of them. Co-operate with RCA investigations and act on their findings. Objective 3. To ensure their own knowledge of HCAI is current and practice is up to date, all clinical staff working within Health and Social Care settings will: Undertake IPC training as part of normal staff induction. Undertake regular IPC training as part of continuous professional development. Attend regular briefing run by the IPC team or others on current infection control issues

10 Head of Facilities To meet the following objectives: 1. To ensure premises are fit for purpose, maintained and clean. 2. Oversee effective implementation of guidance relating to cleaning, decontamination, laundry and waste disposal. 3. Ensure that infection prevention & control team are involved and engaged with any new infrastructure or build. Head of Facilities working within Health and Social Care settings will: Regularly monitor standards of cleanliness, reported at ward/home, department and board level Implement actions to improve high risk areas. Work with infection prevention & control teams and other relevant staff to ensure facilities comply with local and national infection prevention and control guidelines and provide support and solutions to non-compliant areas. Ensure any new facility complies with the Hygiene Code. Objective 4. To comply with relevant duties of the Hygiene Code and demonstrate this through evidence, Head of Facilities working within Health and Social Care settings will: Undertake regular cleanliness audits in accordance with local policy. Ensure all findings and recommendations are implemented in order to guarantee a high standard of cleanliness by complying with the Hygiene Code. Domestic Staff To meet the following objectives: 1. Take individual responsibility to ensure high standard of cleanliness and effective implementation of cleaning guidance. 2. Oversee effective implementation of guidance relating to cleaning, decontamination, laundry and waste disposal. 3. Comply with relevant duties of the Hygiene Code and demonstrate this through evidence. Domestic Staff working within Health and Social Care settings will: Adhere to local cleaning procedures and protocols at all times. Participate in a regular cleaning audit and complete actions resulting from compliance monitoring. Ensure the correct disposal of waste, e.g. sharps and contamination waste

11 Receive relevant training on infection prevention control and cleaning according to local policy and training objectives as set by Facilities Management

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