Cleanliness Champions: Evaluation of impact on HAI

in NHSScotland

Professor Jacqui ReillyHPS

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

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Cleanliness Champion Enrolment by Generic Profession

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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

MRSA bacteraemia rates and uptake of cleanliness champions programme for all Scotland by quarter

MRSA rates and cleanliness champions by quarter ; Scotland

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Cleanliness Champions

MRSA

R= -0.952

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

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MRSA bactrdata 1st issuedHAI TF launched

Mandatory HAI training F/work issuedCleanliness champion training for all charge nursesannouncedCode of Practice issued

Model SICP pols issued -Feb 2006HH campaign announced (with funding and data collection)MRSA g/lines issued (JHI)

Revised HEAT targetZero tolerance with HH announced

QIS standards out (with visits)Model TBPsissued - May 2008Care bundles issuedScreening practices changedSPSP launchedAMR action planCEO HAI responsibilities outlinedNew survfunding

Performance m/ment introduced:ICM fundingHEAT targetABHR requirement (CNO)AMR policy doc issued

Detecting the change point March 2007:

Multimodal campaign implemented from 2003

10000 cleanliness champions were registered on CC programme by this point

Impact on outcomeMRSA Rates, Fitted trends, based upon a model fitted to the data up to Q1 2006 and Interventions

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 .

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Q1 Q3 Q1 Q3 Q1 Q3 Q1 Q3 Q1 Q3 Q1 Q3 Q1 Q3 Q1 Q3 Q12003 2004 2005 2006 2007 2008 2009 2010

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

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2006 (n=836) 2011 (n=525)

Year of survey

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I

Urinary tract infection Surgical site infection

Pneumonia Laboratory-confirmed BSI (including CRI3)

Eye, ear, nose, throat and mouth infection Gastrointestinal tract infection

Skin and soft tissue Other

•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

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