CCCD WELSH HEALTHCARE ASSOCIATED INFECTIONS
SUB-GROUP
MINUTES OF THE MEETING AT CATHAYS PARK
ON 26 SEPTEMBER 2002
CHAIRMAN’S INTRODUCTION
1.
1.1
The Chairman welcomed all present to the Sub-Group’s third meeting.
2. MINUTES OF THE LAST MEETING
2.1
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The minutes were agreed as a true record of the meeting with the following
exceptions:
Titles of those present at the last meeting need amending.
Para 5 Action Plan should also include the need to assess future needs of
community practice.
3. MATTERS ARISING
Minute 3.3 Communications
3.1
ICNA representative reported that she had contacted ICNA’s regarding their
possible involvement in the WHAISG website project. She had identified 2
volunteers.
It was confirmed that if funding of £7,000 could be secured for the server,
existing staff could be used to set the system up.
3.12 It was explained that any correspondence from members of the sub-group to
the Assembly should be directed via civil servant PHPD to the main Committee.
Minute 3.5.3 Training
3.2
NAfW Nursing Officer for Communicable Disease reported that the report was
still in preparation. A handout was produced (at Annex A) outlining the training
available for University of Wales College of Medicine Undergraduates.
3.21
Details was provided of a study module called “You’ve Been Framed”
whereby students undertook a CCTV type experiment of bad infection control
practice on the wards.
3.22
A general discussion followed raising the different experiences of training on
infection control; the need to ensure that it was understood that infection
control was the responsibility of all healthcare workers; medical and nurse
student training and when it should take place; and the variability of induction
training on infection control.
3.23 The following problems were identified:
 The issue of infection control was being treated as a stand alone issue,
rather than a continual process of reinforcement.
 A shortage of senior Infection control nurses generally.
 Wide disparity of training in different colleges and hospitals.
 An understanding of what were the most effective interventions for
learning and training for infection control.
3.24 It was agreed that the importance of infection control needs to be instilled at
ward level, but this needs to be continually reinforced. The 2 main areas for
focus were identified as:
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The need for an integrated operational training programme engaging all
ward staff.
The requirement of standardisation in pre-registration training for nurses.
3.25 It was suggested that there was a need to define the overall structure of
infection control training at a corporate level, followed by local induction training
at ward level.
Minute 3.6 Interventions
3.3
A discussion was held regarding the possibility of using Welsh Risk Pool data
as key Performance Indicators. It was explained that Welsh Risk Pool data is
qualitative rather than quantitative, and that it tends to measure inputs rather
than outputs. Welsh Risk Pool would welcome guidance from the group as to
what data they would like to develop performance indicators, and suggested
that 3 or 4 should be considered.
3.31
There was a consensus that there should be a move towards establishing
effective performance indicators for infection control in Wales.
3.32
In England the following were being considered as PIs:
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MRSA bacteraemia data
Surgical site infections
Outbreak / adverse incident reporting
Clostridium difficile.
Outbreak reporting appears not to lack uniformity, with different definitions and
reporting requirements in place. There may be a need for the group to agree an
improved Wales wide definition.
3.33 In relation to surgical site infections, a simple core data set would be required
that could be developed into a PI. It would be necessary to develop clinical
ownership of the process, and to obtain agreement of the NHS Board to introduce
PIs.
Minute 4 Priorities for HAI in Community Practice
3.4 It was agreed that a document should be produced which outlines the key areas
to be addressed. It was noted that interest in community/primary care infection
control was increasing.
3.41
The Chair agreed to ask the 2 community based members of the group to
prepare the document.
3.42
At a previous meeting the issue of CareHome standards had been raised. It
was explained that the Care Standards include an obligation on care home
owners to notify Care Inspectors about any infectious diseases, and what
steps they have taken to control rectify the problem. This indicated that the
control of infection was receiving wider scrutiny.
Minute 5.2 Action Plan wider presentation
3.5
NAfW Senior Medical Adviser reported that he had taken the issue of
organising an event to publicise the action plan to the Joint Professional
Forum, but they had felt that they were not inclined to support the proposal at
present. However, they would be interested in receiving a report on progress
from WHAISG.
3.51 The possibility of organising regional workshops was discussed, although the
difficulty of securing the attendance of middle management to stress the
importance of implementation was recognised.
Minute 6 Any Other Business
3.6
It was confirmed that there were no objections to the minutes of the Subgroup being placed on the internet.
4.SURVEILLANCE REPORTS
4.1
S aureus bacteraemias – The results were noted, and the group felt that it
was essential to maintain and develop the surveillance programme to ensure
that a detailed picture was available for Health Trusts. The possibility of using
this surveillance as a possible Performance Indicator in future was also
discussed. It was also noted that PHLS hoped to calculate an annual average
to create more meaningful data, and that it would be useful to see the rate of
change rather than absolute rates.
4.2
Alert organisms – The group approved the addition of C difficile surveillance
within mandatory Trust reporting. However, it was noted that there was no
standard data set for clostridium reporting, but this could be extracted from
existing laboratory data, and would also highlight variations in rates and
testing practices.
4.3
Surgical site infections – A presentation was made about HAISSG
Orthopaedic Surveilance Project. The group noted with interest the
information gained by this project and discussed the uses the information
could be to infection control and changing practices. The project and
information gained could be of more use if an increase in medical participation
could be achieved.
4.4
Hospital Outbreaks
It was agreed that reliable data has been available for about 5 years in this
area, but only half the hospitals in Wales are actively engaged in this
exercise. It was reported that the National Patients Safety Agency gathers
information from trusts on adverse incidents, and collates it in an anonymous
way.
4.5
Central venous device bacteraemias
It was reported that PHLS offers surveillance forms to any Trust who wishes
to use them, and would arrange to return any data to those who submit it. One
Trust had piloted the project for a month, and another was due to start the
surveillance in the near future.
4.6
ITU – Infections It was reported that Chair of the Welsh Intensivists Group is
leading an initiative to develop a clinical surveillance programme for HCAIs
occurring in ITUs. A meeting was being arranged to discuss the implication
with colleagues in Scotland and Northern Ireland where similar approaches
are being developed.
5.Serratia bacteraemias in Wales
It was noted that the rates appeared to be higher than in England. The
implications of this epidemiological were unclear. The group felt that further
work was required to clarify the significance of this finding.
6.Summary
The group agreed that there was a need to consider compiling a strategic
document for the group, to suggest the way forward for Healthcare Associated
Infections in Wales. The following issues were identified for inclusion
document:
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A review of the infrastructure for infection control in Welsh NHS Trusts.
Training requirements.
Surveillance.
Interventions.
There is a need to ensure that the framework upon which any
recommendations are made is sound and that they are appropriately
incorporated into clinical governance arrangements, Welsh Risk Pool audit
standards, and the Clean Hospitals initiatives. It was agreed that the
development of outcome measures as PIs should be actively explored.
7.
Date of next meeting.
18 December 2002.