Healthcare Associated Infection (HCAI) strategy 2023 to 2025

Introduction

In 2016, the Scottish Government published the Scottish Antimicrobial Resistance and Healthcare Associated Infection – 5 Year Strategic Framework (2016-2021). This Strategic Framework aimed to support the creation of a ‘zero tolerance approach’ to avoidable infections, controlling healthcare associated infections (HCAIs) and containing antimicrobial resistance (AMR). The Strategic Framework was designed to support NHS Boards in taking forward key delivery areas such as AMR, cleaning and decontamination, IPC, quality improvement, and surveillance.

The Strategic Framework built upon the existing achievements of the NHS in Scotland at the time and acknowledged that the prevention and control of HCAI was an important issue for all settings where healthcare is delivered. The Scottish Antimicrobial Resistance and Healthcare Associated Infection – 5 Year Strategic Framework (2016-2021) was intended to be in place until 2021.

The onset of the SARS CoV-2 (COVID-19) pandemic posed a significant challenge in delivering the 2016 Strategic Framework. Some NHS Board and public body activities aligning with the Strategic Framework were paused, and resources were reallocated in order to respond effectively to the threats presented by the pandemic. As a result of the disruption caused, and the additional pressures which NHS Boards had to manage, some of the later strategic goals from The Scottish Antimicrobial Resistance and Healthcare Associated Infection – 5 Year Strategic Framework were not able to be fully achieved and implemented as presented in the original timeline.

In spite of the challenges posed by the pandemic, several of the actions included in the previous framework were delivered, including the development of a Care Home IPC Manual (CH IPCM), the development of new IPC standards, and the launch of the Infection Prevention Workforce: Strategic Plan 2022 – 2024.

Additionally, the many lessons learned during the COVID-19 response have reinforced the essential role of IPC in reducing the risk of, and responding to, HCAI clusters and incidents. This includes a broader understanding of the barriers to effective IPC. For example, education, guidance implementation, and the challenges posed by the built environment.

The Scottish Government remains engaged with these ongoing pandemic-focused workstreams, which includes the sharing of lessons learned during COVID-19 and feeding in recommendations from independent expert groups into wider pandemic preparedness workstreams. Outputs from these COVID-19-focused workstreams will be taken forward separately.

As Scotland’s response towards COVID-19 changes, the intention of this two-year HCAI Strategy is to establish a new baseline position which will provide the foundations for a five-year IPC strategy which will follow (2025-2030).

The HCAI Strategy (2023-2025) was developed over a condensed period of time in order to provide NHS Scotland with a supportive national direction. Previous HCAI strategies followed a five-year running period to allow for adequate transformation to take place. This current strategy will only cover the interim period of 2023-2025. The overall aim of the HCAI strategy (2023-2025) is to reduce the incidence of HCAIs and aid Health Boards in their recovery from COVID-19.

Development of this Strategy

This strategy was developed by the HCAI Strategy (2023-2025) Oversight Board which was chaired by the Chief Nursing Officer and comprised of Officials of the Scottish Government, expert stakeholders, and relevant National Health Boards. (Full membership details can be found in Annex A).

The Oversight Board was established to ensure the strategy was founded on Health Board experience, up to date evidence, and professional expertise. The strategic goals, objectives, and deliverables have been developed and agreed with Oversight Board members to align with business plans and key workstreams already underway or planned for the period 2023-2025.

A key consideration of the Oversight Board was the wellbeing of staff in Health Services and the question as to how to ensure that the deliverables and outcomes from the strategy not only aid in the reduction of HCAI incidences, but also aid in the improvement of staff wellbeing.

The organisations responsible for completion and implementation of the deliverables will be mindful of the challenges and pressures faced by frontline services at the time of publication and throughout the term of the strategy.

Links to wider healthcare and social care sector

Given this strategy’s relatively short lifespan, and the focus on Health Board recovery from the pandemic, the objectives and deliverables are primarily applicable within the acute hospital environment and therefore do not specifically reference social care.

That being said, Scottish Government recognises that infection risk is not solely restricted to the healthcare environment, and that social care settings play a key role in infection prevention.

This strategy’s Oversight Board included officials from Scottish Government’s Directorate of Social Care and National Care Service Development on the basis that this strategy lays the foundational work for a whole system transformational 2025-2030 IPC Strategy by making cross-organisation links as early as possible. This is being developed in the light of the WHO draft global strategy for IPC being published.

The strategic goals in this current HCAI strategy 2023-2025 were developed to be inclusive of all health and care settings. It should also be noted that some of the deliverables due to be completed in year one will also be relevant to social care staff and settings. For example, the review of IPC learning materials included on TURAS and LearnPRO.[4]

Implementation

By liaising with stakeholders in National Health Boards and encouraging a collaborative interagency approach, the Scottish Government aims to use its national position to ensure programmes of work are aligned, coordinated, and ultimately support Territorial and National Health Boards who deliver direct patient care in the reduction of HCAIs and recovery from the COVID-19 pandemic.

National Health Boards will also take this approach and facilitate, where possible, that appropriate engagement with Territorial Health Boards and other National Health Boards, and NHS Scotland staff to support the overarching aims of this strategy.

The intention of this strategy across its two-year lifespan is Recovery. The year one (2023-2024) deliverables are included in this strategy. We will engage with our stakeholders on the details of year two and conduct an annual review which will inform an updated delivery plan. The Scottish Government will communicate this as appropriate.

Year 1

Year one of this strategy will be dedicated to the ongoing review of existing guidance, processes, and educational materials. The responsible stakeholders for these deliverables will primarily be the Scottish Government and the National Health Boards.

Year 2

Whilst the review of guidance, process and educational materials will continue, year two will focus on planning, implementing, and embedding the outputs of year one. The Scottish Government expect that year two may include specific deliverables for Territorial Health Boards.

By focusing on recovery, it is anticipated that NHS Scotland will be in a strong position to support the development and delivery of the subsequent 5-year IPC strategy.

Monitoring implementation

Following publication of this strategy, the Scottish Government will liaise with stakeholders utilising existing mechanisms and structures to monitor stakeholder progress, implementation, and delivery. In addition, existing data reporting resources will be used to measure this strategy’s impact on post pandemic recovery and overall incidence of HCAI.

The Healthcare Associated Infection (HCAI) Landscape

The graphic below is an illustration of the organisations who work towards reducing HCAIs. Each organisation has a different but important role.

Full role and remit descriptors of this strategy’s key stakeholders can be found in Annex B.

Impact Assessment

Following an Equality Impact Assessments (EQIAs) screening exercise, it was found that people of protected characteristics as outlined in the Equality Act (2010) are not impacted either positively or negatively by this strategy. Therefore, an EQIA was not required in this instance.

World Health Organisation (WHO) Core components

The World Health Organisation Guidelines on Core Components of Infection Prevention and Control (IPC): Programmes at the National and Acute Health Care Facility Level were published in 2016. The WHO Core Components were designed to be applicable for any country and suitable to local adaptation. The WHO Core Components underpin this strategy and were used as a guide when developing the strategic goals and the associated objectives and deliverables.

Scotland can demonstrate adherence to the principles included within the core components through its well-established programmes and initiatives, such as hand hygiene monitoring. Scotland, along with the wider United Kingdom, through its government and stakeholders, are a contributor to the WHO, and regularly report to the WHO on their IPC and HCAI monitoring. It is important to acknowledge these core components and embed their core themes throughout the HCAI strategy.

The eight core components noted below take into account the strength of available scientific evidence, the cost and resource implications, as well as patient values and preferences.

Supporting Documents

This strategy acknowledges the multi-faceted elements required to deliver its aims and recognises that certain elements will link with other published healthcare strategies and policies. This document should therefore be read alongside the healthcare polices and strategies below. Together, these will support the aim of NHS Scotland recovery as well as a reduction in HCAI incidence.

• The World Health Organisation (WHO) Core Components of Infection Prevention and Control
• Excellence in Care Framework
• Healthcare Improvement Scotland IPC standards
• Health and Social Care: National Workforce Strategy
• The Infection Prevention Workforce: Strategic Plan 2022 – 2024
• UK 5-year action plan for antimicrobial resistance 2019 to 2024
• NHS Education for Scotland: Our Strategy 2023 – 2026
• WHO: Draft global strategy on infection prevention and control
• Minimum Requirements for Infection Prevention and Control Programmes
• Care Home Review: A Rapid Review of Factors Relevant to The Management of COVID-19 in The Care Home Environment in Scotland
• Genomics in Scotland: Building our Future

Roles and responsibilities in relation to the delivery of the Scottish HCAI Strategy (2023-2025)

Role of the Scottish Government

The Scottish Government is responsible for overseeing and monitoring the deliverables in this strategy. The Scottish Government will work with stakeholders in the process of delivery and will actively promote collaboration between stakeholders to ensure cross cutting information/learning is shared where relevant.

Role of National Health Boards

As stated previously, this strategy primarily contains objectives and deliverables during year one for the National Boards.

With a view of establishing a new baseline, National Health Boards will conduct evaluations/reviews of the current IPC guidance and processes to assess their relevance, usefulness, and effectiveness. Stakeholders, such as Territorial Health Boards, may be asked to engage in and provide feedback on these reviews, where appropriate.

Role of Territorial Health Boards

While this strategy does not have any initial deliverables for the Territorial Health Boards, the recommendations from year one outputs may lead to operational changes within Territorial Health Boards. The Scottish Government will communicate any relevant recommendations, including appropriate timescales for implementation, and will provide support and direction as appropriate.

Strategic Goals

Using the WHO IPC Core Components as a guide, seven strategic goals were developed in collaboration with members of the Oversight Board. Clear objectives with realistic deliverables for stakeholders are set out in the following section.

Overarching Aim

To reduce the overall incidence of HCAI and support the recovery of NHS Scotland from the impact of the COVID-19 pandemic.

Strategic Goal 1

Infection prevention programmes will be progressed with engagement and agreement from key stakeholders to ensure maximum impact for patients, staff, services, and the wider population.

Strategic goal 1 seeks to ensure all relevant stakeholders are involved in the development and implementation of IPC programmes. Programmes should take into account past learning and incorporate multiple facets when seeking to achieve its goal, including staff wellbeing and the impact on patients.

Strategic Goal 2

IPC guidance and policy, relevant to various health and care settings/staff, will be developed from reviews and evaluation of international evidence of best practice and using a robust engagement process.

Strategic goal 2 seeks to ensure future IPC guidelines and policy will include learning from previous infection incidents (such as COVID-19), be applicable to all health and social care settings where appropriate and align itself with international evidence and best practice.

Strategic Goal 3

A range of educational and practice development resources and formats are available and reviewed at predetermined intervals to ensure they meet the needs of staff at all levels for a range of sectors and professional groups.

Strategic goal 3 seeks to ensure IPC and HCAI education is accessible to all staff in the health and social care sector. By ensuring educational resources are accessible to all staff levels (including non-clinical), this strategic goal seeks to equip staff to feel they have the skills and knowledge of IPC principles to achieve the over-arching aim of reducing the incidence of HCAI.

Strategic Goal 4

HCAI surveillance is relevant, data capture is timely, and the output supports quality improvement initiatives both locally and nationally.

HCAI surveillance is a key tool in the monitoring of IPC guidance implementation and practice. This strategic goal seeks to build on the lessons learned in relation to data surveillance and data sharing during the pandemic, and further scope how best data can be shared at a local and national level to support best practice/quality improvement.

Strategic Goal 5

Tools to support the application of IPC measures will be relevant, fit for purpose, and appropriate guidance/training is provided for interpretation and use.

Strategic goal 5 seeks to support all staff across multiple sectors and roles to have at least a baseline knowledge of the application of IPC practices.

Strategic Goal 6

Incident reporting processes will support the timely identification, investigation, and management of incidents, and will provide opportunities for preventative measures to be implemented.

Strategic goal 6 seeks to ensure reporting mechanisms are robust and provide a mechanism by which learning from incidents can be shared and be used as possible early indicators of HCAI incidents/threats.

Strategic Goal 7

Staff in the health and social care sector will be supported to enhance their capability and improve their confidence in identifying and managing risks within the built environment.

Strategic goal 7 seeks to ensure that learning from previous incidents where the built environment has been a key driver of infection is fully embedded in IPC guidance and staff education resources. Additionally, strategic goal 7 also seeks to ensure that future guidance takes into account the various settings in which care is delivered i.e. not restricted to the clinical environment.