Healthcare Associated Infection (HCAI) strategy 2023 to 2025

Strategic Delivery Plan

The Strategic Delivery Plan expands on the strategic goals to include distinct objectives and deliverables, including responsible stakeholders for delivery.

It is expected that these deliverables will be commenced during year one of this strategy. Deliverables will be used as markers for progress during this strategy’s lifespan.

The overarching aim of this two-year strategy is:

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.

Objectives

1.1 The processes used to develop infection prevention programmes will be evaluated.

Responsible Stakeholder

ARHAI Scotland

Deliverables

Undertake an appraisal of the development of the guidance (focusing on communication, consultation and engagement) within the NIPCM and CH IPCM.

Objectives

1.2 IPC programmes will have active engagement with all key stakeholders

Responsible Stakeholder

All

Deliverables

All National IPC programmes will have a term of reference (ToR) and membership will include all key stakeholders.

Strategic Goal 2

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

Objectives

2.1 Staff will have easily accessible guidance and resources to enable safe practice and promote patient safety

Responsible Stakeholder

ARHAI Scotland

Deliverables

There will be continuous improvement and management of the NIPCM to ensure guidance and resources meet the needs of the service and reflect current available evidence.

Objectives

2.1 Staff will have easily accessible guidance and resources to enable safe practice and promote patient safety

Responsible Stakeholder

Scottish Government

Deliverables

Liaise with ARHAI Scotland to commission the development of national guidance on the management of specific fungal species infection.[5]

Objectives

2.2 Understanding of human behaviour during the COVID-19 pandemic on the application of IPC measures will be incorporated into IPC guidance and education for staff at all levels.

Responsible Stakeholder

NES

Deliverables

The training output from the CNOD-commissioned Behavioural Insights research by Edinburgh University[6] will be housed on TURAS Learn to support leaders to ensure the principles of good communication are adhered to when introducing new or updated guidance.

Objectives

2.2 Understanding of human behaviour during the COVID-19 pandemic on the application of IPC measures will be incorporated into IPC guidance and education for staff at all levels.

Responsible Stakeholder

ARHAI Scotland

Deliverables

Will be able to demonstrate that they have used the behavioural insights principles when developing and/or updating IPC guidance and the NIPCM.

Objectives

2.3 All remaining COVID-19 IPC guidance and policies across Health and Social Care will be reviewed regularly considering emerging evidence.

Responsible Stakeholder

Scottish Government

Deliverables

Review the remaining COVID-19 specific guidance with a view to determine whether these measures are still required.

Ensure guidance changes are communicated with appropriate notice for timely implementation by NHS Boards.

Objectives

2.3 All remaining COVID-19 IPC guidance and policies across Health and Social Care will be reviewed regularly considering emerging evidence.

Responsible Stakeholder

ARHAI Scotland

Deliverables

Continue to review remaining COVID-19 IPC guidance at regular intervals with a view to determine whether these measures are still required.

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.

Objectives

3.1 Support the development of a confident and skilled IPC and antimicrobial stewardship (AMS) workforce.

Responsible Stakeholder

NES

Deliverables

Using an agreed methodological approach, work collaboratively with stakeholders to develop frameworks for both specialist IPC practitioners, as well as a generalist framework for AMS.

Undertake a gap analysis of the current resources to assimilate current resources to the pathways and ascertain further educational resource requirement.

Scope the merits of centralisation of AMR/AMS resources within TURAS Learn to ensure maximum usage.

Objectives

3.2 Support the standardisation of IPC practice across Scotland.

Responsible Stakeholder

NES

Deliverables

Develop an IPC Education Strategy, which will begin the initial development of a general IPC curriculum in the planned 2025-2030 IPC strategy.

Objectives

3.2 Support the standardisation of IPC practice across Scotland.

Responsible Stakeholder

NES

Deliverables

Continue developing bite-sized resources, incorporating stakeholder feedback, to provide a blended learning approach including short animations and podcasts which are aligned to the NIPCM and complement the Scottish IPC Pathway (SIPCEP).

Objectives

3.3 Increase the awareness of and accessibility to IPC training resources at a local and national level.

Responsible Stakeholder

NES

Deliverables

Work collaboratively with health and social care colleagues to ensure that where education resources are developed/maintained, this is done using the best available evidence and in a format that supports the needs of the learner.

Continue to collaborate with NES Digital, NHS Health Board Learning and Development teams to ensure any updates to SIPCEP on TURAS Learn are mirrored in LearnPro to ensure consistency and governance across platforms.

Strategic Goal 4

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

Objectives

4.1 Surveillance Systems and processes will be reviewed not only to consider existing programmes but identify any new priorities.

Responsible Stakeholder

ARHAI Scotland

Deliverables

Will undertake a review of current mandatory surveillance priorities and make recommendations for future priorities, including a review of current mandatory surveillance.

Objectives

4.1 Surveillance Systems and processes will be reviewed not only to consider existing programmes but identify any new priorities.

Responsible Stakeholder

Scottish Government

Deliverables

Evaluate current mandatory surveillance policy in light of the completed review and will communicate any policy changes timeously.

Objectives

4.2 The current National HCAI targets and indicators will be reviewed to ensure they are relevant and reflective of current context.

Responsible Stakeholder

ARHAI Scotland

Deliverables

Complete a review of the HCAI targets and indicators and provide the Scottish Government with the results of the review and any recommendations.

Continue analysis of NHS Board data and report progress towards delivery of HCAI targets and indicators for Scottish Government monitoring.

Objectives

4.2 The current National HCAI targets and indicators will be reviewed to ensure they are relevant and reflective of current context.

Responsible Stakeholder

Scottish Government

Deliverables

Consider the recommendations made by ARHAI Scotland relating to the HCAI standards and indicators.

Communicate the outcome of the ARHAI Scotland review and any changes to the National HCAI targets and indicators to all relevant stakeholders. Ensure there is a lead-in time for implementation of any change.

Strategic Goal 5

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

Objectives

5.1 Assurance will be sought around local processes for Standard Infection Control Precautions (SICPs) and improvement work.

Responsible Stakeholder

ARHAI Scotland

Deliverables

Liaise with Territorial and other National Health Boards to conduct a gap analysis on SICPs monitoring.

Objectives

5.2 Ensure strategic alignment with other relevant strategies pertaining to HCAI and the nosocomial agenda.

Responsible Stakeholder

Scottish Government

Deliverables

Engage in development of the Pathogen Genomic Strategy for Scotland 5 year strategic plan.

Consider relevant recommendations and outputs from the Public Health Scotland (PHS) needs and gap analysis of Scottish microbiology services in line with the Public Health Microbiology Strategy for Scotland.

Strategic Goal 6

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

Objectives

6.1 The methods of reporting incidents and outbreaks will be reviewed to ensure processes support the assessment and reporting of infection incidents and shared learning.

Responsible Stakeholder

ARHAI Scotland

Deliverables

Chapter 3 and Appendices 14 and 15 of the NIPCM will be reviewed to support the mapping of investigations, to explore hypotheses, and ultimately support the identification of preventative measures to reduce the likelihood of further infection incidents.

Objectives

6.2 Data collection methods and processes will be improved to support early warning systems.

Responsible Stakeholder

ARHAI Scotland

Deliverables

Begin development of a local alert/early warning system for high-risk areas in collaboration with a pilot board.

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.

Objectives

7.1 NES will deliver and evaluate flexible learning and development resources to support the specialist workforce members responsible for built environment.

Responsible Stakeholder

NES/NHS Scotland Assure

Deliverables

Continue with the delivery and implementation of the National Learning and Development Strategy for the Specialist Healthcare Built Environment Workforce (2021-2026) and provide delivery measures via their annual action plans.

Objectives

7.2 The learning from built environment incidents and reviews will be reflected in future policy, guidance, and research.

Responsible Stakeholder

NHS Scotland Assure

Deliverables

Ensure learning from built environment incidents and reviews is reflected in updated guidance & policy documents.

Ensure that learning from built environment incidents and reviews is used to develop informed research topics.