1. Cleanliness Champions: Evaluation of impact on HAI in NHSScotland Professor Jacqui Reilly HPS

2. 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

3. How far have we come?

4. 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.

5. Comparisons

6. 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

7. Cleanliness Champion Enrolment by Generic Workplace Setting 0 500 1000 1500 2000 2500 3000 3500 4000 4500 5000 Acute SectorAdult Care Home Sector Community Sector OtherSASNot Known Workplace Setting Number of Enrollments 201120122013

8. Cleanliness Champion Enrolment by Generic Profession 0 500 1000 1500 2000 2500 3000 3500 4000 4500 5000 AHP Dentistry Doctor Domestic Healthcare Assistant Nurse Other Pharmacist SAS Staff SAS Ambulance Staff Student Not Known Profession Number of Enrollments 201120122013

9. What was the impact?

10. 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

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

12. 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.

13. Timeline of major HAI policy initiatives to date

14. Detecting the change point March 2007: Multimodal campaign implemented from 2003 10000 cleanliness champions were registered on CC programme by this point

15. Impact on outcome MRSA 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.

16. Where are we now?

17. Uptake of the CC programme 31599 staff registered 16614 completed Data source: NES August 31 st 2013, HPS Annual report HAI 2013

18. Distribution of HAI types in Acute Hospitals in Scotland in 2006 and 2011 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

19. 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

20. 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?

21. What should we do next…?

22. 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

23. 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