revised framework for mandatory induction training a course has been developed by nes in the form of...

Revised Framework for Mandatory Induction Training

in Healthcare Associated Infection (HAI) for NHSScotland

Contents

1. Introduction 3

Aims of the revised Framework 3

2. The revision process and outcomes 5

3. Learning outcomes 7

Learning outcomes for all staff 7

Additional learning outcomes for 7 Direct Health and Care Staff, Direct Staff and Non-direct Health and Care Staff

Additional learning outcomes for Direct 8 Health and Care Staff and Direct Staff

Additional learning outcomes for Direct 8 Health and Care Staff

Additional learning outcome on antimicrobial 8 stewardship for Direct Health and Care Staff and Non-direct Health and Care Staff

4. Using the revised Framework 9

Principles for managing mandatory 9 induction training in HAI within NHSScotland induction programmes

Appendix 1 11

Appendix 2 13

References 14

The revised version reflects:

• the National Occupational Standards (NOS) in Infection Prevention and Control published by Skills for Health in January 2012 1

• the Infection Prevention and Control: staff working together document published by Skills for Health in August 20112, which defines the core competences for all staff groups and identifies which NOS are necessary to ensure staff are competent

• the National Infection Prevention and Control Manual published by Health Protection Scotland (HPS) in January 2012 3, which updates the Standard Infection Control Precautions (SICPs) on which the original framework was based

• the Healthcare Associated Infection Quality Standards published by NHS Quality Improvement Scotland in March 2008 4 ; these are now administered by Healthcare Improvement Scotland (HIS) and are used by the Healthcare Environment Inspectorate (HEI) as their scrutiny framework.

Aims of the revised Framework

The revised Framework sets out to:

• maximisetherelativelylimitedopportunitiesofferedduring“generic”inductionprogrammesto emphasise the importance of HAI and the key role individual healthcare workers can make to reducing its incidence

• provideafoundationforcontinuingdevelopmentactivitydesignedtoincreaseunderstandingof HAI and improve practice.

While the revised Framework provides a foundation for good practice and helps to ensure consistency of approach to mandatory induction training in HAI throughout NHSScotland, it does NOT provide the structure or content of a course in HAI. Such a course has been developed by NES in the form of the national programme on HAI mandatory induction training, which presents an option for organisations in delivering HAI induction. Information about this programme can be accessed at: www.nes.scot.nhs.uk/education-and-training/by-theme-initiative/healthcare-associated-infections/educational-programmes/hai-mandatory-induction-training-programme.aspx

Instead, the framework provides support to organisations who wish to design their own HAI induction training by setting out principles underpinning the development and delivery of mandatory induction training in HAI and defining learning outcomes against which any locally developed programme should be mapped.

Personnel within NHSScotland organisations who have responsibility for developing and delivering mandatory induction training in HAI will be able to use the revised Framework to plan programmes that enable staff to meet core competencies and national standards based on the National Occupational Standards in Infection Prevention and Control 1 and the National Infection Prevention and Control Manual 3 and to:

• map existing provision of induction training in HAI • audit current resources for induction training in HAI, including personnel with specific expertise,

teaching accommodation and equipment and provision of suitable clinical areas with adequate supervision to facilitate work-based competency development

• design training initiatives to develop selected healthcare workers’ competences in delivering good HAI practice.

1. Introduction

This revised and updated version of the Framework for Mandatory Induction Training in Healthcare Associated Infection (HAI) for NHSScotland builds on and succeeds the original framework developed and published by the Scottish Executive and NHS Education for Scotland (NES) in 2004.

While knowledge acquisition and theoretical preparation are important elements of mandatory induction training, the application of theory in practice is paramount.

It is also important to emphasise that the revised Framework does not attempt to replace the components of current HAI education and practice within NHSScotland. Rather, it complements, supports and strengthens a range of initiatives already in place, such as:

• the work of infection control teams (ICTs)

• the work of link personnel for infection control

• the work of Cleanliness Champions

• HAI-focused content of many professional healthcare initial preparation programmes and post-registration education initiatives

• local policies, procedures, guidelines, standards and training programmes on HAI designed to accommodate the specific needs of groups of healthcare workers

• the foundation materials on HAI in induction programmes for all NHSScotland staff.

In Scotland, Standard Infection Control Precautions (SICPs) are recognised as the basic infection prevention and control measures necessary to reduce the risk of transmission of micro-organisms from recognised and unrecognised sources of infection 3. These sources of (potential) infection include blood and other body fluids secretions or excretions (excluding sweat), non-intact skin or mucous membranes and any equipment or items in the care environment that are likely to become contaminated.

The SICPs were revised in January 2012 National Infection Prevention and Control Manual 3 and are intended for use by all staff, in all care settings, at all times and for all individuals, whether infection is known to be present or not. The revised SICPs are:

1. Patient placement

2. Hand hygiene

3. Respiratory hygiene and cough etiquette

4. Personal protective equipment (PPE)

5. Management of care equipment

6. Control of the environment

7. Safe management of linen

8. Management of blood and body fluid spillages

9. Safe disposal of waste

10. Occupational exposure management (including sharps).

Mandatory induction training in HAI is based on the principle that the greater the number of healthcare workers with direct or indirect patient contact who have an understanding of the SICPs, the greater the chance of promoting high personal standards and behaviours and reducing the prevalence of HAI within NHSScotland.

The National Infection Prevention and Control Manual 3 also sets out specific responsibilities for staff providing care in relation to infection prevention and control. Staff must ensure that they:

• understand and apply the principles of infection prevention and control

• maintain competence, skills and knowledge in infection prevention and control through attendance at education events and/or completion of online training modules from, for example, NES

• communicate the infection prevention and control practices to be taken by colleagues, those being cared for, relatives and visitors without breaching confidentiality

• have up-to-date occupational immunisations/health checks/clearances requirements as appropriate

• report to line managers and document any deficits in knowledge, resources, equipment and facilities or incidents that may result in transmission of infection

• do not provide direct care while at risk of potentially transmitting infectious agents to others: if in any doubt, they must consult with their line manager, occupational health department or ICT 3.

2. The revision process and outcomes

The Department of Health commissioned Skills for Health, in partnership with the Infection Prevention Society (IPS), to identify the Infection Prevention and Control Core Competencies (NOS) for all staff who are not infection prevention and control practitioners, regardless of role or grade (2). Key stakeholders from all four UK countries were engaged in this work.

To support the revision of the Framework for Mandatory Induction Training in HAI, NES commissioned Skills for Health to map the Infection Prevention and Control Core Competencies (NOS) (2) to the SICPs, the result of which is shown at Appendix 1. The mapping also took account of the defined responsibilities for staff described above.

Staff groups for mandatory induction training in HAI are defined in the Infection Prevention and Control: staff working together document 2 and are reflected in Appendix 1. The four staff groups are shown in Box 1.

Box 1.

Direct Health and Care Staff Staffinthisroleareindirect“face-to-face”contactwithpatientsandserviceusers,haveahealthandcare role and require competence in further additional NOS. Examples include medical and nursing staff.

Direct Staff Staffinthisroleareindirect“face-to-face”contactwithpatientsandserviceusersbutdonothaveahealth and care role. They require competence in additional NOS to meet the infection prevention and control demands of their jobs. Examples include ward clerks and receptionists.

Non-direct Health and Care Staff Thesestaffdonothave“face-to-face”contactwithpatientsorserviceusers,butdohaveaclinicalrole. They may walk through and use areas also used by patients and service users. Examples include laboratory technicians.

Non-direct StaffStaffinnon-directrolesdonothaveany“face-to-face”contactwithpatientsorserviceusersbutmaywalk through and use facilities in areas that patients and service users also use. They may offer clinical advice from a distance and provide a service that supports the delivery of care. Examples include medicalsecretariesand“backoffice”staff.

The process of this mapping exercise identified a new NOS, IPC 13, which relates to management for Direct Health and Care Staff, and this has been added to the table in Appendix 1.

Further data from the mapping process can be found on the NES website at www.nes-hai.info.

Learning outcomes for all staff

Following mandatory induction training, all staff will be able to do the following.

1. Find, and refer to, current national legislation and local policy relating to infection prevention and control, particularly:

• prevention of occupational exposure to infection • management of blood and body fluid spillages • management of care equipment • safe disposal of waste, including sharps.

2. Understand the infrastructure for infection prevention and control within the organisation, including the function of infection control teams, microbiology services and HAI Cleanliness Champions.

3. Understand how their role and responsibilities contribute to the overall objective of infection prevention and control and the responsibilities and rights of others, including patients/service users and visitors.

4. Understand how maintaining clean and tidy work areas can contribute to health, safety, and infection prevention and control.

5.Understandanddefinewhatismeantby“thechainofinfection”.

6. Understand and describe when hand hygiene is required and how to perform effective hand hygiene.

Additional learning outcomes for Direct Health and Care Staff, Direct Staff and Non-direct Health and Care Staff Following mandatory induction training, Direct Health and Care Staff, Direct Staff and Non-direct Health and Care Staff will also be able to do the following.

7. Understand the importance of ensuring their fitness for work, the system for reporting illness, the role of the occupational health department (OHD) and their responsibility in relation to infection prevention and control to follow OHD advice and comply with regulations.

8. Describe how the risk of cross-infection is reduced by appropriately dressing for work and applying high standards of personal hygiene.

9. Identify the risks of spillages of blood and other body fluids and understand procedures for

ensuring safe cleaning, disinfecting and removal of spillages from work areas. 10. Understand personal protective equipment (PPE) and describe why and how it is used within the

work environment. 11. Understand the importance of the correct disposal of healthcare waste, including sharps, in

minimising the risk of acquiring and/or spreading infection, and know the policies, protocols and guidelines applicable to their work.

3. Learning outcomes

The learning outcomes are offered as a framework on which the HAI training elements of induction programmes can be placed. They are presented in relation to the four staff groups identified in Infection Prevention and Control: staff working together 2.

Additional learning outcomes for Direct Health and Care Staff and Direct Staff Following mandatory induction training, Direct Health and Care Staff and Direct Staff will also be able to do the following.

12. Understand the importance of cleaning, disinfecting and storing re-usable non-¬invasive care equipment to minimise the risk of spreading infection.

Additional learning outcomes for Direct Health and Care Staff

Following mandatory induction training, Direct Health and Care Staff will also be able to do the following.

13. Understand the risk to self and others through exposure to blood and body fluids and know how to minimise the risk.

14. Understand how to reduce the risk of infection when handling and storing clean linen and removing and disposing of used linen.

15. Understand the principles of isolation and the placement of individuals and what actions should be taken before, during and after the provision of care to minimise the risks of infection.

Additional learning outcome on antimicrobial stewardship for Direct Health and Care Staff and Non-direct Health and Care Staff

Following mandatory induction training, Direct Health and Care Staff and Non-direct Health and Care Staff will also be able to do the following.

16. Understand the importance of compliance with local antibiotic policies and how restriction of the use of certain antibiotics contributes to reduction of HAI and minimising the spread of antimicrobial resistance.

NES has developed an audit tool, Measuring Progress (5), that is designed to enable organisations to assess the effectiveness of their mandatory training in HAI. This can be accessed at: www.nes.scot.nhs.uk/media/653770/mandatory_induction_training_audit_tool.pdf

Careful assessment of staff training needs will be necessary: for example, some staff groups may have already met specific learning outcomes through initial preparation programmes that include Cleanliness Champions training, while other learning outcomes may be considered more appropriate inclusions in regular update activity for Direct Health and Care Staff rather than mandatory training.

Principles for managing mandatory induction training in HAI within NHSScotland induction programmes

• NHSpersonnelwhohaveresponsibilityfordevelopinganddeliveringmandatoryinductiontraining in HAI should work in close partnership with colleagues in, for instance, human resources departments, higher education institutions and specialist teams in designing and delivering the HAI component of induction training programmes for all healthcare workers.

• Otherelementsoftheinductionprocess,suchastrainingincommunication,healthandsafety,quality improvement methodologies,team working and organisational objectives, support the overall effectiveness of HAI mandatory induction training programmes.

• FlexiblemethodsofdeliveringtheHAIelementsoftheprogrammeshouldbepursued,ensuringthat healthcare workers have the opportunity to direct their own learning, in consultation with their line managers/supervisors.

• Healthcareworkersshouldbeabletoaccesscoreeducationmaterialsthroughallresourcesatthe organisation’s disposal. This should include libraries, key policy and procedure documents, information on appropriate statutory requirements, colleagues with particular expertise, and IT resources (including, where appropriate, NES Knowledge Services (www.knowledge.scot.nhs.uk/home.aspx).

• Innovativeapproachestoselfassessmentshouldbeemployed,builtontheprinciplethathealthcare workers should be enabled to verify their own competency acquisition. The personal development planning (PDP) process offers an appropriate medium for this function.

• HAItraininginitiativeswithininductionprogrammesshould,wheneverpossible,haveamultidisciplinary focus.

• InductiontraininginitiativesonHAIshouldhaveexplicitlearningoutcomes.

• Mechanismsforrecordingattendanceat,andcompletionof,inductiontrainingshouldbeemployed at organisational and individual levels.

• Adequatequalityassuranceandauditingprocessesshouldbeinplacetoensuretheongoingfitness for purpose of HAI elements of induction training programmes.

4. Using the revised Framework

Organisations can use the national training programme on HAI mandatory induction training developed by NES (www.nes.scot.nhs.uk/education-and-training/by-theme-initiative/healthcare-associated-infections/educational-programmes/hai-mandatory-induction-training-programme.aspx), or can opt to develop their own programmes relevant to each staff group supported by the learning outcomes set out in Chapter 3.

Standard Infection Control Precautions (mapped to Infection Prevention and Control Core

Competences (NOS))

Direct Health

and Care Staff

Direct Staff

Non-direct Health

and Care Staff

Non-direct Staff

Responsibilities for the implementation of the National IPC Manual: Staff providing care(Gen97; KSF Core 1)

√ √ √ √

SICP 9 Safe disposal of waste SICP 10 Occupational exposure management (including sharps)(Gen 96; KSF Core 3)

√ √ √ √

SICP 2 Hand hygieneSICP 3 Respiratory hygiene and cough etiquette (IPC 2; KSF Core 3)

√ √ √ √

(HSC 241; KSF Core 5) √ √ √ √Responsibilities for the implementation of the National IPC Manual: Staff providing care(Gen 63; KSF Core 5)

√ √ √ √

Responsibilities for the implementation of the National IPC Manual: Staff providing care(Gen 1; KSF Core 3)

√ √ √

Responsibilities for the implementation of the National IPC Manual: Staff providing care(Gen 2; KSF Core 3)

√ √ √

SICP 8 Management of blood and body fluid spillages(IPC 3; KSF Core 3) √ √ √

SICP 4 Personal protective equipment(IPC 6; KSF Core 3) √ √ √

SICP 3 Respiratory hygiene and cough etiquetteSICP 9 Safe disposal of waste(IPC 7; KSF Core 3)

√ √ √

SICP 5 Management of care equipmentSICP 6 Control of the environment(IPC 4; KSF Core 3)

√ √

SICP 4 Personal protective equipmentSICP 8 Management of blood and body fluid spillages SICP 9 Safe disposal of waste SICP 10 Occupational exposure management (including sharps)(IPC 5; KSF Core 3)

√

SICP 7 Safe management of linen(IPC 9; KSF Core 3) √

SICP 7 Safe management of linen(IPC 12; KSF Core 3) √

Responsibilities for the implementation of the National IPC Manual: Managers of all services SICP 1 Patient placementSICP 2 Hand hygiene* (IPC13; KSF Core 3)

√

SICP 1 Patient placement* (Gen 30; KSF G5) √

Responsibilities for the implementation of the National IPC Manual: Staff providing careSICP 6 Control of the environment* (IPC1; KSF Core 3)

√

*Additional NOS for Direct Health and Care Staff

Appendix 1

Relationship between Standard Infection Control Precautions and relevant Staff Groups, mapped to Infection Prevention and Control Core Competences (National Occupational Standards (NOS)

National Occupational Standard Hyperlink to PDF document

GEN1. Ensure personal fitness for work https://tools.skillsforhealth.org.uk/competence/show/html/id/372/

GEN2. Prepare and dress for work in healthcare settings

https://tools.skillsforhealth.org.uk/competence/show/pdf/id/383/

GEN30. Manage patient flow https://tools.skillsforhealth.org.uk/competence/show/pdf/id/2297/

GEN63. Act within the limits of your competence and authority


GEN96. Maintain health, safety and security practices within a health setting


GEN97. Communicate effectively in a healthcare environment


HSC241. Contribute to the effectiveness of teams

https://tools.skillsforhealth.org.uk/external/103_HSC241.pdf

IPC1. Minimise the risk of spreading infection by cleaning, disinfecting and maintaining environments


IPC2. Perform hand hygiene to prevent the spread of infection


IPC3. Clean, disinfect and remove spillages of blood and other body fluids to minimise the risk of infection


IPC4. Minimise the risk of spreading infection by cleaning, disinfection and storing care equipment


IPC5. Minimise the risk of exposure to blood and body fluids while providing care


IPC6. Use personal protective equipment to prevent the spread of infection


IPC7. Safely dispose of healthcare waste, including sharps, to prevent the spread of infection


IPC9. Minimise the risk of spreading infection when removing used linen


IPC12. Minimise the risk of spreading infection when storing and using clean linen


IPC13. Provide guidance, resources and support to enable staff to minimise the risk of spreading infection


Appendix 2

Links to National Occupational Standards within the HAI Mandatory Induction Framework

References

1. Skills for Health. National Occupational Standards in Infection Prevention and Control. Bristol, Skills for Health, January 2012.

2. Skills for Health. Infection Prevention and Control: staff working together. Bristol, Skills for Health, August 2011. (http://www.skillsforcare.org.uk/developing_skills/Infectionpreventionandcontrol/Infectionpreventionandcontrolcompetences.aspx).

3. Health Protection Scotland, NHS National Services Scotland. National Infection Prevention and Control Manual. Glasgow, HPS, January 2012 (http://www.hps.scot.nhs.uk/haiic/ic/guidelinedetail.aspx?id=49785).

4. NHS Quality Improvement Scotland. Healthcare Associated infection Quality Standards. Edinburgh, Healthcare Improvement Scotland, March 2008 (http://www.healthcareimprovementscotland.org/previous_resources/standards/healthcare_associated_infectio.aspx).

5. NHS Education for Scotland. Measuring Progress. A tool to help you audit and assess your organisation’s implementation of Mandatory Induction Training for the control and prevention of Healthcare Associated Infection. Edinburgh, NES, 2005 (http://www.nes.scot.nhs.uk/media/653770/mandatory_induction_training_audit_tool.pdf).

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