SUPPORTING PAPER (FOR INFORMATION) TRUST BOARD

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1 SUPPORTING PAPER (FOR INFORMATION) TRUST BOARD Date of meeting: Thursday, 28 th July 2011 Title of paper: Infection Prevention and Control Annual Report 2011 Presented by: Executive Summary: Head of Clinical Care and Patient Safety The Health and Social Care Act 2008 Code of Practice on the prevention and control of infections and related guidance compliance criteria 1 (1.3) that organisations must produce an Annual Report and release it publicly on the organisation s progress against the objectives of the IPC work programme. The IPC Annual Report provides assurance to the Trust Board of the continuing work undertaken around infection prevention and control during and the organisation s on-going commitment to the IPC / healthcare associated infection agenda. Recommendations: The Trust Board is requested to acknowledge and approve the contents of this report as it provides assurance to the Board of the continuing work undertaken around infection prevention and control during CQC Essential Standards of Quality & Safety: Legal Issues: Involvement and Information Personalised care, treatment and support Safeguarding and safety Suitability of staffing Quality and management Suitability of management There are a number of enforcement actions the Care Quality Commission could impose on the Trust as a result of the any Inspection that may take place; Apply/ impose conditions to the Trust s IPC Registration Issue a warning notice Prosecute for specified offences (maximum of 50,000) Imposing a monetary penalty notice Suspend (for specified period) or cancel (in extreme cases) registration Author: Paul Fell Date: 15 th July 2011

2 Infection Prevention and Control Annual Report Document Reference: Document Profile Box Version: V.1 Ratified by: Date ratified: Name of originator/author: Name of responsible committee/individual: Date issued: Christine McManus Review date: March 2012 Target audience: Document owner: Authorised signatory: Contents Infection Prevention and Control All NEAS Staff Ann Fox 1.0 Introduction Background 2.1 The Health and Social Care Act 2008 Code of Practice Essential Standards of Quality and Safety 2010/11 5

3 2.3 NHS Litigation Authority (NHSLA) Risk Management Standards for Ambulance Trusts (2010/11) National Patient Safety Agency (NPSA) (2009). The national specifications of cleanliness in the NHS: A framework for setting and measuring performance outcomes in ambulance trusts Progress in Infection Prevention and Control Programme IPC Strategy Management and Organisation Annual Programme Board Decisions Public Involvement Policy Review Communication Infection Prevention and Control Service Provision Audit Education and Training Surveillance and monitoring of Healthcare Associated Infections Service and Building Developments Cleaning Services 7.1 Vehicle cleaning Station / premises cleanliness External assurance 8.1 The Health and Social Care Act Other initiatives 9.1 CleanyourHands Campaign Business Case Development and Approval Specific Organisms 11.1 MRSA Bacteraemia Norovirus Professional Networks Conclusion Key documents (references) 18 Glossary of terms 19

4 1.0 Introduction 1.1 The Department of Health (DH) remains firmly committed to reducing healthcare associated infections (HCAI s) and acknowledges this as an important area of clinical practice. It is an integral component in delivering the Clinical Governance/Patient Safety and Risk Management agendas both at a national and local level. The publication of guidance and legislation has determined the infection prevention and control agenda and subsequently impacted on regional and local policy development for reducing the risk of HCAI s. 1.2 The North East Ambulance Service (NEAS) NHS Trust has an ongoing commitment in preventing HCAI s to the population it serves. The overall aim of this report is to ensure that the NEAS is taking the necessary actions to minimise the risk of healthcare associated infections as identified within the national strategy. 1.3 The NEAS is also required to ensure that it meets the requirements of the core domains of the Standards for Better Health (2006). 2.0 Background National Priorities The following publications provide a framework within which the NEAS Infection Prevention and Control Manager operates. 2.1 The Health and Social Care Act 2008 Code of Practice on the prevention and control of infections and related guidance (Department of Health, revised in December 2010) This legal Code of Practice describes a range of evidence based criteria (ten in total) which organisations are required to use to review and inform their current Infection Prevention and Control practices to ensure patients are cared for in a clean and safe environment with the risk of HCAI kept as low as possible. It builds on other key initiatives from the previous documents such as Winning Ways and Saving Lives The Code of Practice ensures good practice is embedded into every day practice across the patient s journey throughout the pre-hospital environment. 2.2 Essential Standards of Quality and Safety 2010/ Under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, all providers of adult social care that carry out regulated activities from 1 April 2010 must be registered with the Care Quality Commission (CQC) who is the regulator of health and adult social care in England. To be registered, each provider must meet essential standards of quality and safety. The CQC will monitor the compliance of each provider with these essential standards and publish updates on performance on the website Compliance inspectors will also use the Quality and Risk Profile (QRP) to assess compliance with the essential standards of quality and safety.

5 2.2.3 In March 2010 the CQC licensed the NEAS NHS Trust to provide the following services: Diagnostic and screening procedures Transport services, triage and medical advice provided remotely Treatment of disease, disorder or injury The CQC registered NEAS without conditions showing that the Trust met the essential standards of quality and safety Outcome 8 (Regulation 12) Cleanliness and infection control the guidance about legislation governing the prevention and control of healthcare associated infections is covered within the Department of Health s publication: The Code of Practice as outlined in section of this document. 2.3 NHS Litigation Authority (NHSLA) Risk Management Standards for Ambulance Trusts (2010/11) The NHSLA is a Special Health Authority, established in 1995 to administer the Clinical Negligence Scheme for Trusts (CNST) and thereby provide a means for NHS organisations to fund the cost of clinical negligence claims There are three levels of assessment containing its own individual question set and scored on a stand-alone basis. The levels are as follows: Level 1 Documenting (Policy) demonstrates that the process for managing risks has been described and documented. Level 2 Implementing (Practice) demonstrates the process for managing risks, as described in the approved documentation, is in use. Level 3 Monitoring (Performance) demonstrates whether or not the process for managing risk, as described in the approved documentation, is working across the entire organisation Criterion 8: Standard 2 Competent and Capable Workforce includes hand hygiene as part of the assessment process. Criterion 8: Standard 4 Clinical Care includes Infection Control. 2.4 National Patient Safety Agency (NPSA) (2009). The national specifications of cleanliness in the NHS: A framework for setting and measuring performance outcomes in ambulance trusts These specifications have been designed to provide a methodology within which healthcare providers can assess the effectiveness of their cleaning services They can be used as: A basis for developing specifications for service level agreements. A standard against which services can be benchmarked. An aid to establishing the right staffing levels. Part of on-going performance management process. A framework for auditing. A benchmark in the drive to reduce HCAIs.

6 A support tool in improving patient and visitor satisfaction levels. 3.0 Progress in the Infection Prevention and Control Programme 2010/ Infection Prevention and Control Strategy Management and Organisation The Director of Clinical Care and Patient Safety is the Trust Board lead responsible for Infection Prevention and Control within the NEAS The Infection Prevention and Control Manager has day to day responsibility for infection prevention and control within the NEAS, also for policy development and review, and associated leadership, education and training The Infection Prevention and Control Group (IPCG) underwent a change of membership and the terms of reference reflect this. It has broad representation from across the organisation including staff side and external agencies. It provides a forum for the co-ordination of all projects in the prevention and control of infection for the Trust. The Group is accountable to the Quality Committee The IPC Group meets bi-monthly and the main functions of the committee are to: Monitor and evaluate the outcomes of the IPC Annual Programme bi-monthly to demonstrate progress. This is to be monitored by the IPCG, Quality Committee, Trust Board and the Director of Infection Prevention and Control Network. Agree the development of appropriate evidence-based infection prevention and control policies, procedures and guidance in accordance with national guidance and legislation. This is reviewed and updated as new information and evidence becomes available. Approve any reviewed/updated IPC policies as and when required. Agree to review and monitor the effectiveness of infection prevention and control policies through the audit programme. Approve the annual infection prevention and control programme and review previous year s progress. Agree to the development of key performance indicators capable of showing improvements in infection prevention and control. Agree and approve the development of infection prevention and control education and training programme into the service s annual training schedule. The Director of Infection Prevention and Control (DIPC) to produce an annual report to demonstrate progress against the actions taken by NEAS to minimise the risk of HCAIs, as identified within the national strategy and the core domains of the Standards for Better Health. This report to be presented and approved by the IPC Group, the Quality Committee and the Trust Board. Highlight/identify issues to the Quality Committee on all matters relating to infection prevention and control. Interpret national infection prevention and control initiatives in terms of their implementation across the NEAS and seek assurances in order to comply with the Health Act 2008 and the Standards for Better Health. Seek assurances that work is being done proactively to effectively assess and manage any risks associated with infection prevention and control issues Assist as directed by the Health Protection Unit in the investigation and management of outbreaks within the NEAS divisions. Recommend the facilitation of IPC issues through the communications network within the NEAS.

7 Provide advice on environmental design and equipment / supplies procurement. Lead and facilitate the training and education of all NEAS staff in infection prevention and control. 3.2 Annual Programme The Infection Prevention and Control Team, in collaboration with the Infection Prevention and Control Group, will develop the annual infection prevention and control programme for the DIPC to take forward for ratification by the Trust Board. The programme will identify key areas to be addressed for the year The programme for 2010/11 consists of the following objectives: To monitor performance against The Health and Social Care Act 2008 Code of Practice for the prevention and control of infection and related guidance. To deliver equipment for those who undertake clinical duties, which reduces infection and contamination so that, the highest possible standard of care can be made available. To deliver environments for those who use or work for NEAS which are hygienically maintained so that the highest possible standards of care can be made available. To ensure that those who work for NEAS are free of and are protected from communicable disease during the course of their work, by working collaboratively with the Trust Occupational Health Department. To provide leadership, focus and direction constantly seeking out opportunities to improve patient and staff safety through the promotion of sound clinical governance arrangements, training, education and personal development. 3.3 Board decisions The Trust Board has overall responsibility for the risk of healthcare associated infections and will base its decisions on risk evaluation and best practice. The Board devolves responsibility to the DIPC. 3.4 Public Involvement The Trust is committed to ensuring that in its effort to combat the spread of infection the general public is kept fully informed of its performance. The Infection Prevention and Control Annual Report is available for public scrutiny. Details of the Trust s Infection Prevention and Control initiatives including its policy and procedures are available to the public, under the freedom of information, via the Trust s web-site Details of the Trust s Infection Prevention and Control initiatives including its policy and procedures are available to the public, under the freedom of information, via the Trust s web-site Under the Care Quality Commission health standards (formerly Healthcare Commission annual health check), members of the local authority health overview & scrutiny committee and service users and their representatives on Local Involvement Networks are invited to comment on the Trust s Infection, Prevention and Control policy. This will include inspection of Trust vehicles and premises and access to Trust officers to answers questions arising from the policy. 3.5 Policy review

8 3.5.1 To ensure best and safe practices are adhered to, all NEAS staff have access to a variety of evidenced based policies which reflect current national guidance and recommendations Staff can access these policies through the Trust Intranet via Docuviewer. Polices will continue to be developed, reviewed and implemented to reflect current evidence base or in the light of any legislative changes The IPC Policy and Strategy has been approved and ratified. 3.6 Communication The IPC Manager continues to act as a resource for the NEAS being available to give advice and information on many different infection prevention and control issues In addition, the IPC Manager continues to work collaboratively with the IPC teams in the acute sectors, Primary Care Trusts and the staff within the Health Protection Agency (HPA) across the North East Current communication networks and forums attended: Healthcare Reduction Partnership Group (as required) National Ambulance IPC Group Infection Prevention Society Regional Meetings Quality Committee NEAS Infection Prevention and Control Group NEAS Medical Devices Group NEAS Environmental Management Working Group NEAS Health and Safety Committee NEAS Clinical Advisory Group (CAG) NEAS Trust Sluice Refurbishment Group NEAS Team Leader meetings when required The Infectious Diseases Consultant based at South Tees NHS Trust will provide out of hours advice on IPC and Infectious Diseases to the NEAS. 3.7 Infection Control Service Provision The IPC Manager and all staff employed by the NEAS have access to relevant legislation and guidance via internet web sites and the services Intranet site under Infection Prevention and Control The Clinical Care and Patient Safety Folder will be available on all NEAS premises and includes all relevant information on Infection Prevention and Control for staff to access as and when required The IPC Manager has an Annual Personal Development Plan (APD) which outlines a programme of relevant professional development for the year ahead. 3.8 Audit

9 3.8.1 The Health Act 2008 Code of Practice states that NHS organisations must ensure that it has in place appropriate arrangements and this must include a programme of audit to ensure that key policies and practices are being implemented appropriately Audits are an essential tool in ensuring best practice is continuously maintained The audit tool which is used to assess the cleanliness of NEAS premises has been developed using the audit matrix designed by National Patient Safety Agency - Standards for Cleanliness A total of 51 station audits were undertaken by the Quality Assurance Officer and the Quality Assurance and Performance officers between July 2010 and March The results are reported to the IPC Group and distributed to the Operational Managers/Assistant Operational Managers and Team Leaders each received an individual report, containing the audit findings, with supporting recommendations on improvements required. Action plans are to be completed and time frames allocated for remedial action. Overall there has been an improvement in overall cleanliness standards on NEAS premises. 4.0 Education and Training 4.1 The Health Act 2008 states that Induction and training programmes for new staff and ongoing education for existing staff should all incorporate the principles of infection prevention and control. 4.2 It is widely recognised that ongoing education activity in infection prevention and control is required in order to increase awareness in policies and improve health care workers compliance with infection prevention and control practices. 4.3 An induction programme for all new employees has been developed and includes an infection prevention and control session. These take place on a monthly basis. 4.5 The Training and Development department undertake mandatory training and education programmes for all staff, which include relevant updates and learning outcomes from the IPC Manager. The training is specific to the grade of staff that attends the course, be that clinical or non-clinical. All training programmes that are delivered reflect organisational and individual staff/service requirements. 4.6 Accident and Emergency crews attend a two skills update as part of the mandatory training programme. Patient Transport Services and other staff employed by NEAS under go annual mandatory training IPC updates. The NEAS also has access to e- learning programmes in order to increase compliance. 4.7 Infection prevention and control is included in Knowledge Skills Framework (KSF) job outlines and personal development plans, therefore staffs training needs will be reviewed and discussed annually via the appraisal system. 4.8 The Training and Development department have key performance indicator target for IPC - percentage of operational staff trained in IPC, set against quarterly targets of 25% increments. This is calculated quarterly and reported via the Integrated Performance Report (IPR)

10 Training data 2010/11 Staff group Number attended % Skills Day (A&E) % Patient Transport Services Control % Headquarters The IPC Manager has attended a number seminars/ conferences during 2010/11 in order to update knowledge and as part of on going professional development The CQC National NHS Staff Survey 2010 results on the subject area of training, learning and development in IPC (Q5e) in the last 12 months showed an increase at 76% compared to 60% in The average (median) for ambulance trusts was 55%. 5.0 Surveillance and Monitoring of Healthcare Associated Infections 5.1 As a provider service, the NEAS are part of the SHA Cluster Leads forum with membership drawn from provider lead clinicians. The aim of the group is to ensure a consistent approach is used to prevent and control HCAI s. 5.2 The group meets monthly and HCAI is discussed as a standing item. A system of action plan updates and root cause analysis underpins much closer working across SHA North East provider/commissioning organisations. 5.3 The NEAS receives HCAI surveillance data from the Health Protection Agency North East and the Strategic Health Authority on a monthly basis. The surveillance data is shared with the IPCC and the Trust Board. 5.4 The NEAS does not have surveillance targets for MRSA Bacteraemias or Clostridium difficile, but aspire to assist with zero MRSA Bacteraemias by working collaboratively across all healthcare settings in order to assist with reducing the MRSA target across the North East SHA. This will be targeted by ensuring that any interventions performed by NEAS staff are not considered to be a risk factor in any case through root cause analysis investigation. 5.5 Root cause analysis (RCA) will be performed on those bacteraemia results which occur within 48 hours of admission and identified as having interventions performed by staff employed by the NEAS. None have been identified during 2010/ Service and Building Developments 6.1 IPC Manager contributes IPC advice to new developments and refurbished facilities. 6.1 Following the inspection by the CQC in July 2009 the report identified the lack of hand washing facilities in sluice areas of premises. A business case was developed by the IPC Manger on the refurbishment of all station sluice areas. This was approved by the Capital Monitoring Group in March 2010.

11 6.3 The Trust Sluice Refurbishment Group was established with terms of reference and a project plan developed which would assist with the progress of the programme. 6.4 The contracts for the refurbishment programme have been awarded to two contractors and work commenced in November 2011 and has now completed as of 30 th March There are several stations to be carried forward to the next financial year due to these being part of shared locations with the fire and rescue service. 7.0 Cleaning Services 7.1 Vehicle Cleaning and Decontamination (the following information was produced by George Gray, NEAS Assistant Operational Support Manager (Equipment and Logistics) Comprehensive clinical instructions on vehicle cleaning and decontamination have been issued to clinical staff in respect of cleaning of equipment / vehicle between each patient, daily cleans for A&E, RRV and PTS vehicles.. All vehicles are supplied with spill kits and sanitising wipes A specifically designed wash system is utilized to clean the larger medical items of equipment. Trolleys, spinal boards, scoops carrying and wheel chairs etc, in order to ensure the equipment is cleaned to specified standards Additional ambulance hygiene assistants have been employed after a review of the existing cleaning schedules. A review was undertaken which had shown a failure rate at approximately 6 weeks, therefore cleaning was then performed on a more regular basis commencing in April A new vehicle wash has just been (March 2011) installed which will improve the external cleaning standard of vehicles Targets: there are 440 individual vehicles, which are cleaned as per the schedule shown below: A&E, Event and UCA vehicles will have a level (A) clean carried out at 6 weeks, a level (B) done at 12 weeks and level (C) done at 24 week intervals. Rapid Response vehicles will have a level (B) clean carried out at 12 week intervals. Patient Transport Vehicles will have a level (B) clean carried out at 12 weeks and a level (C) done at 48 week intervals. Level (A) is a clean of the patient compartment only, Level (B) clean is an intermediate clean of the whole vehicle Level (C) is a further more comprehensive deep clean this involves removing all items of equipment and consumable stocks, then cleaned as per cleaning schedule and check list (NEAS147). Key Performance Indicator: Definition: to determine the effectiveness of the planned cleaning schedule by measuring the amount of planned cleans against the actual amount done per

12 month. This will be reported quarterly and the target will always be to achieve 100% but expect to achieve no less than 90%. Cleans done Cleans required % Achieved Apr % May % June % July % August % September % October % November % December % January % February % March % Total number of cleans 2009/ /11 A&E RRV PTS totals In 2009/10 there were no performance targets or Key Performance Indicator (KPI) to measure the number of cleans against the vehicle cleaning schedule, but since April 2010 this is now reported through the Integrated Performance Report (IPR) Vehicles are planned on the fleet system at the above intervals to attend the cleaning department based at Pallion When the vehicle is cleaned, the equipment is then cleaned using the trolley wash system or by using sanitising wipe and then put back onto the vehicle. Cleaning process is complete Swabbing is done to determine the effectiveness of the planned cleaning process by measuring readings from 4 random swab samples taken by the team leader randomly from 20 selected locations in the vehicle. Key Performance Indicator Definition: percentage of the base-line reading must be within 90% of the target meter reading i.e. if the target reading is 200 then anything under this = 100% and any reading up to 200 (10% tolerance) is acceptable. The KPI target of 90% is reported through to performance. Number of swab Number of swab % Achieved samples taken sample passing April % May % June % July % August %

13 September % October % November % December % January % February % March % Any swabbing failures for the percentage achieve are subsequently cleaned again to achieve 100% pass rate before once again going into operational duty Procedures can be found in the following documents: QSSD672 Flow Chart QSSD640 Cleaning specification NEAS147 Check sheet 7.2 Station cleanliness Following the audit of station cleanliness and the inspection visit by the CQC it was suggested that a deep clean of all NEAS sites takes place to improve on current standards. A business case was prepared and approved. The deep clean programme commenced in July 2010 and completed with the exception of Pallion workshops in March In order to maintain cleanliness standards in all the divisions a cleaning specification has been produced, this is currently out to tender at the time of this report. It is anticipated that this will be in place by July External assurance 8.1 The Health and Social Care Act The Health Act 2008 introduced a statutory duty on NHS organisations to observe the provisions of the Code of Practice on HCAIs. Failure to observe the Code could potentially result in an Improvement Notice being issued by the Healthcare Commission, or an organisation being placed on Special Measures for significant failings The Trust has been working throughout 2010/11 to ensure that the organisation fully complies with the Code of Practice through acknowledging that effective prevention and control of infection has to be embedded into everyday practice and applied consistently by everyone The 2010/11 action plan incorporated the core criteria within the Code of Practice and demonstrates the arrangements for the prevention and control of HCAI in the NEAS The NEAS Clinical Care and Patient Safety Assurance Framework provides a comprehensive method for the effective and focused management of the key principle risks in order to meet Infection Prevention and Control objectives. This is reported to the Quality Committee and the Trust Board on a regular basis in order to report and prioritise action plans and gain assurance.

14 8.1.5 There has been no further inspection by the CQC on the infection prevention and control agenda since Evidence was submitted to the CQC as part of the registration process in Other Initiatives 9.1 CleanyourHands campaign The National Patient Safety Agency (NPSA) CleanyourHands (CYH) Campaign has been successful in raising awareness and improving hand hygiene in the all NHS healthcare settings. Unfortunately the CYH Campaign was abolished in December 2010 and the campaign model no longer implemented and has seen the withdrawal of campaign materials Your 5 moments for hand hygiene continues to be promoted throughout the service for those staff delivering care to service users. It is included in induction, statutory and mandatory training sessions and leaflets are available via the Trust intranet site The Trust recently changed manufacturers of the soap and moisturiser products and the Trust now has bespoke dispensers depicting the correct hand washing technique In November 2010 the IPC Manager on behalf of the NEAS produced and submitted a paper to the Deb Hand Hygiene Awards Scheme on how the service had implemented hand hygiene initiatives and improved hand hygiene practice. The prize was an educational grant between 500 and 2000 for the successful applicant. The NEAS were notified in February 2011 that they had been successful and had won first prize The CQC National NHS Staff Survey 2010 has shown an improvement from the 2008 results in the following areas: Percentage of staff saying hand washing materials (hot water, soap and paper towels, or alcohol hand rubs) are always available 51% compared to 36% in Ranking compared with all ambulance trusts in 2010 showed above (better than) average result Business case development and approval 2010/ The following business cases where presented and approved during 2010: TC10-12R Purchase of wipe able straps for stretcher, spinal boards and scoop stretchers. TC10-13R Additional Equipment Vernagel absorbent granule sachets and Vene K single use disposable tourniquet Post project review has been undertaken on the introduction of new products during Specific organisms

15 11.1 MRSA Bacteraemia There have been no known cases of MRSA Bacteraemia linked to ambulance clinical procedures Norovirus Last winter saw another year on year increase of Norovirus in the community and local hospitals. The impact of this for the NEAS was the increased exposure of the virus to ambulance staff and the risk of cross infection from the vehicle environment. Advice was issued to enable all staff to reduce their risk of contracting and spreading the virus to other staff or patients Professional Networks 12.1 Participate in the Infection Prevention Society locally and nationally to use information and resources to inform practice locally within the NEAS Use networks to link into and get feedback from the Health Protection Agency North East Regional HCAI Surveillance group to inform the NEAS of forthcoming national surveillance programmes Attend the IPC National Ambulance Service Group which provides a national network for IPC specialists working within the ambulance service environment and to encourage and facilitate the sharing of IPC information and resources between NASIPCN members Conclusion 13.1 The Infection Prevention and Control Team has been and continues to be faced with many local organisational and national challenges and diversities To meet these challenges it is important that IPC remains embedded in everyday practices and that all staff within the organisation continue to have a responsibility in ensuring a safe environment is maintained for patients, themselves and their colleagues and that the risk of cross infection is minimised Key documents 14.1 This section identifies the key documents which have impacted on the infection prevention and control agenda and have been used to inform the Infection prevention and Control Annual Work Plan Care Quality Commission (2010) Guidance about compliance: Essential standards of quality and safety. CQC. London. Care Quality Commission (2010) Guidance about compliance: Judgement Framework. CQC. London Department of Health (2008) The Health and Social Care Act 2008: Code of Practice for on the prevention and control of infections and related guidance. DH, London

16 Department of Health (2007) Saving Lives: reducing infection, delivering clean and safe care. High Impact Intervention (HII) No. 2 Peripheral intravenous cannula care bundle. DH, London. Department of Health (2008) Ambulance guidelines: reducing infection through effective practice in the pre-hospital environment. DH, London. Department of Health (2002) Winning ways: working together to reduce healthcare associated infection in England. DH, London. Department of Health (2002) Getting ahead of the curve: a strategy for combating infectious diseases. DH, London National Patient Safety Agency (NPSA) (2009) The national specifications for cleanliness in the NHS: A framework for setting and measuring performance outcomes in ambulance trusts. NPSA, London. NHS Litigation Authority (NHSLA) (2010) Risk Management Standards for Ambulance Trusts (2010/11). NHSLA, London. Pratt, R.J. Pellowe, C.M. Wilson, J.A. Loveday, H.P. Harper, P.J. Jones, S.R.L.J. McDougall, C. Wilcox, M.H. (2007) epic 2: National Evidence-Based Guidelines for Preventing Healthcare-Associated Infections in NHS Hospitals in England. Journal of Hospital Infection. Elsevier publications, Glossary of Terms APD DIPC DH HCAIs HPA IPS KSF MRSA NEAS NHS NHSLA NPSA PCT RCA IPCC IPCM IPCT Annual personal development plan Director of Infection Prevention and Control Department of Health Healthcare Associated Infections Health Protection Agency Infection Prevention Society Knowledge Skills Framework Meticillin resistant staphylococcus aureus North East Ambulance Service National Health Service National Health Service Litigation Authority National Patient Safety Agency Primary Care Trust Root cause analysis Infection Prevention and Control Committee Infection Prevention and Control Manager Infection Prevention and Control team Ann Fox Director of Clinical Care and Patient Safety / Director of Infection Prevention and Control (DIPC) March 2011.