AlistairAt the last survey of acute hospitals in Scotland in 2016, a quarter of all hospital acquired infections were found to be caused by urinary catheters.

For this reason, Healthcare Improvement Scotland is beginning to target the safe management of urinary catheters through inspections of acute hospitals.

Urinary catheters are used to enable short or long term bladder drainage and around 20% of patients in acute hospitals have urinary catheters installed. However, their use is associated with an increased risk of infections by enabling micro organisms to gain entry to the bladder.

These new inspections build on the quality assurance programme that has been carried out since 2009 to improve the safety and cleanliness of Scotland’s hospitals. In that time Scotland has seen an impressive reduction in hospital acquired infections.

To create the new methodology for the targeted inspections, we decided to work closely with NHS Highland and Forth Valley, and tested the final methodology in NHS Highland. To achieve this, it was necessary to create an environment where the NHS Boards felt comfortable engaging with us –

bearing in mind that this can be difficult when our inspections can often result in bad news for hospitals.

To create the new inspection process, a draft methodology was developed following a review of the current guidance and discussion with the Scottish Patient Safety Programme – this was shared with NHS Forth Valley who helped to refine the methodology which allowed us to develop draft a tool for how the inspections would work.

Following on from this, two visits were arranged to NHS Highland, supported by Iona McGuaran Lead Nurse Raigmore Hospital and the Infection Control Manager , Catherine Stokoe to refine and test our methodology . The initial visit provided an opportunity to discuss our draft methodology with ward staff, lead nurses, the improvement team at Raigmore, practice educator facilitators, the infection control team and senior managers.

The visits were an opportunity to have constructive engagement and to discuss the practical applications of our inspections. The engagement was positive and open, leading to the inclusion of a more practical way of assessing if hospitals were complying with good practice.  The testing of the new methodology was an opportunity for NHS Highland to engage with the inspection teams on the test visits and to share the findings.

This process has allowed us to focus on what will bring about increased safety for patients. The new methodology will focus on the management of urinary catheter care and will follow established core practices of the current inspections for safety and cleanliness. As part of this new methodology there will be a greater emphasis on the preparation of equipment prior to undertaking the procedure. And, where possible, the inspectors will hold discussion sessions with key staff to discuss a variety of issues including leadership, surveillance of infections and education.

A key aspect that is new to our inspections is that the final report will be a Board-wide, meaning that inspectors may need to visit multiple sites as part of each NHS board inspection. It is anticipated that this will be 2-3 sites for most NHS boards. The inspectors will visit a number of wards and departments where urinary catheters are inserted and maintained, they will also speak with staff involved in the catheterisation procedure and ongoing catheter care and maintenance.

These visits will be unannounced and informal feedback will be given in each area visited with a full feedback session provided at the time of the inspection. And, of course, the final report will be published for everyone to read and see how each NHS board is performing; their strengths and the areas they need to improve.

We’d like to thank all the staff at NHS Highland and Forth Valley for their commitment to working with us to improve care and safety for patients. With such hard work and enthusiasm behind the creation of this new inspection process, we’re excited about the inspections and the opportunity to further decrease the number of infections caused within our hospitals. Look out for the first inspection report in the next few months.

We’ve just completed our first inspection to NHS Fife and the report will be published on the 31st October.