What is the purpose of the Short HTA on the Healthcare Associated Infection?
How will the assessment be carried out?
How will the report affect patient care?
How was this topic selected for assessment?
Who should I contact about this assessment?
What is a Short HTA?
Health Technology Assessment (HTA) is a process used by NHS Quality Improvement Scotland (NHS QIS) to advise the NHS in Scotland about a specific health intervention (e.g. medicine, equipment or diagnostic test). HTA evaluates the clinical and cost effectiveness of the various ways in which the health intervention can be used, comparing alternative interventions where appropriate. Patient and organisational aspects, including professional, legal and ethical issues are considered in detail.
At the end of all assessments, recommendations are made to NHSScotland. These are published in a comprehensive assessment report accompanied by a short summary suitable for people without specialist knowledge of the topic. The report and summary are made available to health professionals and the public. The recommendations are evidence based but value judgements are also made following discussion with experts.
It is recognised that some topics require less thorough investigation and have a narrower focus than others, perhaps with few organisational or patient issues. Consequently NHS QIS has developed a new process called a Short HTA.
What is the purpose of the Short HTA on Healthcare Associated Infection?
It is widely accepted that good hand hygiene practices are important in reducing the incidence of healthcare associated infection (HAI) (Larson 1988). Guidelines and standards relating to infection control have reflected this by including detailed guidance on when, in the course of clinical care, hands require to be washed or decontaminated in order to reduce the risk of cross-infection.
It has also been documented that compliance with guidelines and recommendations on hand hygiene has been unsatisfactory and as a result a range of initiatives to improve compliance with hand hygiene have been introduced in a variety of healthcare settings (Pittet & Boyce 2001). The use of alcohol gel as an alternative, in some clinical situations, to hand washing with soap and water has been given some credence following the publication of the results of a study conducted in Geneva which showed sustainable improvement in compliance with hand hygiene and an associated reduction in HAI rate (Pittet et al. 2000). The intervention in this study included provision of alcohol hand rub. A number of other studies of the use of alcohol hand gel for hand hygiene have been published indicating similar results.
Although we are aware that alcohol hand gel is used in Scottish hospitals at present, it is unknown how widely available this product is across the country, in what clinical areas it is provided and in what form of dispenser it is available. It is also unknown what brands of product are being used and the relative effectiveness of these products in achieving compliance, and who has access to alcohol hand gel.
The aim of this Short HTA is to critically appraise the existing literature on clinical effectiveness of alcohol hand gels to improve hand hygiene compliance, and to critically appraise the existing economic evaluations. A survey of current usage of alcohol hand gels in Scotland will be conducted to inform the budget impact of any recommendations following this review of the literature to be determined.
How will the assessment be carried out?
Health Technology Assessment is an internationally recognised process. Evidence identified by literature searching together with evidence provided by experts, patient interest groups and manufacturers will be critically appraised and robust analyses will be undertaken by expert staff. Questionnaires may be undertaken to ascertain current clinical practice and patient preferences.
NHS QIS staff from a variety of disciplines will conduct the assessment and will also seek advice from health professionals who are expert in this area.
There will be a consultation period during which a draft report and recommendations will be published on this website. Anyone with an interest in the topic will be invited to submit comments. All comments will be given due consideration and the report will be updated accordingly.
How will the report affect patient care?
The results of the assessment will be used as the basis of recommendations for NHSScotland on the provision of alcohol hand gel to improve compliance with hand hygiene and reduce the incidence of healthcare associated infections. It will then be up to health professionals in NHSScotland to ensure that these recommendations are put into practice.
How was this topic selected for assessment?
The Scottish Executive HAI Task Force has requested details of the evidence of clinical and cost-effectiveness of improving hand hygiene for the prevention of HAI.
Who will be involved?
The assessment will be undertaken by a multidisciplinary team of NHS QIS staff. The following people have agreed to provide expert advice:
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Dr Alan Macdonald, Consultant Microbiologist, Crosshouse Hospital, Kilmarnock
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Professor Mary Henry, Consultant Nurse, SCIEH
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Dr Syed Ahmed, Consultant in Public Health Medicine, NHS Greater Glasgow
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Dr Karen Lee, Lecturer, School of Nursing & Midwifery, Dundee
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Ms Liz Gillies, Director of HAI Education, NHS Education Scotland
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Professor Elizabeth Russell, Public Health Consultant, Aberdeen
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Dr Nicholas Graves, Health Economist, Queensland University
Who should I contact about this assessment?
The assessment is being led by Dr Karen Ritchie who would welcome any enquiries (see contact details below):
Dr Karen Ritchie
Senior Health Services Researcher
NHS Quality Improvement Scotland
Delta House
50 West Nile Street
Glasgow G1 2NP
Tel: +44 (0)141 225 6891
E-mail: karen.ritchie@nhshealthquality.org
NHS QIS invites comments regarding the proposed scope of the assessment and would welcome any submissions of evidence relating to the topic.