Health Protection Network for Scotland

Health Protection Network for Scotland

Review of Activities2007 - 2008

The Health Protection Network (HPN) is a network of existing professional organisations and networks in the health protection community across Scotland. It aims to promote, sustain, and coordinate good practice. The HPN supports a systematic approach to development, appraisal and adaptation of guidelines, seeking excellence in health protection practice.

Supported by Health Protection ScotlandHealth Protection Scotland (HPS) is a non-profit, public sector organisation which is part of the Scottish National Health Service. It is dedicated to the protection of the public’s health.

Health Protection Network site: http://www.hps.scot.nhs.uk/about/HPN.aspx

Citation for this documentHealth Protection Network. Health Protection Network for Scotland. Review of Activities 2007-2008. Health Protection Scotland, Glasgow, 2008.

Published by Health Protection Scotland, Clifton House, Clifton Place, Glasgow G3 7LN. Health Protection Scotland is a division of NHS National Services Scotland.

First published September 2008

© Health Protection Network 2008

The Health Protection Network has made every effort to trace holders of copyright in original material and to seek permission for its use in this document and the associated quick reference guide. Should copyrighted material have been inadvertently used without appropriate attribution or permission, the copyright holders are asked to contact the Health Protection Network so that suitable acknowledgement can be made at the first opportunity.

Health Protection Network consents to the photocopying of this document for the purpose of implementation in NHSScotland.

All other proposals for reproduction of large extracts should be addressed to:Health Protection Network Health Protection Scotland 1 Cadogan SquareCadogan SquareGlasgow G2 7HF

Tel: +44 (0) 141 300 1100

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Designed and typeset by:Graphics Team, Health Protection Scotland

http://www.hps.scot.nhs.uk/about/HPN.aspx

Health Protection Network for Scotland - Review of Activities 2007 - 2008

Table of ContentsPreface 1

Chair’s report 2

Coordinator’s report 4Developing a Professional Network 4Spreading the Evidence-based Culture 4Developing a Robust Agenda to Support Good Practice 5

HPN Membership 6HPN Steering Group 7Health Protection Scotland (HPS) 8Scottish CPHM (CD/EH) Group 8Health Protection Nurse Specialists Scottish Network (HPNSSN) 9The Royal Environmental Health Institute of Scotland (REHIS) 9Scottish Clinical Virology Consultants Group (SCVCG) 10Scottish Microbiology Forum (SMF) 10Society of Chief Officers of Environmental Health in Scotland (SoCOEH) 10Scottish Public Health Network (ScotPHN) 11Public Interest Representative 11

Working Groups 12Constructing a systematic approach to produce guidance 13Guidelines on Management of Legionella Outbreaks & Clusters in the Community 14Adaptation of NICE Tuberculosis Guidelines for use in Scotland 16Health Protection Management of VTEC Infection 18Update of TRAVAX 20Guidelines for the Control of Measles in Scotland 21Risk Communication 23Model Infection Control Policies on Transmission Based Precautions 25

Public Involvement Strategy 27

Communication Strategy 27

Appendix 1 – Networking and sharing 28

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�Health Protection Network for Scotland - Review of Activities 2007 - 2008

PrefaceThe Health Protection Network (HPN) has made considerable progress since it was first proposed in 2003. At that time, a number of public health incidents had led to concerns about the arrangements to respond to such events. The HPN was conceived to improve health protection in Scotland, by bringing together those working in this field to share good practice in a network, analogous to a Managed Clinical Network.

In 2004, a Working Group considered options for establishing the HPN and defined the purpose of the network. Following this in 2005, an implementation group under the chairmanship of Dr Charles Saunders laid the foundations of the network. Dr. Alex Sánchez-Vivar was appointed as HPN coordinator to take forward the establishment of the network. In 2006, the members of the HPN Steering Group were identified from within their respective professional bodies, and the HPN Steering Group was convened under the chairmanship of Dr Oliver Blatchford in late 2006.

The HPN Steering Group has been busy since its inception, as its members have developed opportunities for working together. In parallel with the work on the development of guidance on specific health protection topics, it became apparent that there was a need to have clearly identified methods for guidance production, and for the identification of guidance topics, so the Steering Group has also been considering these issues.

Throughout this time, reports on the development of the HPN have been received by the Health Protection Advisory Group (HPAG). HPAG had been established to monitor arrangements for protecting the health of Scotland and to advise the Scottish Chief Medical Officer (CMO) on the quality and appropriateness of health protection plans and services. The members of HPAG are, like the members of the HPN, drawn from a wide range of organisations, including representatives from NHS Boards, local authorities, HPS and other national health protection organisations, as well as relevant professional and staff organisations.

I believe that this first Review of Activities of the Health Protection Network (HPN) in Scotland reflects the wide range of activities in the network and indeed within Health Protection in Scotland. It is a great achievement and all those involved are to be congratulated. In no other field is it so important to have effective collaboration. I consider that this network will make an essential contribution to health and health care in Scotland. I welcome this report and I look forward to the implementation of guidance produced under the auspices of the HPN, which will help the health protection community in Scotland and thereby benefit the health of the population of Scotland.

Professor Jim McEwenChair, Scottish Health Protection Advisory Group

2 Health Protection Network for Scotland - Review of Activities 2007 - 2008

Chair’s reportManaged Clinical Networks (MCNs) have been a central feature of NHS policy in Scotland since 1999. The Health Protection Network (HPN), which was established in 2006, was based on this MCN model. Unlike previous MCNs, the HPN was not directly involved in the provision of clinical care; however, the experiences of MCNs in other fields showed that there was value to establishing networks of different professionals, resulting in improved standards of care.

The HPN Steering Group, comprised of representatives of the professional bodies involved in the Network, first met in October 2006. Like any new organisation, its first task was to decide how it would function to meet the agreed needs for which it had been established. The Steering Group decided then that HPN should function as a network of networks; it would have Working Groups active in a range of different health protection areas, all reporting to the Steering Group. The Steering Group drafted formal terms of reference, subsequently approved by the Health Protection Advisory Group, which formalised these structures and reporting arrangements.

At the outset, the Steering Group agreed that the function of the HPN was to bring together different professional groups working in health protection in Scotland to:

develop and disseminate guidance for best practice, based on available evidence

develop and use best practice standards to facilitate peer audit of professional practice

report on best practice in health protection

support professional development of health protection in Scotland.

Over the past year, the HPN has focussed on the first of these functions as the Steering Group decided that the other areas were best achieved, once the HPN had established itself by publishing some robust evidence-based guidance.

When the HPN was initially established, there were already some groups working on producing evidence-based guidance for health protection topic areas. The Steering Group agreed that these existing projects, which crossed boundaries between professional groups, should be welcomed as Working Groups under the auspices of the HPN. These groups were working on topics such as producing new guidance for the management of Legionaires’ disease and collating guidance for communicating health protection risks with members of the public. There was also a group reviewing evidence-based guidance from the National Institute for Clinical Excellence (NICE) on tuberculosis management, adapting this for Scotland.

During the past year, the Steering Group received several new proposals for other topic areas for health protection guidance which Working Groups have since taken forward under the auspices of the Network. This report contains further details of the progress made in these Working Groups. We have been

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3Health Protection Network for Scotland - Review of Activities 2007 - 2008

pleased to see the enthusiasm of these groups and the excellent progress they have made. We are looking forward to being able to consult widely in the health protection community in Scotland on those pieces of work which are now nearing completion.

At its inception, because it was not clear how much work would be undertaken under the auspices of the HPN, nor what resources would be needed to support the HPN activities, the HPN was not given a formal budget. Instead, Health Protection Scotland has met its incidental operating costs. The Steering Group has recognised that the production and publication of guidance will require resources, so we have recently taken steps to seek a more secure funding stream.

In September 2008, our one day conference will be discussing our experiences of establishing the Network, producing guidance in the area of health protection and to publicly launch several guidance documents. A wide range of delegates, from Scotland and from other countries, are attending.

Over the past year, the Steering Group has recognised that we do need to have formal procedures for proposing and selecting topic areas for the production of guidance. We also need to have more formally described methodologies for the production of de novo guidance, and for the adoption and adaptation of pre-existing guidance produced elsewhere. We have recently established a sub-group to draft recommendations for the Steering Group to address these needs.

In concluding, I should like to thank everybody who has contributed to the work of the Health Protection Network during the past year. In particular, I thank Alex Sánchez-Vivar, the network coordinator, and Maggie Macdonald, who provides administrative support. I have appreciated the commitment of members of the Steering Group, who have so willingly given their time and thoughts in support of the Network development. Finally, I thank the members of the Working Groups, whose enthusiasm and energy will result soon in the publication of useful guidance, for the benefit of the health protection professional community in Scotland.

Oliver Blatchford, CPHMChair of the Health Protection Network (HPN)

� Health Protection Network for Scotland - Review of Activities 2007 - 2008

Coordinator’s reportOur first Review of Activities becomes an opportunity to bring an exciting document with real communication power to our stakeholders, and a quality benchmark of our own development. We are pleased to report how the Health Protection Network (HPN), recently only an ambition, has now become a reality. This stands alone as a testament of the commitment and efforts of many of our colleagues across Scotland, and as a reflection of an active membership of the Network.

I subscribe to the Chair’s words of appreciation, and extend it to those who have believed in us, and worked with us along the way, in establishing a multi-professional network, and in facing the demands of our agenda.

Developing a Professional NetworkWith regards to the Network’s beginnings, we thank NHS QIS Standards Development Unit for their support of our initial proposal to develop and establish the HPN. Hilary Davison – Head of the unit – and Sara Brown, helped us to navigate the complexities of a multidisciplinary forum. Colleagues from other MCNs also helped us understand some of the issues arising in establishing an MCN-like network. While we were progressing with our organisational and management arrangements (see page 6), we were pleased to be able to present our vision for the HPN, at the First Annual NHS Networks Conference in London, on St Andrew’s day, 2006!

Spreading the Evidence-based CultureThis report describes the demanding agenda we have pursued. It has been exciting to work on the potential for the HPN to become a driver for evidence-based health protection practice in Scotland.

The HPN is greatly indebted to the Scottish Intercollegiate Guidelines Network (SIGN) for help in understanding the implications of operating with clearinghouse functions. With their help, we are developing our own validated framework in generating, adapting and updating evidence-based guidance for health protection (see page 13). We are grateful to our colleagues in SIGN, particularly Roberta James, Robin Harbour and Safia Qureshi, for their assistance in individual HPN projects, and their genuine interest in supporting the development of our own evidence-based agenda.

As a result of this collaborative partnership with SIGN, the HPN and HPS have grown in confidence in identifying and implementing evidence-based knowledge, thus providing professional authority to engage with stimulating and informed discussions. Within this context, we have established an opportunistic link with Health Scotland (HS), through Andrew Tannahill – Head of Evidence for Action (HS), with whom we share a common ground to interpret and validate primary


evidence for public health. As we unfolded this particular dialogue with Health Scotland, Mike Kelly – Director of the NICE Centre for Public Health Excellence – invited us to bring our understanding of the application of evidence based principles to health protection, to the NICE Annual Conference a year ago.

We have established wider links in the evidence-based medicine (EBM) community, raising the profile of the HPN in the UK and internationally. This has resulted in developments of collaborative sharing of practice with health protection colleagues from the HPA, the Koch Institute in Berlin, the Instituto Carlos III in Madrid, and in our subscription, as technical members, to the Health Evidence Network (HEN), of the WHO Regional Office for Europei http://www.euro.who.int/HEN/Network/20080�09_5.

Developing a Robust Agenda to Support Good PracticeThe HPN Working Groups that have been developing specific guidance, report their progress within this document. We shall soon be able to take some of these informed recommendations and disseminate them, to start the process of translating them into practice. We recognise the demanding agenda and challenges that HPN Working Groups have faced during the guideline development process. We are grateful for their strong conscientious efforts and commitment in delivering robust and valid guidance, and commit ourselves to take action on the highlighted challenges.

We believe that this report also shows the creativity and innovation of the HPN members. In moving into our second year, we face the challenge of ensuring that the health protection community in Scotland is supported and represented by the HPN, as we continue to champion the need for action on promoting, sustaining, and coordinating good practice.

Alex Sánchez-Vivar, MB MPhilCoordinator of the Health Protection Network (HPN)

i HEN is conceived as network of technical members and financial partners, involving United Nations agencies with a mandate related to health, organizations working with evidence-based health policy and health technology assessment, other institutions and governments interested in funding advanced projects related to public health issues. As technical members of HEN, the Health Protection Network (HPN) has been granted permission to use both the WHO emblem and HEN logo in the publication of this report.

http://www.euro.who.int/HEN/Network/20080109_5

http://www.euro.who.int/HEN/Network/20080109_5


HPN MembershipThe Network membership is multi-disciplinary and multi-professional, representing a wide range of stakeholders, including:

Scottish CsPHM (CD/EH) Group who report to the Directors of Public Health and the Scottish Affairs Committee of the Faculty of Public Health

Health Protection Nurses Specialist (Scotland) Network

The Royal Environmental Health Institute of Scotland

Scottish Clinical Virology Consultants Group

Scottish Microbiology Forum

Society of Chief Officers of Environmental Health in Scotland

Scottish Public Health Network

Public Representative

Health Protection Scotland

(Further details on each of these constituencies are found in the following pages)

Given the ‘national’ nature of the Health Protection Network (HPN) , formal agreements for members representing Local Boards and Local Authorities to participate in the network are required.

Figure 1: HPN Structure and AccountabilityCPHM Consultant in Public Health MedicineREHIS Royal Environment Health Institute of ScotlandScotPHN Scottish Public Health NetworkHPNS Health Protection Nurse Specialist (Scotland) NetworkSCVCG Scottish Clinical Virology Consultants GroupSMF Scottish Microbiology ForumSoCOEH Society of Chief Officers of Environment Health in ScotlandHPS Health Protection ScotlandCMO Chief Medical OfficerHPAG Health Protection Advisory GroupFPH Facualty of Public Health

CMO

HPAG

SteeringGroup

CPHM

REHI

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ScotPHNHPNS

SCVCGSMF HPS

Public

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SoC

OEH

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FPH

Directors in

Public Health

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HPN Steering GroupContact Constituency

Dr Oliver BlatchfordHPN Chair

Scottish CPHM (CD/EH) Group who report to the Scottish Directors of Public Health Medicine and the Scottish Affairs Committee of the Faculty of Public Health

Dr Alex Sánchez-VivarHPN Coordinator Health Protection Scotland (HPS)

Dr Martin Donaghy(deputy Mr Paul Kingsmore) Health Protection Scotland (HPS)

Mr Alan Morrison Society of Chief Officers of Environmental Health (SoCOEH)

Mr Bernard Forteath The Royal Environmental Health Institute of Scotland (REHIS)

Dr Bill Carman Scottish Clinical Virology Consultants Group (SCVCG)

Mr Brian Gorman Public Representative

Dr Charles SaundersScottish CPHM (CD/EH) Group who report to the Scottish Directors of Public Health Medicine and the Scottish Affairs Committee of the Faculty of Public Health

Dr Mary Hanson Scottish Microbiology Forum (SMF)

Mrs Mary Waugh(deputy Mrs Mary Quinn) Health Protection Nurse Specialists Forum (HPNS)

Mr Phil Mackie(deputy Miss Ann Conacher) Scottish Public Health Network (ScotPHN)

Miss Maggie Macdonald Admin Support Officer for the HPN

Chairs or lead authors of HPN Working Groups, if not already members

Others with specialist interests co-opted as needed


Health Protection Scotland (HPS)Health Protection Scotland (HPS) was established by the Scottish Executive to strengthen and coordinate health protection in Scotland. This is to protect – in partnership with others – the Scottish public from being exposed to health hazards, and to limit any impact on health when such exposures cannot be avoided.

HPS actively engages in the HPN activities in order to further the aims of ensuring a consistent, efficient and effective evidence-based advice and to support good practice. In doing so, HPS upholds the benefits of supporting an integrated and sustainable national network among the health protection community in Scotland, capable of sustaining and improving a competent workforce.

As HPS provides management and administration support to the HPN, interaction between HPS and the network is secured and enhanced. The HPS Medical Director represents HPS’ interests in the HPN Steering Group, and makes sure HPN activities are reported back to HPS.

Scottish CPHM (CD/EH) GroupThe Scottish Consultants in Public Health Medicine (Communicable Disease and Environmental Health) group is formed of all the Consultants practising in this specialist area, representing their professional interests. CsPHM (CD/EH) are key operational players in the delivery of health protection, at health board level, in Scotland.

The CsPHM (CD/EH) group is interested in ensuring that all of its members work to consistently high standards. The CsPHM (CD/EH) group is actively involved in formulating guidance for practice for common health protection issues, basing this guidance on evidence where available. Adherence to common guidance will enable more effective responses to health protection incidents and may reduce variations in practice.

The current chair of the HPN is a member of the CsPHM (CD/EH). For this reason, another CPHM (CD/EH) has been coopted to the HPN Steering Group to represent their interests. The CsPHM (CD/EH) representatives feed back to their group about activities of the HPN.

The CsPHM (CD/EH) members of the HPN Steering Group also represent the interests of the Scottish Directors of Public Health and the Scottish Affairs Committee of the Faculty of Public Health.


Health Protection Nurse Specialists Scottish Network (HPNSSN)The Health Protection Nurse Specialists Scottish Network (HPNSSN) is the professional forum for nurse specialists working within health protection in Scotland’s NHS Boards. HPNSSN provides a professional forum supporting an experienced, skilled health protection workforce, improving health protection practice across Scotland.

The HPNSSN is represented on the HPN Steering Group, contributing expertise in various different areas of health protection practice. HPNSSN aims to use evidence based guidance from HPN Working Groups to improve best practice amongst its members.

The Royal Environmental Health Institute of Scotland (REHIS)The Royal Environmental Health Institute of Scotland (REHIS) is an independent, self-financing organisation incorporated by Royal Charter in 2001. It is a national awarding body of professionals. It also promotes the advancement of environmental health, for the benefit of the community. REHIS aims include:

stimulating general interest in and disseminating knowledge about environmental health

promoting education and training in matters relating to environmental health

maintaining high standards of professional practice and conduct on the part of environmental health officers in Scotland.

The Institute’s membership of, and active participation in, HPN ensures the promotion of the environmental health profession’s role in health protection and the Institute’s objectives to other members of the network.

The representation of REHIS on the HPN Steering Group provides the opportunity for development of evidence based guidance for areas of practical interest which cross practice boundaries between environmental health professionals and those active in other health protection areas.

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Scottish Clinical Virology Consultants Group (SCVCG)The Scottish Clinical Virology Consultant Group’s (SCVCG) membership is drawn from all clinical consultant-grade virologists across Scotland, and operates as a discussion forum to represent their professional interests.

SCVCG aims to provide advice on national management policies and to respond jointly to national initiatives and consultations. Their activities range from discussions of issues that affect good practice in clinical virology, to sampling, diagnostic tests, and management of viral infections.

SCVCG’s participation in the HPN Steering Group fosters an active partnership with other professionals in the health protection community by ensuring coordination of tasks and prioritisation of work most useful to clinical virology.

Scottish Microbiology Forum (SMF)The Scottish Microbiology Forum (SMF) aims to promote the specialty of Medical Microbiology in Scotland and to support the Specialty Adviser in the provision of advice to the Scottish Government Health Directorates on national issues relating to Medical Microbiology.

All NHS diagnostic and reference laboratories are represented in the SMF. Microbiology service provision is central to health protection activities, and medical microbiology expertise supports the function of the Network.

A report of the activities of HPN is presented at SMF meetings and SMF members actively contribute to Working Groups developing guidance on best practice, accountable to the HPN.

Society of Chief Officers of Environmental Health in Scotland (SoCOEH)The Society of Chief Environmental Health Officers (SoCOEH) represents senior management of the local authority Environmental Health services in Scotland. The Society is actively engaged with COSLA, government departments and agencies providing information and advice, and working for the successful implementation of the development of the Environmental Health service portfolio.

Beyond this partnership working, the Society promotes the sharing of experience and good management practice and works to develop the efficient and effective delivered Environmental Health service for Scotland today.

The SoCOEH offers professional Environmental Health expertise to the Network and to the HPN Steering Group, and makes sure HPN activities are accounted to the Society members.

��Health Protection Network for Scotland - Review of Activities 2007 - 2008

Scottish Public Health Network (ScotPHN)The Scottish Public Health Network (ScotPHN) aims to facilitate joint working between all organisations involved in health improvement and health services by providing a means of communication and through specific projects in areas of national importance.

ScotPHN and HPN are partners in driving forward the public health agenda, and it is therefore important that they complement each other’s roles, each contributing to the other’s activities.

The chair of the ScotPHN is a member of the HPN Steering Group and the ScotPHN facilitator attends the Steering Group.

Public Interest Representative The HPN Steering Group recognised that it was important for the governance of the network that the interest of the Scottish public should be represented in its decision making processes. The Steering Group accepted that the HPN was different to other MCN’s (such as the diabetes or cancer networks) as there was no single patient or consumer group which was specifically interested in general health protection matters.

The Steering Group decided that a public interest representative should join the Steering Group. It was also decided that where there were appropriate patient representatives or consumer groups which had a specific interest in topics under consideration at Working Group level, then they should be invited to contribute to the work of that group.

We were pleased to be able to welcome Brian Gorman, who also sits on the Health Protection Scotland Clinical Governance committee, as the public interest representative on the HPN Steering Group.


Working GroupsThe Health Protection Network has convened Working Groups to deliver specific areas of work, covering aspects of good practice in the prevention and control of infections or environmental hazards in Scotland. These activities will included area such as:

Collating and disseminating evidence of best practice

Setting standards related to this evidence

Supporting peer audit of these standards

Supporting continuous professional development in health protection

Working Groups report to the Steering Group by submission of minutes and reports from their chairs noting progress against their work plans. The Working Groups currently active in the HPN report on their progress below.

Figure 2: HPN Working Group Structure

HPN Working Groups’

KMPG

Evidence andExpertise

Education andTraining

QA

Clinical Governance

QAFWorking Group

Guidelinesin progress

CPD

Professionalaudit

Health Protection Scotland

QAF Quality Assurance FrameworkCPD Continuous Professional DevelopmentQA Quality AssuranceKMPG Knowledge Management Programme Group

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Constructing a systematic approach to produce guidanceIn order to manage the network functions, the HPN is currently focused on the development of guidance as a means to support the drive towards evidence-based decision making in all areas of health protection.

The development of guidelines, under the auspices of the HPN, will follow a consistent and systematic approach, in line with the SIGN principles, and validated by a common framework in generating, adapting and updating evidence-based guidance for health protection. All Working Groups developing guidelines and who are accountable to the HPN should comply with this framework (figure 3).

Figure 3: HPN/HPS Guidance Development Framework

Review and Update

TrainingCPD

Guideline Publication Impact Assessment

Extended Consultation and Peer Review

Consultation Document

Drafting Process

FormulatingRecommendations

Considered Judgement

Evidence Tables

Critical Appraisalthrough AGREE instrument

Critical Appraisalthrough SIGN 50 CA tools

Literature chosen

Sifting

Existing Guidance Inclusion/ExclusionCriteria

Primary Studies and Grey literature

GDG constituted

HPN/HPS Guidance Development Framework

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V Editing, Publishingand Implementing

Formulation ofRecommendations

Identificationand Evaluation

of Evidence

Formation ofthe GDG and

evidence gathering(including training

issues)

Topic Selectionand Scope

Time Scale

HPN SG

Report Back

Report Back

Report Back

Report Back

Report Back

Search Strategydrawn and followed

Key Questions

Meeting 1

Meeting 2

Meeting 3

Meeting 4

Topic Sugestions

HPN SG Health Protection Network Steering GroupCPD Continuous Professional DevelopmentGDG Guidance Development Group

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Guidelines on Management of Legionella Outbreaks & Clusters in the CommunityThe need for this guideline arose following an outbreak of Legionnaires’ disease in West Fife in 2004. The outbreak report recommended that the Scottish Executive should consider the need for training of field officers in the inspection and sampling of water systems and the development of inter-agency guidance to aid investigation and control of Legionella.

While the Legionella outbreaks are infrequent in Scotland, they have the potential to have a high impact on the population’s health. An NHS board is unlikely to experience more than one outbreak in three years, while local authorities might not have one in a decade. We therefore aimed to produce clear and concise guidance for those who might never have experienced such an outbreak with the necessary support.

This guideline was the first to be undertaken under the auspices of the Network. The guidance has taken two years to complete. The guideline covers all aspects of investigation and management of outbreaks, including epidemiology, environmental investigation, environmental sampling, microbiological investigation, risk assessment and communication, and the control of the putative sources of Legionella.

The guideline is targeted towards Consultants in Public Health Medicine and Environmental Health specialists. It recognises the key support provided by frontline and reference laboratories and national agencies, including Health Protection Scotland and the Health and Safety Executive, as well as the need to interface with European Agencies such as The European Working Group for Legionella Infections. The guideline will also be supported with training for field officers to ensure that they are prepared for incidents in the future.

The final publication of the guideline has been delayed, pending the enactment of the Public Health (Scotland) Act, 2008, so that the chapters on legislation reflect the the new legislation.

We believe that this has been a valuable exercise which brought together key stakeholders involved in managing an incident or an outbreak and that the guideline will reflect the improved understanding of each others’ roles, which we developed through this partnership.

In conclusion, we would like to thank all colleagues who participated in the Guideline Development Group for their expert advice which informed the final document.

Rod House, Chair of the Guidelines Development Group

Alex Sánchez-Vivar, Guideline Programme Coordinator

�5Health Protection Network for Scotland - Review of Activities 2007 - 2008

Guidelines on Management of Legionella Outbreaks and Clusters in the Community

Guidelines Development Group (GDG)

Martin Donaghy, HPS Medical Director (Co-Chair of the Group)

Rod House, HPS Consultant Environmental Health (Co-Chair of the Group)

Garry Ahrens, Tayside Scientific Services, Microbiologist/Senior Analyst

Juliet Brown, SIGN Information Officer

Harris Cooper, HSE, HM Inspector of Health & Safety

Giles Edwards, Legionella Reference Lab, Head of Legionella Reference Lab

Martin Gibson, HSE Principle Specialist Inspector (Occupational Hygiene)

Lesley Haldane, HPS Project Support Officer

Jackie Hyland, CPHM NHS Fife

Roberta James, Programme Director, SIGN

Brian Lawrie, Senior EHO, South Ayrshire Council

Margaret McGuinness, Senior Scientist, Scottish Water

Jim McMenamin, Consultant Epidemiologist, HPS

George Morris, Scientific Policy Adviser, SGHD

Kevin Pollock, Epidemiologist, HPS

Ahsan Saleem, HM Principle Specialist Inspector (offshore), HSE

Alex Sánchez-Vivar, Coordinator of the Health Protection Network (HPN), HPS

Eisin Shakir, Epidemiologist, HPS

Colin Wallace, Environmental Health Manager, South Ayrshire Council

John Watt, Team Leader of Environmental Services, Fife Council

Editorial Group

Rod House, Chair of the Group

Alex Sánchez-Vivar, Guideline Programme Coordinator

Kevin Pollock


Adaptation of NICE Tuberculosis Guidelines for use in ScotlandThe English National Institute for Clinical Excellence (NICE) commissioned a set of guidelines on the clinical diagnosis and management of tuberculosis and measures for its prevention and control in 2000. This guidance was a successor to the British Thoracic Society’s TB guideline and was intended for use in England and Wales and was not necessarily directly applicable to Scotland.

A Scottish TB guideline group was then established with the remit of developing TB guidelines specifically for use in Scotland. The group had representation from TB nurses, respiratory physicians, ID physicians, paediatricians, the Scottish Mycobacteria Reference Laboratory, occupational health, public health, Health Protection Scotland and The Scottish Government. The TB guideline Working Group adapted the existing NICE guidelines for the Scottish context and then used the AGREE instrument to appraise the guidelines for their use in Scotland.

Following a period of consultation by stakeholders, it is anticipated that the Scottish TB guidelines will be published by mid September 2008. One consequence of the Scottish TB guidelines work has been that The Scottish Government have recently announced their commitment to develop a TB action plan for Scotland and have asked HPS to coordinate this.

Jim McMenamin, Chair of the Guidelines Development Group

Eisin Shakir, Guideline Programme Coordinator


Adaptation of NICE Tuberculosis Guidelines for use in Scotland


Jim McMenamin, HPS Consultant Epidemiologist (Chair of the Group)

Syed Ahmed, CPHM, NHS Greater Glasgow and Clyde *

Oliver Blatchford. CPHM, NHS Greater Glasgow and Clyde

Jim Chalmers, CPHM, ISD, National Services Scotland **

Annemarie Deans, TB Nurse Specialist, NHS Fife

Susan Duthie, TB Nurse Specialist, NHS Grampian

Neil Hamlet, Consultant in Public Health Medicine, NHS Fife

Adam Hill, Respiratory Physician, NHS Lothian

Nick Kennedy, Infectious Diseases Physician, NHS Lanarkshire

Ian Laurenson, Director, Scottish Mycobacteria Reference Lab

Jim Miller, CPHM, NHS Lanarkshire***

Ceri McSparron, TB Nurse Specialist, NHS Lothian

Jimmy Paton, Paediatric Respiratory Physician, NHS Greater Glasgow and Clyde

Alex Sanchez-Vivar, Co-ordinator of the Health Protection Network (HPN), HPS

Eisin Shakir, Epidemiologist, HPS

Jon Spencer, Consultant Occupational Physician, NHS Tayside

Janet Stevenson, CPHM, NHS Lothian

Elizabeth Stewart, Senior Medical Officer, Scottish Government

Mary Waugh, Health Protection Nurse Specialist, NHS Dumfries and Galloway

Christine Weir, TB Nurse Specialist, NHS Lanarkshire

* Left the group in April 2007 replaced by Oliver Blatchford

** Left the group in December 2007 and not replaced

*** Left the group in June 2007 and replaced by Janet Stevenson

Editorial Group

Jim McMenamin, Chair of the Group

Eisin Shakir, Guideline Programme Coordinator

Alex Sánchez-Vivar (Guideline Methodology)


Health Protection Management of VTEC InfectionThis Working Group was established by the HPN Steering Group to review and revise existing guidance published by the Scottish Infection Standards and Strategy Groupii.

The revised guidance aims to provide easily accessible advice for management of single cases, groups of cases, and contacts of suspected, probable and confirmed VTEC infection, to prevent further cases. The guidance addresses some aspects of early clinical management, particularly where it may affect health protection, but it does not provide further advice on the clinical management of cases, once a diagnosis has been proven. The guidance will be based on research evidence where possible, and drawing on expert consensus where necessary.

This guidance is intended to inform local professional judgment not replace it. It is not a substitute for advice on specific issues from appropriate experts. The guidance does not provide advice on the detailed conduct of an outbreak investigation, which can be found elsewhereiii. Nor does it go into detail about infection control in the domestic, childcare or healthcare settings, which can also be found elsewhereiv.

John Cowden, Chair of the Guidelines Development Group

Kevin Pollock, Guidelines Programme Coordinator

ii Scottish Infection Standards and Strategy Group. Guidance for the Diagnosis and Management of Suspected or Proven E.coli O157 infection. J R Coll Physicians 2004; 34: 37-40 http://www.rcpe.ac.uk/publications/articles/journal_34_1/E_coli_O157.pdfiii Food Standards Agency (Scotland)/Scottish Government Health Department (Cairns Smith Group). Guidance on the investigation and control of outbreaks of foodborne disease in Scotland. FSA(S) 2006. http://www.food.gov.uk/news/newsarchive/2005/nov/outbreakcontrolscotlandiv Health Protection Scotland. Hand hygiene campaign: http://www.washyourhandsofthem.com/ and also Health Protection Scotland. Model infection control policies. http://www.hps.scot.nhs.uk/haiic/ic/modelinfectioncontrolpolicies.aspx

http://www.rcpe.ac.uk/publications/articles/journal_34_1/E_coli_O157.pdf

http://www.rcpe.ac.uk/publications/articles/journal_34_1/E_coli_O157.pdf

http://www.food.gov.uk/news/newsarchive/2005/nov/outbreakcontrolscotland

http://www.food.gov.uk/news/newsarchive/2005/nov/outbreakcontrolscotland

http://www.washyourhandsofthem.com/

http://www.hps.scot.nhs.uk/haiic/ic/modelinfectioncontrolpolicies

http://www.hps.scot.nhs.uk/haiic/ic/modelinfectioncontrolpolicies


Guidelines on Health Protection Management of VTEC Infection


John Cowden, HPS Consultant Epidemiologist, (Chair of the Group)

Jim Beattie, Consultant Paediatric nephrologist, Yorkhill Hospital

John Coia, Consultant Microbiologist, NHS Greater Glasgow and Clyde

Jim Dixon, EHO, Perth & Kinross

Mary Hanson, Consultant Microbiologist, Scottish E.coli O157/VTEC Ref Lab

Helen Howie, CPHM, NHS Grampian

Mary Locking, Epidemiologist, HPS

Malcolm McWhirter, Senior Medical Officer, SGHD

Kevin Pollock, Epidemiologist, HPS

Roland Salmon, Consultant Epidemiologist, NPHS Wales

Alexander Stewart, General Practitioner

Andrew Todd, Consultant ID Physician, Monklands Hospital

Alex Sanchez-Vivar, Coordinator of the Health Protection Network, HPS

Linda Whetren, Health Protection Nurse, Fife NHS Health Protection

Editorial Group

John Cowden, Chair of the Group

Kevin Pollock, Guideline Programme Coordinator

Mary Locking


Update of TRAVAXThe Travel Health Section (THS) of Health Protection Scotland (HPS) produces national guidance for travellers from the United Kingdom, disseminated via the TRAVAX® and fitfortravel® websites. Publishing evidence-based travel medicine guidance involves appraising the clinical and epidemiological evidence in order to ensure that all interventions are appropriate. Evidence for travel recommendations may arise from a wide range of sources including surveillance information, clinical reports, outbreak data, peer-reviewed literature and expert opinion.

Ensuring the scientific evidence base for TRAVAX advice has required a systematic and consistent evidence gathering methodology. This has been developed in collaboration with the HPN, in particular for the changing epidemiology of typhoid infection. This development in systematically analysing epidemiological data for travel medicine is unique, worldwide. The methodology is being adapted for other areas of travel related health advice.

Due to ever-changing patterns of disease worldwide, it is necessary to keep the guidance under review, and hence to review the methodology. We have recently established links with European partners and are hoping to develop this approach for Europe-wide evidence-based travel medicine guidance.

Kitty Smith, Medical Lead, HPS

Fiona Genasi, Nurse Consultant, HPS

Chris Redman, Epidemiologist, HPS

2�Health Protection Network for Scotland - Review of Activities 2007 - 2008

Guidelines for the Control of Measles in ScotlandThe development of guidelines for the public health management of measles was prompted by two outbreaks of measles infection in two separate regions of Scotland in 2006. Local public health protection teams felt that having national guidelines in the management of these outbreaks would have been beneficial.

In response, a Working Group of HPN was set up in 2007 to develop guidelines for the public health management of measles outbreaks in Scotland. The Working Group used a modified AGREE tool to appraise existing guidelines and generated evidence tables from published research.

The Working Group has developed algorithms for management of high risk patient groups and for occupational exposures. An enhanced measles surveillance form and outbreak report form have been created and are included in an appendix. The draft guidance will be circulated for consultation and it is hoped that final publication will be in September 2008.

David Breen, Chair of the Guidelines Development Group

Joy Tomlinson, Guidelines Programme Coordinator


Guidelines for the Control of Measles in Scotland


David Breen, CPHM (CD/EH) (Chair of the Group)

Trevor Gibbs, RCGP Scotland Deputy Chair (Policy)

Dave Haldane, Occupational Health Physician

Pamela Joannidis, Infection Control Nurse

Monica Maguire, Health Protection Nurse, NHS Greater Glasgow and Clyde

Katy Sinka, Epidemiologist, HPS

Joy Tomlinson, SpR Public Health

Lorna Willocks, CPHM (CD/EH)

Dave Yirrell, Consultant Clinical Scientist

Editorial Group

David Breen, Chair of the Group

Joy Tomlinson, Guideline Programme Coordinator



Risk CommunicationThe Health Protection Network (HPN) was commissioned by the Health Protection Advisory Group (HPAG) to develop guidance to assist public servants with their role of communicating with the public about health risks. A stakeholder group was convened in early 2007 and this group included representatives from a wide variety of sectors including partners from health protection such as NHS boards, local government, SEPA and Scottish Water as well as representatives from the Scottish media.

The group utilised the HPN’s algorithm for the development of guidelines, and identified 7 extant guidelines on risk communication. We modified and piloted a WHO endorsed instrument called AGREE (Appraisal of Guidelines Research and Evaluation) and used it to assess the quality and suitability of endorsing these guidelines for use in Scotland. The process confirmed that each of the guidelines had strengths, but that no single guideline was suitable for overall endorsement.

The Steering Group elected to develop guidance for Scotland which would include the strengths of all the extant guidelines. The guideline has been written and it is hoped that the guidance will be launched in September of 2008 at the HPN conference. Following this, it is hoped to collaborate with NHS Education for Scotland to provide support for implementation across the NHS.

Martyn Evans, Chair of the Guidelines Development Group

John JM O’Dowd, Guidelines Programme Coordinator

2� Health Protection Network for Scotland - Review of Activities 2007 - 2008

Guidelines on Good Practice for Risk Communication


Martyn Evans, Director, Scottish Consumer Council (Chair of the Group)

Alex Sánchez-Vivar, Coordinator of the Health Protection Network (HPN), HPS

Andrew Slorance, Communications Manager, Health and Wellbeing, Scottish Government

Asia Boyce, Project Support Officer, HPS

Cameron Stark, CPHM, NHS Highland

Colin Ramsay, Consultant Epidemiologist, HPS

Diana Webster, CPHM, NHS Grampian

Eleanor Bradford, Health Correspondent, BBC Scotland

Jackie Hyland, CPHM, NHS Fife

Jackie Woods, Senior Information Officer, Health and Safety Executive

John O’Dowd, SpR in Public Health Medicine, NHS Lanarkshire

Lorna Renwick, Health Improvement Programme Manager, Health Scotland

Margaret McGuinness, Senior Scientist, Scottish Water

Martin Donaghy, Medical Director, HPS

Paul Burgess, Information Officer, Health and Safety Executive

Paula Charleson, Policy Advisor (Human Health) Environmental Strategy, SEPA

Robert Howe, Head of Environmental & Strategic Services, South Lanarkshire Council

Shona Hilton, Research Associate, Medical Research Council

Editorial Group

Martin Donaghy

Martyn Evans, Chair of the Group

John O’Dowd, Guideline Programme Coordinator


Colin Ramsay

Asia Boyce, Secretariat

Alex Mathieson, external writer


Model Infection Control Policies on Transmission Based PrecautionsThe need for guidance for transmission based infection control arose from the Scottish Government’s Healthcare Associated Infection (HAI) Task Force. This activity has been taken under the umbrella of the HPN as it was using HPN methods to produce consistent evidence based guidance on the infection control measures required to prevent and control infections that are transmissible by a known route and that are not controlled by the use of standard infection control precautions alone.

The Working Group has produced a set of three separate policies which are designed to be used separately or together if required. They cover:

Droplet Precautions

Contact Precautions

Airborne Precautions.

Following consultation on the draft guidelines, these have recently been published on the HPS website http://www.hps.scot.nhs.uk/haiic/ic/modelinfectioncontrolpolicies.aspx.

Claire Kilpatrick, Chair of the Guidelines Development Group

Heather Murdoch, Guidelines Programme Coordinator

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•

•

http://www.hps.scot.nhs.uk/haiic/ic/modelinfectioncontrolpolicies.aspx


Model Policies Transmission Based Precautions


Claire Kilpatrick, Nurse Consultant in Infection Control and Team Leader, HPS (Chair of the Group)

Ms Senga Abraham, Care Services Manager

Dr Margaret Brown, Project Lead- HAI - NES

Mr Robin Creelman, Public Involvement

Mrs Carol Fraser, HAI Advisor, The Scottish Govenment

Mrs Vivienne Simpson, Practice Education Coordinator, NES

Dr Thomas Gillespie, Consultant Microbiologist Infectious Diseases

Ms Pauline Hope, Infection Control Nurse

Ms Pamela Joannidis, Snr Infection Control Nurse

Mrs Jacqueline Jowett, Independent Sector

Mrs Audrey MacKenzie, Professional Advisor Iinfection Control, Scottish Commission for Care

Heather Murdoch, Senior Information Scientist, HPS

Ms Sara Murdoch, Health Protection Nurses

Mr John Veto, Lecturer/Podiatrist

Mr Samuel Whiting, Infection Control Manager

Co-opted for Transmission Based Precautions Model Policies only:

Dr David Haldane, Occupational Health

Dr Andrew Todd, Consultant Infectious Diseases

Editorial Group

Claire Kilpatrick, Nurse Consultant in Infection Control and Team Leader, HPS

Heather Murdoch, Senior Information Scientist, HPS

Jackie McIntyre, Senior Nurse Infection Control, HPS

Donald Bunyan, Information Scientist, HPS

Caroline Creasey, Information Officer, HPS


Public Involvement StrategyIn addition to the public representation at the HPN Steering Group, HPN seeks to establish active public involvement in planning and developing the network functions.

Initial conversations with the Scottish Consumer Council (SCC) and Patient and Public Involvement (PPI) networks are currently being developed to ensure the interest of the Scottish public is represented in the different Working Groups focused on producing specific guidelines for health protection.

Communication StrategyA communications strategy was drafted within the early stages of the network development, outlining communication work for the first phase. The network has now been in operation since October 2006 and it has sought to date active participation from the health protection community across the country through their representatives in the HPN Steering Group.

The HPN is currently moving into a new phase, where action plans to adopt common approach to develop evidence-based guidance for professionals will be implemented across the organisation through Working Groups who feedback to the network.

Specific objectives of this strategy are:

1. Network members awareness

To increase professionals of the health protection community across Scotland awareness of:

the existence of the HPN and action planswhere they can get detailed information about the networkfeedback channels.

2. Network engagement and commitment

To encourage engagement and commitment with stakeholders.To seek and promote collaboration with UK and European bodies who share interest in evidence-based practice for health protection activities.

3. Survey participation – if / when appropriate

To achieve a high response rate amongst the health protection community across Scotland.

Further details of the communication strategy in place can be accessed at http://www.hps.scot.nhs.uk/about/HPN.aspx

•••

http://www.hps.scot.nhs.uk/about/HPN.aspx


Appendix 1 – Networking and sharingPlease see our page on the NHS networks site: http://www.networks.nhs.uk/networks/page/��85

http://www.networks.nhs.uk/networks/page/1185


Notes

Health Protection Network for Scotland

Documents

Transcript of Health Protection Network for Scotland