Over the last five years, NHS Supply Chain procurement exercises have benefitted from increased frontline clinical engagement, ensuring high-quality and cost-effective products that meet the needs of the NHS. In this article, Sue Green outlines how clinical engagement has supported the development of a robust infection prevention and control framework for the provision of hand hygiene products and services.
In 2019, the NHS Supply Chain Framework for Hand Hygiene and Associated Products and Services renewal process was launched, with a requirement for extensive engagement between the NHS Supply Chain clinical team and frontline clinicians and infection prevention and control (IPC) teams across the country, and for evaluation of products, to ensure that they meet requirements.
Hand hygiene products are ubiquitous and essential for safe healthcare provision, which aims to minimise the risk of cross infection from hands and the environment. Accordingly, to identify the essential product requirements, as defined by representative end users, a stakeholder map was developed and an engagement plan devised, to ensure that the end user customer needs and specialist knowledge from a wide range of users and specialists was captured
Over 14 months, members of the NHS Supply Chain clinical team engaged in a variety of ways, including: site visits; conference stands; attendance at Trust and specialist meetings; questionnaires and surveys; and face-to-face and virtual meetings, with a wide range of stakeholders from across the country. These included microbiologists, pharmacists, clinical procurement, infection prevention and control, and other specialists from NHS Trusts; frontline clinicians from various professions working in various settings – including community, acute, primary care and ambulance Trusts, care homes, prison healthcare and mental health services; as well as specialist and professional bodies – such as The Royal College of Nursing (RCN) and the Infection Prevention Society
Guidance and quality standards around infection prevention and control require that healthcare staff are trained in effective hand decontamination techniques (NICE 2014) and that they maintain competence, skills and knowledge in infection prevention and control by attending education events and/or completing training (National infection prevention and control manual for England, 25 January 2023). The World Health Organization (WHO) promotes inclusion of the “My Five Moments for Hand Hygiene” approach and the correct procedures for “hand rubbing and handwashing”, and cites evaluation of hand hygiene practices as another vital element of the strategy to improve hand hygiene.
Consequently, it is perhaps not surprising that, during engagement, infection control leads across all services identified both education and audit services – along with the provision of supporting materials and resources (as shown below) – as being an essential part of hand hygiene product provision and something that would strongly influence their final product selection:
- Provision of education materials – which might include face-to-face training in Trust, webinars, online training, and a range of supporting materials, such as posters (these might be available as downloads or as hard copies and might be able to be made Trust specific).
- Training for link practitioners and support for ‘Train the Trainers’.
- Support with independent audits.
- Support for study days and infection prevention and control campaigns and initiatives (local and national e.g. World Hand Hygiene Day).
The renewal of the hand hygiene product framework presented a unique opportunity for NHS Supply Chain to ensure that a base line provision of additional services, as identified by stakeholders, was provided by all suppliers of hand hygiene products and that these services met the high standards required by the NHS. As some suppliers provided additional services and resources, a further opportunity was identified: that it would be possible to promote and reward this added value.
The requirements for these services, identified and approved, by a subset of initial stakeholders and our Clinical Council, (whose membership includes senior IPC and decontamination clinical specialists, along with RCN and IPS representatives), set out the product essential specification. This document sets out all the minimum requirements that a product or service must meet before it is considered suitable to be provided by NHS Supply Chain. These included the following requirements:
- Training and auditing materials have been written or reviewed and agreed by a subject matter expert.
- Trainers must have been trained by a subject matter expert to deliver the training content.
- There is face-to-face (local to Trust) or online hand hygiene compliance training to staff provided on at least an annual basis.
- Training is based on the World Health Organization’s ‘Hand Hygiene in Healthcare’ guidance and the ‘Five Moments’ model and as agreed with the Trust infection prevention and control team.
- Education materials include: guides on how to wash and sanitise hands; hand hygiene posters to promote the importance of hand hygiene; signage on and/or around dispensers, drawing attention to the products and demonstrating correct use.
- A free of charge annual audit is provided to the Trust across all usage areas, or as agreed by the customer, which includes reporting hand hygiene compliance levels in line with customer-agreed measures, and development of any resulting improvement action plans with the customer
The proposed methodology was highly innovative. Suppliers would be provided with scenarios (these included ambulance and acute Trust settings) and were asked to prepare a detailed response as to how they would meet the varying needs of different Trusts. They would be asked to develop and present a short webinar clearly demonstrating their ability to plan and deliver high quality training and audit services to Trusts. This would need to be in line with current guidance and examples of resources would need to be shown. Each scenario would be scored against an assessment framework (the evaluation criteria). Suppliers were given an opportunity to present their education and training, and audit proposals, which would then be scored by a panel of NHS Supply Chain and external subject matter experts and Trust IPC leads.
Suppliers would be required to demonstrate that they met the minimum standards set out in the specification. In addition, they would also have an opportunity to be awarded additional points for exceeding these and so increase their chance of their products being available from the NHS Supply Chain online catalogue.
Suppliers had the opportunity to inform the procurement team and IPC review panel about any additional support they would offer, such as supporting local and national or international campaigns and events (e.g. World Hand Hygiene Day) and to gain credit for offering some of the “nice to haves”, which were identified during the engagement process, but not included in the specification (e.g. the provision of update training more frequently than the annual minimum requirement would score additional points, as would the ability to provide bespoke posters and materials for individual Trusts).
The NHS Supply Chain clinical, trading and contracting teams worked together to develop the evaluation criteria, referring again back to external clinicians and experts to clarify points and offer approval. The team tested the criteria against incumbent suppliers’ services to ensure that they were fit for purpose and while potentially raising the standard of training and education offered by all suppliers.
Unfortunately, in early 2020, the project was stalled due to the COVID-19 pandemic and the introduction of a national PPE cell, which became responsible for securing hand hygiene products for the NHS.
When the procurement for hand hygiene products came back to the team in mid-2021 additional stakeholder engagement took place to ensure the original requirements were appropriate and to see if learning from the pandemic necessitated any enhancements or modifications
Post-pandemic, Trust IPC teams had greater awareness and understanding of the relevant EN standards to show efficacy of the products and of the need for supply resilience. Independent microbiologists were consulted to ensure that the standards set out in the specification were still appropriate and sufficient. Other subject matter expert feedback, such as that from the RCN, included the need to explore sustainability with suppliers, as well as the need for more products that supported hand protection and skin health, such as emollient based barrier creams.
Stakeholder feedback post-pandemic still reinforced the need for excellent support from suppliers in relation to hand hygiene training and education, with training and education aligning with the latest IPC guidance from the RCN, WHO and the Health and Safety Executive (HSE).
Conversations with existing suppliers technical and clinical specialists supported the development of understanding about the challenges that they had faced during the pandemic, how they had managed them and what they had learned. Suppliers said that they were committed to ensuring that their products and support services met (and in many cases exceeded) the required standards.
Having ensured the specification and the evaluation methodology and criteria remained fit for purpose, and having shared this with the IPC Clinical Council, suitable and enthusiastic assessors were recruited from the Council. These were all IPC specialists.
The supplier webinars were reviewed and scored against the objective criteria, by members of the NHS Supply Chain clinical, trading, and contracting team and the external subject matter experts recruited from the IPC Clinical Council. Suppliers showed in detail how they would manage and provide training and audit, that had been developed and was delivered by suitable persons, in a variety of situations. They showed examples of their resources and the ways in which training and resources could be accessed. Suppliers who did not demonstrate that they met the minimum standards were unsuccessful and those that exceeded the criteria were scored accordingly. This score formed part of the overall assessment of the suppliers’ products and services, enabling NHS Supply Chain to procure and provide products and services to the NHS that met their needs
In conclusion, the innovative decision to include supplier webinars, to be scored objectively as part of the formal evaluation process, against requirements developed through direct engagement with the NHS, was validated.
It raised the bar for suppliers and gave them the opportunity to demonstrate how they would work with Trusts to supply evidence-based infection prevention education, training and audit that met the needs of the NHS.
Trusts will now receive, as a minimum, an education, training, and audit package that has been developed and agreed with appropriate experts and users from the NHS. In addition, suppliers have shown how they will support IPC leads to identify the training needs of the workforce, and provide specialist designed training for a wide range of staff both on induction and annually. To support the audit programme, as well as the education materials agreed with Trust leads, many will also provide bespoke information that promotes local Trust policy.
Additionally, the external stakeholders who took part in the process provided very positive feedback about the benefits of this collaborative and innovative initiative:
“Working with NHS Supply Chain has been an invaluable insight into the sheer amount of work that goes into product decision making and having the clinical input from a range of clinical settings across the NHS means that the products chosen are suitable for all sectors, approved by clinicians and meet all our requirements, and usually have a cost benefit too – what is not to like?
“The hand hygiene webinars were a great way to not only discuss each product in their design and ability, but also to share our thoughts on the benefits of each product and any challenges. Having a group of clinicians and team members discussing not only the product but the company delivery, enabled us to make informed choices and decisions on the products and identify where improvements could be made.
“This will help raise the standard of education delivered by suppliers in the future. It has all been a worthwhile and beneficial process for us all,” commented Deborah Bullock, head of clinical safety, national specialist advisor, infection, prevention and control (AACE), North West Ambulance Service NHS Trust.
Fionnuala Browne, lead nurse infection prevention and control, Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, added: “This collaborative project engaged with IPC experts across healthcare, to identify what is most valuable from their perspective in terms of a hand hygiene specification from suppliers.
“This not only challenges suppliers to deliver to these high standards and to innovate in their offerings but also supports busy IPC teams with a more comprehensive education and training package for their workforce.”
The NHS Supply Chain national framework for Hand Hygiene and Associated Products and Services launches on 12 June 2023.
About the author
Sue Green is a clinical procurement and quality assurance specialist. She is a registered general nurse with over 25 year’s clinical and managerial experience in both the acute and ambulance setting. She has worked with the clinical procurement quality and assurance team, since November 2018, and joined DHL (on the NHS Supply Chain Contract) in 2018, following a year spent working across the Acute and Ambulance sectors supporting joint procurement of products easily transferred with patients from the ambulance to emergency department.
Sue Green is a clinical procurement and quality assurance specialist. She is a registered general nurse with over 25 year’s clinical and managerial experience in both the acute and ambulance setting. She has worked with the clinical procurement quality and assurance team, since November 2018, and joined DHL (on the NHS Supply Chain Contract) in 2018, following a year spent working across the Acute and Ambulance sectors supporting joint procurement of products easily transferred with patients from the ambulance to emergency department.
