JPP PG March 2016 (Vol:05 Issue:01)

Journal of Perioperative Practice

PROCUREMENT GUIDE March 2016 Volume 05 Issue 01 01423 881300 www.afpp.org.uk

01423 881300 www.afpp.org.uk

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Journal of Perioperative Practice PROCUREMENT GUIDE March 2016 Volume 05 Issue 01 www.afpp.org.uk

Contents

Welcome to your March 2016 Guide 06 Inventory management

15 Product News:

11 Product News:

16 Product News:

13 Product News:

17 Product News:

14

18 News

and GS1 standards

MiniLap速 instruments, SD Healthcare

BD Safety

Product News: PROACT Creative PC-900B

Detergent choice from sch端lke

Wardray Premise TOF Watch

i-gel速 supraglottic airway from Intersurgical, LaproSurge 3mm range

Journal of Perioperative Practice Procurement Guide information In print within the AfPP Journal of Perioperative Practice covering national AfPP members, but also with a dedicated print and e-distribution to supplies and purchasing managers.

May 2016 Infection Control/Prevention, Decontamination

Key Sectors: NHS Supply Chain, Independent Hospitals, Higher Education.

Medical Device Companies.

September 2016 Anaesthesia/Airway Management/Difficult Airways

Published 6 times a year we will focus on procurement issues in every edition as well as specialist subjects which for the following year include:

July 2016 Consumables

November 2016 Safety/Sharps Safety/ Patient Safety

Contact Information: Advertising, Sponsorship & Partner Packages.

Frances Murphy Account Manager Open Box M&C T: 0121 200 7820 E: frances.murphy@ob-mc.co.uk Editorial Chris Wiles Head of Publishing/Editorial AfPP T: 01423 882950 E: chris.wiles@afpp.org.uk

PR & press material.

All press releases welcome and we will feature as many as we can in each issue, all press releases need to be submitted to: Frances Murphy Account Manager Open Box M&C T: 0121 200 7820 E: frances.murphy@ob-mc.co.uk

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Inventory management and GS1 standards What are the implications on my role as a healthcare professional?

Explains how GS1 standards and inventory management bring much-needed change across the entire NHS, focusing on the benefits it brings to staff.

Tipping more than 1.6 million people, the NHS employs one of the world’s largest workforces; and every employee contributes to the effectiveness of the healthcare system. So how many know about GS1 standards and inventory management? How many are aware they can make a contribution to its success?

Whether staff are aware of GS1 standards and inventory management or not, all staff are involved in this continuous improvement programme.

However unless staff are directly involved in the changes such as those working in the procurement and supply chain teams, it is unlikely that communication around these key developments has filtered across to every member of staff, particularly those in the frontline.

This oversight misleads people into thinking it does not affect them, or that it does not fall under their remit. In contrast, these changes require commitment from everyone. It’s not simply about nurses scanning products, it must be viewed as a bigger picture; a message which should reach the frontline.

GS1 standards So what does GS1 mean? A major issue for the NHS is the inability to compare data across systems. The first step towards

As the NHS becomes increasingly cost pressured, the organisation as a whole has to become more efficient in the way it runs dayto-day processes at all levels.

overcoming this is to have data standards that the sector abides to enable healthcare professionals to view data across systems and understand what products are being used, when, where and on whom.

Between a front-end electronic patient system and back end finance system, a myriad of solutions exist in every trust, which at some point touch patient information. Many hospitals have more than 100 solutions with separate coding, and, or data structures. The use of global standards enables data from these systems to be compared and or talk together, with common data for analysis. It is now mandatory for trusts to implement GS1 standards.

Why is the government implementing GS1?

GS1 is integral to create efficiencies as good data provides managers with real visibility of the cost drivers at the front line. Product choices, staff choices, and inefficient processes are highlighted and it provides the workforce with a real insight into how many choices and decision are costing.

As the NHS becomes increasingly cost pressured, the organisation as a whole has to become more efficient in the way it runs day-today processes at all levels.

There is always a focus on ‘high-spend’ areas, traditionally theatres and departments such as cardiology. However, real progress can be gained through looking at inefficient processes and learning the lessons from how the

commercial world uses first-class technology to secure efficiencies.

Patient safety is at the core of this too. Being able to understand exposure on faulty products, who’s at risk and where they are, alongside managing product recalls.

Inventory management: what it means for GS1 standards There are three government initiatives where inventory management is a key stepping stone to help understand who, when and where products are used: track and trace, the ability to track products from the supplier to the patient; the eProcurement Strategy, making the replenishment process more efficient and visible; and patient level costing and service line reporting, to understand the cost drivers in the NHS. Engaging the healthcare workforce The direct link between engaged staff, and better care and happier patients, has already been widely cited, and there has been an increase in employee engagement in recent years.

Involving staff in the changes that GS1 standards and inventory management bring, and maintaining communicating every step of the way is vital; staff are more satisfied, efficiencies are improved, it leads to better clinical outcomes, and ultimately improves patient care.

Maximising engagement A successful rollout can hinge on how engaged teams are, not

>>

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>> only in terms of keeping them up-to-date on the changes, but also helping them recognise existing issues that it addresses and opportunities it brings.

The current issues that teams should be aware of here is that supply chains in the NHS lack maturity, and this has created a number of problems: • Lack of stock control and visibility • Wastage of consumables, and costs associated to disposal and reordering • Shortage of management information • Excess clinical time spent ordering and managing stock • Lack of product traceability • Large volumes of storage space required • Inadequate control of consignment stocks

It is these issues that GS1 standards and inventory management, together, help overcome.

With a dispersed, shift-based workforce, it’s paramount to include everyone and equip individuals with the drive to adopt change and buyin. Staff engagement can present a stumbling block, so regularly use a combination of communication methods to diminish barriers and ensure key messages reach everyone.

Senior leadership Senior leadership plays a fundamental role in helping to break down boundaries.

Senior staff must look to involve staff in the changes, and remain approachable, open and honest about the issues that GS1 and inventory

management help overcome, as well as the changes to existing working patterns.

Other trusts Support and networking with colleagues at other trusts who are at different stages is incredibly beneficial. This helps share best practice and gain a greater insight into what works, and what challenges to expect. It also help trusts yet to embark on the process, reach new heights in procurement practices.

GS1 GS1 itself is a good source of information and advice.

The website has a great deal of information including videos that demonstrate the progress achieved in hospitals across the country.

Events Throughout the year national and regional exhibitions, conferences, seminars, and workshops help people gather information and share best practice. These are invaluable sources of information to keep visitors up-to-date on the latest developments.

Intranet Use the intranet to publish organisation-wide messages such as a guide to the change, how it affects staff, and regular progress updates.

Provision for dialogue between intranet users encourages discussion and opinion around the topic which is also useful.

Other internal communication methods Email, videos, notice boards, newsletters, and staff training

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present excellent ways to promote current progress. GS1 is a good source of assistance here too, and will send a representative into hospitals to provide an in-depth view of the key points. This allows trusts to appoint a GS1 champion to communicate messages throughout the organisation.

Social networking Different staff respond to different communication channels so consider social networking. Twitter, LinkedIn and Facebook present opportunities to both find out more about GS1 and inventory management.

Healthcare & supply chain media Specialist healthcare publications, as well as those produced for supply chain and procurement professionals are good references for up-to-date news and developments.

Department of Health Although the Department of Health has initiated demonstrator sites and has awarded funds to six hospitals for the development of their system to meet GS1 standards and the requirements for inventory management, this means that other trusts still have targets to meet and currently no funding to do so. So what is the Department of Health proposing to do for the rest of the trusts, as they do not expect the rest of the trusts to pause waiting for the demonstrator sites to be available?

Certainly more advice, information and support is required, perhaps the Department of Health would have been better placed funding a GS1 consultant to each trust for the next two years?

Senior staff must look to involve staff in the changes, and remain approachable, open and honest about the issues that GS1 and inventory management help overcome, as well as the changes to existing working patterns.

largely because the key messages have not reached them. Whilst some back the changes and acknowledge that it’s a positive step forward for their roles, it’s clear many frontline workers remain confused and uninvolved in the developments.

One of the reasons this may be getting overlooked by clinicians is the belief that ‘it’s not my job.’ Although it is a procurement exercise, clinicians have just as important a role to play as the procurement teams in the future of the strategy.

Importantly they need to realise the eventual power of being able to link product selection to patient outcome, so discussions on price are more about long term value to the NHS and patient. The mechanics of being able to get to that point start with the initiatives of track and trace today; clinicians at all levels are critical to the success of this initiative, and evolving new way of ensuring their choices are the best for the patient and also working with the procurement functions.

More than this, with an aging population, the NHS and the staff within it are under unprecedented pressures, both financially and being able to supply services to meet demand. We are entering the worst time of year when winter pressures take the NHS to the limit. Funding a spiralling budget for the NHS is a challenge for any political party, and the NHS has to become savvier about how it works, and use the best technology to ensure money is not wasted and instead used on looking after people.

The benefits to staff include:

What’s in it for me?

Whilst procurement teams are fully aware of the implementation of GS1 standards, views and opinions of clinicians vary considerably,

Power of data It enables healthcare professionals to access reliable and robust data to make more informed decisions,

and perform their roles more effectively and efficiently. It also minimises the risk of errors which benefits patient safety.

Improves processes Former approaches used to manage hospital supplies are now redundant. Innovative technology has transformed the entire process, enabling great strides in terms of efficiency.

Returning to the frontline Clinicians want to spend time with patients, not ordering or form filling. In terms of replenishing products required for instance, approaches were often heavily manpower reliant.

In fact, a number of studies indicate that up to 25 per cent of nursing time is spent in managing supplies and re-ordering.

Frontline staff would have to put aside significant amounts of time to fulfil largely admin-related tasks, such as ordering and collecting stock, however GS1 and inventory management now reallocates these duties to procurement teams which frees up frontline staff to spend more time with patients.

More organised working environment In theatre departments, clinicians historically stored their own supplies, however this is no longer necessary.

The physicality of a trust plays a huge impact on the management of supplies.

Some have centralised stores rooms and large new PFI buildings, many still work in old Victorian buildings with a lack of storage space; reducing stock on the shelf and managing it more efficiently creates a cleaner, more effective and organised working environment.

Innovative approach Trusts are recognising the need to adopt innovative processes, >>

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>> practices and products to take a leap forward. Some of these changes are not huge, yet have a large impact, and require staff to take ownership and get involved. Working for a trust that fosters new innovative approaches is motivating and exciting, and presents an element of kudos within the industry.

Part of the bigger picture There is enormous pressure to reduce expenditure without reducing the standard of patient care, and one of the most effective ways to achieve this is by getting procurement into better shape; reducing wastage, minimising the risk of fraud, cutting costs.

Everyone is part of the bigger picture, to not only help individual departments

improve, and their trust, but the NHS as a whole.

The right technology The NHS is notoriously bad at assigning buying technology; there have been some large and well publicised failures.

It is so important that the choices made around the solutions for managing and replenishing inventory are well informed. The clinician tends to look at cabinet solutions favourably as it also gives them organised storage (and storage is always an issue) but the technology is outdated and so are the processes, and could never grow into more advanced supply chain processes that could gain further savings. Failed cabinet installations are prevalent, and the capital expenditure is significant.

A further issue is solutions coming on to the market that are in the early stages of development, they are cheap for that very reason, and procurement professionals fall into the trap; these options are not cheap in the long term, and waiting for development delays savings.

for change, and to enable the NHS to act smarter with budgets, and become truly world class, innovative technologies are at the heart of these changes. It affects, and improves the day-today roles of the entire NHS’s workforce; even if they don’t know it yet.

To avoid this scenario, look to select the technology base well; ensure it’s modern, maintained and understand where that technology will be in 10-15 years’ time. Also consider the experience of the team and look to a technology partner rather than a supplier; someone to work closely with to make sure technology is put to the best use.

Nicola Hall Managing Director at Ingenica Solutions

Conclusion Inventory management and GS1 standards are a catalyst

www.ingenicasolutions.com For further information contact Ingenica Solutions 0845 0660 100, visit www.ingenicasolutions.com or email info@ingenicasolutions.com Follow us on Twitter @ IngenicaS @NicolaHall68509

Product News 11

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MiniLap® MiniLap® instruments, with their slim 2.3 mm shaft diameters for the graspers and 2.4 mm shaft diameters for the MiniPolar probes, can be percutaneously inserted into the abdomen using an integrated needle tip.

The grasper jaws or probe can then be deployed to grasp or coagulate tissue.

The patented deployment design allows grasper jaws to open up to 12.5 mm to grasp difficult structures, eg: distended gall bladders.

This simple concept of ‘manipulation’ has obvious value and due to the unique features of the device, surgeons from multiple specialties adopt its use as a percutaneous complement in multi-port laparoscopy.

M: +44 (0)7739 628969 P: +44 (0)1494 532761 E: ian.mellors@teleflex.com Teleflex, Grosvenor House, Horseshoe Crescent, Old Town Beaconsfield, Buckinghamshire HP9 1LJ

www.teleflex.com

SD Healthcare We are SD Healthcare Limited an independent supplier of products for use in Ophthalmology. Our portfolio of products covers Ophthalmology and its sub-specialties, corneal, refractive and vitreoretinal surgery.

We offer single-use ophthalmic surgical instruments, custom-made procedure packs, IOLs, ophthalmic gases, Excimer lasers, patient beds and corneal transplant products.

We are official distributors for world famous ophthalmic brands including: ARCAD; AcuFocus; Surgitrac

Instruments; Moria Surgical; SCHWIND eye-tech solutions; and brumaba OPERATING TABLE SYSTEMS. We supply both the NHS and private sector. www.sdhealthcare.com Tel: +44 (0)161 776 7620

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Protect yourself

Every day healthcare workers are at risk of serious infections as a result of needle stick injuries.

As carers we often forget to protect and care for ourselves, in the same way we wish to protect and care for our patients. We need to always think of the risks that we take and remember, if we are not well ourselves we cannot care for others.

Even when an infection is not transmitted, the emotional impact of needle stick injuries

can be severe for a healthcare worker and their family. When we protect ourselves with safety engineered devices we are also protecting our families, if we are exposed to risk of serious infection they are possibly as well. Whether it be living with a fatal infection or the stress of not knowing, you can imagine or have maybe experienced the toll it can take on your family.

The Health and Safety (Sharp Instruments in Healthcare) Regulations 2013 came into force on 11th May 2013 and are a means for your employer to provide a safe work environment combined with safety devices which minimise the risk of needle sticks. Remember your own safety and help your employer provide a safer work place for you and your colleagues.

For information on BD safety devices go to www.bd.com/uk For a copy of our safety catalogue call 01865 781 666

Product News

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PROACT PROACT Medical Present the Creative PC-900B. The Creative PC-900B is a compact handheld Capnograph and Pulse Oximeter offering extremely easy to use technology, with bright clear displays and full user adjustable alarms.

• Creatives Variable Flow (50-250ml/min) Sidestream Technology allows it to be used for intubated and non-intubated patients and low flow sample lines • Monitors EtCO2/FiCO2, RR, SpO2 and PR • The adjustable pump flow rate allows it to be optimised for both Adult and Infant patients.

• The device can store and display up to 24 hours of graphic and tabular trend even after it has been powered off and downloads to free PC reporting software Please contact us for further information.

PROACT MEDICAL Tel: 01536 461981 Email: sales@proactmedical.co.uk

Product News

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Detergent choice from schülke gigasan® ND from schülke is the latest addition to the extensive range of disinfectants and detergents from schülke, which is designed to offer choice, convenience and cost savings. gigasan ND is a non-enzymatic neutral detergent for the manual cleaning of medical and surgical instruments, including endoscopes and endoscopy equipment. Because of the ultra- concentrated formulation a 5 litre container of gigasan ND can be diluted into 12,500 litres of in-use solution. This makes gigasan ND a highly cost effective neutral detergent and also saves on storage space.

If an enzymatic detergent is preferred, gigazyme® contains enzymes and surfactants for optimum cleaning performance. gigazyme is available in both 2 litre and 5 litre pack sizes.

Whether gigasan ND or gigazyme is used, gigazyme® ready-to-use spray foam can be used for the immediate pre-cleaning and disinfection of surgical instruments, including flexible endoscopes.

T: +44 (0)7739 628969

gigazyme spray foam includes three different enzymes for cleaning and disinfection and is designed to keep soiled instruments moist for a prolonged period of time.

Tel: 0114 254 3500 Email: mail.uk@schuelke.com Web: www.schulke.co.uk schülke UK Ltd, Cygnet House, 1 Jenkin Road, Meadowhall, Sheffield S9 1AT

E: ian.mellors@teleflex.com

W: www.teleflex.com

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Wardray Premise Wardray Premise was delighted when they were appointed distributor of the TOF Watch in the UK & Ireland.

The TOF Watch offers an accurate and reliable method of objective acceleromyographic (AMG) monitoring of neuromuscular blockade.

The TOF watch overcomes the problems associated with subjective monitoring.

The TOF Watch can accurately measure the depth of neuromuscular blocking agents (NMBAs)to help assess: 1. onset time of NMBAs; 2. the need for administration of maintenance doses of NMBAs; 3. when to administer reversal agent; and 4. when to safely extubate the patient.

Full details of Wardray products are available at www.wardray-premise.com or contact the Company’s Head Office: Tel: 020 8398 9911; Fax: 020 8398 8032 Email: sales@wardraypremise.com

A LEADING UK SUPPLIER OF OPERATORS’ STOOLS FOR NHS CLINICIANS Winners of Clinical Seating OJEU contract for Barts & The London NHS Criteria: Ergonomics, Infection Control and Build Quality and MRC Laboratory of Molecular Biology Operating Theatres • Anaesthetics Eye Clinics • Recovery • ICU • HDU Pain Management • Ultrasound Maternity Units • Delivery Suites Clinical Areas Unit C1, Ford Airfield Industrial Estate, Arundel, West Dussex BN18 0HY Telephone: +44 (0)1243 811881 Fax: +44 (0)1243 811855 Email: colin@murrayequipment.co.uk www.murrayequipment.co.uk

Product News 17

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i-gel® supraglottic airway from Intersurgical i-gel® is a truly unique, single use, second generation supraglottic airway with a soft, gel-like non-inflatable cuff.

Quick, easy and reliable to insert, i-gel® accurately positions itself over the laryngeal framework to provide a reliable perilaryngeal seal without the need for an inflatable cuff. It also incorporates a gastric channel for improved safety, an integral bite block to reduce the possibility of airway occlusion and a buccal cavity stabiliser to aid rapid insertion and eliminate the potential for rotation. i-gel® is ideal for use in anaesthesia, and in adults for resuscitation and as a conduit for intubation with fibreoptic guidance. i-gel® is currently available in seven sizes and is supplied sterile in an

innovative, colour-coded protective cradle or cage pack.

For more information visit www.i-gel.com Contact information: Intersurgical, Crane House, Molly Millars Lane, Wokingham Berkshire RG41 2RZ England Tel: (0)118 9656 300 Fax: (0)118 9656 356 Email: info@intersurgical.co.uk Web: www.intersurgical.co.uk

Introducing the 3mm laparoscopic set from LaproSurge Ideal for use in gynaecology, paediatric and general laparoscopic surgery.

The 3mm range from LaproSurge includes a comprehensive range of reduced-diameter laparoscopic instruments enabling surgeons to perform less invasive surgery without a compromise on strength or rigidity of instruments.

3mm laparoscopy provides many undeniable clinical and cosmetic advantages without requiring the surgeon to alter operating technique. Accessing the

abdominal cavity through 3mm ports has both the cosmetic benefit of reduced skin scarring and the clinical benefits of a reduced level of tissue damage, port-site herniation and wound infection, faster recovery and a reduction in pain scores.

of conventional laparoscopic triangulation with the numerous additional advantages of reduced incision size.

The high quality and costeffective 3mm instruments from LaproSurge enable surgeons to achieve the ergonomics

Tel: 020 8950 8662 Email: uk@laprosurge.com Web: www.laprosurge.com/ products/3mm-laparoscopy

Please contact us for more information - quote ‘AfPP March’ for your free samples.

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BSI and ACRES developing global accreditation standards for clinical research sites The British Standards Institution (BSI) and the Alliance for Clinical Research Excellence and Safety (ACRES) have announced a multi-stakeholder collaboration to develop global standards of excellence for clinical research sites and lay the groundwork for site-recognition and accreditation.

London-based British Standards Institution (BSI), a leader in promoting excellence through standards development for business processes globally, and Massachusetts-based Alliance for Clinical Research Excellence and Safety (ACRES), a multisector collaborative building a global system for clinical research, have announced a major strategic partnership to promote excellence and improve quality and efficiency in medical product development worldwide. BSI joins ACRES

ongoing Site Accreditation and Standards Initiative (SASI) with the intention to develop and implement standards of excellence for clinical research sites and engage with all parties of the clinical research endeavour to develop an innovative process for ‘dynamic accreditation’ of research sites that will promote, recognize and reward excellence.

BSI and ACRES also announced their intention to create professional stakeholder groups

to oversee and maintain the standards, and to operate the global accreditation process.

Formed in 1901 as the world’s first national standards body and providing services to more than 70,000 sites in 150 countries across a range of industry sectors, BSI brings deep experience in standards development and accreditation processes to ACRES efforts.

BSI and ACRES will work with stakeholders from across the clinical research endeavour in

developing both the standards and the system for independent third-party accreditation.

Gary Slack, SVP for Global Healthcare at BSI, announced the new partnership, noting “BSI believes excellence must be a habit, that excellence and responsibility must be embedded in sustainable business practices, and by doing so, improved quality and effectiveness are not just achieved, they are inevitable. We share these beliefs with ACRES and are excited to be part of these long-overdue efforts.”

SASI, building on its previous efforts in surveying and consulting on current site quality criteria, is constructing a comprehensive set of standards covering essential domains of patient and subject engagement and protection, site personnel, research integrity, facilities, information systems and data management, management and administration as well as quality management. These standards and derived metrics will enable an innovative ‘dynamic accreditation’ process that automatically monitors operational data in real time to continuously improve site and system performance, benefitting stakeholders while minimizing research site burdens.

“High-performing quality research sites are critical elements in a safe, effective system for testing new medical products and doing clinical research to develop new therapies. For too long we have failed to recognize and reward truly excellent, professional sites and lacked a system for doing so. No more--this is true

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AfPP’s Theatre access course Who’s it for?

This course has been tailored specifically for medical device representatives but may also be suitable for students wanting to get a ‘taste’ of theatres.

Where is it held?

Either at AfPP HQ in Harrogate or onsite at your offices (a minimum of 10 delegates are required for onsite courses).

What do you get out of it?

- An understanding of theatre etiquette, correct protocol and the roles and responsibilities of those within theatres.

What does it cost?

- £250+VAT for medical device representatives - £150+VAT for students

- A certificate and theatre access course ID pass card.

The course can also be ‘tailor made’ to your specifications.

How long does it last?

The course is valid for two years, after which you will be required to complete a refresher module.

To book your place or for further information, please call Kelly Squires on 01423 882969 or visit www.afpp.org.uk/events/theatreaccess

transformational change, a new way of doing things, and the expertise that BSI brings to ACRES global collaboration brings the future much closer than anyone could have imagined”, said ACRES president and co-founder, Dr. Greg Koski.

Arti Bajpai, co-chair of ACRES Global Standards Working Party developing the standards, commented “ACRES will not itself create nor hold the standards—as an enterprisewide effort, everyone—sites, sponsors, CROs, ethics review committees, patients, providers and regulators—has a stake in the standards. Like the accreditation process itself, they too must be dynamic.” Bajpai, president of Pennsylvaniabased Compliance and Quality Integration (CQI) Consulting, and co-chair Dr. Amir Kalali, Head of the Neuroscience Center of Excellence at Quintiles and co-founder of CNS Summit, are currently assembling domain-specific standards teams to coordinate and evaluate the new standards, targeted for public comment and evaluation in 2016.

NHS England to launch procurement exercise NHS England to launch procurement of national stereotactic radiosurgery/radiotherapy service following consultation.

NHS England will shortly launch a procurement exercise aimed at identifying providers of a national service for stereotactic radiosurgery/radiotherapy (SRS/SRT).

The move comes after a period of extensive public consultation, (ran from 24 Jul 2015 to 13 Oct 2015) which has resulted in a new approach to service delivery, and a revised service specification.

SRS/SRT are forms of radiotherapy which deliver precisely targeted beams of radiation to a tumour site. They are often used in the treatment

of brain tumours, as there is less risk of damage to healthy tissue when using this approach.

Historically, services were commissioned by primary care trusts, which led to some variation in access across the country.

NHS England, as the single national commissioner of SRS/ SRT since 2013, has carried out a review of service provision in England, which has enabled a more strategic approach to be taken to service delivery, enabling equitable access to high-quality services across England.

The procurement process will identify which providers will be commissioned to deliver SRS/ SRT from spring 2016, with contracts due to be awarded in the New Year.

NICE quality standards The healthcare-associated infections quality standard has been published on the NICE website. You can view the quality standard at: http://www.nice.org. uk/guidance/qs113