IPPOL01 Management of MRSA by Provide Community

Policy for the Management of Meticillin Resistant Staphylococcus aureus (MRSA)

(including screening for Podiatric Surgery)

Version: V10

Ratified by:

Infection Prevention Group

Date ratified: 21/05/2024

Job Title of author: Infection Prevention and Control

Reviewed by Committee or Expert Group Infection Prevention Group

Equality Impact Assessed by: Head of infection Prevention and Control

1. Introduction

Meticillin Resistant Staphylococcus aureus (MRSA) is a strain of Staphylococcus aureus that has developed resistance to Flucloxacillin and other related antibiotics. MRSA infection can lead to serious complication resulting in additional mortality and morbidity for patients as well as contributing to increased healthcare costs.

The main source of MRSA transmission in healthcare is via the hands of healthcare workers and remains the principal route for patients acquiring MRSA By its very nature MRSA is an opportunistic bacterium which can colonise skin and spread easily in the right conditions MRSA colonization occurs when bacteria can reside on an individual but there are no signs of infection. MRSA can colonize patients’ skin and subsequently be dispersed into the environment when skin scales are shed. MRSA can survive in dry and dusty environments or on contaminated surfaces and equipment. Hands become contaminated when touching surfaces and through their interactions. This contamination becomes the main route of spread by healthcare workers hence the emphasis on effective hand decontamination at the point of care to minimise spread.

2. Purpose

The purpose of this policy is to minimise risk and maximise best practice in the prevention and management of MRSA.

Good infection control is essential to ensure that people who use our health and care services receive safe and effective care. If basic principles of infection control are followed, the risks to our patients of acquiring MRSA or any other Health Care Associated Infection (HCAI) will be effectively minimised in all types of community settings.

3. Definitions

Term Definition

MRSA

Meticillin resistant Staphylococcus aureus are bacteria identified as resistant to the Meticillin antibiotic group.

MSSA Meticillin sensitive Staphyloccus aureus are bacteria that can be treated with Meticillin antibiotics.

MRSA Colonisation

The presence of MRSA on mucosal and skin surfaces, without the presence of clinical manifestations of illness or infection.

DIPC Director of infection Prevention and Control

PIR Post infection review

Bacteraemia The presence of MRSA in the blood stream. This type of MRSA infection can lead to septicaemia and has a high mortality rate.

MRSA infection The presence of MRSA in a body site, where there is clinical evidence of infection

MRSA screening The process of obtaining microbiological swabs to identify the presence of MRSA

Decolonisation

The process of eradicating or reducing asymptomatic skin carriage of MRSA, through the use of topical anti-bacterial applications

Elective admission

A patient admitted following a planned period of waiting. This may be from a waiting list, from being “booked” (i.e. given a date at the time the decision to admit was made) or following any other plan for delayed admission

Direct contact is the main route of transmission of direct human to human contact The hands of healthcare workers have the potential to transfer MRSA from one person to another or from one body site to another if hand hygiene is not performed.

Indirect contact Transmission of MRSA can occur when there is no direct human to human contact but contact with environmental surfaces and equipment that are colonised with MRSA

Endogenous spread is when a person transfers organisms from one part of the body to another. This can be done by the patient themselves or by a member of staff who fails to carry out correct hand hygiene between different episodes of care on the same person.

MRSA care pathway

SICP’s

Terminal or deep clean

An MRSA care pathway is a prescriptive risk assessment template to follow to ensure that patients are screened for MRSA and treated until the screening results are known.

Standard Infection control Precautions are infection prevention practices used to avoid the transmission of infectious agents. Precautions are used with any patient, regardless of known or suspected infection status

A high level clean of the environment and equipment which is required once a patient with a known infection has vacated a room or bed space.

4. Duties

Specific Responsibilities

Infection Prevention and control is everyone’s responsibility and depends upon members of staff maintaining high standards of care This includes contract, temporary or visiting staff working for Provide who must familiarise themselves with this policy

Chief Executive

The Chief Executive has overall statutory responsibility for the prevention and control of infections including MRSA and ensuring that appropriate management systems for infection prevention & control are in place.

The Chief Executive delegates responsibility to the Director of Infection Prevention and Control (DIPC) who reports directly to the Board (Health &Social Care Act, 2008, 2015).

Director of Infection Prevention and Control (DIPC)

• Is responsible for overseeing the development and implementation of infection prevention and control best practice across the organisation inc. prevention and management of MRSA infections

The IPCT possesses expert knowledge of IPC and provides specialist support with the provision of IPC services throughout the organisation.

• The IPCT supports and aims to reduce the risks of Healthcare Acquired Infections

• The IPCT advises, informs and ensures appropriate control measures are put in place to stop or minimise the spread of infections.

Assistant Directors

• It is the responsibility of the Assistant Directors to ensure that all staff read this policy

• That there is consistent compliance with MRSA screening, reducing risks of HCAIs and completion of related IPC audits

• Are aware of exceptions found during audit and provide actions to resolve any issues

• Are aware of any cases of MRSA bacteraemia in their services and have overall responsibility for ensuring non-compliance issues identified during are rectified

Ward managers/clinical manager/community team managers

• Ensure that staff adhere to policy and there is consistent compliance with MRSA screening, reducing risks of HCAIs and the completion of related IPC audits

• Are aware of exceptions found during audit and provide actions to resolve any issues

• Participate in and contribute to infection reviews of MRSAs bacteraemia and any hospital acquired infections

• Ensures all samples sent to the laboratory are followed up in a timely manner and results obtained to enable treatment (if required)

• Ensures all MRSA screens are reported monthly to the infection prevention team (where appropriate)

Ward staff and all clinical staff

• Ward staff must ensure all patients are screened on admission within 2 hours and placed on MRSA care pathway. If delayed a datix must be completed and recorded.

• All clinical staff should ensure the patient (or their next of kin) is informed and given a full explanation of any positive result

• Make patients aware of the reasons for MRSA screening and decolonisation

• Inform patients of their screening result as soon as it is available

• Use patient MRSA leaflets to supplement information regarding MRSA colonisation/infection

• Be consistent in the use of protective equipment whilst caring for any patients with MRSA inc. in isolation (where appropriate)

• Advise visitors about the need for hand hygiene whilst visiting and the location of facilities

• Inform any receiving ward/unit/care home and patient transport services that the patient is colonised/infected with MRSA (ensuring patient confidentiality at all times)

• Staff are aware that MRSA colonisation should not restrict the transfer/discharge of a patient to another health care setting, their home or residential care

• Clean and disinfect shared items of equipment used in the delivery of patient care after each use; ideally utilise single use or single patient use equipment where possible

• All staff should be familiar with their specific responsibilities for cleaning and decontaminating the clinical environment and the equipment used in patient care

• All clinical staff should ensure that MRSA status has been clearly recorded in the patient record (HCAI SystmOne template on clinical tree)

• Clinical staff should be aware of their responsibility to report MRSA positive cases to the IP team by completing an HCAI alert form which should be e-mailed to: provide.infectionpreventionteam@nhs.net

Pre-Assessment Nursing Team (Podiatric Surgery)

Clinical Lead for Podiatric Surgery

• Strategic responsibility for ensuring systems are in place to facilitate staff awareness of the pre elective MRSA screening service and to ensure appropriate support is given to enable staff in delivering the required practice

Microbiologists (MSE)

• Responsible for reporting on all the screening samples and liaising with the preassessment team and Matron.

5. Consultation and Communication

This document was formulated after reviewing local and national policies and after discussion and review of the Infection Prevention team / IPC Group at Provide

6. Monitoring

This policy will be reviewed by the Infection Prevention Team every three years and updated with any national or local changes to practice.

7. Process

A risk assessment must be undertaken on all inpatients to minimise the risk and reduce transmission of MRSA in patients being transferred or admitted with colonisation or MRSA infection.

National and local evidence shows that certain people/patients will be at increased risk of acquiring MRSA, including (but not restricted to) those who:

• Have been MRSA positive in the past

• Have had an admission to a healthcare facility in the last six months

• All patients with a wound or a wound that has been present for longer than two weeks (excluding leg ulcers)

• Has a wound that is showing clinical signs of infection

• Live in residential settings i.e., nursing, or residential homes

• Have an in-dwelling medical device e.g, urinary catheter, intravenous device, enteral feed tube or tracheostomy tube etc.

• Have a chronic skin condition i.e., eczema or psoriasis

• People who inject drugs (PWID)

• People whose immune system is compromised by existing disease

• Healthcare workers

• Direct inter-hospital or ward transfers

Inpatient risk assessment.

• An MRSA care pathway must be completed on admission for patients admitted to inpatient area– (template on SystmOne)

• If patients are moved between hospitals an Inter-healthcare infection control transfer form should be completed (staff intranet/template on SystmOne)

• If patients are found to have MRSA infection or colonisation a Healthcare associated infection alert form must be completed – (staff intranet/ template on SystmOne

8. Inpatient admission screening and decolonisation for community ward

An MRSA care pathway must be completed for all patients admitted to a community hospital ward.

The MRSA care pathway must be started on day 1 of the patient’s admission:

• All patients admitted to the ward are risk assessed and put on the MRSA care pathway. If the patient is positive, they will continue the pathway for 5 days receiving decolonisation treatment. The pathway can be found on SystemOne (See SystemOne MRSA template)

• All patients are screened on admission within 2 hours

• This must be evidenced in the variance section of the MRSA care pathway and recorded on SystemOne.

• All patients admitted to the ward from the community should be checked on SystmOne to identify if they a record of a previous MRSA positive result

MRSA Screen

MRSA screen consists of the following:

• Nose (both anterior nares)

• Perineum / groin

• Wounds, indwelling devices and if cough present obtain sputum

Microbiology request forms should state:

MRSA admission screen or pre admission if elective screen.

Please take swabs from:

Nose – use one swab (blue-topped swab) to screen both nostrils (nose). Moisten the swab in the transport medium before sampling both inner nostrils. Place swab (0.5-1cm) into the front of each nostril and rotate to collect sample. There is no need to introduce the swab further into the nose. 1 swab for both nostrils.

Perineum or groin – use one swab for both left and right groin areas (See Appendix 1 How to take an MRSA screen)

MRSA screen swabs from MSET will contain one tube, place both swabs inro tube. Ensure the buds of the swabs are immersed in the transport medium.

N.B In some incidences dry swabs without medium maybe required for screens that are sent to services outside Mid and South Essex such as East Suffolk North Essex Foundation Trust (ESNEFT). To use dry swabs, moisten swab with sterile saline or sterile water. one swab for both nostrils and one swab for left and right groin area

If the patient has the following, take further swabs (1 from each site) to complete the full screen:

• Invasive device (i.e., PEG, peripheral line): swab

• Skin lesions and wounds: swab

• Catheterised patient: CSU sample

• Productive cough: Sputum sample

Screening results should be back within 24/48hrs with 7-day microbiology service MRSA results can be checked using pathology system ‘ICE’. In the event MRSA screens have been sent to ESNEFT for patients in Northeast Essex staff must contact the microbiology department to gain results.

Following a positive MRSA result (community hospital)

• Record result on MRSA pathway

• Inform patient of their positive result. Explain status to patient and give patient an MRSA leaflet. Document /record this action on SystemOne

• If possible, isolate patient inside a single room within 2 hours and refer to isolation policy

• If, unable to isolate please complete risk assessment and document in variance section of MRSA pathway

• Complete HCAI alert form: email to provide.infectionpreventionteam@nhs.net

• Continue 5-day decolonisation regimen: record this on the MRSA care pathway

• Ask the ward GP to review any current antibiotics the patient is taking considering the MRSA result. GPs can contact MSEFT microbiologist for advice if required

• Inform the cleaning team, place signage & isolation precautions on door as per isolation policy and risk assessment.

A negative MRSA results

• If result is negative - Inform patient of their negative result and document action.

MRSA 5- day decolonisation regimen:

• Mupirocin (Bactroban) 2% nasal ointment applied to both anterior nares three times daily for 5 days (apply a match head size amount each time)

• Daily washes with antibacterial body wash (Octenisan) for 5 days. If excessive skin drying occurs, consider Oilatum Plus (not ordinary Oilatum) as a bath / shower additive. Ensure Octenisan is clearly labelled with patient’s name. This is a single patient use product

• Hair wash with antibacterial body wash (Octenisan) on day 2 and day 4 of the treatment regimen

• For bed-bound / decreased-mobility patients, Octenisan wash mitts can be used in place of the body wash. No rinsing off is required. Hair can be washed on day 2 and 4 using the Octenisan wash cap.

• Encourage daily change of flannel, towel, personal clothing and bedding.

• After day 5 of treatment patients will return to normal soap for washing. A further MRSA screen is required on day 8.

• If the MRSA screen result is NEGATIVE no further treatment is required, and isolation precautions can be discontinued.

• Where the day 8 MRSA screen result is POSITIVE the IPCT must be contacted to discuss further treatment. MRSA

Antibacterial (Octenisan) body wash

Antibacterial (Octenisan) hair wash

Mupirocin (Bactroban ointment 2%)

Treatment of Mupirocin-resistant strains

Where Mupirocin resistant strains are identified treatment will be advised by the reporting laboratory or Consultant Microbiologist or the Infection Prevention team. Alternative antimicrobials may be advised such as Naseptin cream or Polyfax ointment. Both require application to anterior nares. Naseptin contains peanut oil so must not be used on patients with a nut allergy.

Post treatment screening

No further screening is required once MRSA regimen is completed for community hospital wards, unless requested by the microbiologist, medical doctor

The patient may become recolonised over time especially if they have a chronic wound/skin condition. Previously colonised patients are always considered a risk for MRSA carriage on subsequent admissions to hospital.

Consent

The procedures should be discussed with the patient, so they are aware of the treatment process and can give informed consent

9. Management of MRSA: Community Patients

MRSA in community patient (when to suspect & swab)

Patients in their own homes do not usually require MRSA swabbing as part of routine admission onto a new caseload. However, some patients may be discharged back into the community still undergoing treatment/decolonisation for MRSA. This should be continued as per discharge instructions/transfer letter. This may vary in accordance with the recommendations from the hospital i.e., Addenbrookes, MEHT and ESNEFT. If you are unclear contact the ward to confirm instructions.

It is essential to check the MRSA history of all patients and record on SystmOne.

It is important to establish if the patient has risk factors for / previous history of MRSA colonisation and swab for MRSA if appropriate

Management of Community MRSA positive patient

• If an MRSA positive result is received for a patient with MRSA infection/colonisation contact the GP and inform the GP to ensure that they are aware of the result. GP’s will follow their local MRSA guidelines

• Report on SystmOne HCAI template and email electronic HCAI alert form to provide.infectionpreventionteam@nhs.net

• Monitor for signs of sepsis, cellulitis, pneumonia, urinary tract infection, wound infection

• Ensure MRSA status is fully explained to patient and a MRSA information leaflet is given to patient/family/carers

• Reassure the person that MRSA infection/or colonisation does not present a risk to healthy people in the community

• Advise the person (and/or their carer) to keep wounds, cuts, and abrasions covered until they are healed and dry

• Advise the person (and/or their carer) to maintain good hygiene with regular hand –washing/washing and washing of clothing/ bed linen

• Advise the person not to share personal items where possible in order to prevent possible contamination e.g. towels, clothing, bedding

• If possible, try to see people who are known to be colonised with MRSA at the end of your clinic/surgery list to prevent possible transmission to others

• Observe good hand hygiene as per hand hygiene policy

Post treatment screening

No further screening is required once MRSA regimen is completed.

10. Waste

Waste generated by MRSA patient in their own home

Where a patient in their own home has been diagnosed with MRSA and is not being cared for by a healthcare worker (HCW), their waste is not classed as infectious waste.

However, when a patient is receiving care from Provide staff, a waste risk assessment must be completed to accurately assess whether the waste generated is infectious The risk assessment template is on SystmOne and must be completed for all patients at the initial assessment.

Risk assessment should be based on professional assessment inc. clinical signs and symptoms, and any prior knowledge of the patient. For example, if a wound assessment indicates that the wound is infected, all associated contaminated dressings should be classified as infectious waste and discarded into a clinical waste bag (orange) and arrangements made for collection as per local policy.

11. Podiatric Surgery

Some elective surgical procedures have been identified as procedures that require patients to be screened for MRSA prior to procedure. Podiatric surgery falls into this group

Screening

Screening is required in the 12 weeks prior to admission. If the date of admission falls outside this timeframe the patient requires further screening

Results

Details of the date and time of the screen should be recorded in the patient’s notes/care pathway by the person performing the screen. A result will be available in 3 working days

Results are imported directly in to SystmOne by the lab and should be viewed and filed in a timely manner. The extension number to chase or query results is 5019.

Negative MRSA result

The surgery can go ahead as planned if the patient has a negative screen from the preceding 12 weeks prior to the date of admission. The result must be recorded in the patients care pathway. If surgery is delayed beyond twelve weeks, screening should be repeated

Positive MRSA result

Pre assessment clinic/ nurses

The team will inform the patient that the result is positive either by phone or letter. Any concerns that the patient may have will be addressed. The GP will be informed and advised of decolonisation required for the patient.

The patient will be asked to contact their GP for the 5-day decolonisation protocol. If antibiotics are required for prophylaxis, these must include cover for MRSA (i.e. in the hour before the first operative incision.)

• On admission to Day stay unit Surgeon and Anaesthetist must be informed

• Podiatrist with independent prescribing is responsible for ensuring correct use of antibiotics on induction, depending on type of surgery

Where a patient on list to come in does not have MRSA screen result

• If the screen has not been processed on time / or cannot be found, the operation date may require to be postponed and the patient informed.

• The patient should be directed to pre assessment for MRSA pre-screening Consent

• The need for testing should be explained to all patients and verbal consent obtained.

• Verbal consent must be obtained for screening.

• If a patient initially refuses to be screened, they should be informed that it is procedure and be given a patient information leaflet. If they continue to refuse to be screened the pre assessment nurse will inform the Clinical Lead for the service. This must be documented on the patient’s consent form. This patient will be risk assessed and will be put at the end of the operating list and treated as a patient who is MRSA positive.

• If a patient lacks the mental capacity to consent to screening refer to the Mental Health Capacity Act 2005 and inform Clinical Lead for the service and Safeguarding Lead.

12.References

Coia, J., Duckworth, G., Edwards, D., Farrington, M., Fry, C., Humphreys, H., Mallaghan,C.andTucker,D.,2022. Guidelines for the control and prevention of meticillin-resistant Staphylococcus aureus (MRSA) in healthcare facilities

Implementation of modified admission MRSA admission screening guidance for NHS 2014 https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/345 144/Implementation_of_modified_admission_MRSA_screening_guidance_for_N HS.pdf

DepartmentofHealthImplementationofmodifiedadmissionMRSAScreening GuidanceforNHS(2014).DepartmentofHealthexpertadvisorycommitteeon antimicrobialresistanceandhealthcareassociatedinfection(ARHCAI)

The Health and Social Care Act 2008: Code of Practice for the NHS on the prevention and control of healthcare associated infections and related guidance DH

NICE Clinical Guideline 125 (2019) Surgical site infections: prevention and treatment

Guidanceonthereportingandmonitoringarrangementandpostinfectionreview processforMRSAbloodstreaminfectionsfromApril2014(version2). https://www.england.nhs.uk/wp-content/uploads/2014/04/mrsa-pir-guidapril14.pdf

Appendix 1 How to take an MRSA Screen

Sites

Nose & Groin

MRSA Swabbing Guide

Any invasive device entry site / open wound / eczema / psoriasis / burns

Do not routinely take throat swabs

Equipment required

Bacterial culture swab Microbiology form Non sterile, non-latex gloves

Procedure for Nose and Groin

Nose:

Remove swab from culture tube, insert the swab into nostril, and gently rotate the swab and remove.

Repeat the procedure with the same swab in the other nostril. Without touching swab anywhere else, place in the culture medium provided.

Groin:

Use one swab; rub firmly over both left and right groin areas

After specimen collection

Label specimen carefully check patients name and hospital/NHS number is correct and write clearly and legibly. Please document any recent antibiotics and relevant medical history on the specimen form

Appendix 2: How to Use Octenisan Body Wash

• Use Octenisan Body Wash every day as a liquid soap, for a shower, bath or wash. It is easier to use Octenisan in a shower, however if you are unable to get in a shower, it is perfectly acceptable to use the lotion for a strip wash each day.

• Use Octenisan Body Wash as a shampoo to wash your hair twice a week.

• Continue to use Octenisan body wash everyday (for 5 days) before you are admitted for your surgery.

• If your skin becomes irritated stop using Octenisan and see your GP.

o Ensure that your hair and body are wet

o Put 30ml of solution onto a damp washcloth

o Leave the lotion on your skin for 3 minutes before rinsing

o Apply all over hair and body paying special attention to the areas indicated in red

o Rinse off thoroughly

o Dry with clean, dry towel

o Put on clean underclothes/nightwear every day

octenisan® wash mitts

Antimicrobial wash mitts for convenient body washing

In NHS Supply Chain

Our Plus

• excellent skin and mucous membrane compatibility

• broad antimicrobial efficacy

• contains allantoin for gentle and soothing skin cleansing

• colour and perfume free

• ready to use, no rinsing required

• improved health and safety as no water required

• easy and convenient to use, saves time

Areas of application

• for bedside washing of whole body – please follow instructions on packaging as to use of these mitts.

• 1 new packet to be used each day.

• suitable for use by patients with limited mobility or for washing bedridden patients

• for antimicrobial washing including decolonisation and prophylactic washing.

Appendix 3: Pre-Admission MRSA Risk Assessment For a Patient who does not meet screening criteria

If a patient is assessed as ‘High Risk’ – then screen patient:

High Risk Patients

• Known to be MRSA positive

• Identified as being MRSA positive in the past

• From a nursing home / residential home

• Has been a patient in any hospital in last 6 months

• Any healthcare worker – community or acute setting

• Patient has been transferred from hospital abroad

• Immuno-suppressed patients – Long term steroid use

• Diabetic patients

• Renal dialysis patients

• Patient with long term invasive device e.g. urinary catheter

• Patient with chronic skin breaks, to include pressure sores

• Patient with dermatological condition including cellulitis

• Detainee admitted from any prison

• If partner / spouse known to be MRSA

• If carer of person known to be MRSA

• Patient being admitted for insertion or reinsertion of a PEG tube

Sign to confirm the screening process has been explained to you

Tick

EQUALITY IMPACT ASSESSMENT TEMPLATE: Stage 1: ‘Screening’

Name of project/policy/strategy (hereafter referred to as “initiative”):

MRSA policy

Provide a brief summary (bullet points) of the aims of the initiative and main activities:

The policy & protocol is to ensure that all HCWs follow evidence –based practice in respect of prompt notification, prevention, and management of MRSA

Project/Policy Manager: Lucy Ellis

Date: 21/05/24

This stage establishes whether a proposed initiative will have an impact from an equality perspective on any particular group of people or community – i.e. on the grounds of race (incl. religion/faith), gender (incl. sexual orientation), age, disability, or whether it is “equality neutral” (i.e. have no effect either positive or negative). In the case of gender, consider whether men and women are affected differently.

Q1. Who will benefit from this initiative? Is there likely to be a positive impact on specific groups/communities (whether or not they are the intended beneficiaries), and if so, how? Or is it clear at this stage that it will be equality “neutral”? i.e. will have no particular effect on any group.

Neutral

Q2. Is there likely to be an adverse impact on one or more minority/under-represented or community groups as a result of this initiative? If so, who may be affected and why? Or is it clear at this stage that it will be equality “neutral”?

Neutral

Q3. Is the impact of the initiative – whether positive or negative - significant enough to warrant a more detailed assessment (Stage 2 – see guidance)? If not, will there be monitoring and review to assess the impact over a period time? Briefly (bullet points) give reasons for your answer and any steps you are taking to address particular issues, including any consultation with staff or external groups/agencies.

Neutral

Guidelines: Things to consider

Equality impact assessments at Provide take account of relevant equality legislation and include age, (i.e. young and old,); race and ethnicity, gender, disability, religion and faith, and sexual orientation.

The initiative may have a positive, negative or neutral impact, i.e. have no particular effect on the group/community.

Where a negative (i.e. adverse) impact is identified, it may be appropriate to make a more detailed EIA (see Stage 2), or, as important, take early action to redress this – e.g. by abandoning or modifying the initiative. NB: If the initiative contravenes equality legislation, it must be abandoned or modified.

Where an initiative has a positive impact on groups/community relations, the EIA should make this explicit, to enable the outcomes to be monitored over its lifespan.

Where there is a positive impact on particular groups does this mean there could be an adverse impact on others, and if so can this be justified? - e.g. are there other existing or planned initiatives which redress this?

It may not be possible to provide detailed answers to some of these questions at the start of the initiative. The EIA may identify a lack of relevant data, and that data-gathering is a specific action required to inform the initiative as it develops, and also to form part of a continuing evaluation and review process.

It is envisaged that it will be relatively rare for full impact assessments to be carried out at Provide. Usually, where there are particular problems identified in the screening stage, it is envisaged that the approach will be amended at this stage, and/or setting up a monitoring/evaluation system to review a policy’s impact over time.

EQUALITY IMPACT ASSESSMENT TEMPLATE: Stage 2:

(To be used where the ‘screening phase has identified a substantial problem/concern)

This stage examines the initiative in more detail in order to obtain further information where required about its potential adverse or positive impact from an equality perspective. It will help inform whether any action needs to be taken and may form part of a continuing assessment framework as the initiative develops.

Q1. What data/information is there on the target beneficiary groups/communities? Are any of these groups under- or over-represented? Do they have access to the same resources? What are your sources of data and are there any gaps?

N/a

Q2. Is there a potential for this initiative to have a positive impact, such as tackling discrimination, promoting equality of opportunity and good community relations? If yes, how? Which are the main groups it will have an impact on?

N/a

Q3. Will the initiative have an adverse impact on any particular group or community/community relations? If yes, in what way? Will the impact be different for different groups – e.g. men and women?

N/a

Q4. Has there been consultation/is consultation planned with stakeholders/ beneficiaries/ staff who will be affected by the initiative? Summarise (bullet points) any important issues arising from the consultation.

N/a

Q5. Given your answers to the previous questions, how will your plans be revised to reduce/eliminate negative impact or enhance positive impact? Are there specific factors which need to be taken into account?

N/a

Q6. How will the initiative continue to be monitored and evaluated, including its impact on particular groups/ improving community relations? Where appropriate, identify any additional data that will be required.

n/a

Guidelines: Things to consider

An initiative may have a positive impact on some sectors of the community but leave others excluded or feeling they are excluded. Consideration should be given to how this can be tackled or minimised.

It is important to ensure that relevant groups/communities are identified who should be consulted. This may require taking positive action to engage with those groups who are traditionally less likely to respond to consultations, and could form a specific part of the initiative.

The consultation process should form a meaningful part of the initiative as it develops, and help inform any future action.

If the EIA shows an adverse impact, is this because it contravenes any equality legislation? If so, the initiative must be modified or abandoned. There may be another way to meet the objective(s) of the initiative.

Further information:

Useful Websites www.equalityhumanrights.com Website for new Equality agency www.employers-forum.co.uk – Employers forum on disability www.efa.org.uk – Employers forum on age