Control of Infection

Jayne Cutter

The consequences of HCAI are:

Delay in healing

Death or disability

Loss of earnings for patients

Increase in cost of care/treatment

Ward closures/staff sickness

Litigation costs

Media …….

Cover-ups, lies and the cynical conspiracy that let a superbug claim 90 lives

16 October 2007

What can we do?

‘No lepers, lunatics, or persons having the falling sickness or other contagious disease, and no pregnant women or sucking infants, and no intolerable persons, even though they be poor and infirm, are to be admitted in the house; and if any such be admitted by mistake, they are to be expelled as soon as possible’

(Bishop Joscelin of Bath and Wells, 1219 on the Hospital of St John, Bridgewater)

Or we could…

•Maintain high standards of environmental cleanliness

•Reduce bed occupancy

•Recruit and retain sufficient knowledgeable, well paid, well

motivated healthcare professionals

•Hand hygiene

However, none of this is revolutionary

However, it seems that:

•Failure to relate education to practice

•Infection control procedures compromised in the face of:

– High patient throughput

– Low staff: patient ratio

– High level of patient movement from ward to ward

•Insufficient unit based instruction and supervision

•Inadequate quality control for cleaning services

•Insufficient data to monitor outcomes

Reducing healthcare associated infection is complex because:

‘The operation of a health service depends upon a complex interaction between the patient, the environment in which care is provided and the people, equipment and facilities that deliver the care.’

(Sir Liam Donaldson, CMO, England)

Scottish Infection ManualGuidance on core standards for the control of

infection in hospitals,health care premises and the community

interface

July 1998

National strategies/key National strategies/key publicationspublications

                                                                                                                  

                 

Objectives:

•To ensure a safe environment for patients and

staff in healthcare settings

•To promote the key message that ‘infection

prevention and control is everyone’s business’

•To ensure a robust accountability and

governance framework for prevention and control

of healthcare associated infections

Key principles:

•All staff to understand and discharge their responsibilities in relation to infection control

•Clinical teams to be responsible for infection control outcomes

•Infection control programmes to be supported by adequately resourced infection control teams

•Trusts to adopt comprehensive surveillance and audit

•Trust programmes and strategies to focus on reducing infection rates

•Effective systems to be developed for internal and external access to information

How do we achieve these objectives? Some examples:

Wales England Scotland Northern Ireland

Non executive director

to be trust ‘champion

for cleaning, hygiene

and infection

Directors of Infection

Prevention and Control

appointed

Healthcare

Associated Infection

Task Force headed

by CNO

Infection Prevention

and Control Leads

appointed

Trusts to manage

locally agreed

healthcare associated

infection reduction

targets

Mandatory MRSA

bacteraemia reduction

programme

National Monitoring

Framework for

Cleaning

Regional leadership

– Infection

Prevention and

Control Steering

Group

Review of infection

control resources

MRSA Improvement

Teams funded by DOH

National Policies Feedback of

surveillance to

stakeholders

Other initiatives:NPSA, ‘Cleanyourhands’ campaign

‘However beautiful the strategy you should

occasionally look at the results…’

(Winston Churchill)

How do we evaluate the success of these interventions?

•Audit – ICNA (now IPS) audit tools, hand hygiene,

environment, decontamination of equipment, compliance with

policies

•National standards – Controls Assurance Standards, Welsh

Risk Management Standards, National Cleaning Standards,

‘Hit Squads’

•Prevalence studies

•Surveillance – national and local surveillance with feedback

The third national prevalence study of infections in hospitals. Overall rate in the UK – 7.6% (approximately

11% in second national prevalence study)

(WAG, 2007)

Types of HAI

16%

14%

10%

8%5%12%

19%

1%

15%

Gastrointestinal system

Lower respiratory tract(not pneumonia)

Pneumonia

Primary bloodstream

Other

Skin and soft tissue

Surgical site

Systemic

Urinary tract

(WAG, 2007)

(Health Protection Agency, 2007)

(Health Protection Scotland, 2007)

(Health Protection Agency, 2007)

(Health Protection Agency, 2007)

(WAG, 2007)

Challenges in infection

•Drug resistance– Antibiotics and antivirals– Vaccines – antigenic variation

•Emerging infections– Old recurring diseases– “New” infections

•Molecular basis of infection– Improved understanding of disease causes– Novel drug targets

•New antibiotics

Challenges for Infection Control

•Development and application of more rigorous infection control policies •Development in decontamination methods

– Sterilisation - heat, irradiation, filtration, chemical– Disinfection: chemical

•Prevention/treatment of infection in vivo– Antibiotics, antivirals– Vaccines

•Waste management