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 Manual Guidance on core standards for the control of infection in hospitals, health care premises and the community interface July 1998 National strategies/key publications

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: WalesEnglandScotlandNorthern 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 PoliciesFeedback 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

(WAG, 2007)

(Health Protection Agency, 2007)

(Health Protection Scotland, 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