With the imminent closure of the National Programme for HCAIs and the radical reform of NHS services following the Health White Paper ‘Equity and Excellence: Liberating the NHS’ and the ‘Healthy Lives, Healthy People’ Public Health White Paper in July and November 2010 respectively, there is a real danger that confusion arising from change will lead to a lapse in patient safety and thereby an increase in healthcare associated infections from the community to the hospital environment and vice versa.
The Public Accounts Committee Reports in 2000, 2005 and the most recent, ‘Reducing Healthcare Associated Infection in Hospitals in England, Fifty–second Report of Session 2008–09’, together with the influential ‘Dr. Fosters Hospital Guide – Focus on Patient Safety’ in 2009, outlined serious concerns about this quality of patient care and the need to combat infection.
The conclusions from these Reports helped to shape the now-recognised multi-faceted approach to reducing HCAIs, identifying a series of common themes at the heart of the problem:
- Effective leadership from the top;
- Management of risk, responsibility and governance structures – systemic mechanisms in place;
- focus on staff recruitment, retention, training and communication;
- Escalation and isolation – performance management techniques;
- The importance of the utilisation of accurate information, data monitoring, continual surveillance and screening;
- Prudent antibiotic prescribing, and, of course;
- The overriding priority of meticulous cleaning of clinical areas and the use of appropriate resources and equipment to maintain a clean environment.
The National Programme for HCAIs formalised this process into a cycle of Action based around the principles of establishing:
- A Clear Vision and Plan
- Measurement and
Moreover, the Care Quality Commission, with responsibility for registering, monitoring and enforcing quality standards, has helped to deliver progress amongst healthcare organisations; the registration process for any healthcare organisation wishing to legally provide services involves compliance with the established quality and safety standards, including any “Code of Practice issued by the Secretary of State in relation to the prevention or control of healthcare associated infections”.
This registration process now incorporates Acute Trusts, all adult social care organisations, private and voluntary healthcare, and from April 2011, ambulance services, prison health services, independent midwifery services, dental practices and other groups new to registration.
The role of now regular surveillance, screening and monitoring processes as recorded by the Health Protection Agency has also contributed greatly to a significant reduction in key infection rates of MRSA bacteraemia – from 7,700 in 2003/4 to 1,898 in 2009/10, a 75 per cent reduction, in Quarter 3 2009-10, there were 444 cases, a 64 per cent decrease in acute trust cases and 53 per cent decrease in others – and C. difficile – in Quarter 3 2009-10, there were 6009 reported cases, 3027 in Acute Trusts, 2982 others, a decrease of 51 per cent from 12,248 in 2007-08, a 57 per cent decrease in Acute Trust cases and 41 per cent decrease in others.
The progress recorded to date in reducing both MRSA and Clostridium Difficile now needs to be replicated for other infections, in particular MSSA and E. Coli, whilst simultaneously delivering the planned structural and efficiency challenges ahead for the health sector.
Reducing HCAIs 2011 – Maintaining Patient Safety: Breaking the Cycle of Infection will provide our annual policy update on reducing HCAIs from both international and national clinical leads, showcasing best practice and innovative technologies in developing effective future strategies.
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