Transcript Control of Infection

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 …….
16 October 2007
Cover-ups, lies
and the cynical
conspiracy that
let a superbug
claim 90 lives
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)
National strategies/key
publications
Scottish Infection Manual
Guidance on core standards for the control of
infection in hospitals,
health care premises and the community
interface
July 1998
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
Healthcare
Prevention and Control Associated Infection
appointed
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)
Types of HAI
Gastrointestinal system
Lower respiratory tract
(not pneumonia)
15%
Pneumonia
16%
Primary bloodstream
1%
14%
19%
Other
Skin and soft tissue
10%
12%
5%
8%
Surgical site
Systemic
Urinary tract
(WAG, 2007)
(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