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Control of Infection
Jayne Cutter
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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 …….
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Cover-ups, lies and the cynical conspiracy that let a superbug claim 90 lives
16 October 2007
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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)
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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
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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
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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)
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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
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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
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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
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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
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Other initiatives:NPSA, ‘Cleanyourhands’ campaign
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‘However beautiful the strategy you should
occasionally look at the results…’
(Winston Churchill)
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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
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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
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(WAG, 2007)
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(Health Protection Agency, 2007)
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(Health Protection Scotland, 2007)
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(Health Protection Agency, 2007)
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(Health Protection Agency, 2007)
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(WAG, 2007)
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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
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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
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