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Make preventing hospital infections the goal – not treating them!

NICE, the National Institute for Care and Health Excellence, recently (February 2016) published its new quality standard covering ‘organisational factors’ in preventing and controlling healthcare-associated infections in secondary care settings.

In other words, management teams at hospitals and other in-patient, out-patient and day care units and facilities are expected to have policies and procedures in place to monitor and evaluate patient infections picked up after admission or treatment has started.

While we celebrate this advance, infection prevention and control are not new areas for NICE. It has previously published various quality standards* and we are imminently promised another standalone quality standard on antimicrobial stewardship, currently in production. The Health and Social Care Act 2008 also plugs some of the gaps not comprehensively and specifically covered by NICE.

Yet despite these existing standards, the 2012 English National Point Prevalence Survey from Health Protection Agency reported that 6.4 per cent of in-patients in acute care hospitals had a healthcare associated infection in 2011. This is more than one patient in every 16. This rate almost quadrupled for pneumonia and other respiratory infections (22.8 per cent), and nearly trebled for urinary tract infections (17.2 per cent).

As the MTG discovered in 2014 when researching its report Infection Prevention and Control – Combatting a problem that has not gone away https://mtg.org.uk/bulletins/infection-prevention-and-control-combating-problem-has-not-gone-away], awareness around healthcare-acquired infections is a major problem for the NHS.

The numbers are startling:

  • around six in ten NHS Trusts (58 per cent) that responded to a Freedom of Information request fail to collate the total number of cases of six common infections (sepsis; septicaemia; norovirus (aka the winter vomiting bug); urinary tract infections and blood infections caused by catheters; and pneumonia from ventilators)
  • three-quarters of Trusts (74 per cent) keep no records at all of the number of associated deaths
  • and just one Trust said that it measured the total number of extra nights that patients stay in hospital due to infections acquired in the course of their treatment.

This means that almost universally across the NHS there is no real sense of the extent, cost and impact of healthcare-acquired infections. So while any new guidance is welcome, we need to put stronger carrots in place that encourage Trusts to invest in technologies that can reduce infections (changing the type of catheters used can substantially reduce the numbers of painful urinary tract infections, for example) as well as the judicious use of sticks to penalise Trusts for complacency.

It is perverse in the extreme to reimburse Trusts for treating patients who acquire an infection in that same Trust’s hospital. So we must end the situation where Trusts are in effect rewarded for making a patient’s health situation worse, and at the same time better align financial incentives with the goal of lower infection rates.

A hit on the wallet will force them to take infection prevention and control more seriously. And, as with MRSA and E.Coli, mandating the keeping of records will ultimately deliver better care.

*Quality standard 61 is an overarching quality standard on infection prevention and control / Quality standard 49 is focused on surgical site infection.

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