Do we really have to be afraid to go into hospital?

 

In the most recent figures MRSA cases in the UK averaged 9.8 per 100,000 patient days - Holland the figure was just 0.4 per 100,000.  Why?

 

There are similar huge differences in C.diff rates across Europe.  Why do the figures vary so massively?

 

What can we do to learn the lessons from other healthcare systems on disease control and apply them here in the UK?

 

Liz Lynne MEP debates the issues and Chaired the panel with Professor Gian Maria Rossolini, University of Sienna and Health First Europe; Martin Kiernan, Vice President of the Infection Prevention Society and Nurse Consultant, Southport and Ormskirk Hospital NHS Trust; and Derek Butler, Chair of MRSA Action UK.

 

Liz Lynne MEP spoke of her work in the European Parliament and Health First Europe, where she has been highlighting the significant differences in being able to prevent and control healthcare associated infections here in the UK compared with some of our EU member states.  This was a serious issue and we needed to know how we could bring our hospitals up to the standards enjoyed by some of the Northern European countries.  With many Trusts missing the target to cut MRSA by half and C.diff rising, was the deep clean enough?  We needed to learn lessons from Europe. At the medical centre in the European Parliament Liz had spoken with Doctors and Nurses from Spain, Germany and Finland.  In Finland healthcare workers are screened and sent home for treatment if colonised, visitors wear masks - are these too many precautions?

 

Screening is to be brought in here for all elective surgery, but screening for A&E patients won't be fully available until 2011, should this be speeded up, are these patients a high risk as their history isn't known when they are admitted.

 

We need to look at Care Homes and Nursing Homes, provide more training.  Old people are at risk with catheters and pressure sores.  It only takes one person not to follow procedures for an infection to happen.

 

We needed an EU Code of Best Practice.  This is something the EU Commissioner will take forward.  We need to come together to develop the Code of Practice with Health First Europe, and reduce avoidable healthcare infections to zero.

 

Liz Lynne MEP introduced Professor Gian Maria Rossolini from Health First Europe.  Health First Europe is a non-profit, non-commercial alliance of patients, healthcare workers, academics and healthcare experts and the medical technology industry.

 

Professor Rossolini gave an overview of his work in Sienna and outlined the position with healthcare associated infections in Europe and in the USA.  The numbers of estimated deaths in the USA were equivalent to a small city dying every year.

 

The prevalence of MRSA and C.diff was moving around the health economy, from the hospital setting, long-term carehomes and ambulance authorities in Europe.

 

The Netherlands had adopted an aggressive strategy with proactive surveillance and judicious use of antibiotics.  There was evidence to show that surveillance and putting in measures where patients had been screened and found to be positive worked.  Where there are hospitals with limited resources surveillance was carried out in Intensive Care Units and these had begun to show an impact.

 

Martin Kiernan outlined the role of the Infection Prevention Society, formerly known as Infection Control Nurses Association.  It was the oldest such organisation in the world, formed in 1970 and had expanded to include professionals from across the health economy in 2006.  They were not a campaign organisation or association, but there to provide an education and support network.

 

There were more and more vulnerable patients now in healthcare system with the average age of patients now rising to the over 70 age-group.

 

Martin also carries out a role with the Improvement Teams that go into Hospital Trusts to make recommendations on how to drive down infection rates.  They were finding many bloodstream bacteraemias could be prevented if more care was taken over peripheral drips.  It seems that cannulation is done routinely in many healthcare settings, and it must be remembered that putting lines in is as invasive as surgery, there was a higher risk of introducing bacteria directly into the bloodstream than through a surgical site incision, as this was a direct route to the bloodstream.  A surgical site infection would have an opportunity to heal before getting into the bloodstream.  It was important therefore that everyone has personal accountability for these processes.  If cannulation is necessary the staff looking after the patient should sign and monitor the cannula, it should be removed after 72 hours, if this is not adhered to then this can be tracked back and that person is accountable.

 

Policies and procedures have always been there, but not adhered to, if you read the 1968 guidance on Staphyloccocus aureaus you wouldn't find any difference in the guidance written today.

 

Nursing homes were difficult as the environment has soft furnishings and it is difficult to keep clean.  Patients who have wounds or catheters should be risk assessed.  The Care Quality Commission will have a big role to play in their regulation.

 

More use of tissue viability nurses was needed, there are big issues with pressure sores in care homes.

 

It is necessary to break down each case and ask how could we have done this better, using route cause analysis was an essential part of learning and improving.

 

The panel answered questions from the audience, some of whom had been personally affected by someone close to them having MRSA or C.diff, and some of whom had contracted MRSA.

 

Liz Lynne MEP thanked everyone for attending.  To learn more about her work in the European Parliament and the work of Professor Gian Maria Rossolini, visit the Health First Europe website.

Press coverage of the event:
Lives depend on NHS learning the lessons to control superbugs

Liz Lynn MEP pictured with Derek Butler, Maria Cann, Professor Gian Maria Rossolini and Martin Kiernan