Meeting with Shadow Health Secretary
The Rt Hon Andy Burnham MP

Friday 25th May 2012

Derek Butler, Chairman of MRSA Action UK met with the Shadow Health Secretary Andy Burnham to talk about the key issues facing patients and the wider public surrounding MRSA and other healthcare associated infections. The meeting was timely with the recent publication of the Health Protection Agency report on healthcare associated infections and antimicrobial usage, and the changes coming on how healthcare is commissioned and regulated.

Derek Butler, Chair of MRSA Action UK and The Rt Hon Andy Burnham MP,
Shadow Health Secretary

The five key areas being raised were being taken with a view to gaining cross-party support to tackle the problems faced in healthcare, and providing the best possible outcomes for patients in preventing healthcare associated infections, ultimately saving lives and the high costs involved in treating avoidable infections when they occur.

1. Information on quality and standards

Derek spoke of the need for clear information on quality and standards. There is a commitment to provide good quality information for patients about their personal care and records, and it is recognised that patients should have access to data about quality to help them make informed decisions about where and how they choose to receive care. For this to happen patients need to be aware of the standards that they can expect, whether this relates to the right time and right place for hand hygiene - directly at the point of care, or whether its including understanding the principles of aseptic technique so that they can feel empowered to ask if they need to.

We want to see clear unambiguous information made available on wards and in surgeries - it's empowering for patients if they can see the standards to expect, then everyone is clear on what they have to deliver, and, although we shouldn't have to ask, staff should welcome being asked to wash their hands, and welcome interaction if a patient wants to ask if a procedure is being carried out correctly.

In terms of information on infection reporting there are many more pathogens than MRSA and C.diff and these should be reported where there are significant risks to public health, and this may vary between regions. The Northwest has a high incidence of C.diff compared to other regions and there are other developments with more resistant strains of Carbapenemase bacteria in the Northwest and nationally. Of concern is the lack of regular reporting of surgical site infections and other significant infections including pneumonias and urinary tract infections. This was highlighted in the recently published point prevalence survey "English National Point Prevalence Survey on Healthcare-associated Infections and Antimicrobial Use, 2011". It is interesting to note that Wales had a lower proportion of patients with a healthcare associated infection than England. This needs understanding - perhaps there are things we can learn from our colleagues in Scotland and Wales.

2. Antibiotic stewardship and regulation

Derek spoke of the need to work in collaboration with stakeholders, regulators and pharmaceutical companies. We welcome the antimicrobial stewardship strategy highlighted in the "English National Point Prevalence Survey on Healthcare-associated Infections and Antimicrobial Use, 2011" and we believe this has to be combined with encouraging antibiotic discovery. The establishment of sustainable research and development will require incentives that reduce the regulatory barriers and development costs to assure adequate return on investment with pharmaceutical companies, the announcement of £180m of EU funding to kick start the pharmas into action is only a partial solution. The key components to a successful strategy is a streamlined regulatory and approval process to facilitate the introduction of new, safe and effective antibiotics and collaborative working. Antimicrobial resistance is a strong feature in the findings and will continue to develop.

We face a global problem with health tourism, and this has been highlighted more recently with the development of NDM-1 and the effect this has on bacteria. Working in collaboration with other governments, the European Union and the World Health Organisation is needed for our future safety. At present the World Health Organisation rates antimicrobial resistance as the third biggest threat to human health. This, in our opinion, can only rise to a second or first place threat as antimicrobial resistance grows and spreads without impunity.

MRSA Action UK's view is that prevention is always better than cure, and this survey has highlighted the need to focus on sustained education of all clinical staff on the methods of prevention of avoidable infections. We believe a consistent approach to competencies in device insertion, using aseptic non-touch techniques, coupled with rigorous approaches to monitoring of hand hygiene compliance, and strategies to remove the bio burden of harmful bacteria from the environment in clinical settings with targeted cleaning, underpinned by environmental testing, could also significantly reduce the risks of infection to patients.

3. Public information campaign on the importance of hand hygiene

Derek reminded the Shadow Health Secretary of the promised public information campaign on the importance of hand hygiene by his predecessor Alan Johnson when Labour were in power. Derek also referred to correspondence relating to this issue from 2009, where Andy Burnham had recognised the importance of raising awareness of respiratory and hand hygiene during the flu outbreak. Andy informed Derek that had Labour won the last election he would have introduced the public information campaign as this was one of his priorities if returned as Secretary of State for Health. Both Derek and Andy agreed that the public needed to be aware of the problems surrounding bacteria, they needed to be aware of the role that they can play in helping the medical profession to control the spread of bacteria and more importantly it was recognised that the information must be set at a level the public understand, and any information campaign, Andy agreed, must include patients and patient groups in it's formation.

We believe information should be aimed at improving compliance by healthcare providers, but also aimed at helping the public understand the part we can all play in clean, safe care. This has been an ambition for both Labour and the coalition. At the recent Gov Today conference we heard about innovative ways of promoting hand hygiene with care providers, and Minister of State for Health Simon Burns attended the conference where he made a commitment to providing a campaign, and in going further.

He commended NHS staff across the country for their efforts in reducing infections. He said that national statistics can hide local problems and he was setting new ambitions to reduce infections even further, "I want to see a further 29% reduction in MRSA bacteraemias and an 18% reduction in C.difficile infections, which will be no more than 900 MRSA infections and 3,500 C.difficile infections by April 2013." - We don't think this is challenging enough as these targets have all but been met nationally, his next comments recognised what we have been saying about it not being the case in every region - he said:

"There would be no free rides on the tail coats of the trail blazers, but individual responsibilities for all."

The Minister also gave a commitment to surveillance of other pathogens and wished to see a zero tolerance to all avoidable infections. Maria Cann from MRSA Action UK asked the Minister of State for Health: "Patients need to be able to take control of their care and know what's involved and what to expect, when are we going to see a good public information campaign on antimicrobial resistance and hand hygiene?"

The Minister said "I think that raises an extremely important question because however much work and effort is taken by medical professionals in the hospital setting or the community setting, the benefits are obviously there, they are only part of the picture."

"Because patients also have an important role to play, it's a matter that we are looking at because more has got to be done on a national level and also on a local level, hospital by hospital, to get the message across to patients and to their families, and visitors coming into the hospitals, that they need to participate in schemes. The only way of doing that is by making sure they are educated and they are then in the habit of taking part in the same procedures that doctors and nurses do, and others associated with providing care, when going about their business, both in the hospital setting and elsewhere."

MRSA Action UK believe the public information campaign must include care home facilities as the staff in these establishments are, in the main, domestics and healthcare assistants and, from our experience, often have limited knowledge of the basics of the 5 moments of hand hygiene, how to wash hands correctly and the right time right place for the use of alcohol gel.

We would like to see this public information campaign brought to fruition as soon as possible and would like to request that the Shadow Health Secretary raise the question about "When, How and Who" will be involved in it's concept and that patients and patient groups are fully involved.

4. Patient-led inspections

There is to be a more central role for patients and a new system of Patient-Led Inspections will replace Patient Environment Action Teams from 2013. The results of the new inspections will be reported publicly to help drive up standards of care.

This is an important development that we hope will provide public assurance and protection, to help restore public trust and confidence in the action being taken to prevent and control healthcare associated infections, in what should be a caring environment.

We believe a clean environment is important but should not be looked at in isolation. Staff attitudes and behaviours need to be considered. Targeted cleaning where high impact interventions could make a significant difference to the safety of the patients' environment should be undertaken. ATP testing using swabs of high touch areas should be requested, before and after cleaning, you can't see bacteria or spores that may be harmful for the vulnerable patient.

"The halo effect" will be present during inspections and as such there should be some consideration given to remote video auditing. You can observe staff behaviour and cameras need not be focused on patients, but you would see evidence of hand hygiene practice and the way staff clean an area, this is very effective and is being used in UK and US hospitals. We are asking for the opportunity to feed into the final guidance that comes from this exercise, as this should be about real involvement, and prevention of infections should be high priority in giving safe care.

It is well documented that observation and feedback makes a significant difference to compliance, and a holistic approach to patient-led inspections, whereby independent observation of hand-hygiene and environmental testing of high touch areas could make a significant difference to the outcome of patient-led inspections.

Derek raised the spectre of the Maidstone and Tunbridge Wells debacle and that, in his opinion, had there been patient-led inspections at the time, with those patients able to report those concerns to an independent body, the problems at Maidstone and Tunbridge Wells could well have been nipped in the bud early, and helped to prevent the tragic and unnecessary loss of lives that occurred. Many industries who deal with the public consult and have public engagement in improving their business, because it makes economic, social, and moreover, common sense.

5. Universal Screening

We have yet to find out the outcome of the National One Week Study on MRSA Screening. Derek asked the Shadow Health Secretary's views on universal screening as we believe it saves lives, and should be extended to incorporate MSSA and, when the technology is available, other pathogens where there is more prevalence. This enables effective decolonisation prior to surgery, significantly reducing the risk of infection, and unnecessary prolonged use of antimicrobial topical treatments where they may not be needed, bearing in mind we are trying to avoid building up resistance.

We have been made aware that there are some in the NHS who see universal screening as a waste of resources and money. Their argument is that the money could be spent in other areas of infection control that would in their opinion give better value for money.

The point that seems to be being lost by the staff in this argument is that those very same people have argued that they need better isolation facilities to help them in their infection control. The universal screening program introduced by the last Labour government actually opened up the more efficient use of the scarce isolation facilities experienced in our hospitals. If we look at this from the perspective that before universal screening the staff could only assume who was "high risk, medium risk and low risk".

If a patient was deemed as high risk they were placed in isolation until any results were returned from the laboratory giving the status of the resulting swabs. If the result came back negative, then the patient was moved on to a general ward. This meant that the isolation room was taken up by a patient who was negative for bacteria, either colonised or infected, and was not available for a patient who was confirmed as positive for bacteria. Even a low risk patient who is deemed as unlikely to be either colonised or infected with bacteria such as MRSA could be a carrier and pose a risk to any other patient on a general ward, we cannot see the bacteria we are talking about. Having a patient in an isolation room that is not a carrier or infected can add huge amounts of money to the cost of treating a patient.

The advantage with universal screening is that it enables the staff to far better utilise the scarce resource of isolation rooms, and combining this with the rapid PCR tests now available giving results in two hours, means that the isolation rooms can be used to maximum effect and efficiency. This would therefore prevent the huge waste in resources and monies that may otherwise happen. Universal screening can be used if required to ascertain the prevalence of infections within the community coming in to the hospital. This practice of search, isolate and destroy has been used for decades in Northern Europe and we believe it's why they have the success at reducing resistant bacteria we have seen grow at an alarming rate in the last two decades.

He also asked if MRSA Action UK had been involved in the NOW study and Derek informed him that we were never invited to participate in the study, and when we attempted to have an input we were told it was too late to include our questions on the patients' experience of screening, and the study went ahead without our input. Andy asked if we had made representation to the Department of Health asking why we weren't included, Derek replied that we had, and the Department of Health had said "in hindsight, we should have been involved". Andy asked if we had an opinion of why we weren't involved, and Derek replied "that we as a patient charity had campaigned long and hard, for universal screening and were pleased when it was introduced". We believe there are those within the Department of Health who were aware of our stance on this issue, and that universal screening has our whole-hearted support, because it is part of a wider package of the Search and Destroy policy - we believe this is why we were excluded.

Derek said the meeting was very productive and was informed that the charity had been very influential in raising the importance of infection prevention and control. There would be opportunities to have an input into Labour's policy on health in the future and Andy Burnham would take forward our concerns with the current government.

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(c) MRSA Action UK 2012