Meeting with the Department of Health to discuss enhancing the mandatory surveillance of healthcare associated infections
22nd November 2012

Derek Butler and Maria Cann met with Claire Boville, Head of Policy, Healthcare Associated Infections, Carole Fry, Nursing Officer Communicable Diseases, Department of Health and Mike de Silva, Healthcare Associated Infections, Department of Health.

The purpose of the meeting was to discuss proposed changes in the way the reporting of healthcare associated infections would inform policies for delivering a more joined up approach to dealing with preventable healthcare associated infections.

Carole gave an overview of where the Department of Health were with measures to tackle healthcare associated infections, and the recommendations that the Advisory Committee on Antimicrobial Resistance and Healthcare Associated Infection (ARHAI) were proposing following the Healthcare Associated Infection and Antimicrobial Point Prevalence Survey that was conducted in 2011.

There were recommendations to undertake wider surveillance of surgical site infections, which included 17 categories. There was more work to take forward in terms of agreeing which should be mandatory and which should be left to Trusts to benchmark at a local level.

A sub group led by Professor Peter Wilson was looking at bloodstream infections, plus other infections in critical care, this would include adult, paediatric and neonatal nursing. This would initially be voluntary to get this up and running, steered by an independent oversight group with representatives from adult, paediatric, neonatal and critical care expertise. A survey of Trusts was currently underway to find out what is important to them in terms of a focus on reporting. There is a stakeholder event on 10th December, with recommendations being taken to Ministers around that time. The aim is to have the programme up and running by the middle of next year.

The sub group had considered Caesarean sections and had concluded that surveillance can be considered at a local level. Any concerns would be able to be addressed through Commissioners if necessary.

E.coli bacteraemia would continue to be included in the mandatory surveillance, and it was recognised that some may not be preventable. A sample of 1,500 patients with E.coli bacteraemia would be investigated to track and find any patterns.

GRE bacteraemia would be carried out locally on a voluntary basis. Trusts would be expected to keep on top of any local issues. Alert monitoring would take place.

Clostridium difficile would remain a mandatory requirement as there were many more infections and some Trusts were not performing as well as others.

There were proposals to screen certain specific patient groups for MSSA. There was an expectation that when targets began for reducing MRSA bacteraemia MSSA bacteraemia would also reduce, but there has not been any reduction either in the community or in the hospital setting.

Mike de Silva said that the current government were committed to a zero tolerance approach to preventable infections, and a lot of work has gone into developing a toolkit list of likely causal factors. If Trusts and CCGs can't agree on the route cause analysis then a Post Infection Review (PIR) would be undertaken by Directors of Public Health, who will say what needs to happen.

The joined up approach is being developed with the Local Government Association, as Directors of Public Health sit within local government, with Hospital Trusts, Commissioning Boards and CCGs. All will be accountable and expected to take a zero tolerance approach.

Philip Pugh, Strategic HCAI & AMR Training and Development lead at the Health Protection Agency was developing a Care Homes Resource for Care Home Managers, the CQC and Health Protection Units. They wanted to embed consistency, honesty and commitment to achieving zero tolerance with the structured PIR tool and share learning on weaknesses.

The Directors of Public Health would be accountable; the development of the new data capture system would enable more timely and meaningful information.

The proposal to move back to monthly reporting would be more acceptable if this was broken down by hospital site which was something that the Department of Health would take back to the advisory sub group.

We will remain in contact with the Department of Health during the final developments of the proposals, although we are not wedded to the idea of weekly reporting we are of the opinion that the published data should be at the hospital level for the purposes of openness and transparency.