Healthcare associated infections:
    Department of Health & Stakeholders national event
    18th February 2009 - Inmarsat, London

Janice Stevens, National Director of the Healthcare Associated Infection Programme

Janice welcomed everyone and reaffirmed The Cleaner Hospitals Team's passion and determination to continue to drive down healthcare associated infections and outlined the work that was continuing to bring about the significant reductions in healthcare infections.  The Improvement Teams were continuing work with Trusts to address those that were not doing so well.  Janice had attended events hosted by the Improvement Foundation where work with care homes was taking place, it was encouraging to see that these events were stacked with people wanting to find out how to take action.  In essence search and destroy was being employed with the screening prior to elective surgery, with the aim of getting colonisation down. 


The NHS Constitution now makes explicit the need to take infection prevention and control seriously, patients have the right to be given information, and to be involved in discussions and decisions.


The Care Quality Commission would be effective from the 1 April 2009.  The Health and Social Care Act 2008, and Code of Practice for the Prevention and Control of Healthcare Associated Infections, had been updated to include registration requirements for NHS organisations.


The day was an opportunity to meet new people with the common aim of reducing infections.  New developments and technologies were showcased from the "Design bugs out" programme by Nigel Campbell from the Design Council, which as the name implies is about designing technology, equipment and furnishings to help make the environment as "bug-free" as is possible.  Five winning designs came from manufacturers responsible for iconic designs such as Virgin Atlantic's Upper Class airline seats, Herman Miller chairs and Parker Pens.


We believe this will make a significant difference for patients' comfort and safety, and also make the patient environment more conducive to reducing the risks of spreading pathogens.  This meets the objectives of creating patient bedside furniture - which is easy to clean and maintain, cost effective and sustainable.  The launch of the winning designs will be in April, click here to read more.


Paul Cryer - Technology Helping to Fight Infection

Paul Cryer from the NHS Purchasing and Supply Agency gave an update on a range of solutions with specific emphasis in helping eradicate MRSA, Clostridium difficile and other healthcare infections. The programme incorporates product surgeries where any commercial organisation having an interest in healthcare infection technology can book to meet with Department of Health officials and scientific officers to discuss their product development programme or seek to remove blockages from the system of getting the NHS interested.


The team's role is to look at technology and ask, does it work and by how much, and to ask what is the overall in use value and what barriers can we take away to improve.  Porton Down were testing disinfectants that are used in hospitals to test which are best, do they deal with C.diff spores, they were looking at efficacy and price.  Peter Wilson UCH, had carried out a year long study at the Royal Free in two Intensive Care Units, super cleaning takes 50% more resources, the other method of cleaning using Micro Fibre made no difference to infection rates.


Other innovative technologies from the Smart Ideas programme included portable isolation units, portable toilets and handwash facilities that required no plumbing.  These are being trialled at Wolverhampton, Nottingham and UCH in London.


The isolation units have an air door, a whole bed space disinfection solution and take one hour to put up.  The waterless toilet is a smart solution as Clostridium difficile can have an 8 foot aerosolistic flow, the toilet has a built in fan and hermetically sealed bags for dealing with waste.


Public perceptions of healthcare associated infections

Qualitative Research December 2008


The Department of Health had commissioned qualitative research as they needed to understand attitudes and behaviours around healthcare associated infections and gain an understanding of the wider public perception on infection.  An education campaign was needed. The Department of Health were currently doing the creative work and a National Public Campaign would launched be at the end of the summer.  Health Secretary, Alan Johnson announced the plans for a campaign in September 2008: 

"Patients and relatives can do more to remind doctors and nurses of their duty to maintain high standards of cleanliness.   We want people to have a broader understanding of infections and feel able to ask staff whether they have washed their hands or not.  The proposed NHS constitution gives patients responsibilities as well as rights. These should include high standards of personal hygiene to avoid bringing infections on to a hospital ward and constant vigilance to check on the cleanliness of NHS staff."  The Department of Health will work with Ashley Brooks, a businessman who has survived a hospital-acquired infection and launched a campaign to get patients more involved in infection control.", Tuesday 23 September 2008


"MRSA Action UK is encouraged to see that the Health Secretary is to set out details of a public campaign which is aimed at public empowerment. The Health Secretary also wants the public to have a broader understanding of infections and our Charity has consistently campaigned for a far more reaching campaign such as that which the Department of Health funded in the 1980's with the AIDS campaign which informed the public of the dangers of that particular virus. We believe that now is the time to take that extra step and for this Government to show the radical thinking combined with the political courage to ensure every person in this country fully understands the fight we have with these bacteria in our hospitals. This campaign should go that extra step by becoming a national campaign on TV, Radio and in the National newspapers.

We are extremely pleased to see that the Department of Health is to work with Mr Ashley Brooks who suffered and nearly died from MRSA.  We welcome the involvement of organisations such as the Patients Association in respect to developing top tips for patients and visitors.  MRSA Action UK would go one-step further and include the Doctors and Nurses in this campaign to reinforce the message that Healthcare Infections are everyone's business. MRSA Action UK categorically reaffirms to the Health Secretary, it's previous statements that patients, relatives and visitors engagement in helping to control infections in our hospitals has to supplement that effort and must never be assumed that it will replace the responsibility that the medical staff have in ensuring patient safety.  We have reservations on the issue of patients and relatives doing more to remind and to encourage Doctors and Nurses to wash their hands. Unconscious patients, including those who are too ill or are too afraid reinforces the ultimate responsibility for patient safety remains solely with the staff. This message should be reiterated by the Health Secretary in his comments to the staff in the NHS." Wednesday, 24, Sep 2008

Amy Smith, Research Works, spoke on the unpublished findings of the research which included the views and perspective of relevant healthcare professionals on how an information and education campaign should run.


The research reaffirmed that patients and the general public were not getting the information they need.  There was a need for a broader education campaign.  The public trusted the voice of the health professional more than anyone else (namely the media and the Government).  Information needs to be local, relevant and impartial.


A discussion took place and the research was broadly welcomed, it was felt that it was necessary to define the scope of the infection arena, it was not just about MRSA and Cdiff.  It was important to sustain the focus on reducing infections and drive forward.  We found it useful as it highlighted some of the things that our organisation deal with on a regular basis, we were able to feedback on screening for MRSA and the questions were are asked.  People were finding it difficult to cope with decolonisation in the home prior to elective surgery, there was no linkage with support that could be obtained from the PCT and Social Services if they needed help with laundry and the daily routine required for the decolonisation regime.

NHS Choices - Mark Pownell, Deputy Editor


NHS Choices receives 5 million hits a month.  Mark Pownell outlined the data is rigorous and evidence based, recent developments included:


-         Carers Direct

-         Research and clinical trials

-         Medicines

-         Rare diseases

-        Kiosks for those without internet access - GP surgeries, pharmacies, mobile phones, libraries, launderettes

-         Comments on GP practices

-         Livewell: bullying, Going into hospital


Current infection data included

     -        MRSA bacteraemia infection at trust level

     -        Hip and knee surgical site infection

Future data would contain

-        Individual hip and knee surgical site infection

-        C diff data

-        Hospital level data


Communication and information were themes for workshops in the afternoon.  Although the main focus was around launching an information campaign aimed at the public and patients, there were concerns around the quality of information that was published at local level with regard to Clostridium difficile and the use of alcohol gel.  A debate around the need to emphasise that ALCOHOL GEL DOES NOT WORK ON C.DIFF ended in one group going away to focus on how this issue could be addressed.  All the stakeholders were mindful of the need to wash with soap and water to remove the hazard of C.diff spores, and then use the alcohol gel to remove other bacteria, but the NPSA had highlighted in their presentation that barriers to hand hygiene included the location of sinks or lack of them, and reported skin problems through frequent cleaning.  The issue of skin problems is a controversial one, if a healthcare worker does have continuous problems with lesions, then it is not possible to remove bacteria such as Staphylococcus aureas, therefore their suitability to carry out clinical practice is questionable, and in our view not practicable.


Compliance with the Code of Practice for the Prevention and Control of Healthcare Associated Infections and the provision of information was a strong theme that was discussed.  The CQC would have more powers, how do we make sure that national messages can be consistently implemented?


People will do things locally, how do we make sure that information is quality?  Mark was responsible for NHS Choices meeting the Department of Health's Accreditation Scheme for the provision of information therefore data on the NHS Choices website would have to convey the right message.


There may be scope to tie the work of the CQC in with the Accreditation Scheme in providing information, more thought could be given to that.  Janice would invite the CQC to the next stakeholder meeting to discuss compliance with the Code of Practice.


NHS Choices and the Public Education Campaign
What information should patients know, what information should the general public know?

HCAI content

-        What information do people want to know?

-        What information is missing on NHS Choices?

-        What do they need to know?

-        What tasks does the information help them achieve?

-         How should the information be structured?


The campaign landing page will be the hub of information empowering people who want to ask questions, giving confidence with ready made questions to ask.  What do patients and visitors need to know, what level of detail?

-         Information for patients

-         Information for relatives and staff

-         Information for carers


There was consensus amongst the patient groups that the message should be clear, quality information with one message that should be a nationally adopted standard, the information should meet the Department of Health's Accreditation Scheme for information. 


Patient empowerment is about knowledge and being safe in the knowledge that there are standards of care that not only are an expectation, but a right.  It is important to remember that whilst some patients may be willing to question and, when in doubt, challenge, it is not their duty.  The onus is on the healthcare profession to deliver that standard. Our tips for Going into Hospital are designed to give empowerment to patients who want to be involved and have a say, but we do not advocate that the healthcare profession should rely on the patient as a safety net to providing safe, quality care.


MRSA Action UK had discussed walking someone through the process of finding out the essential information they need to make a choice about going into hospital.


All patients who contact MRSA Action UK were more worried about infections than having to wait for their operations.  The first port of call to help patients for us is Dr Foster's website.  Postcode and procedure are entered, most people want to be close to home for support from family and / or friends.  One screen gives nearest comparator hospitals and infection rate per 10,000 bed days for MRSA bacteraemias and Clostridium difficile.  Of particular value is the ability for patients to see inpatient data, mortality rates and waiting times.


The question that is always asked is how many infections does a particular hospital have -we can't answer that question.  We guide patients to the Health Protection Agency Website.  Surgical Site data is incomplete from a patient perspective, it may meet the criteria set down by the Health Protection Agency but it does not meet the needs of the patient.  The patient also wants to know the number of bacteraemias for the hospital, but it's only available by Trust, similarly for Clostridium difficile.


NHS Choices gives the Healthcare Commission inspection rating, data on cleanliness, the same information on MRSA bacteraemias per 10,000 bed days, patient feedback - which is open and honest, and facilities and patient support.  We have asked for a link to Dr Foster's to be placed on the NHS Choices website.


We believe that hospitals should publish how many infections they have, by procedure and surgeon, they should make it available as real time information on-line and at the hospital door.  "Choose and Book" is a great concept, but only if you have the information you need to help make that choice, and there is still a long way to go, but we are getting there.


NHS Choices data has to be validated, however we believe NHS Choices should publish the Health Protection Agency real time data with the caveat that this data is to be validated to check that it meets the Department of Health's criteria.  The Health Protection Agency always publish their information with caveats. Without better reporting healthcare establishments are not equipped to manage performance on healthcare infections and patient and public confidence will continue to decline.


In a recent study Sue Jolley BA, Cert Ed, RGN concluded  healthcare professionals need to address concerns by providing clear and factual information about MRSA.  "Patients need clear, factual information about MRSA, including relevant rates of infection and comparative risks. Individual trusts could provide this through their infection control teams to ensure the information is relevant and specific to the local situation. This could be easily achieved since the DH has introduced a mandatory MRSA surveillance system in acute trusts in England, and figures are published every six months."  Jolley, S. (2008) Assessing patients' knowledge and fears about MRSA infection.


We also believe that data on emerging threats from other infections should be made available as and when this occurs.

If you or someone you care about has been affected by a healthcare infection and you wish to discuss this with us, please contact us at