Reducing Healthcare Associated Infections 2010 was an opportunity for Maria Cann and Derek Butler to catch up on the latest developments following the change in government and publication of the white paper "Equity and excellence: Liberating the NHS"  The paper introduces changes to the structure and governance of healthcare.  It was an opportunity for delegates to air their views and concerns on the way forward.  Several speakers and delegates highlighted the lack of a mention on antimicrobial prescribing and how this may impact on infection rates.  It was apparent that we had reached a plateau and innovation and good governance would play a significant role in understanding the problems and driving infections to the irreducible minimum.

 

Professor Brian Duerden compared new pathogens and emerging threats to the spread of infection and the Black Death.  He posed the question - had we forgotten how infections spread?  There would always be interaction between human and microbial populations.  MRSA crept up in the 1990s; there were few cases of bacteraemia before then. It is a new organism that affects vulnerable patients and people receiving healthcare, its effects and increase were very real.  It was not just better diagnosis it was a real increase.

 

The challenges faced in the early part of the decade included 7,700 MRSA bacteraemias 2003/04; C.diff was a UK epidemic with 51,767 cases in 2005 and over 55,000 in 2006.

 

Where are we now?  There had been a 75% reduction in MRSA bacteraemia from 2001 to 2010.

ONS statistics showed a reduction in recorded deaths last year, but MRSA Action UK know there is still ambiguity on the recording of the organism from patient experiences.  We must do things properly to avoid infections, focus on asepsis and judicious antimicrobial prescribing. Screen and decolonise to reduce the risk to patients and others.  Bring down wound, skin and soft tissue infections.  The C.diff objective was being set over the next few weeks.

 

Antibiotics were life saving magic bullets, they are a finite resource and we cannot practice in modern medicine without them.  They are different from other chemotherapy in that they affect the physiology of other patients, this is unique.

 

There is still more to be done.  National Audit Office and Public Accounts Committee reports and recommendations are being considered, as are death certification and extended surveillance.  Weekly data was now available, invalidated, but it gives a picture and surveillance opportunity in real time.  Preventing avoidable infections was an Organisational responsibility; a Management responsibility and Personal responsibility.  We need the data and audit results to keep it there at the top of the agenda.  E.coli, MSSA and ESBL strains, Carbapenemase producers (eg NDM) were being discussed for future publication.

 

Ginny Edwards noted that figures had started to plateau following the massive improvements this decade.  Ginny outlined how the improvements happened and how this should continue.  It was about taking the time to understand the challenge and implement improvements.  There was comprehensive communication, recognising some teams would need support.  The Chief Executives and Non Executive Directors must want it to happen.  Chief Executives need to empower the people and lead not endorse.

 

The Department of Health Improvement Teams carried out diagnostics through interview and discussion, gathering data and information and observation.  Reports, recommendations and solutions were identified with staff.  The use of route cause analysis had been a key tool in bringing improvements and this approach would need to continue to be used in the battle to reduce multiresistant superbugs.

 

Brian Leeming presented case studies featuring The Royal Liverpool & Broadgreen University Hospitals NHS Trust and Blackpool Fylde & Wyre Hospitals NHS Foundation Trust.  Leeming Creative Designs had created innovative poster campaigns to raise awareness of the importance of preventing infections.  The posters are also on display in Royal Preston Hospital and provide timely reminders at high foot fall areas, in taxi stands and car parks around the hospitals' sites.  They are a great way to remind everyone about infection prevention and control.

 

 

 

The masterclasses and stands were of great interest, BD were showcasing the ability to screen for MSSA and MRSA for elective surgery and emergency admissions, screening for MSSA can be carried out at no extra cost and Blackpool Victoria Hospital were the first in the country to take up the opportunity to reduce the risks of contracting MSSA.  3M gave an interesting insight into reducing the risks of infection through the use of new technologies.  They quoted Professor Didier Pittet and his analogy of the stepwise prevention of catheter-related infection, 30% are avoidable through essential measures involving basic hygiene, surveillance and feedback.  60-80% were avoidable through education on technical aspects, care bundles and techniques such as asepsis, a further 90+% may be avoidable through the use of technologies such as coated catheters and dressings.

 

The drop in infection rates had reached a plateau and there was still a lot more to do and this was a common theme discussed at the conference.