Reducing HCAIs '09

Clean Safe Care Conference and Exhibition 
June 17th 2009

Bharat Patel welcomed everyone and outlined that all the speakers today were on a mission to encourage everyone to reduce healthcare associated infections.  The conference provided an excellent forum for discussion and information sharing, previewing the latest technological successes and providing a timely reminder of the latest guidelines, legislation and Government strategies in targeting infection and saving lives.  Bharat introduced Professor Ann Keen MP, Parliamentary Under Secretary of State for Health Services at the Department of Health. 



Dr Bharat Patel, Health Protection Agency Consultant Microbiologist,
Regional Microbiology Network Healthcare Associated Infection Lead for London

Professor Ann Keen MP, Parliamentary Under Secretary of State for Health Services at the Department of Health

Professor Keen addressed the conference and spoke of the great progress that had been made and that NHS staff had done well to exceed the national target of halving MRSA from its level in 2004.  Safety and quality were top of the agenda and despite the perception that the UK was the worst in terms of infection rates, she said we were not.




From MRSA Action UK's perspective we would beg to differ on that opinion and feel that particular statement is debatable, with the European Antimicrobial Resistance Surveillance System showing the UK has having recorded more staphylococcal infections than any other participating European country in 2007.  The proportion that were showing resistance to the antibiotics used to treat it has fallen, so there are signs of improvement, but as the recent National Audit Office report demonstrates, there are still a vast array of infections that cause bacteraemias that are not recorded, so it is really is not possible to say with any certainty whether the UK is indeed still the 'worst' participating partner in the European surveillance system.


Professor Keen wanted staff to know about the success stories, but the media only seemed to want to publicise bad news, it was a shame that the NHS couldn't have it's own channel so that staff could share the good news and good practice.  On the morning of the Maidstone and Tunbridge Wells report on the GMTV sofa Professor Keen was faced with a photo of a man with medals and a headline stating that "Hitler couldn't kill him, but the NHS did", she was asked if she was ashamed.  She had to admit that yes she was.


Professor Keen outlined the duty to patients and their safety.  The National Audit Office report showed that estimated savings of 141 million to 263 million pounds had been made through reducing avoidable infections.  Some Trusts had gone beyond the targets and the Health Protection Agency data showed a continuing downward trend.


There was, she said, a variation in performance and this was being addressed.  Andy Burnham MP, the newly appointed Health Secretary, was asking for views to put to the National Quality Board for the new MRSA Objective.  Clostridium difficile was still posing challenges.


There was a need to understand the barriers and change the culture, there would be a need for robust accountability from Board to Ward.  Executive and Clinical Leadership were key.


Professor Keen said she had just come back from a visit to Massachusetts Hospital where serious reportable events were published on the website.  Nurses were in charge of quality.  Nurses had an hour break at lunch time, there was a ratio of five patients to one nurse.  The staff were looked after and this impacted on the quality of care.  We can learn from this.


In response to the requests to Whitehall about conditions in our hospitals the Design Council had come up with solutions.  Infection Prevention and Control is the norm and a requirement of registration with the Care Quality Commission, who will assess compliance with the Health and Social Care Act 2008.  China and America were looking at our model and our success.


Janice Stevens MA. RGN
Associate Director of the Department of Health HCAI Programme

Janice Stevens MA. RGN Associate Director of the Department of Health HCAI programme was seconded to the Department of Health in 2005 to work for the Chief Nursing Officer and design and lead the Healthcare Associated Infections programme.


The Programme has played a major part in the significant success of the NHS in going beyond the Government's target of halving MRSA blood stream infections across England, with a 65% reduction on the 2003/04 baseline. In addition, the latest published quarterly figures on C. difficile infections figures show a 35% decrease on the 2007-08 average and mean that the NHS is well on its way to delivering its target. She describes this role as the most exciting frightening but rewarding of her career, but one she couldn't resist. It sits at the heart of delivering high quality care, something that has remained her priority and passion.


Janice spoke of the need for leadership, accountability and assurance.  Four years ago people did not think it was possible to achieve a 50% reduction in MRSA bacteraemias.  Now there was a change in culture and belief.  Hospitals were cleaner and less cluttered, gel was everywhere.  Everyone believes infection is preventable now.


Other guest speakers included Nigel Ellis, Head of National Inspection and Assessment from the Care Quality Commission.  We were pleased to see that the inspections will still be risk based, but will take into account local intelligence from patients and patient groups.  It will also be more about outcomes and services as they are perceived with less boxes of files having to be produced in advance of inspections, policies and procedures would be required where any problems were perceived, but this would not now be in advance of inspections.  A registration requirement is to comply with the Hygiene Code, and there are strong powers of enforcement where these are not adhered to.


Trusts are no longer notified that they have been selected and no longer need to submit information before the CQC inspect


Professor Brian Duerden CBE, the Department of Health's  Inspector of Microbiology and Infection Control  spoke of the keys things to effectively target healthcare associated infections, include antibiotic stewardship, restricting the use of broad spectrum agents, looking at stop dates, prophylaxis (preventative antibiotics) only being given one dose.


Paul Cryer, the Department of Health's Programme Manager, Healthcare Associated Infection Technology Innovation Programme, gave an update on fast tracking new technologies.  He encouraged participants to ensure their Strategic Health Authorities were making provisions to attract funding to the products that could significantly reduce the bio-burden of healthcare associated infections.



Paul Cryer updates the conference on the showcase hospitals where innovative technologies are trialled


There were breakout sessions where MRSA Action UK took the opportunity to join discussions about the technologies being used to help reduce the bio-burden.  Fighting infections from inside out was an interesting session considering silver-coated nano-particles for use on intravascular devices.  Biofilms build up quickly on any medical devices in a patient's body, as quickly as 24 hours after insertion, despite attention to strict aseptic technique; therefore devices with antimicrobial properties can serve to help prevent the acquisition of bloodstream infections.  We asked if the company had considered the use of chloramides where people had intolerance to silver, they will be looking further into the possibility of using this technology too. 


Blackpool Fylde & Wyre Hospitals NHS Foundation Trust gave a presentation on the use of PCR rapid screening, they were among the first Trust to use this for emergency admissions, the test had helped to save lives through rapid detection and being able to provide the most effective antibiotics when patients had been admitted showing signs of infection.  We asked if this test was given on discharge, as patients are now being discharged into the community with complex needs and knowing the infection status was important, the Trust does not use the PCR test but conventional testing, we asked if in an ideal situation people going in community hospitals for example, if it would be better to be able to know results quickly, as community hospitals were the poor relations of the NHS and this didn't really seem fair to expect them to accept patients without knowing how to treat infections appropriately.


A system for clinical governance was demonstrated at another session.  The software was impressive enabling clinicians, ward managers and decision makers to track performance against key targets.  It was not only useful for infection prevention and control, but for all the key outcomes demonstrating quality and safety.  We asked if it was possible to publish top-line indicators on Trust's websites, since it was a web-based system, it was indeed possible to do so and national indicators could be compared region by region as national comparative data is held within the system.


This holds with our belief that if you can't measure then you can't demonstrate improvement.


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