Reducing HCAIs 2012

Reducing Infection: Improving Health Outcomes,
Manchester 6th June 2012

Four delegates attended Reducing Infection: Improving Health Outcomes in Manchester.

Professor Sir Brian Jarman, OBE, Emeritus Professor, Faculty of Medicine, Imperial College London chaired the event and the question and answer debates.

There were some interesting presentations from Professor Derrick Crook, Consultant Microbiologist/Infectious Diseases at the University of Oxford, and our colleague Dr Bharat Patel, Consultant Microbiologist, at Health Protection Agency.

There was consensus that there was still more to do with variability in performance. Trusts that do well are those that experience better leadership, engagement and a sharper focus using their local surveillance and information, providing a rapid response where causes of problems are identified. An open honest dialogue and a better organisational culture where there is willingness to change behaviours were key in success.

Reliable consistent practice was needed to sustain improvements, ensuring all systems are working to an optimal level. It was important to learn from good practice and disseminate what works widely.

Professor Crook highlighted some of the observations we have been making for some time, which was the higher prevalence of common healthcare associated infections in the community setting. Both Staphylococcus and Clostridium difficile have been presenting outside of the hospital environment more frequently, proportions have changed due to the recorded numbers of cases falling in hospitals, but nonetheless there are some worrying developments.

Mandatory reporting of Clostridium difficile is applicable to the over 2's, however there was some evidence that there had been cases in infants possibly linking to giving solid food at an early stage. Transmission from pets was also mentioned in the presentation. Dr Ken Strauss, Global Medical Director, BD Diagnostics - GeneOhm, gave a very interesting presentation on scientific discovery and development. Insulin was discovered in 1921 and used on a diabetic dog by Drs. Banting and Best in Toronto. In 1922 the first human patient to receive the treatment, 14 year old Leonard Thompson, suffered a severe reaction, as it was not known that injecting straight into the vein using a 40mm needle would cause a diabetic coma. BD developed the first safe 18mm needle to be able to deliver the insulin safely into the fat.

The presentation dealt with preventing needlestick injuries. Around a third of needlestick injuries can result in MRSA, 40% of injuries in care homes occur when treating diabetic patients, just one area of care that highlights the importance of developing equipment and needles that present less of a risk of injury. The role of industry in helping to deliver safe care was an important one, and, of course, one that has to be controlled. Someone has to manufacture medical devices, and we needed to resist the blanket condemnation of industry and support the many honest professionals who strive to make it work for society and work in partnership with healthcare professionals.

Surgical site infection (SSI) surveillance in primary care was presented by Professor Judith Tanner "The Department's approach to mandatory national surveillance means there is still no grip in surgical site infections." "Progress is being hit by a lack of decent data."
Source: House of Commons Public Accounts Committee, November 2009

The comments of the Public Accounts Committee are something we are only too familiar with, and Judith's presentation showed just how much under-reporting there is in terms of surgical site infections, with many hospitals not counting superficial infections and not telling the patient that they have an infection - again something we are all too familiar with, as many of us didn't know about infections and the extent of them until we had obtained our loved one's medical records.

In a point prevalence survey in 2006 the commonest HCAIs were:

-Gastrointestinal 22%
-Respiratory 20%
-Urinary Tract 19.7%
-Surgical site 13.8%

In 2011 the proportions changed, although the research was not directly comparable there was slightly more recognition of the problem, perhaps because more hospitals are being open about their reporting:

-Respiratory 22.8%
-Urinary Tract 17.2%
-Surgical site 15.7%

In a survey conducted by Judith these were just some of the comments of patients with a surgical site infection:

"I can't cope, I can't cope, I just can't do this..."

"There was a stage when I just wanted to die"

"I was in utter despair"

Of the 17 patients interview 9 didn't know they had a deep surgical site infection.

Patients who definitely had an infection in Judith's survey commented:

"I don't know why you've asked me to take part in this"

This patient had been readmitted with a wound infection and had to have 3 cycles of antibiotics.

"I didn't realise I'd got an infection, there may have been one but the hospital say"

"I've got a big rash on my knee, the antibiotics made it go away"

"I was on an antibiotic drip but I thought that was normal after an operation"

"I wasn't told I had an infection until after id been discharged the second time"

"The nurse told me it's nothing to worry about, it's not MRSA"

A patient with coli form bacillus was told to say it was colonised and not infected, doctors don't like admitting there is an infection.

"Apparently the metal work deteriorated and they don't know why"

"You've broken my record, you're the first patient I've ever had to get an infection." - Amazing??

It is clear from Judith's research that a level playing field and more honesty is needed in terms of dealing with healthcare associated infections. If you don't measure it then you can't monitor your performance, and you will continue to see patients in utter despair.

Remote video auditing (RVA) hand hygiene program in the US being introduced to the UK National Health Service was presented by Professor Sir Brian Jarman, OBE, Emeritus Professor, Faculty of Medicine, Imperial College London

Improving hand hygiene compliance to reduce healthcare associated infections must be a top priority for healthcare systems around the world. To date, there has only been one technology that has been featured in a major article in a top academic medical journal which was proven to cost effectively measure, improve and sustain high rates of hand hygiene performance. The study detailed how Arrowsight`s Remote Video Auditing services were used by a large healthcare system in the US to improve hand hygiene compliance in an ICU from a baseline rate of less than 10% to over 80% in a matter of weeks and then sustain the improvements for over three years.

Sir Professor Brian Jarman spoke about the current trends of healthcare associated infections and mortality rates in England and how this new healthcare technology can benefit the NHS.

A conservative estimate of around 6.6% of hospital admissions are associated with adverse events, half of which are believed to be avoidable, and around 8% of these can result in death, this equates to around 25,000 avoidable hospital deaths a year.

Healthcare associated infections are more often than not avoidable, and as such a raft of measures have been introduced in England. Voluntary surveillance in 1990 was stepped up to become mandatory in 2005/06. The 'cleanyourhands' campaign was introduced from 2005. The 'deep clean' funding in November 2007 helped to signify the change in attitude to listening to patients about cleanliness standards in hospitals. Statistical process control and monthly alerts, use of 'care bundles' and 'checklists' of accepted clinical practice adopted. PEAT inspections (using patients) and self-assessment audits with peers often showed discrepancies in opinions on hand-hygiene with compliance being as low as 10% and as high as 99-100%, therefore we need to ask if RVA auditing should be tried.

The debate continues and will be the subject of the first UK Summit on Hand Hygiene Sustainability in Health Care at GovToday's conference in October.

The last presentation of the day given by Karen Egan of Mid Cheshire Hospital's Foundation Trust highlighted something that everyone in attendance should relate to:

By 2080 the population aged 80+ will have doubled... healthcare workers are relatives and patients too... and the legacy they leave is their insurance policy in old age and ill health!

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

The information on this website is for general purposes only and is not a substitute for qualified medical care, if you are unwell please seek medical advice.

(c) MRSA Action UK 2012