Reducing healthcare associated infections conference

Tackling antimicrobial resistance
25 June 2014

The conference gave an insightful view into the future for antibiotics and how resistance means considering radical changes to how we use them. The discovery void continues and more worryingly even if we were to develop more antibiotics in the near future, we are already in a position where we are experiencing some untreatable infections.

Daily Telegraph columnist Joe Shute chaired the conference and was an excellent master of ceremonies. His article 'Too Much of a Good Thing' is compelling reading and highlights the complexity involved in the battle with antimicrobial resistance. It was good to see the Longitude Prize Award being promoted by speakers at the conference. We had worked hard to get everyone to vote for ANTIBIOTICS in the public vote, and with each person that we encouraged, we are sure they went back to their organisations and did the same, so thanks to all those people who voted and helped win the £10 million prize fund to come up with solutions to tackle this global problem.

We all know the devastating impact of a loved one contracting an infection that would not respond to antibiotics and the consequences. Many of us will have thought about the environment and the food we eat and perhaps wondered just what impact the culture of overuse of antibiotics is having. Well if anyone is ever in any doubt or expresses cynicism if you mention the need to preserve and look after antibiotics and think about the environment, then you can rest assured we have the evidence to show the potential damage that complacency to the antimicrobial resistance issue is causing.

A presentation on the analysis of bathing water on our beaches was given, and it is clear that in sewage polluted water there is a bacterial soup of multi drug resistant organisms lurking. They may be diluted, but they are there. Mixed with the biocides and detergents that these organisms happily live with, it makes the thought of swimming in the sea less inviting. It's always a good idea to avoid beaches that have not been given a clean bill of health.

There were other interesting presentations that dealt with the practicalities of trying to minimise the use of devices that can pose infection risk to patients in hospital. A simple way of measuring urine output was to make use of jugs and also to consider weighing incontinence pads, deducting the weight of a dry pad. This approach means that the patient doesn't have to keep a urinary catheter in, reducing the risk of infection. It was notable that E.coli infections showed an increasing trend in hot weather, suggesting a link with dehydration. Making sure patients are hydrated may not seem to be an infection prevention intervention, but dehydration appears to have links with urine infections - a lot of which are E.coli and increasingly difficult to treat.

There was an animated panel debate on hand hygiene during the lunch break. This was chaired by Professor Didier Pittet who was joined by Derek Butler, Sheldon Stone, Harriet Ddungu, Head of Infection Prevention and Control Northamptonshire Healthcare NHS Foundation Trust and Professor Alan Johnson from Public Health England. Professor Didier Pittet asked if there was a perception that the highly successful Cleanyourhands campaign is losing momentum, and if this was the case was it because of lowering infection rates for the published figures for MRSA and Clostridium difficile, was there complacency creeping in?

Some excellent examples of good practice in promoting hand hygiene were given, but this was not universal practice in listening to the views of the patient representatives and the panelists, performance is mixed.

One of the aims of the Hand Hygiene Alliance was to take the success gained from the Cleanyourhands campaign into the community, but reports from patients showed that this was patchy. There were good practices happening in terms of caring for people in the home environment, but sometimes it was difficult if healthcare practitioners were faced with sinks full of dishes and little chance of good place to wash their hands. Taking soap, water and paper towels along was the fallback intervention that was needed.

Australia had a system where audit and feedback on hand hygiene was published along with infection rates, this was a mandatory reporting requirement and the staff were suitably trained to enable this to happen. Much of the observation that occurs in the UK appears to be flawed as audits are returning 95% compliance, yet patients often complain of poor or no hand hygiene events when receiving care, the audits can be at best, cursory in these cases. In the community its difficult as you can't have observational audits, you can use patient feedback by giving community healthcare teams short questionnaires to be returned in a prepaid envelope, and one trust was doing this, but the cost argument was looming - but what price do you put on avoiding infections - the costs of this form of receiving feedback may well outweigh the cost of giving patients infections through poor practice, both in monetary and human terms.

We spoke of the appetite for hand hygiene with children. One of the top keyword searches on the MRSA Action UK website related to accessing downloadable hand hygiene posters, in particular posters for children. Professor Alan Johnson spoke of e-bug, the resource that had been developed by Public Health England for schools, we advised that there was evidence to suggest it wasn't being used in all schools and MRSA Action UK had approached the Department for Education suggesting that it should be part of the curriculum.

We gave examples of the work in Wakefield where the local school was working with the local hospital trust, with the children designing posters that were published and put up in the hospital. One infection control lead in the audience talked of the work her trust was doing with schools and in the community. This fuelled a debate about making things mandatory. Should teaching hand hygiene be part of the national curriculum, and was mandatory reporting in the way Australia structured their governance the way forward. There was a lot of good work going on with schools and community infection control teams. Any mandatory reporting and mandatory training on any curriculum means it has to be resourced, since services are decided on and commissioned at a local level it seems unlikely that a mandatory approach would be taken, whatever the consensus of opinion may be on the importance of hand hygiene.

A snapshot of the presentations and a link to the GovToday website with the full programme is available here.

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(c) MRSA Action UK 2014