Tuesday 23 February 2016

Derek Butler a founding member and chair of MRSA Action UK, chaired the inaugural Infection Prevention & Control Conference, hosted by Knowlex. This opportunity to highlight the effect that healthcare-associated infections have on patients and their families, kept the conference focused on the patient. Maria Cann and Helen Bronstein also attended and networked and provided resources for delegates visiting our stand. Our thanks go to Knowlex for the sponsorship of the stand and delegate places.

The conference heard from Jeremy Knox, Deputy Head of the Review on Antimicrobial Resistance, he told delegates that the final report on Antimicrobial Resistance will be presented to the Prime Minister this summer and will make recommendations on the global response and action needed to tackle Antimicrobial Resistance.

KPMG provided analysis through the economic lens and estimate 10 million lives will be lost each year to Antimicrobial Resistance by 2050, costing 100 trillion dollars – to put this into context global output is 75 trillion dollars output each year, so this is the business case, Antimicrobial Resistance threatens humanity and business.

Research and development is focussed on well established markets in terms of the antibiotic pipeline, it's not commercially attractive. Financial support could theoretically come from bodies such as the Gates Foundation, Wellcome Trust, and pharmaceutical industry. Research showed 60% of antibiotic prescribing may be inappropriate, so the way we prescribe has to change.

Hugh F McIntyre, Chair of NICE Quality Standards showed delegates that 74% Antimicrobial prescriptions are from Primary Care. Commissioners use the NICE quality standards as levers to deliver safe quality care. Delegates pointed out that Commissioners don’t always register as stakeholders for consultation and involvement, and commented on the Sepsis guideline stakeholder consultation that had closed the day before the conference. Hugh said that it was essential for stakeholders to get involved. Ron Daniels had given an informative and emotive presentation on the effects of Sepsis, and pointed out the impact that the NICE pathway on identifying Sepsis was likely to impact significantly on Trusts with the algorithm pointing suspected cases to GPs and A&E, Commissioners needed to be involved.

Russell Hope from Public Health England gave a presentation on mandatory surveillance and published figures. In terms of bacteraemia the source is a voluntary field. MRSA bacteraemia are now more likely to be associated with skin and soft tissue infections, these used to be line related, interventions brought these down. For post infection review the 48 hour classification is a rule of thumb, and primary care apportioned may become trust apportioned with further investigation, this impacts on the year-end figures being different and changes in quarterly published figures.

Ian Gould, Consultant Clinical Microbiologist and Director of Medical Microbiology at Aberdeen Royal Infirmary, presented the "antibiotic paradox" – showing how antibiotic usage is paradoxically causing more infections – with resistant infections such as MRSA and others adding to the burden.

The impact of antibiotic prescribing on C.diff was hugely significant. If an individual is prescribed a cephalosporin, for the next 3 months they are 8 times more at risk of contracting Cdiff than the rest of the population. If an individual is prescribed ciprofloxacin (fluoroquinolone class), for the next 3 months they are 30 times more at risk of contracting C diff than the rest of the population.

Bringing in diversity to antibiotic prescribing is needed to reduce the development of resistance.

During the panel debate Maria Cann asked “How do we make sure that pharmacists and GPs are equipped with the specialist skills needed to prescribe antibiotics appropriately within local formularies? And how do we equip prescribers with the knowledge and skills to bring in diversity of prescribing of Antimicrobials?”

Shared knowledge, education and collaborative working were all essential to tackle the problem.

The afternoon plenary was joined by experts from NHS England and Public Health England.

Dr Philip Howard from NHS England said that the C.diff objectives for 2016/17 were not going to be significantly different to this years. C.diff is ubiquitous and is found everywhere in the environment including soil and water and be carried asymptomatically with levels of up to 7%, so there is never going to be no C.diff. In terms of the objective, CCGs and Acute trusts need to show continuous improvement and there is discretion to introduce sanctions.

Before 2014/15 a £50k fine per C.diff infection was imposed. One year a Trust had a £5 million fine. The checklist to identify if C.diff was due to a lapse in care was introduced in 2014. The irreducible minimum will vary. Recent research in a Trust showed 94 cases (14%) were due to a lapse in care. Trusts are asked of the one in six who died was it recorded on the death certificate.

Our colleague Pauline Harrington presented on Surgical Site Infection Surveillance. Surgical site infections (SSIs) are one of the biggest threats to delivery of safe surgery and second most frequent healthcare associated infection, accounting for 17% of all infections in Europe and 29% in the USA. SSI lead to extended illness, long-term disability, avoidable death, increased antibiotic consumption and the additional cost is estimated as 7 billion euro a year in Europe.

Many SSIs are preventable, there is an extensive evidence base on the effectiveness of prevention measures. A key component of quality standards is surveillance. 258 NHS Hospitals and 113 independent sector hospitals are registered in the Public Health England surveillance programme. There are 17 categories of surgical procedure, orthopaedics are mandatory, other categories are voluntary. Public Health England will work with commissioners so that they have a full understanding of the data, particularly where there are outliers. There are plans to make other methods of post discharge surveillance mandatory. Hospitals will have to find the resources in a time of financial constraint. An electronic patient questionnaire is under development to assist with the resources needed.

The true cost and consequence of getting infection control wrong was presented by Derek Butler. Delegates noted the ages of loved ones who had been affected and the procedures that were routine, and had led to the contraction of avoidable infections. Only one victim in Derek's presentation had MRSA mentioned on their death certificate, demonstrating that reported numbers of people who die from the effects of healthcare associated infections are an underestimate. With avoidable infections causing so much pain for those of us who lose family and the consequences for the increased use of antibiotics we cannot afford to let strategies to prevent avoidable infections slip to the bottom of the agenda.

At the end of his presentation Derek asked delegates if they would be confident to allow someone close to them to receive treatment in their hospital with absolutely no involvement from themselves. No-one felt confident enough to raise their hands.

During the panel discussion the issue of caring for vulnerable people in their homes arose, sometimes it is difficult to achieve the right environment for optimal infection prevention and control due to the person’s home environment. An example of no running hot water was given. Whilst carrying supplies to achieve hand hygiene is an option it is always important to work with other agencies when this happens. Carers can contact their CCG and work with Social Services to identify issues and carry out an integrated approach to providing support.

Networking opportunities included contact with other organisations. We will be helping to promote information about Sepsis and have obtained materials from the Sepsis Trust to raise awareness of the signs of sepsis. CMV Action were also at the event and we will be helping to tie in links to other organisations that can help raise awareness of CMV, a rare condition caused by a virus that can harm unborn babies, contracted from the dribble of toddlers – hand hygiene is a key factor in reducing the risks to pregnant mums with toddlers.

Maria Cann accepted the offer of making a short film on the experience of losing her daughter to meningitis and sepsis bringing the human touch to a symposium in return for a donation to MRSA Action UK. The film will be available to our charity for training and information.

To view the full programme and speaker profiles visit the KNOWLEX website

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