Welcome to MRSA Action UK 

The Charity providing information, support and advice for patients and carers about MRSA and other healthcare associated infections. Below is a summary of the annual patient safety conference attended by Derek Butler

Derek Butler, Chair, attended the Patient Safety 2011 Conference held at Church House, London, which focused on the safety of patients and eliminating never events. The definition of a never event is "an event that causes harm to a patient that is avoidable and therefore should never happen".

The conference launched the "Prevention and control of healthcare-associated infections quality improvement guide" developed by NICE and the Health Protection Agency for those giving care outside of the hospital setting.

We had responded as members of the Hand Hygiene Alliance, and lobbied strongly to have a quality statement which would refer to existing hand-hygiene guidance and clinical audit tools.  This didn't happen which was disappointing, but hand-hygiene does feature more prominently in the final guide.  We will be endorsing the guide and giving feedback to regulators on how effective it is, as we are often contacted by patients and carers, including professionals, outside of the hospital setting with regard to giving safe care.

There were some interesting presentations, most notably from Plymouth Hospitals NHS Trust, presented by Helen O'Shea, Deputy Chief Executive, and Dr Alex Mayor, Medical Director. The presentation touched on infection control and hygiene with four key controls:

  • Strong leadership encouraging everyone in the trust to play their part, from the porter and cleaner to Chief Executive being involved in infection prevention and control, and hygiene
  • Resource infrastructure, placing money in the right place ensuring it delivered the most efficient return for infection prevention and control, and hygiene
  • Accurate data, ensuring that the data was up to date accurate and detailed
  • Supportive challenge, supporting those who challenge poor practice where patient safety could be compromised

    The presentation also touched on an issue close to the charity's heart, surgical site infections. The hospital collected data showing the significant morbidity and mortality and the excessive costs involved when patients contract surgical site infections.   The financial cost was in excess of 4,000 pounds per infection, so clear strategies needed to be in place to control and monitor surgical site infections. The introduction of the system had encouraged a reduction of surgical site infections by 30% and a cost savings of almost 40%.  The hospital ensures that surgical site infection surveillance carried on after discharge by encouraging patients to complete a survey after 28 days to post back to the hospital. To date over 60% of patients have completed the forms and returned them to the hospital.  It was interesting to see one group of medical professionals who actually encourage this system, that being the surgeons.
    The CQC gave a presentation regarding its role on patient safety, we have seen, more recently, the role they had played in highlighting incidents where patients have been let down in relation to care.  There were some weak points regarding the CQC not being able to ensure that hospitals go beyond the hygiene code.  In this the CQC's only remit is to ensure that hospitals do not go below the standard in the hygiene code, Derek pointed out that the code was only a minimum standard, yet in other industries regulators expect them  to attain above their minimum codes.

    There was an interesting presentation by NHS Direct which showed that many patients have found this system to be beneficial, Stuart Toulson from NHS Direct gave an insight into how the system works, and whilst there were some imperfections overall it worked well, saving some 3 million visits to A&E and over 16 million visits to a doctor.  It actually saved time and resources for 999 calls when they were not needed at all. Stuart also made it clear that those trained to work at NHS Direct are trained professional medics with years of clinical expertise, they have contact with various clinical practitioners from many fields.

    The final presentation was from Dr Suzette Woodward from the National Patient Safety Agency (NPSA) who gave an insight into the role since its conception in 2003. She informed the delegates that the NPSA will completely cease from July 2012 and that a lot of the work will be taken up by Healthwatch, the new regulator.  Suzette did say that when the NPSA was set up they expected no more than a hundred complaints in a year or incidents relating to patient safety, in fact within days of its conception they were recording 3,000 incidents a day, which is the equivalent to a million reported incidents a year.

    Derek Butler contributed to the debate with the most thought provoking question of all "How many of you here today would be happy to have a loved one treated in your hospital?"  Regrettably only around half of participants raised their hands, which was a similar response from the figure publicised by the CQC from the 2010 NHS Staff Survey (63%). The challenge for everyone was, but particularly those who did not put up their hands, to go back to their organisations and whenever they saw poor practice to raise this, not only with the individual concerned, but at Board level too.


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 info@mrsaactionuk.net

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 2011