First Workshop - Solihull, 29th January 2009

The National Picture

Janice Stevens, Director - MRSA / Cleaner Hospitals Programme, Department of Health

Janice opened the event by giving an overview of the national picture of healthcare infections. Whilst it had been acknowledged that the Government had achieved a 50% reduction in MRSA bacteraemias over four years, not all NHS Trusts were successful in achieving this goal. Janice informed the audience that teams from her department have gone into hospitals who had failed to make significant enough reductions in MRSA bacteraemias to help them achieve their goal. Janice explained that changing the culture with regard to healthcare infections sits at the heart of everything the NHS does every day. She said that fighting healthcare infections is not an "add on", it's about what we do or fail to do when treating patients. It's about not dealing with aspects of patient care as we should do, such as dealing with surgical site incisions, wounds or catheters.

 

Janice reported good news on C.diff infections, the target to reduce by 30% by 2011 had more or less been attained.  However, as with MRSA, some hospitals were struggling to make significant enough reductions, and that the job now was to target those hospitals and give them help.

 

Janice explained that it's the front line staff in hospitals and care homes that can make the biggest difference in reducing infections. We will never attain zero infections overall, but taking a zero tolerance approach means not accepting any infection, and making infection prevention and control everyone's business. Patients do not have to contract avoidable healthcare infections, she said that contracting an avoidable healthcare infection should be looked on as an insult to the patient.

 

Janice said that infections are about dignity and that with C.diff when a patient contracts this type of infection, we've ensured that they lose all dignity.

 

Janice spoke on aseptic non touch technique and said that this has to be re-established, staff seem to have lost the ability to use it, and they have to be re-trained in this technique to reduce the chances of a patient contracting an avoidable healthcare infection.  In her presentation Janice was candid in her comments regarding roles and responsibilities of staff who care for patients, she said there has to be consequences for staff not doing things right.  She re-iterated that there has to be compliance with procedures, including hand hygiene and staff must be trained to be compliant and then assessed at regular intervals.

 

Janice also touched on the subject of patients' rights to ask or challenge medical staff to wash their hands and gel them before touching the patient.  She also mentioned that although patients have the right to ask, staff have a duty and a right to challenge their colleagues for failing to be compliant with procedures, otherwise they became complicit with transgressors, and must then face the consequences, the same as their colleagues.

 

Janice ended by saying that staff in hospitals and care homes do a marvellous job caring for patients and residents, in sometimes difficult circumstances.  We must never lose sight of the vision, that whilst we are reducing healthcare infections, they are still far too high, and only a zero tolerance towards avoidable healthcare infections is acceptable.

Multi-Agency Working - Derek Butler, Chair MRSA Action UK

 

MRSA Action UK's presentation considered the risk factors involved for people who move between the hospital and community setting, and how carers, whether formal or informal carers, need the support of the teams within the Primary Care Trust to help reduce the risks of infection.

 

-       Some of the main risk factors for the acquisition of MRSA include previous hospitalisation, intravascular lines, catheters, other indwelling devices, pressure sores, underlying disease and recent antibiotics.  Antibiotics can also cause Clostridium difficile

 

-       A patient who has had an infection or has been previously colonised with MRSA, will most likely have multiple vulnerabilities.  Diabetes, cancer, or other conditions can compromise their immune systems.  They may require wound care, help with urinary catheter care or enteral feeding.  A patient with mobility difficulties can be vulnerable to pressure sores which can become infected with MRSA or other bacteria

 

The presentation demonstrated that with extra care and support from the Primary Care Trust and other agencies infection is not inevitable.

 

MRSA Action UK outlined the new challenges arising from screening for MRSA and the work needed to support patients going into hospital.  If patients are found to be MRSA positive and decolonisation is required this may cause anxieties, and the decolonisation regime will need to be carried out effectively so that the patient will be able to have their surgery.  Support for informal carers at home and for staff in care homes will need to be available, and the community Infection Control Teams will need to respond to this new challenge.

 

When analysing healthcare infections in the community it is evident that two thirds of reported cases have had prior contact with hospitals.  There is already a policy of accepting the elderly in nursing homes and residential homes who have a healthcare associated infection, and there is evidence of colonisation from patient and client contact.  Key interventions for MRSA and Clostridium difficile were covered in the presentations and challenges identified.

 

The talk also featured the Lincolnshire Care Pathways Partnership Integrated Care Pathway, and pictorial guide for patients.  A form is also available for patients or residents who transfer between healthcare providers to pass on important information about their infection status and can be downloaded here

 

MRSA Action UK's presentation is aligned to the Assessment Framework's Change Principle 1, Adopt a multi-agency approach to ensure effective co-ordination of nursing and personal care to prevent and control healthcare associated infections

 

Other useful resources featured at the event

 

Dr Bharat Patel, Consultant Medical Microbiologist at The Health Protection Agency, London introduced infection control in care homes. This provides links to a series of seven short films on The Health Protection Agency website. These are designed to provide staff with an introduction to infection control.  The web page also contains links to other resources and useful websites.