To tackle antimicrobial resistance (AMR), there must be an increased focus on infection prevention, healthcare leaders warned at NHS England's IPC AMR conference. However, it will require a more 'integrated approach' between hospitals and the community...
At NHS England’s Infection Prevention & Control 2020 conference, antimicrobial resistance (AMR) topped the agenda. The Corona virus, Covid-19, has dominated the headlines, in recent weeks. AMR commands significantly less attention in the National press – despite posing a much greater existential threat to mankind in the long-term.
Somewhat overshadowed by the media panic around the new “killer bug from China”, an awareness campaign has been running across the UK to tackle the issue of AMR, with the slogan: “I’m a resistance fighter”. It was clear from the conference that, while Corona virus is one of many battles that we must fight, AMR is the war that we must all win.
Speakers at the conference re-iterated that one of the most important weapons in our armoury is infection prevention. Professor Stephen Powis, National Medical Director, NHS England, commented: “AMR and infection prevention are two sides of the same coin. The simplest way to tackle AMR is to prevent infections in the first place.”
He highlighted the National Action Plan to reduce resistant infections by 10%, halve healthcare-associated Gram-negative blood stream infections and reduce antibiotic use in humans by 15%.
“In terms of antibiotic prescribing in primary care, we are doing relatively well – between 2013 and 2018, there was a reduction of 13%. There is more work to be done, but we have made good progress. We are doing less well in secondary care, where there has been an increase of 8%. We also continue to see an increase in resistant bloodstream infections (up 35%),” commented Powis.
Gram-negative bloodstream infection, in particular, are becoming a key focus and the Government has introduced a target as part of the 2020/21 Standard Contract to tackle the problem. Providers will be required to commit to reducing E.coli, P.aeruginosa and Klebsiella spp. However, the current regime of financial sanctions for MRSA and C.diff will be removed, as the system attempts to move away from a ‘punitive’ approach.
Efforts to reduce community-onset infection will be intensified and there will be a continued focus on urinary tract infections (including CQUIN for patients with catheters). Linda Dempster, head of infection prevention and control, NHS England, pointed out that UTI is a significant risk factor for Gram-Negative bloodstream infections (accounting for 50%), making this a priority area for improvement.
Dempster added that 80% of cases of E.coli, 70% of Klebsiella and 61% of P.aeruginosa originate in the community. Tackling Gram-Negative bloodstream infections will require working collaboratively across boundaries, between health and social care, therefore. Care homes, GPs and community health professionals will need to be part of the solution. An integrated healthcare approach will be challenging, but must become a priority.
There is still a great deal that hospitals can do to tackle AMR through infection prevention. A simple, 10-point surgical site infection (SSI) prevention bundle reduced SSI from 63% to 30%, when introduced at Oxford University Hospitals’ Hepato-Pancreato-Biliary (HPB) surgical unit. Giles Bond-Smith, general emergency and HPB surgeon, from Oxford University Hospitals revealed that this also had the benefit of improving times to chemotherapy for cancer patients and reducing stay. When implemented on other departments, the results were equally impressive. As the bundle saved over £1 million, the financial benefits of introducing these infection prevention efforts proved to be significant.
Compliance with aseptic technique and hand hygiene were also highlighted as ongoing challenges. Unlike training in CPR, practical training in aseptic technique is poorly implemented across NHS Trusts; staff are simply ‘told they must do it’ and not shown how, said Stephen Rowley, the clinical director of ANTT – a healthcare initiative that aims to standardise aseptic technique.
The conference and exhibition provided an insight into technologies, approaches and strategies aimed at improving infection prevention behaviours – from the single standard aseptic non-touch technique – known as ‘ANTT’ (adopted by 81% of Trusts in England, 100% of Trusts in Wales and 51% of Trusts in Scotland), to a hand hygiene simulator tool (Surewash) designed to improve proficiency in the WHO hand hygiene technique. Gerard Lacey revealed how the University of Dublin has used the technology as part of a five-day induction for physician assistants, to assess competency.
The conference, organised by Knowlex, in association with NHS England, took place at the National Conference Centre, Birmingham.
