Tackling infection: is there enough support?

This year’s report published by the Department of Health (The Health and Social Care Act 2008: Code of Practice for the NHS on the prevention and control of healthcare-associated infections and related guidance) keeps the issue of healthcare-acquired infection (HCAI) at the forefront of the NHS agenda – and rightly so. The new regulations came into force in April of this year and highlight, among other things, the increasing need to “provide and maintain a clean and appropriate environment which facilitates the prevention and control of HCAI.” Media attention has also focused on the issue, with senior figures in healthcare committing to tackling the problem of HCAIs. According to the latest data from the HPA, cases of MRSA have fallen 7% over a quarter period – 676 cases were reported between October and December 2008, compared to 725 cases in the previous quarter. Despite these gains, as the health minister, Ann Keen, recently pointed out: “one avoidable infection is one too many”. Therefore, with Government targets putting increasing pressure on healthcare services to demonstrate compliance, reduce the spread of infection and promote patient experience, is enough being done to support the staff charged with the responsibility? Furthermore, what else can be done to make sure the statistics continue to fall? While no apologies should be made for introducing strict regimes in healthcare settings to support screening and tougher cleaning standards, the Government must be mindful of the pressure it puts on frontline staff to put these policies into practice – otherwise these demands could negatively impact on patient outcomes; good intentions could lead to increasingly over-worked and under-resourced personnel; and positive policies could exacerbate the very problem they were designed to tackle. The Royal College of Nursing told a recent meeting at the Scottish Labour party conference that initiatives introduced by the Scottish Government to tackle HCAIs were putting a strain on the limited number of infection control nurses and nurse epidemiologists who work for the NHS. In my view, Carol Anne Knox – a charge nurse in NHS Lothian – was correct in her assertion that: “Senior charge nurses need to be given the authority, appropriate resources and support they need to run the ward and ensure safe and effective patient care.”

A continental approach

It is the responsibility of the whole of the healthcare community to strive for reduced levels of HCAIs but the direction, support and resources must first be in place to ensure front line clinicians have the right tools for the job. Last year’s report by the European Union highlighted the need for the introduction of two crucial amendments to existing legislation, in order to help tackle healthcare-acquired infections: firstly, an increase in screening of health workers, and, secondly, a call for an EU-wide code of conduct which would encourage increased sharing of best practice among EU countries. Surgical barrier products, drapes and gowns, provide an example of where standardisation within Europe would provide benefits. In operating theatres in other European countries it has long been unacceptable for healthcare professionals to use non-technical products (often made with traditional textiles) which do not meet with EN 13795 standards. Yet in Britain there are loopholes within the Medical Devices Directive (MDD), which exist because the MDD only applies to medical devices placed on the external market. This means that older style traditional cotton drapes and gowns, which offer little barrier protection and add an additional problem with their tendency to produce lint, can still be used, having been supplied from a healthcare facility’s own laundry (which would be deemed to be supplying an internal market). This discrepancy needs to be addressed as a priority. The argument made for using these materials would be that they provide cost benefits – but, in most cases, when a "whole cost" analysis is completed, products that meet EN13795, supplied by external companies are shown to be more cost-effective. Even where cost analysis favours the internal laundry, considering the additional expense required when a patient suffers an HCAI, and the investment the NHS is making to eradicate infection, this must surely be a false economy, as well as a dangerous practice. It should be the duty of Notified Bodies when auditing sites, or the Care Quality Commission to stamp out the use of sub-standard materials. Considering other differences between healthcare practices around Europe will provide opportunities for further recommendations relating to staff and patient safety and the information on which to base decisions on future policy.