Infection Control Today: Perspectives

The Reformation of a National Institution
Combating the Burden of HAIs: A British Perspective
By John Hughes and Tracey Armitage

“A failing National Health Service that puts patients at risk in hospitals that are dirty and riddled with deadly bacteria.”

In Control editor Tracey Armitage presents Marcos Da Silva, MD at RMP (UK) Ltd with their award for innovation in infection control.

Unfortunately, to the less informed, and largely thanks to the media, this is a snapshot image of how the United Kingdom (UK)’s National Health Service (NHS) hospitals are perceived; a grotesquely exaggerated, over-simplified snapshot, but bad news sells newspapers and dirty hospitals, deaths from superbugs and contaminated surgical instruments are far more interesting to the public than a focus on the infinite good that the NHS achieves every day. Is it scaremongering or dutiful, good reporting?

First and foremost, the National Health Service is a phenomenal invention, and the British public needs to remember just how lucky it is to have this enormous, free facility available to it whenever it needs it.

Despite this, being admitted into a UK hospital can be somewhat of a lottery. On the one hand, we have cutting-edge, state-of-theart establishments that are at the forefront of techniques, technology, and treatments; on the other hand, we have archaic buildings that are inadequately equipped, ineffectively managed, and poorly maintained. You would be forgiven for thinking that a direct correlation exists between this and our standards of hygiene in individual hospitals, but the situation is not that simple. Some of our finest hospitals have been highlighted as those most prone to healthcare-associated infections (HAIs), and while the NHS cannot be blamed for the evolution of HAIs, it has certainly taken a leading role, with Britain’s hospitals now the worst in Europe for MRSA.

It all began in the 1940s when a euphoric welcome was given to the world’s first broadspectrum antibiotic, penicillin. Sadly, this jubilation was short-lived when only two years later there were documented cases of penicillin-resistant Staphylococcus aureus. Perhaps this was a cautionary tale for more prudent prescribing.

Today, antibiotic resistance is still a major factor in the escalating problem of HAIs, but environmental issues are far more prevalent. Dirty hospitals and poor hygiene practices are life-threatening issues and it is these that make the daily headlines and cost the NHS £1 billion annually.

Alarmingly, one in 10 patients who enter a British hospital will contract a nosocomial infection, and of those, 10 percent will die from it. Officially, this amounts to 5,000 deaths from HAIs in the UK every year – almost double that of fatal accidents on British roads. Unofficial records show the figure to be much nearer 30,000 deaths. Furthermore, forecasters predict a raging epidemic of MRSA over the next two years that will amount to a staggering 150,000 deaths. According to experts, the total number of HAIs could easily strike 1 million people during this same 24- month period. This is unforgivable. Patients have entrusted their care to hospitals that should be beyond reproach when it comes to matters of hygiene and cleanliness.

So far, public concern is only further compounded by the inconsistency and controversy that surrounds measures to prevent these deaths. Report after report of carefully researched evidence that is then camouflaged by spin doctors … the creation of hospital league tables to applaud our top-performing establishments and absurdly deprive the poor performers of the very funds they need to make them safe places to be treated … and a seemingly endless gamut of healthcare focus groups, government committees, independent trials, investigative reports, patient forums, new charters and staff initiatives. In short, a great deal has been said and written about controlling HAIs, but actions speak louder than words.

In July 2004, Dr. John Reid, secretary of state for health in the UK made a very welcome statement that hopefully heralds more positive action. In this he promised: “a new campaign — led by patients and nurses — involving all NHS staff to bring everywhere up to the level of the best.”

In support of this statement, the NHS will soon benefit from a National Infection Control Manual which will provide a blueprint for best practice at all levels; a blueprint for zero tolerance of HAIs. To make this a reality, and as Dr. Reid indicates, the culture within the NHS must also change so that every member of the healthcare team embodies responsibility and accountability: a multi-disciplinary, cross-boundary approach to a multi-faceted problem.

Accountability is something Britain’s “supermatron,” Christine Beasley, in the new role of chief nursing officer, also considers to be paramount, and a new career structure called “Agenda for Change” will see all hospital staff (except doctors who are governed by different guidelines) return to training and have lessons in basic hygiene and infection control. Basic hygiene tests must be passed and staff that do so will receive a pay rise. Those who repeatedly fail risk being dismissed.

A further requirement will be more emphasis on awareness campaigns in problem areas such as housekeeping and cleaning, handwashing, device decontamination, waste control, sharps safety, surgical-site care, and patient isolation techniques.

At last, the NHS is fighting the issues on the front line and then complementing this strategy with improved monitoring and surveillance techniques to police it.

The UK’s Association of Professionals in Infection Control (APIC) was launched to help incident-proof the scenario even further. We felt there was a definite need to take a fresh look at the situation from a more pragmatic standpoint.

APIC, alongside many other organizations, helps fight HAIs. There are no instant solutions and there are no short-term answers, but what has most recently materialised is that the NHS is moving toward a much more open and positive culture. This reform will save lives and is most welcomed by enthusiastic healthcare staff that are both ready and willing to bring about change. New practices, new products and new policies will consolidate this enthusiasm into real-life benefits.