Infection Control Today: Perspectives

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

Afailing National Health Service that puts patients at risk in hospitals that aredirty and riddled with deadly bacteria.

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

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

Despite this, being admitted into a UK hospital can besomewhat of a lottery. On the one hand, we have cutting-edge, state-of-theartestablishments that are at the forefront of techniques, technology, andtreatments; on the other hand, we have archaic buildings that are inadequatelyequipped, ineffectively managed, and poorly maintained. You would be forgivenfor thinking that a direct correlation exists between this and our standards ofhygiene in individual hospitals, but the situation is not that simple. Some ofour finest hospitals have been highlighted as those most prone tohealthcare-associated infections (HAIs), and while the NHS cannot be blamed forthe evolution of HAIs, it has certainly taken a leading role, with Britainshospitals now the worst in Europe for MRSA.

Time to Act

It all began in the 1940s when a euphoric welcome was given tothe worlds first broadspectrum antibiotic, penicillin. Sadly, this jubilationwas short-lived when only two years later there were documented cases ofpenicillin-resistant Staphylococcus aureus. Perhaps this was a cautionary tale for more prudentprescribing.

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

Alarmingly, one in 10 patients who enter a British hospitalwill 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 showthe figure to be much nearer 30,000 deaths. Furthermore, forecasters predict araging epidemic of MRSA over the next two years that will amount to a staggering150,000 deaths. According to experts, the total number of HAIs could easilystrike 1 million people during this same 24- month period. This is unforgivable.Patients have entrusted their care to hospitals that should be beyond reproachwhen it comes to matters of hygiene and cleanliness.

So far, public concern is only further compounded by theinconsistency and controversy that surrounds measures to prevent these deaths.Report after report of carefully researched evidence that is then camouflaged byspin doctors the creation of hospital league tables to applaud ourtop-performing establishments and absurdly deprive the poor performers of thevery funds they need to make them safe places to be treated and a seeminglyendless gamut of healthcare focus groups, government committees, independenttrials, investigative reports, patient forums, new charters and staffinitiatives. In short, a great deal has been said and written about controllingHAIs, but actions speak louder than words.

Zero Tolerance

In July 2004, Dr. John Reid, secretary of state for health inthe UK made a very welcome statement that hopefully heralds more positiveaction. 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 aNational Infection Control Manual which will provide a blueprint for bestpractice at all levels; a blueprint for zero tolerance of HAIs. To make this areality, and as Dr. Reid indicates, the culture within the NHS must also changeso that every member of the healthcare team embodies responsibility andaccountability: a multi-disciplinary, cross-boundary approach to a multi-facetedproblem.

Accountability is something Britains supermatron,Christine Beasley, in the new role of chief nursing officer, also considers tobe paramount, and a new career structure called Agenda for Change will seeall 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 awarenesscampaigns in problem areas such as housekeeping and cleaning, handwashing,device decontamination, waste control, sharps safety, surgical-site care, andpatient isolation techniques.

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

Building Solutions

The UKs Association of Professionals in Infection Control(APIC) was launched to help incident-proof the scenario even further. We feltthere was a definite need to take a fresh look at the situation from a morepragmatic standpoint.

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