Comment

Time to act in the fight against AMR

Katherine Murphy, chief executive at the Patients Association, calls on the government and the healthcare community to work together to combat the growing economic and human costs of inadequate infection control and the crisis of antimicrobial resistance (AMR).

Established in 2015 to address key areas of healthcare policy impact on patients, the All Party Parliamentary Group for Patient Safety, run by the Patients Association, has held an inquiry into AMR and healthcare-acquired infections. The result is the publication of our report, ‘Time to Act: Inquiry into Hospital – Acquired Infections and Antimicrobial Resistance’. Taking evidence from clinicians, academics and NHS England, the APPG has produced a broad outline of the issue and made clear recommendations for taking steps to combat it.  

The threat of AMR is nothing short of cataclysmic for medical science not only in the UK, but for every country, in every continent and for every individual. The rise in the incidence of healthcare-associated infections (HCAIs) and the increasing prevalence of AMR in the UK is a clear cause for concern. The chief medical officer, Professor Dame Sally Davies, suggests that the global costs of AMR are profound, and it has been estimated that if we do not act now AMR could account for 10 million extra deaths a year and a cumulative cost of £100tn of economic output by 2050. In addition, with the progress of AMR, these infections will become harder and more expensive to treat as the arsenal of available, effective treatments becomes more limited.  

In England, more than 6% of hospital patients acquire some form of infection during the course of their hospitalisation. This economic strain on the NHS is not irreversible, but provides a potential for NHS trusts to make savings. There is a consensus that a 15% reduction in HCAI is achievable, which would avoid costs of around £150m annually.

The Patients Association has received a number calls on its national helpline in regards to HCAIs. For instance, one caller’s mother unfortunately passed away in hospital in 2016, following a seven-week stay in hospital. After being admitted for joint pain, which was subsequently treated within a two-week period, the patient was transferred to another medical ward where problems arose as the level of care declined. This resulted in the patient acquiring four infections, with care assistants demonstrating a lack of safe care through not changing her catheter which led to urinary tract infections. The patient ultimately contracted pneumonia, leading to her death in hospital.  

Based on a comprehensive overview, the report makes a number of clear policy recommendations to the government, the Department for Health, devolved health authorities and professional bodies: 

1. The Care Quality Commission must, during its hospital site inspection, get assurance that testing and reporting algorithms are accurate, fair and represent the true burden of infections
2. Expand existing surveillance programmes to include less well-known but increasingly prevalent infections, potentially employing supplementary electronic reporting systems. Raising awareness of the scale of infections, such as those caused by CPE (Carbapenemase-producing Enterobacteriaceae), should be considered crucial in training and educating medical staff
3. Increase transparency surrounding infection statistics, making infection rates more accessible for members of the public. This could potentially include making statistics available in hospitals, wards and online in an easily-digestible form. Maintaining league tables of the most successful hospitals and clinics has the potential to be misleading. However, highlighting best practice and promoting shared learning from the best performers should be fostered and encouraged. Protecting informed patient choice by honouring their selection of care setting is a crucial aspect of this strategy
4. Working with patients, their families and visitors to ensure that infection control protocols are followed at all times is an important part of reducing HCAIs. Working with the wider healthcare community and service users should be considered in all infection control and reduction strategies
5. Standardising best practice for clinical staff and ensuring there is access to necessary equipment and consumables is integral to delivering consistently high-quality care across services and throughout the country. These best practice guidelines should be made available in an accessible way for patients and for all clinical staff. Continuing training and ongoing professional development should reflect updates to best practice
6. Changing organisational culture to eliminate complacency and establish an expectation that no infection is inevitable, and that there is ‘zero tolerance’ for preventable HCAIs and SSI (Surgical Site Infection)
7. Reducing the demand for antimicrobials by breaking the link between antibiotic prescription in primary care settings, applying and ensuring compliance with stringent stewardship guidelines and educating patients, staff and policymakers
8. Implementing rapid diagnostic technologies in primary care settings and making the case for point of care testing has the potential to revolutionise treatment and save money for the healthcare system. Setting and expectation of a diagnosis as part of anti-micro bacterial prescription can play a direct role in combatting AMR and HCAI
9. Forming an infection control covenant to share responsibility for good practice with the entire healthcare community, patients, staff and policymakers 

As previously noted, AMR is a growing issue of global concern. Decades of outmoded prescribing practices and the use of antibiotics in agriculture have driven a rise in the proportions of bacteria resistant to these life-saving drugs. As a consequence of this, the risks associated with infections in hospital and clinical settings have dramatically increased. 

The Patients Association is therefore urging the government, healthcare providers, academics and industry to acknowledge the report and its recommendations in order to work together to combat the growing economic and human costs of inadequate infection control and the crisis of AMR.

FOR MORE INFORMATION

The ‘Time to Act: Inquiry into Hospital – Acquired Infections and Antimicrobial Resistance’ report can be accessed at:

W: tinyurl.com/NHE-Patients-Association