interviews

Tackling infection prevention locally

Dr Emma Burnett, a lecturer and researcher in infection prevention at the University of Dundee’s School of Nursing and Midwifery and a board member of the Infection Prevention Society (IPS), talks to NHE’s David Stevenson about the need for a local approach to tackling infection prevention.

In 2007, MRSA bloodstream infections and Clostridium difficile infections (C. diff) were recorded as the underlying cause of, or a contributory factor in, approximately 9,000 deaths in hospital and primary care in England, according to a report by the National Audit Office. But since then, investment in infection prevention and control (IPC) teams and services have made a significant contribution to the successful control of these two important infections. 

Despite the success, where health organisations have seen the numbers of MRSA bloodstream infections and C. diff infections falling by 57% and 45% since 2010, earlier this year the IPS issued a statement calling on health providers in the UK to maintain investment to “prevent serious risk to patient safety”. 

This was because a survey of the society’s members revealed that almost a third had seen a reduction in the IPC services where they work, with over a quarter reporting a reduction in IPC posts or hours. 

Dr Emma Burnett, a board member of the IPS, told NHE that one of the biggest challenges going forward is maintaining and building on the achievements of the last 10 years. 

“Year-on-year, we have seen a remarkable reduction in MRSA bloodstream infections, which is really fantastic, and there has been a reduction in C. diff infections,” she said. “We have made some really big achievements there. I think one of our biggest challenges is that we can’t afford to take our eye off the ball, and we need to sustain the progress that has been made and then continue to make further improvements. 

“We have seen reduced MRSA and C. diff infections, but we are seeing increasing numbers of gram-negative bloodstream infections – and quite a significant increase. That is really due to the increase in resistant organisms that we have seen – E.coli has been the main one – but that is causing us a lot of problems at the moment.” 

In England, the government has introduced an aim to reduce gram-negative bloodstream infections by 50% by 2021, “and that is a significant reduction that we have to focus on”, according to Dr Burnett. 

As highlighted in the IPS member survey, Dr Burnett stated that healthcare professionals, within hospital and community settings, are under extreme pressure.

As well as staffing issues, they are dealing with complex care and doing a lot more work with less resource, she explained: “From an IPC point of view, we need to promote a positive culture within our healthcare organisations and, actually, make it easier for people to do the right thing – so making sure that they have the equipment, the resources and the training so they are equipped and competent in dealing with the complexities that we are seeing.” 

Discussing funding cuts to public health budgets and working closer with local authority and commissioning partners, Dr Burnett admitted that there had been quite dramatic cuts to funding, but argued that “there is a lot you can do despite this”. 

“Ultimately, we are striving to achieve the same thing,” she explained. “It is very tense and difficult, but it is about having a strong commitment from everybody, not working in siloes, and working together within organisations, with stakeholders and with the wider organisations. 

“You need to have a real strong leadership there to streamline that support across organisations and between them to embed that concept of leadership.” 

Tackling infection locally and in community settings 

Another challenge is that there needs to be more of a focused approach in community settings. 

“It is a natural assumption that most of these infections are hospital-acquired, but actually many can have a community onset,” she told us. “We have to have a real focus on community settings, so tighter antimicrobial stewardship and more preventative measures in the community so patients don’t have to come into the hospital and so they don’t need antibiotics.” 

Dr Burnett, who has specialised in IPC since 1996, added that a one-size-fits-all approach is not appropriate for tackling infection prevention, “because locally, nationally and globally we have our own issues and problems depending on the infrastructure, settings, the patient group and the complex conditions”. 

Asked about the importance of the ‘Infection Prevention and Control Commissioning Toolkit: Guidance and information for nursing and commissioning staff in England’ to provide support for healthcare professionals, NHE was told that the resource is there for organisations to take and adapt to their own needs. 

“Although we have some level of consistency in what we are looking at and striving to achieve, the toolkits and guidance we have, and the documentation we have, are all there for local organisations and teams to adapt to meet and address the needs in their area,” said Dr Burnett. “There is no point having a one-size-fits-all approach when maybe an organism or issue isn’t prevalent or appropriate in one organisation. That is one of the beauties with IPC teams and the expertise we have within the IPS; we have a lot of expertise in a lot of different areas of healthcare-associated infections (HCAIs) and IPC.” 

© PeopleImages

Antimicrobial stewardship, patients and IPS support 

We have made huge progress on the antimicrobial stewardship agenda, and it isn’t just about antibiotic prescribing – it is about making sure that every single healthcare worker has a role in antimicrobial stewardship, reflected Dr Burnett, adding that the work is about reducing the need for prescriptions through IPC and preventive care. 

The other really important key in taking IPC strategies forward is engaging patients and the public, and ensuring that the healthcare profession is able to communicate the right information to the right people. 

“People are informed about HCAIs and infection control issues more now than they have ever been,” she added. “It is important to use their perceptions and experiences, and making sure they are part of the team and that they are taking responsibility for reducing infections; for example, by following the guidance they receive when they are prescribed with antibiotics, not stocking up on antibiotics, and engaging them. It should not be a ‘them and us’ situation.” 

Asked about the ambition to halve gram-negative bloodstream infections by 2021 and the support the IPS can provide, Dr Burnett noted that the society’s vision says it all: “that no person is harmed by preventable infection”. 

Speaking to us ahead of the IPS Annual Conference, which took place on 18-20 September, she said: “We have a huge community of experts, educational opportunities, and we conduct lots of research and support international activities. 

“Going forward, it is about supporting organisations on a local, national and global basis to embed best practice IPC in healthcare. We have a huge network within the IPS, and it again goes back to not working in siloes.

 “Sometimes, if we have issues ongoing at a local level, another organisation elsewhere could have already experienced this and found the solution. It’s all about talking to each other and finding out what works and doesn’t. One of the key issues is that we need to look within organisations and identify what is going well, and learning from this. There is a lot that we do that works really well.”

FOR MORE INFORMATION

W: www.ips.uk.net

Top Image: 

© turk_stock_photographer