Patient safety

The war on HCAI

Paul Fredericks, head of specialist statutory regimes at the Healthcare Commission

Healthcare associated infections have added to the daily challenges that hospital staff face.

It is no secret that the NHS has struggled to deal with the likes of MRSA and clostridium difficile.

Catching such an infection is also a genuine and frightening concern for patients.

Each statistic we see on rates of infection represents real patients who suffered what was often a preventable illness.

There was no question, therefore, that we needed a change of culture to restore public faith in this aspect of NHS performance; safety and infection control had to be placed at the very top of the priority list for every healthcare organisation.

The Healthcare Commission has contributed to a drive to ensure that there is consistent attention to infection control, for every patient, in every moment of healthcare.

In June we announced the biggest programme of inspections to prevent and manage healthcare associated infections. This will involve visits to 120 NHS trusts to check compliance with the government’s hygiene code.

The code, which came into force one year ago, outlines 11 compulsory duties that aim to prevent and manage healthcare associated infections.

For example, trusts are required under the code to have in place appropriate management systems for infection prevention and control. There should be regular reports for the board providing ‘board to ward’

accountability for reducing risk of infection and provide a clean and appropriate environment for patients.

We are using data on rates of infection, as well as a range of other data collected throughout the year, to identify trusts that may not be meeting requirements and are targeting visits accordingly.

Visits are unannounced so we can see the hospital in action. What we are looking for is whether trusts are taking infection control seriously. Is it a key part of their day-to-day business? Could it effectively manage an outbreak should it occur and reduce risk to all patients?

Teams of assessment managers look at the cleanliness of the hospital’s environment as well as practices and procedures that are in place to prevent and manage infection. For example, they may look at procedures for isolating patients, hand hygiene and for cleaning equipment.

So far we have visited some 40 trusts and have found many examples of good practice. These confirmed that all trusts have a designated director of infection control who is accountable to the board and systems in place to ensure all relevant staff are appropriately trained in infection control.

We’ve also issued recommendations to some trusts, which are mostly compliant with the hygiene code, but need to address certain issues. These, for instance, have urged managers to ensure healthcare-associated infection information is circulated at ward level to help inform clinical decisions and we asked for systems to inform staff of investigation outcomes to ensure learning from incidents.

Where assessment managers identify serious breaches of the code, it will publicly issue an “improvement notice”, which requires trusts to take the action that is necessary.

The first improvement notice was issued in July, requiring the trust to rectify problems in the training of staff, lack of knowledge about procedures for isolation and poor hand hygiene by the end of August.

If a trust does not adequately respond to an improvement notice, we can ask the secretary of state or Monitor to impose special measures and oversee a programme of improvements in the trust.

Inspection reports from the 120 visits will be published monthly on the Commission’s website at www.healthcarecommission.org.uk.

The hygiene code visits form just one part of our broader programme to reduce healthcare associated infections in healthcare organisations.

Every trust visited as part of the annual health check, which gives a performance rating to every NHS trust in England, is being assessed on core standards that relate to infection control.

We are also driving improvements in how healthcare organisations prevent and manage outbreaks of infection by identifying best practice.

In July, we published a national study into healthcare associated infection that outlines comprehensive practical advice for trusts to consider in their attempts to reduce rates of infection.

Ultimately, there must be a clear commitment from the trust’s board to infection control. There must be staff designated to infection control with the time to commit to it. There needs to be regular analysis of what is happening in the trust by the board and staff, scrupulous attention to cleanliness, and policies on isolation, management of beds and the prescribing of antibiotics.

Trusts must also remember that amid the complexity and the array of competing priorities, the safety of patients is paramount.

Many trusts have developed systems of infection control that are integrated into every aspect of healthcare, from the way the board operates, right through to the frontline of healthcare delivery.

We are beginning to win some battles. Rates of MRSA are declining and clostridium difficile is now rising less quickly. Meanwhile, patients are reporting improvements in hand hygiene and cleanliness of the hospital’s environment.

But there is no quickfix solution to healthcare associated infection.

The struggle is ongoing.

We must restore confidence and provide assurance to patients that hospitals are doing all they can to minimise rates of infection.

It is a challenge that we all face together: trusts, strategic health authorities, representative bodies, regulators and government.

Tell us what you think – have your say below, or email us directly at [email protected]