Medical experts are reported on the BBC website as putting patients at risk by the potential transmission of influenza from staff to patient. It is being suggested that staff who fail to be vaccinated are placing patients in jeapordy. Reporting that the uptake this year has been poor (one in 7 seven in England and one in five in Scotland), the reasons for this are given as staff do not think they need the vaccine because they are not sick, others are put off because they mistakenly believe the jab will give them flu or are worried about side effects whilst other staff say they simply “haven’t got the time”, or just cannot be bothered to get vaccinated. I do wonder if access to vaccination sessions and a limited number of these due to hard-pressed Occupational Health departments are also implicated in poor uptake rates. The message is clear though, staff should consider vaccination, as they and their patients will benefit.

The Children’s Laureate Michael Rosen has written a poem entitled ‘These are the Hands’ for the NHS60 celebrations. You can read it, listen to it and see celebs reading sections on the Department of Health website. It is excellent!

A team from Oxford University and the Medical Research Council have expressed the opinion that the new system of fining Trusts for HCAIs that is to commence next year is inherently unfair. The article in this weeks BMJ even goes as far as arguing that under the proposed system financial penalties will be almost impossible to avoid. There are clear anomalies in the system and the authors point to a scenario where, because of the mathemetics, an organisation may have 199 cases and recieve no penalty, whereas a single extra case will push them into a fine of 2% of contract revenue which could amount to millions of pounds. Thankfully these penalties are at the discretion of PCTs, some of which may wish to look to return the penalty to the ‘offending’ organisation in a ring-fenced manner to be spent on Infection Prevention measures.

Readers of The Times this week may have seen an article covering a day that a reporter spent with Annette Jeanes, Nurse Consultant at University College London Hospital. Calling her a cross between Kim and Aggie meet Dr Death probably wasn’t the most flattering description, but it is an entertaining piece with typically honest views from Annette. I struggle a bit with Dr Gant’s description of a hospital bug multiplying so well that over a weekend it’s weight would exceed that of the known universe. Why worry about black holes appearing in Switzerland..

The Health Protection Agency’s Dr Cliodna McNulty today presented the e-bug! programme to a meeting at the Science Museum in London. The teaching pack is being launched to coincide with the first European Antibiotic Awareness Day Conference hosted by the Advisory Commitee for Antimicrobial Resistance and Healthcare-associated infection (ARHAI).

The HPA’s new e-Bug! teaching resource uses interactive games and lesson handouts to explain the need for prudent antibiotic use and will be made available to schools across the UK and the rest of Europe from 2009. The programme has already recieved some positive media coverage from the BBC.

The Association for Professionals in Infection Control (APIC) have published the results of a study looking at Clostridium difficile in inpatient facilities. Data shows that 13 out of every 1,000 inpatients in the survey were either infected or colonised with C. difficile (94.4% infected). This rate is 6.5-20 times higher than previous incidence estimates that were more limited in scope (one hospital or hospitals in one state and used different methodologies). You can find the results of this interesting piece of work here.

The Press Association have reported on a parliamentary question tabled by Lib Dem MP Paul Burstow which looks at the numbers of patients where pressure sores were reported as at least a contributory factor. These wounds are sometimes implicated in significant bacteraemic events, including MRSA. Hansard records show that there are in excess of 900 cases annually, with the North-West of England having the highest number of cases in all but one of the reported years. Surely it is about time that these preventable events were tackled head-on. Bed sores are avoidable and many would feel that they are a significant measure of quality of care. The numbers of deaths are surely only the tip of the iceberg, however there is no data on the exact size of the problem exists.

Preventing these events makes sense in terms of reducing morbidity and mortality, economic sense in reducing nursing time taken performing dressing changes and the dressing materials themselves and ecological sense as many of these wounds may be treated with antibiotics, leading to increasing resistance.

There is evidence that the media are now latching onto this issue and raising the profile of Tissue Viability and Wound Care can only be a good thing.

The Manchester Evening News reports that workers in the contracted out laundry in South Manchester have complained about the risk of contracting Hepatitis B from laundry sent by a local massage parlour that it had a contract with. Given that they are handling hospital laundry routinely, should the workers not have been vaccinated against this disease as a matter of course?

Thanks to Andrew Jackson for flagging up that the NHS Core Learning Unit package for online vascular access training is now available. The address of the site is http://www.corelearningunit.nhs.uk/. This will be a useful resource for those who have to use these important invasive devices in their cinical practice

The Department of Health have published a new report that looks back at the Deep Clean programme and provides a series of case studies that look at different aspects of how a programme was implemented and how it will be sustained. You can download the document here

Well it’s friday afternoon and I thought I’d share something that is not infection-related. As many might know, my lectures over the years have often referred to human gaseous emissions. Researchers have now found out that a component of this gas, and in particular the component related to the smell of rotten eggs, is in fact potentially beneficial in terms of reducing blood pressure. Thus men over the years have actually been protecting their partners with these helpful emissions and have been signalling their presence with an indicator chemical. Perhaps time to re-look at the expression ’silent but deadly’..

Researchers are now to look for ways forward – perhaps a staple diet of Guinness and balti chicken jalfrezi would be good for the collective blood pressure of the nation in these difficult times, althought what the effect on global warming would be I don’t know

The latest figures from the Health Protection Agency show a 37% fall in the number of reported cases of C. difficile when compared with the same period (April – June) in the previous year. This has at last been reported in a positive way in the media. Cause for celebration? No. Cause for optimism? Possibly, if this is sustained. There is now every chance that the DH Target of a 30% reduction could be met in the first year. That would be good news; not because the target would be met, but because it would demonstrate that effective Infection Prevention and Control produces tangible benefits for the NHS and not least to the patients. The achievement of significant reductions in healthcare-associated infections should be a wake-up to those who feel that healthcare infections are an inevitable consequence of treating an increasingly ageing population with ever more invasive methods.

The message is clear. Infection Prevention and Control works; for patients and their families, for individual organisations and for the NHS as a whole.

A newspaper has repoted a cluster of infection in babies in a neonatal unit in Canada. It will be interesting to see if this is an actual or pseudo-outbreak, as this organism is not thought to cause clinical infection in the very young. If this is a true cluster it could be evidence of changing epidemiology in this important infection. You ca find the story here.

NICE have published the guideline for Surgical Site Infection. You can find the guideline in all it’s forms here. This publication is welcome after a long and difficult gestation and has been produced under the expert Guideline Development Chairmanship of Professor David Leaper. The report makes recommendations for further studies that are required in order to fully assess the clinical effectiveness of many interventions for which no recommendation could be made.

I wholeheartedly welcome the policy statement last week from the Royal College of Surgeons of England. The key sentence was as follows.

“Intuitive interventions that have no evidence base and whose implementation does not harm patient safety or outcomes should be accommodated where practically possible, though priority should be given to evidence-based best practice. For example, surgeons should adhere to the ‘bare below the elbows’ policy contained within the 2008 hygiene code when in direct contact with patients.”

We understand that there isn’t the evidence to prove that this will be effective, however this is a most welcome statement and I look forward to a similar common-sense response from the rest of the Colleges. You can find the Policy Statement in whole here.

The NHS in Wales is about to implement the findings of a working party that has recommended a consistent approach be adopted country wide reports the BBC. It will be interesting to see the final report when published and if there is any movement on the provision of changing facilities that are so sadly lacking in most healthcare establishments.

Still, at least there’s a solid evidence base that shows that this will reduce infection..

The Medicare system of healthcare provision in the USA is preparing to increase the number of conditions that will not be paid for under the system. As hospitals cannot levy any resulting charge on the patients themselves they must therefore bear the cost of these events themselves.

The conditions that kicked off this process in Oct 2007 were

• Object inadvertently left in after surgery
• Air embolism
• Blood incompatibility
• Catheter associated urinary tract infection
• Pressure ulcer (decubitus ulcer)
• Vascular catheter associated infection
• Surgical site infection- Mediastinitis (infection in the chest) after coronary artery bypass graft surgery
• Certain types of falls and trauma

The latest proposals will add in another nine conditions if aproved and will serve to strengthen the patient safety agenda, placing prevention right at the forefront of hospital safety programmes

• Surgical site infections following certain elective procedures
• Legionnaires’ disease (a type of pneumonia caused by a specific bacterium)
• Extreme blood sugar derangement
• Iatrogenic pneumothorax (collapse of the lung)
• Delirium
• Ventilator-associated pneumonia
• Deep vein thrombosis/Pulmonary Embolism (formation/movement of a blood clot)
• Staphylococcus aureus septicemia (bloodstream infection)
• Clostridium difficile associated disease (a bacterium that causes severe diarrhea and more serious intestinal conditions such as colitis)

This would concentrate minds somewhat

And this is actually good news. The Healthcare Commission today have published the compliance declarations of NHS Trusts in England and a large number are being open and honest about the current state of play. Athough this has been presented in the media as yet another set of failures, the fact that Trusts are openly acknowledging non-compliance means that robust action plans are being prepared that can be monitored and progress demonstrated. I would be more worried about organisations that state compliance when they are not as recognition and acknowledgement of problems is the first stage of remedying them. Patients should feel reassured that their local hospitals are being open and honest on this issue.

To me it’s a bit like choosing where to eat on an evening out. I would actually choose to eat in an establishment that has recently been prosecuted for failing a food standards inspection as if they are open you could be absolutely guarantee that standards are now being met through the inspection process and you may not be able to say this about every eatery in town.

Of course, this is the first stage in this process as these declarations have yet to be ratified by the Healthcare Commission through cross-checking and it will be interesting to see how many organisations have overstated their position, for examples some may have declared compliance with reductions in MRSA when having overshot the target by some distance when the final figures are known

The BBC website has reported on a paper presented in the USA by scientists from the Welsh School of Pharmacy that looks at the possibility of the mis-use of wipes being a possible vector for MRSA. I suppose this is possible, but as usual, if items such as these are used correctly then the risks should be minimal. Staff who have had the apporopriate training and who are motivated to implement what they’ve been taught will reduce the risk of this occurring. Papers such as these are useful in demonstrating the risks to those who can become blase about good practice and it is good to see that the BBC sought comments from Tracey Cooper from the Infection Prevention Society.

The first reported cases of the ST398 strain prevalent in dutch swine have been recorded in adults in Scotland reports The Daily Mail. Formerly The Soil Association have reported on this in 2007 and produced a report that makes for interesting reading. The Mail amongst others reports that these cases in humans in Scotland are not related to contact with pigs (well not living ones anyway) and it will be interesting from an epidemiological angle to determine where this strain was acquired from. Until now cases in humans have normally been related to contact with livestock. There is at least one report of a hospital cluster of colonsation in staff with this strain, which is non-typable and commonly resistant to Tetracycline (Oxytetracycine is commonly used in pigs in Holland).

Could the food chain be a vehicle? High standards of food hygiene should be adequate to reduce the risk of transmission from meat to a minmal level and as long as hand washing takes place after handling raw meat and thorough cooking takes place then there should be no problem. As ever, high standards of hygiene are our protection from disease.

Yet again another Hospital has fallen to a secret camera concealed about the person of an agency cleaner. BBC Wales will broadcast the story tonight at 7.30pm tonight. The report will highlight the following: No training, no CRB checks, no time to clean etc.

So, a completely new set of findings then.. I know that on the face of it this will look dreadful, but I do wonder just how much footage was shot in order to make the final version. It would be nice to know so that a balanced view could be made.

Still, as they say, all publicity is good publicity; especially in the battle to reduce HCAI

The Office for National Statistics has published death rates for each NHS organisation in England and Wales, along with total deaths for each. The headlines, as usual, do not match the story. Take the Grauniad for example: “Superbug hospitals named and shamed”. I wonder if the headline writers ever read the article before putting pen to paper. The problems with this headline are many.

• The data relates to deaths where MRSA or C. difficile are mentioned and are not necessarily the primary cause of death
• Deaths related to these organisms where they are not mentioned on the death certificate are not counted
• The data relates to where the death was recorded
• The data does not relate to where the infection was acquired
• Most of the deaths related to people over 85 years of age who had multiple courses of antibiotics for other medical conditions

All preventable deaths from these important investigations should be thoroughly investigated in order to look for opportunties to improve practice and protect the vulnerable. Unfortunately the completion of death certificates was not particularly god at the time of the collection of these statistics. Hopefully the guidance produced by the Chief Medical Officer in 2007 will lead to better data on which firmer conclusions can be drawn.

In case you missed it at 7.20 this morning the Radio 4 ‘Today’ programme has looked at the ‘Superbug’ problem in a very sensible manner. No surprises for guessing who one of the contributors was but worth listening to one of the contributors digging himself expertly out of a hole. If the links stops working, the programme is available on the R4 Today website for the next seven days

The media have been exercised by stories of a cure for MRSA over the weekend. On further scrutiny this turns out to be a nasal gel for carriage. Useful I’m sure but will it save 1600 lives annually (so reports the Record). Other reports are more guarded with an extremely sensible response from Derek Butler from MRSA Action UK. Yes, a new treatment for MRSA colonisation of the nose would be very welcome.

A cure for MRSA? No

The BBC have reported that the attempt by lawyers acting on behalf of the Greater Glasgow Health Board have failed in their bid to have a claim for healthcare-acquired MRSA thrown out prior to the full hearing stage. The case seems to centre on claims of poor hand hygiene and failure of hand hygiene facilities and supplies (Times article). It will be very interesting to follow this case (if and) when it reaches trial to see what the implications for the Health Services in the UK are.

Things seem to be moving in this way over the water in Ireland also, with a healthcare worker who contracted MRSA whilst undergoing treatment being awarded a six-figure out-of-court settlement.