Infection Prevention (UK)

HIS Meeting Posters up to usual standard

Martin — Tue, 12 Oct 2010 17:19:24 +0000

The seventh International Conference of the Hospital Infection Society is currently taking place in Liverpool, UK and as ever the posters are proving a fertile area for new and practical work. There are some really creative pieces of work that attendees can take away and put into practice easily, hoever I was particularly struck with one from Stephanie Main, a Medical Student from Newcastle University who undertook a small-scale piece of work looking at compliance with Trust policy with regard to Urinary Catheter Management and finding that it was low. Stephanie also looked in the medical notes at the stated rationale that a urinary catheter was inserted into a vulnerable person and finding a wide range of reasons, including measurement of output and incontinence. There are other ways of managing these issues and I do wonder just how many urinary catheters are placed inappropriately and how many patients recieve antibiotics for a UTI that they would not have got if a catheter had not been passed.

The Season Approaches..

Martin — Thu, 30 Sep 2010 23:23:30 +0000

Well, we’re fast approaching ‘kick-off’ in the 2010-11 Norovirus season. After a bumper year in the previous year what will the forthcoming winter bring? I wonder if anything will come of Ben Lopman’s excellent paper in the Journal of Hospital Infection earlier this year? Will we be using the intelligence that this resource could provide that may give us an inkling of what is to come, something to pick a significant sound from the background noise? Sadly I suspect not. NHS Direct is a valuable tool that should be used as an early warning system, however will we again see a winter where wards and whole hospitals are closed? We must do more to take advantage of the opportunities that are presented to us.

HM Government abolishes key Advisory Committees

Martin — Fri, 24 Sep 2010 17:49:35 +0000

Hmm… Interesting. The BBC has managed to obtain a copy of a list of ‘quangos’ that are recommended to be abolished. Among them are ARHAI (Advisory Committee on Antimicrobial Resistance and Heathcare-associated Infections) and the Advisory Committee on Dangerous Pathogens. Still, at least there’s nothing to be worried about there then.

After all, I’m sure that ESBLs and NDM-1 will soon be a thing of the past and that the future antibiotic-wise is rosy. Without ARHAI lobbying there would be over-the-counter antibiotics for sale in the UK and they have produced a number of important reports including the recommendations on priorities for surveillance that the DH are currently considering in response to the Public Accounts Committee flack. Interestingly it isn’t mentioned in the current consultation on indicators. Am I the only one who feels slightly uncomfortable about a Government that feels it needs no impartial advice?

…. and we’re back…

Martin — Thu, 23 Sep 2010 19:50:13 +0000

Well after a two-year gap during which time I’ve been um.. rather busy it’s time to resurrect the blog. Times have changed somewhat; targets achieved, death rates down, job done. Er, possibly not. Although it was most people’s best guess that controlling MRSA and C. difficile would lead to a similar fall in other infections this hasn’t quite turned out to be true. Sensitive S. aureus and E. coli bacteraemias are on the up and there are new kids on the block. So we Infection Prevention specialists are still needed after all..

Pressure on NHS Staff not to give patients the ‘flu

Martin — Tue, 16 Dec 2008 20:54:16 +0000

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.

Children’s Laureate Poem for NHS 60

Martin — Tue, 16 Dec 2008 20:40:22 +0000

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!

Fines for HCAIs ‘Unfair’ say Experts

Martin — Fri, 21 Nov 2008 22:07:46 +0000

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.

‘The Times’ spends a day with Annette Jeanes at UCLH

Martin — Thu, 20 Nov 2008 15:38:35 +0000

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..

e-bug! Resource launched at European Antibiotic Awareness Day meeting

Martin — Tue, 18 Nov 2008 19:49:23 +0000

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.

APIC publish US C. difficile study results

Martin — Thu, 13 Nov 2008 19:01:35 +0000

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.

Pressure Sores Death Stats Published

Martin — Mon, 10 Nov 2008 22:28:24 +0000

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.

Hospital laundry workers object to washing massage parlour sheets

Martin — Sun, 09 Nov 2008 13:24:46 +0000

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?

Online vascular access training available

Martin — Fri, 31 Oct 2008 07:29:28 +0000

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

CNO England publishes ‘From deep clean to keep clean’

Martin — Wed, 29 Oct 2008 08:48:28 +0000

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

Research throws up unusual and ‘beneficial’ finding

Martin — Fri, 24 Oct 2008 13:12:28 +0000

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

C. diff falls, media recognition

Martin — Thu, 23 Oct 2008 17:35:13 +0000

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.

C. difficile in babies reported in Canada

Martin — Wed, 22 Oct 2008 22:14:31 +0000

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 Surgical Site Infection Guideline Published

Martin — Wed, 22 Oct 2008 22:02:57 +0000

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.

Welcome Statement from the Royal College of Surgeons

Martin — Sun, 19 Oct 2008 19:51:51 +0000

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.

Wales to adopt uniform approach

Martin — Mon, 23 Jun 2008 22:07:45 +0000

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..

Medicare plan to up the ante on iatrogenic events

Martin — Tue, 17 Jun 2008 19:42:06 +0000

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

Trusts own up to service deficiencies

Martin — Mon, 16 Jun 2008 21:37:55 +0000

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

Wipes in the Dock – Guilty or not guilty?

Martin — Tue, 03 Jun 2008 22:13:45 +0000

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.

Pigs raise their ugly heads.. again

Martin — Mon, 02 Jun 2008 21:43:54 +0000

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.

Watch out, Cleaner’s about: Another ‘undercover expose’

Martin — Mon, 02 Jun 2008 12:14:40 +0000

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