Complex issue of healthcare acquired infections
Health care acquired infections are of immense concern to patients and members of the public.
Perhaps surprisingly the levels of HCAIs actually remain lower in Northern Ireland than in England and Wales.
While generally the focus is on hospitals, infections can be acquired in the community, nursing homes and all other health institutions.
Most people are now aware of MRSA but a different infection, Clostridium difficile, was responsible for the recent outbreak within the Northern Trust area.
Departmental officials have appeared before the Health Committee to update members and answer questions.
Much has been done already but there are other important measures to be pursued. An additional 9 million is being made available.
The reporting of these infections must improve. For years, there was disparity across different Trusts in how they were recorded on death certificates.
More restrictions on relatives visiting patients are envisaged, with exceptions made for the very ill, elderly and children.
However, increasingly visitors have been assisting with tasks such as feeding the patient while nursing staff are stretched with other patients or completing paperwork.
The level of cleanliness is only one aspect of a complex problem.
However, cleanliness must be rigorously enforced. The potential implications of contracting out cleaning services have been discussed by the committee.
Members of the public are critical when they see nurses and other health workers out shopping, for example, in their uniforms.
The dress of staff is important, as are their designated changing areas. Items as insignificant as doctors' ties can carry infection.
In other parts of Europe, doctors and other health staff in all hospital departments wear blues or greens, such as theatre staff would be seen in here.
Staff change into these on arrival for work and leave them behind when they are heading home. Further information would be required on the resources implications of introducing a similar practice.
It will never be possible to eradicate these infections, but their rate can be reduced.
Decreasing
Progress has been made in decreasing health care acquired infections in other parts of the world.
There are comparatively low rates of MRSA, for instance, in the Netherlands where, a 'search and destroy' policy has been pursued. The Dutch have strict policies on antibiotic prescribing and firm guidelines on screening and isolation.
The inappropriate use of broad-spectrum antibiotics is a key problem. Some bacteria become resistant to antibiotics, because the drugs have been prescribed inappropriately.
An extra pharmacist is now to be employed by each trust to seek to eradicate poor antibiotic prescribing. All trusts ought to have rigorously-enforced protocols on the use of broad-spectrum antibiotics.
In March 2006, the Department published Changing the Culture: An Action Plan for Prevention and Control of Healthcare Associated Infections in Northern Ireland 2006-9.
A detailed assessment must be made of the actions which have resulted, what difficulties there are in implementing actions, and what progress has been achieved. There is also a Ward Sister's Charter in existence.
The National Audit Office determined eight years ago that acquired infections cost approximately 1 billion per year in England.
NHS Quality Improvement Scotland found in 2004 that they cost over 186 million per year in Scotland.
It is estimated that three million people are affected by healthcare associated infections across the EU annually, with 50,000 deaths resulting.
Across the water, the Government has already admitted they are unlikely to meet the MRSA reduction targets they set themselves.
There is much more to patients acquiring infections than merely cleanliness. Invasive procedures, high bed occupancy rates, increased transfer of patients, low staff to patient ratios and admissions all contribute.
Many of those who die from health care acquired infections are elderly with compromised immunity and multiple major illnesses.
DHSSPS have committed to ensuring single rooms for new hospitals and where possible in future, major refurbishments.
Inspections
The new acute hospital in South West will be the first new-build hospital to have single rooms for all appropriate patients. Unannounced hygiene inspections will occur at all hospitals. High risk patients such as those in Intensive Care, neonatal and renal units will be screened for MRSA as well as those undergoing elective orthopaedic surgery and vascular grafts.
There will be rapid response cleaning teams at all hospitals and a regional hand hygiene campaign.
Five new Infection Control Nurses will be employed by the Trusts. The Infection Control performance of Trusts will be monitored more closely with statistics published each quarter. However, it is clear that infection prevention and control is everyone's responsibility.
It remains to be seen what impact the new measures from DHSSPS will have. Many have already been tried to a greater or lesser extent with little real evidence of improvement.
The Health Minister has committed to reducing MRSA by 10 per cent and Clostridium difficile by 20 per cent. It represents a challenge for everyone across the health sector.
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