NICE, in partnership with the Health Protection Agency (HPA), is developing advice on the prevention and control of healthcare associated infections (HCAIs) in secondary care settings as part of a pilot project. Draft advice identifies the organisational characteristics, arrangements and practices that indicate whether a secondary care Trust is effectively preventing and controlling HCAIs.
The 2009 National Audit Office report on reducing HCAIs identified four systemic issues that needed to be addressed in order to reduce infection rates – creating a culture of continuous improvement; the importance of a whole-system approach, with clear structures, roles and responsibilities, to achieve further reductions; ensuring staff compliance with good infection control practice; and monitoring and recording hospital prescription and use of antibiotics. Drawing on recommendations from the best available evidence, the draft advice consists of 12 statements and indicators that provide markers of high quality, cost-effective practice and care in the prevention and control of HCAIs in secondary care Trusts.
• Trusts should put a surveillance system in place to gather data and monitor HCAIs. The data collected is used to inform responses to HCAI incidents in a timely and appropriate manner.
• Trusts need to proactively engage with multiagency collaborations to reduce HCAIs within local health and social care organisations.
• Trusts should ensure agreed, multi-agency patient admission discharge and transfer policies provide clear, concise guidance to organisations on critical steps to take to minimise harm from HCAIs.
• Trust Boards should demonstrate leadership to ensure a culture of continuous quality improvement for minimising harm to patients from HCAIs.
• Trusts should prioritise the development of a skilled and knowledgeable workforce that has the capacity and capability to deliver continuous quality improvement to prevent and control HCAIs.
• Trusts should ensure standards of cleanliness above the national minimum requirement and should demonstrate this through visual and objective scientific measurements.
Commenting on the draft advice, Professor Mike Kelly, director of the Centre for Public Health Excellence at NICE said: “People who use healthcare services should be entitled to receive safe and effective care, and central to that is the need for effective infection prevention and control. In recent years there has been a significant improvement in the prevention and control of HCAIs, most notably MRSA and C. difficile, which has reflected the introduction of a number of policies and procedures designed to reduce rates of infection. Despite these successes, however, HCAIs still pose an unacceptably high burden, both for patients in terms of discomfort, disability and, for some, death, and for the NHS in terms of the cost of dealing with them. Good infection control practice can only be achieved with strong organisational support and commitment to implementing policies that are practicable and effective in preventing and controlling healthcare associated infections. This draft advice outlines how secondary care organisations can take a whole system approach to tackling the problem, based on the best available evidence, and focuses on organisational-level structures, activities and practices. I would encourage all those with an interest in this area to submit their comments on this draft advice via the NICE website.” The final public health advice for the prevention and control of HCAI in secondary care settings is expected to be published in November.
Photo Credit: CDC/Lois S. Wiggs/janice Carr
