Scary subject, I have seen the result of an HAI when “M” was in Grimly Dark hospital, the hospital knew she had MRSA in her nasal passages 23 days before it entered her blood but did bugger all about it; the reason given was that would cost too much.
Following the “emergency” surgery to repair a cut bowel and a leaking anastomosis, the MRSA caused the wound from the surgery to grow to 17cm by 5cm, while she lay in ICU, I suppose “M” was ‘lucky’ to survive only to die from undiagnosed bowel cancer.
HAIs are still a massive problem for patients:
There is
This from the Taxpayers alliance.
And the Committee of Public Accounts
has issued this, I don’t know the date.
1. Hospital acquired infections are those that are neither present nor incubating when a patient enters hospital. Their effects vary from discomfort for the patient, to prolonged or permanent disability and even death.[1] This is a very serious subject in terms of the impact on patients and costs to the National Health Service. The best estimates we have suggest that each year there are at least 100,000 cases of hospital acquired infection in England causing around 5,000 deaths, and the cost to the NHS may be as much as £1 billion a year.
2. Not all hospital acquired infection is preventable, since the very old, the very young, those undergoing invasive procedures and those with suppressed immune systems are particularly susceptible.[
2] In his report the Comptroller and Auditor General estimated, from information provided by infection control teams in hospitals, that across all NHS Trusts infection rates could be reduced by 15 per cent by better application of existing knowledge and realistic infection control practices. Attributing costs to hospital acquired infection is complex and uncertain but the potentially avoidable cost is around £150 million a year.[
3] On the basis of his report we took evidence from the NHS Executive and the Chief Medical Officer on what was known about the extent, cost and effects of hospital acquired infection and how infection control could be improved.
3. Two overall points emerge from our investigation:
The NHS do not have a grip on the extent of hospital acquired infection and the costs involved and are unlikely to have the information they need for a further 3 to 4 years. Without robust, up to date, data it is difficult to see how the Department of Health, the NHS Executive, health authorities and NHS Trusts can target activity and resources to best effect. This lack of data mirrors our concerns about significant weaknesses in NHS information and systems that have arisen in our recent hearings on medical equipment; inpatient admissions, bed management and patient discharge; and hip replacements. Effective information is essential for good management and effective health care, and central to NHS modernisation.
A root and branch shift towards prevention will be needed at all levels of the NHS if hospital acquired infection is to be kept under control. That will require commitment from everyone involved, and a philosophy that prevention is everybody's business, not just the specialists. Leadership and accountability, through the new controls assurance process, is crucial, as is education and training, and monitoring of performance and progress. New investment is also needed. The NHS Executive have launched an array of initiatives to help make this happen, but the results have yet to work through, and we are not convinced that the Executive have given these initiatives sufficient priority when allocating resources.
On improving infection control
(iii) The NHS Executive acknowledge that it should be possible to reduce the incidence of hospital acquired infection by 15 per or more, avoiding costs of some £150 million and saving lives. Since 1996, and particularly since 1998, the NHS Executive have taken a series of actions and initiatives to address this issue, but do not expect to see tangible, measurable progress until 2003. Such progress will be essential for the NHS to meet their duty and commitment to patients (paragraph 45).
(iv) Key to achieving progress will be the effective implementation of the new Controls Assurance System, which builds on the statutory duty of chief executives for quality of care. This will raise the profile of hospital acquired infection, especially in the 20 per cent of Acute NHS Trusts that do not have a strategy for dealing with it. Every Trust has to have a plan in place by July 2000 setting out priorities for action and produce an annual report on progress. We look to the NHS Executive to let us have an initial summary report of progress, priorities and key issues by the end of April 2003 (paragraph 46).
(v) Complacency, poor prescribing practice and misuse of antibiotics has led to the emergence of drug resistant infections. As the Chief Medical Officer told us, there are no simple solutions any more. The NHS Executive have now launched initiatives to look at the more prudent use of antibiotics, and to monitor and control prescribing including the new Government strategy to tackle antibiotic resistant infections announced in June 2000. We expect this work to lead to evidence-based guidance on effective prescribing strategies (paragraph 47).
(vi) Hospital hygiene is crucial in preventing hospital acquired infection, including basic practice such as hand washing. We find it inexcusable that compliance with guidance on hand washing is so poor. We note the steps the Executive have now taken to improve awareness and education, but look to them to audit progress and report back to us by the end of 2001 (paragraph 48).
(vii) The increased priority and attention that is rightly now being given to hospital acquired infection has not been matched by resources. Some new money, £5 million over two years, has been allocated, some extra infection control nurses have been appointed, and the Executive accept the case for investment in smaller wards and isolation facilities. The scale of hospital acquired infection calls for sufficient funding to ensure that hospitals can tackle the problem effectively, and so reduce the impact on patients and NHS costs (paragraph 49).
(viii) The NHS Executive recognises that more effective bed management can help reduce hospital acquired infection. Greater use of smaller rooms and single bed rooms is now part of health service planning, and the Executive accept that increased investment in isolation facilities is a priority. But high throughput of patients is also a factor. As we noted in our report on Inpatient Admissions, bed management and patient discharge, some hospitals are operating at very high levels of bed occupancy. Wider application of best practice will help Acute Trusts manage beds better. Trusts also need to ensure that infection control is an integral part of their bed management policies (paragraph 50).
(ix) The Chief Medical Officer accepts that in staffing infection control teams, a ratio of one nurse to 250 beds is a good benchmark for NHS Trusts. But many Trusts have much larger numbers of beds per nurse. While local variations in circumstances and practice may account for some of these variations, we expect the NHS Executive to carry out further research, in conjunction with the Infection Control Nurses Association, with the aim of developing staffing guidelines for Trusts (paragraph 51).
6. Various estimates of the size, cost and impact of the problem were presented to the Committee. Figure 1 summarises the key figures, their bases and their reliability. [
5] Though not necessarily consistent with each other,[
6] they suggested that:
At any one time around 9 per cent of patients had a hospital acquired infection;
There are at least 100,000 hospital acquired infections in England and Wales each year, and possibly many more;[
7]
Around 5,000 patients die each year in the United Kingdom as a direct result of acquiring an infection;[
8]
These infections may be costing the NHS around £1 billion a year;[
9]
While few Trusts monitor infections that develop after a patient leaves hospital, several studies have indicated that between 50 and 70 per cent of surgical wound infections occur post-discharge.[
10]
7. The NHS Executive acknowledged that hospital acquired infection was a very serious issue but that the information available was limited. The estimate that there were at least 100,000 cases of hospital acquired infection a year made a number of assumptions, excluded key areas such as teaching hospitals and intensive care units, and did not include infections that present post discharge. These could be significant and the 100,000 is likely to be an underestimate.[
11] Research was continuing into post-discharge infection, and the Executive hoped to have the results in the summer, and promised to share it with us.[
12]
8. The Executive did not have data on the incidence of hospital acquired infection by NHS region or Trust, nor comparative data between England, Northern Ireland, Scotland and Wales. In particular, they could not identify the worst performing hospitals.[
13] They noted that hospital acquired infection was a world wide problem, but here too the information was sketchy. Any international information that was available was really just a composite of country-wide studies and it was very difficult to make judgements about international comparisons. But in the Executive's view, England was doing better generally than most Scandinavian countries, did roughly as well as the USA in relation to MRSA (methicillin resistant Staphylococcus aureus), but did not do as well as some other European countries such as France and the Netherlands. Overall, they saw England as in the middle of the league rather than at the top.[
14]
Enough of the dry “facts” HAIs are fairly easy to combat, good hand hygiene by medical staff, visitors and the patients themselves is paramount,
As is “proper” cleaning and disinfecting of wards, beds, floors and equipment, I wonder how many cross infections are caused by the Oxygen level finger clips passed from patient to patient without being disinfected?
There are useful resources out there for both medical staff and the public, one such is
haiwatchnews.com who also has a campaign called
Not on my watch with tools and information regarding this serious topic, this is not an advert, just a source of information which is worth a visit.
Another decent source is the
Safe Patient project again an American site.
Because sadly there are not many sources in the UK, at least not current sources, we seem to keep stats like this to “need to know”, and clearly the UK public are not on that list.
The office for national statistics has
this for Clostridium Difficile and this for
MRSA which seems to suggest that infections are falling, better late than never I suppose.
The point is that HAIs are serious, they disable and can kill, and the frustrating thing is that they are mostly preventable, with just a bit of thought and common sense thousands of patients could actually leave Hospital fitter than they were when they were admitted.
Angus
Angus Dei on all and sundryAnglishLitAngus Dei politico
