Health Business

Healthcare AssociatED Infection (HCAI) has never before been recognised in quite the same way that it is today. It is at the top of the agenda in every healthcare establishment.  
    
In England, with the advent of the Care Quality Commission (CQC), the goal posts for acute healthcare have shifted irrevocably. All acute NHS Trusts were required to register with the new regulatory body, the CQC, from the 1 April 2009. Full registration is dependent on compliance with the new Health and Social Care Act 2008 which replaced the Health Act 2006.  
    
21 NHS Trusts, including one ambulance trust, have been given registration ‘with restrictions.’ If they don’t improve to the required standard they could be forced to close their doors as in effect it becomes a criminal offence to offer healthcare without the approval of the CQC. And it seems that a very firm stance is being taken by this new organisation.   
    
Registration of NHS trusts in 2009/10 applies to all acute trusts (both foundation and non-foundation trusts), ambulance trusts, mental health care trusts (including learning disability trusts), primary care trusts, and NHS Blood and Transplant. It does not yet apply to primary care trusts that only commission services, or services commissioned from independent providers, such as GPs and dental surgeries.

Know your obligations
Healthcare providers need to assess themselves against the nine criteria in the new Health and Social Care Act 2008, to check that they meet the required standards. This should be combined with implementing remaining actions on recommendations made in any previous Health Care Commission inspection, alongside actions taken to meet any deficiencies identified against their self assessment for ‘Standards for Better Health’.
    
Acute healthcare providers will also have to ensure that they are meeting national guidelines for MRSA screening of elective surgical patients and that they are practising within the target numbers set for Meticillin resistant Staphylococcus aureus (MRSA) bacteraemia and Clostridium. difficile infection. Any breaches of these targets may incur not only financial penalties but also negative publicity. In the era of choose-and-book, reputation is everything – who wants to be the next ‘Panorama’ story?  
    
There has been huge emphasis on reducing MRSA, with national targets set in 2005 to halve the number of bacteraemias. This target was achieved in 2008 but further ‘stretch’ targets are pushing numbers lower still which is great news for patients but challenging for the Infection Prevention and Control Teams who may well require additional inspiration as well as resourcing.

Success so far
So how are infection prevention professionals achieving these reductions and how can they go further? Often it is ‘back to basics’ infection control that is making the difference.  Good hygiene in particular increased cleanliness in hospitals over the last decade since the introduction of the annual ‘Patient Environment Action Team’ inspections; better antibiotic stewardship to reduce over-use and inappropriate use of antibiotics; and education of staff especially on hand hygiene and standard principles have all contributed.
    
Ensuring mandatory training for all staff has been a big step forward. However, reaching all staff is not always easy but it is the only way to ensure that the important message from the Health Act 2006 is promulgated – effective infection control, embedded into everyday practice and practised by everyone has to be the way forward.
    
One area still being worked on is the provision of trained infection prevention control (IPC) staff for all areas of healthcare. Currently there are still small teams covering large areas and finding suitably trained and experienced infection control staff is proving to be increasingly challenging. There are not enough training courses on offer around the UK. Groups such as the Infection Prevention Society (IPS) play a vital role in providing ongoing education and support for IPC practitioners.

Infection Prevention 09
The IPS will this year be delivering the UK’s premier Infection Prevention Conference and Exhibition, offering a dynamic blend of the best of the UK and world-wide speakers on infection prevention. Infection Prevention 09 will focus on three key themes over three days: Informing expert practice, followed by Promoting excellence in Infection Prevention and Sustaining Systems for Patient Safety. This is a very important educational event for not only IPC staff but also anyone involved in infection prevention.
    
A wide range of current topics will be covered alongside an exhibition from key companies offering Infection prevention and control solutions and very importantly, innovation.
     
Speakers include Professor Mark Wilcox, Consultant/Clinical Director of Microbiology, Leeds General Infirmary, who will be focusing on MRSA in care homes. He will describe the scope of MRSA in the care home setting, the implications, and possible interventions. He will also examine the implications of MRSA colonisation in care home residents and discuss possible interventions.  
    
Professor Christine Moe, from Emory University, Atlanta will be describing why Noroviruses are such successful pathogens in healthcare settings. She will review the epidemiology of norovirus infections and outbreaks, describing the characteristics of noroviruses that allow them to be successful pathogens and will review public health measures to prevent and control norovirus transmission
    
Other highlights of the conference include: Professor Gary French from Guys and St Thomas’s looking at microbial resistance; Professor Hilary Humphries from Dublin discussing cost effective management of MRSA; Professor Jacqui Reilly, Consultant Nurse Epidemiologist from Scotland looking at how we review evidence; and Professor Robert Pratt examining the pursuit of excellence.

Sharing best practice
There will also be a drop in day, where interested healthcare workers will be able to listen to some of the country’s leading infection prevention and control staff talk about how they put infection prevention and control into practice. There will also be a concurrent day focusing on improvements in intravenous therapy – an area that can be a significant contributor to HCAI but in which infections can also be reduced to almost zero with effective management. 17 CME credits are also available for attendance at this prestigious and informative event.
    
The requirement for registration with the new ‘Care Quality Commission’ and compliance with the Health and Social Care Act means healthcare providers can’t be complacent in provision of knowledge and understanding of infection prevention. Across the UK we must look to promote learning opportunities for staff and share knowledge and experience. This is what will continue to drive down infection rates and give the public the reassurance it craves.

References
Health and Social Care Act 2008 Care Quality Commission website: www.cqc.org.uk/
    
An Intervention to Decrease Catheter-Related Bloodstream Infections in the ICU.  Pronovost P, Needham D, Berenholtz S, Sinopoli D, Chu H, Cosgrove S, et al. New England Journal of Medicine 2006;355(26):2725-2732.

For more information
Infection Prevention 09 is being held from 21-23 September 2009 in the Harrogate International Centre, North Yorkshire. For registration and breaking news see www.ips.uk.net, call 01506 811077 or e-mail
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