Preventing and controlling healthcare-associated infections

Abstract

“Nine in 10 hospitals failing on hygiene.” “MRSA deaths double in four years.” The thousands of newspaper headlines over the past 15 years in the UK have symbolised the nation's fascination with healthcare-associated infections and increased the pressure for action. Moving beyond such headlines to develop clinical solutions was the focus of a conference hosted by The Lancet Infectious Diseases on Dec 11–12 in London, UK.Healthcare-associated infections are universal, but their global burden has yet to be ascertained. Given, though, that a quarter of operations done in a well-equipped rural hospital in Tanzania are linked to surgical-site infections, and millions of cases of hepatitis B annually are caused by unsafe injection practices, the burden is likely to be huge. What shocks most, though, is that the illness and deaths that result are largely preventable.What can be done to reduce healthcare-associated infections? Act quickly was a clear message from the conference. In the UK, a decade was wasted while meticillin-resistant Staphylococcus aureus (MRSA) took hold in hospitals. By implementation of a bundle of infection-control procedures, mandatory reporting, legislation to introduce a standard code of practice, and target setting, MRSA bacteraemias have halved in number in England since 2004. But community-associated MRSA, which is now epidemic in the USA, is a growing problem elsewhere. Furthermore, in the UK new guidelines to counter the increasing threat of Clostridium difficile are written but await ministerial action.What else can be done? Antibiotic stewardship to prevent the generation of resistant microbial strains is needed. Hand hygiene can be improved with alcohol-based rubs, as advocated by WHO's patient safety initiative. What hands touch, though, is also important and cleaning contaminated surfaces must be improved.Creating a safety culture within healthcare settings is crucial, so that all staff take some responsibility. With infection control and appropriate antibiotic prescribing integrated into healthcare settings, moving beyond doing no harm to improving health outcomes becomes more likely. “Nine in 10 hospitals failing on hygiene.” “MRSA deaths double in four years.” The thousands of newspaper headlines over the past 15 years in the UK have symbolised the nation's fascination with healthcare-associated infections and increased the pressure for action. Moving beyond such headlines to develop clinical solutions was the focus of a conference hosted by The Lancet Infectious Diseases on Dec 11–12 in London, UK. Healthcare-associated infections are universal, but their global burden has yet to be ascertained. Given, though, that a quarter of operations done in a well-equipped rural hospital in Tanzania are linked to surgical-site infections, and millions of cases of hepatitis B annually are caused by unsafe injection practices, the burden is likely to be huge. What shocks most, though, is that the illness and deaths that result are largely preventable. What can be done to reduce healthcare-associated infections? Act quickly was a clear message from the conference. In the UK, a decade was wasted while meticillin-resistant Staphylococcus aureus (MRSA) took hold in hospitals. By implementation of a bundle of infection-control procedures, mandatory reporting, legislation to introduce a standard code of practice, and target setting, MRSA bacteraemias have halved in number in England since 2004. But community-associated MRSA, which is now epidemic in the USA, is a growing problem elsewhere. Furthermore, in the UK new guidelines to counter the increasing threat of Clostridium difficile are written but await ministerial action. What else can be done? Antibiotic stewardship to prevent the generation of resistant microbial strains is needed. Hand hygiene can be improved with alcohol-based rubs, as advocated by WHO's patient safety initiative. What hands touch, though, is also important and cleaning contaminated surfaces must be improved. Creating a safety culture within healthcare settings is crucial, so that all staff take some responsibility. With infection control and appropriate antibiotic prescribing integrated into healthcare settings, moving beyond doing no harm to improving health outcomes becomes more likely. Lancet conference on healthcare-associated infectionsThe Lancet conference in London, UK, on healthcare-associated infections (HAIs) brought together 26 expert speakers from nine European countries (Dec 11–12, 2008). The crucial importance of hand hygiene as a preventive measure, and as a patient-safety issue, was a reoccurring theme of the meeting. Noting that doctors' compliance with hand hygiene was still in the 17–30% range, Andrew Pearson (Health Protection Agency, London) asked: “You wouldn't fly in a plane whose pilot's skills were as poor as that would you?” Full-Text PDF