Government targets interfere with the battle against superbugs

I want to highlight here a new report by the BMA which focuses on the war on healthcare associated infections (HCAIs), or as they are perhaps more well known - ‘superbugs’.

The report illustrates very well how we’ll never win this battle, unless long-term strategies are introduced. Short term solutions like alcohol gel, dress code and deep cleansing must be backed uo with sustainable evidence-based improvements that will protect more patients in the future. Without a change in direction, the risk to patients caused by HCAIs and the burden on our NHS are set to continue.

‘Tackling healthcare associated infections through effective policy action’ calls for a range of measures to minimise the spread of infection and strong governmental commitment focusing on long-term policies that tackle patient throughput and high bed occupancy. It’s not enough any more for politicians to announce new initiatives that are just sound bites. Genuine patient safety comes from embedding long-term strategies to tackle superbugs.

The report says that overcrowding and understaffing in the UK healthcare system adversely impacts on infection control practices, including decreased hand hygiene, increased movement of staff and patients, and worse staff to patient ratios. These problems can only be addressed with strong organisational support that underpins the effective functioning of healthcare teams.

With an ageing population and advances in medical technology and treatments, more patients are being treated than ever before and many are increasingly vulnerable to infection. Infection control is the responsibility of all, from the highest level of hospital organisation and management, to healthcare professionals, patients and visitors.

Key areas for action outlined in the report include:

• Reducing bed occupancy rates should be considered a priority in the development of policies relating to the number of available beds, admissions targets and bed management policies.
• Effective workforce planning to ensure adequate staffing to match workload.
• Dress code policies should be evidence-based with emphasis on the appropriate use of disposable protective clothing (eg gowns and gloves) when healthcare staff are exposed to potential contamination.
• Adequate resources should be provided for thorough everyday cleaning with an emphasis on cleaning high-risk near-patient hand-touch sites.
• The introduction of screening policies should be evidence-based and take into account the practical and cost implications associated with the isolation of patients, visitors and staff who are carriers.
• Compliance with hand hygiene protocols should be facilitated through education, motivation and improved access to hand washing facilities.
• Strategies need to be developed for optimal antibiotic use.

Much of this was also raised by BMA Cymru Wales, in a media briefing we held earlier this year, which we also blogged on here.

I don’t doubt that hygiene, hand-washing and antibiotic policies have extremely important roles to play, but if we want to reduce the spread of infections we must put safety in front of political targets. With many hospitals already working at full capacity, this will only get more pressurised as winter arrives. The pressure to turn around patients too quickly and the lack of adequate isolation facilities create critical challenges to maintaining high quality patient care. We want safe, timely care and treatment, not just fast care.

Patient safety has to be at the forefront of the Welsh NHS

This Western Mail article regarding NHS safety breaches is a cause for concern for anyone working in the NHS, as well as to patients.

Patient safety is paramount at all times in the Welsh NHS, but it would perhaps be naïve to think ALL risks can be removed. For instance, when the health service is running at full capacity, with staff under pressure to get patients in and out of hospital quickly, it is inevitable patient care will suffer at some point. It is also at times like this, with such a high turn over of patients, that cleanliness standards are likely to fall, which can lead to the spread of hospital acquired infections such as C. difficile. Just last week the Welsh Conservatives published figures showing the rate at which such infections are spreading in Wales.

Here are a few of the recommendations the BMA has made in the past in trying to prevent such incidents of hospital super bugs;
• Healthcare professionals must follow hygiene standards relating to hand washing. Effective hand hygiene is the single most important intervention in infection control.
• Hand hygiene needs better ward/clinic design and provision; hot water and liquid soaps play an important role.
• Health professionals are duty bound to ensure that they and their colleagues fulfil their responsibilities with regard to infection prevention and control. Senior staff should lead by example.
Health care settings must be kept clean and dust free. Clinical and non-clinical waste must be disposed of effectively and appropriately.

It’s easy for such basic hygiene measures to fall by the way side, when the pressure is on NHS staff for a quick turn around in treating and discharging patients.
It is also worth highlighting a recent report from the Welsh Liberal Democrats,which showed how unsafe actual NHS buildings are, for both staff and patients, because basic, yet essential maintenance work, isn’t being carried out.

It isn’t really until you start delving a bit deeper and really looking behind these figures that you can identify such issues and then start putting them right. And these statistics show just how important an initiative one like the Save 1,000 Lives Campaign really is, which was set up with the primary aim to reduce risks to patient safety.