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.

Pressures on NHS bed risks patient safety

Today, we’re highlighting the dangers of cramming patients onto hospital wards, at the same time as the number of beds on wards, are falling.

Because we’re so concerned, we’ve just held a media briefing with Dr Andrew Dearden, Chair of Welsh Council and Dr Stefan Coghlan, Chair of the BMA’s Welsh Consultants Committee.

Figures show that over a ten year period (1997-98 to 2007-08) the total number of NHS beds in Wales fell by nearly two thousand. But, in that time the percentage bed occupancy increased from 78.7% to 82.8%1, which has led to our growing worry for the safety of patients.

Dr Coghlan outlined in the briefing how the NHS is being pushed to breaking point with more patients being treated and despite managerial efforts to reduce the time that patients spend in hospital, the average length of stays, is actually increasing, as the number of beds available for them, is shrinking. This is putting an intolerable strain on staff and causing a great deal of stress and confusion to patients. We certainly wouldn’t be able to cope in a crisis. It is just unsustainable.

The situation has been getting worse during the first few months of this year. A worrying combination of unprecedented emergency admissions, more planned surgery to meet access 2009 targets and so called efficiency savings with pressure to balance the books by the end of the financial year has resulted in unacceptable bed pressures. NHS managers have been holding crisis meetings on a daily basis about where to put patients. We seem to be getting to a point where it’s a case of ‘any bed will do’.

“Hot-bedding” where patients are moved around wards as beds become free appears to be a worrying trend too. Three or more patients could have been in the same bed, on the same day. This constant swapping can cause real confusion and distress, particularly for more elderly patients, who end up not knowing where on earth they are. This makes it very difficult for families visiting, to locate their loved ones, even for doctors to find their own patients. It may not be the best use of a consultant’s time, trying to track down patients and we have heard instances of patients being forgotten about, as they are moved from ward to ward.

And it is the most vulnerable that this impacts upon. The elderly, infirm patients who are most affected by being moved, are also the patients most likely to be moved from wards, to accommodate new admissions. Moving elderly patients can precipitate acute confusional states and general deterioration in their health.

Over-crowding and moving people around hospital wards can increase the risk of contracting and passing on infections, such as C.difficile. Last month, the Welsh Conservatives obtained figures showing that in 2007-08, more than 3000 people aged over 65 contracted the C.difficile infection.

NHS Trust finances could be a possible reason for the decline in bed numbers. There are extra financial pressures on managers at the moment, to balance their books, before the planned NHS reorganisation becomes fully operational in October. And one of the easiest ways of making efficiency savings is to cut bed numbers, regardless of the dire consequences this can have for patient care.

So, the BMA is calling for a change in bed occupancy policy, with less emphasis on dwindling bed numbers, at a time when we have a growing ageing population, who need more long-term treatment in hospitals. Patients, in particular elderly ones, are being put in danger and this must not be allowed to continue.

We also feel it would be beneficial to change the way statistics are collated and reported so that they better reflect what is going on in Acute hospital beds.

It would be good to hear from any members or the wider medical profession, if they've encountered any of the above issues...

Statistics available at http://www.statswales.wales.gov.uk/tableviewer/document.aspx?FileId=1996