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.

To wear a white coat, or not to wear white coat? That is the question…

OK, so I’ll make this clear from the start, I do NOT have a problem with the Welsh Assembly Government’s recent announcement to introduce colour-coded uniforms for nurses in NHS Wales. It will undoubtedly help patients identify who’s who. But more importantly here, there needs to be adequate laundry services and sufficient change of clothing to assist in reducing cross infection. Is this guaranteed? Given the fact that in this article the Assembly only “hopes to have laundries in hospitals”, let’s hope it’s more than just an aspiration.

On another point – the same article has the Chief Nursing Officer Rosemary Kennedy quoted as saying “We do have doctors floating around with white coats flapping around behind them. We have got very lax.”

This is disparaging of the many doctors in NHS Wales who are hard working, often for many excessive and continuous hours to plug gaps in rotas. They are far from “floating around”. Little wonder then that Wales is not top of junior doctors destinations with comments like this.

I don’t really think doctors and white coats “flapping” or otherwise is the real issue here when it comes to hygiene. They are no more of an infection risk than any other type of hospital clothing. What matters most is having comprehensive laundry facilities, with fresh clothing frequently available. We can of course hope for this!

This highlights a bigger issue about NHS uniform policy and it’s something that the BMA’s Welsh Medical Student’s Committee (WMSC) has been trying to get clear guidance and a straight answer on for some time now.

18 months ago the WMSC wrote to the Health Minister asking for clarification regarding hospital hygiene and “white coat” protocols and the committee, despite repeated attempts, is no closer to getting an answer on this, with the policy seemingly decided on an individual trust basis. So, our more junior members, when on rotation, are going to different hospitals, where in some cases, they can wear white coats and in others, are told it’s not acceptable to wear them. All this confusion still remains, despite the fact that an All Wales Uniform Working Group was set up by the WAG to look into white coats protocol amongst other things, more than a year ago. Not much “flapping” going on there then!