MRSA Action UK’s Andrea Jenkyns chaired the APPG on infection prevention and heard from four experts in the field of antimicrobial resistance; Dr Tessa Lewis from the NICE antimicrobial stewardship guideline development group; Simon Warren from The Royal National Orthopaedic Hospital; Dr Dakshika Jeyratnam from King’s College Hospital; and Professor Jonathan Cooke from Imperial College London.
The first APPG meeting considered four White Papers written on infection control, commissioned by Dr Raheelah Ahmad, which argued that to truly address antimicrobial resistance, action has to take place not just in hospitals but beyond and consideration must be given to all aspects of patient care and pathways. This includes the community; primary and hospital care; healthcare professionals; and patients within and across these settings.
The group launched their policy recommendations on hospital-acquired infections and called for action to prevent more lives being lost, in their second meeting in March this year. Guidance published at the meeting challenged the Government to act to eliminate a 'culture of complacency'. It also called on the NHS to make information on infection rates more accessible, so that patients can make informed decisions about their care.
At the meeting on May 9th The Patients Association published a report calling for Clinical Commissioning Groups to implement NICE's 2015 Antimicrobial Stewardship guidelines, which are aimed at minimising the risk of antibiotic resistance. This came after results of a Freedom of Information request from 144 Clinical Commissioning Groups in England by The Patients Association, which revealed:
· 88% haven’t fully implemented NICE’s Antimicrobial Stewardship guidelines as standard
· Almost a 31% don’t have a ‘named’ individual responsible for the implementation of an Antimicrobial Stewardship programme
· 10% don’t have a local Antimicrobial Stewardship programme in place at all
The APPG has focused on ensuring that patient safety remains at the forefront of the Government’s agenda, by bringing together interested Parliamentarians, members of the public and healthcare experts to address all issues affecting patients in the care sector.
The latest White Paper that has been commissioned by the APPG considers what measures can be used to drive a continuing focus on tackling healthcare associated infections and antimicrobial resistance.
Questions for further consideration arising from the work of the APPG:
· Are there better measurements to tackle healthcare associated infections and antimicrobial resistance?
· Are there new organisms or infection information that should be published and focussed on?
· Are there additional requirements for mandatory reporting, does it tell us enough?
· Do financial penalties benefit the system – Commissioners need to use their expertise to show where resources should be reinvested to tackle healthcare associated infections and antimicrobial resistance.
· How can we be assured that we are achieving a sustainable behavioural and cultural change?
· Restrictive antibiotic policies to help control C. difficile and MRSA may contribute to the emergence of antibiotic resistance to carbapenems. How do we minimise and address any negative unintended consequences?
· Reporting avoidable healthcare associated infections should not be restricted to MRSA and C. difficile. Leadership in incident reporting, lessons learned and the role that Commissioners have to drive improvement are key to driving and sustaining behavioural and cultural change. How do we ensure commissioners are including this in their quality and safety agenda?
· How do we involve healthcare providers in benchmarking processes to improve ownership?
· Who is publicly available data of benefit to? Does it do harm by causing unnecessary anxiety for patients? Is this meaningful data for patients? – Making sense of the information for patients is important, people who approach MRSA Action UK are often upset that they didn’t understand the risks and should know if a hospital has a good record on prevention and treatment of infections when they happen.
Potential new measurements:
· Hospital acquired urinary tract infections
· Increased reporting and targets for surgical site infections
· Carbapenem resistant organisms
· Norovirus infection
· Hospital onset influenza
· Hospital onset pneumonia
· Hospital onset bacteraemia
· Isolation facilities audit
· Hand gel consumption
· Hand hygiene audits –– including “fly on the wall” and peer challenge observation to assess organisational / ward culture, namely are colleagues highlighting lapses with each other when they observe them?
· Compliance with central line, urinary catheter or ventilator care bundles
· Staff training in infection control (including temporary staff)
Andrea has worked well with the Patients Association to bring these issues to the fore and MRSA Action UK are proud to have her lead this cross-party review and give patients a voice where we can influence the safety agenda for patients.
Derek Butler
Chair
MRSA Action UK
http://mrsaactionuk.net
email: derek.j.butler@mrsaactionuk.net
telephone: 07762 741114
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