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Eurosurveillance, Volume 7, Issue 50, 11 December 2003
Articles

Citation style for this article: Lee A. Report for action from England's chief medical officer on reducing healthcare associated infection in England. Euro Surveill. 2003;7(50):pii=2343. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=2343

Report for action from England's chief medical officer on reducing healthcare associated infection in England

Allison Lee (allison.lee@hpa.org.uk), Health Protection Agency Communicable Disease Surveillance Centre, London, England

The chief medical officer for England (CMO) has published a report for action entitled Winning Ways: Working together to reduce Healthcare Associated Infection in England (1, 2). Until recently, healthcare associated infection (HCAI) had a relatively low profile compared with other areas of the health service. HCAI was one of the key areas identified in the CMO's infectious diseases strategy for England, Getting Ahead of the Curve, in 2002 (3). This new report sets out the actions necessary to reduce certain healthcare associated infections and to curtail the rise of antibiotic resistant organisms in England.

Advances in medicine have led to a huge number of benefits to patients including increased survival and enhanced quality of life. Several of these advances increase the risk of HCAI and because of this HCAI cannot be completely eliminated. However, this does not mean that we cannot make progress in the prevention and control of HCAI and this report outlines seven action areas to be addressed.

The seven action areas identified in the report are:

1. Active surveillance and investigation;
2. Reducing the infection risk from use of catheters, tubes, cannulae, instruments and other devices;
3. Reducing reservoirs of infection;
4. High standards of hygiene in clinical practice;
5. Prudent use of antibiotics;
6. Management and organisation;
7. Research and development.


In addition to a reiteration of best practice for the management of medical devices, hospital cleanliness and the design of infection control into healthcare premises (4-7), the report includes a number of new measures. These include:

 

The appointment of a Director of Infection Prevention and Control in each organisation providing National Health Service (NHS) services. This director will report directly to the Chief Executive and the Trust Board and be responsible for the infection control team within the healthcare organisation.

 

Chief executives will be aware of their legal duties to identify, assess and control risks of infection in the workplace.

 

NHS Trust chief executives will ensure, over time, that there is an appropriate provision of isolation facilities within their healthcare facilities.

 

Further development of the mandatory surveillance system for HCAI. This will include:

 

 
Bloodstream infections, including, but not limited to methicillin resistant Staphylococcus aureus (MRSA);
 
Surgical site infections;
 
Clostridium difficile infections;
 
Glycopeptide resistant enterococci (GRE)
 
Post-discharge infections;
 

Serious incidents associated with infection.

 

Clinical pharmacists, medical microbiologists and infectious diseases physicians will support prudent antibiotic prescribing. Narrow spectrum antibiotics will be preferred to broad spectrum and the choice of antibiotic will be governed by local information about trends in antibiotic resistance or known sensitivity data (8,9).

 

An investigation of new systems to control HCAIs, such as collaborative links between the Inspector of Microbiology and the National Patient Safety Authority to ensure that root cause analysis and Hazard Analysis and Critical Control Point (HACCP) are used.

 

Rates of HCAI in each area of the country will be published on the CMO's website (http://www.doh.gov.uk/cmo/). A national audit of deaths from HCAI will be established. Some of these deaths will be investigated to identify lessons learned.

 

A national research strategy will be implemented to underpin effective action and ensure that new developments in the understanding of HCAI are rapidly translated into benefits for patients. £3 m (€4.3 m)have been allocated to this new research programme. This will include an exploration of the potential for epidemiological modelling and molecular methods to improve infection control, and the feasibility for vaccines to prevent HCAI.

 

Serious outbreaks of infection in healthcare settings will be reported to the HPA, which will provide advice and support for the management and control of the incident.

 

All appropriate healthcare staff will be up to date with immunisation for hepatitis B, tuberculosis, influenza and chickenpox.

The Department of Health for England will publish further guidance on the roles and responsibilities of infection control teams and will ensure that its expertise and specialist agencies are made available to facilitate change and improvement in local National Health Service (NHS) facilities. The department will also ensure up-to-date information is provided to the public and patients on infection control and prevention.

 

The Commission for Healthcare Audit and Inspection (CHAI) will be asked to give priority to assessing NHS performance in reducing HCAI.

 

References:
  1. Health Protection Agency. Report from the Chief Medical Officer - Winning Ways: Working together to reduce Healthcare Associated Infection in England. Commun Dis Rep CDR Wkly 2003; 13 (50): news. (http://www.hpa.org.uk/cdr/PDFfiles/2003/cdr5003.pdf)
  2. Chief Medical Officer. Winning Ways. Working together to reduce Healthcare Associated Infection in England. London: Department of Health; December 2003. (http://www.doh.gov.uk/cmo/hai/index.htm).
  3. Department of Health. Getting ahead of the curve: a strategy for combating infectious diseases (including other aspects of health protection). A report by the Chief Medical Officer. London: Department of Health; 2002. (http//www.doh.gov.uk/cmo/idstrategy/index.htm)
  4. NICE. Infection control: Prevention of healthcare associated infection in primary and community care. Clinical Guideline 2. London: National Institute for Clinical Excellence; June 2003. (http://www.nice.org.uk/pdf/CG2fullguidelineinfectioncontrol.pdf)
  5. Pratt RJ, Pellowe C, Loveday HP, et al. The epic project: developing national evidence-based guidelines for preventing healthcare associated infection. Phase 1: guidelines for preventing hospital-acquired infections. J Hosp Infect 2001; 47 (suppl; S3-S82). (http://www.doh.gov.uk/hai/epic/htm)
  6. NHS estates. Decontamination programme: strategy for modernising the provision of decontamination services. Leeds: NHS estates; 2003. (http://www.decontamination.nhsestates.gov.uk/guidance_information/index.asp)
  7. Department of Health. Advisory committee on Dangerous Pathogens. Infection at work: controlling the risks. A guide for employers and the self employed on identifying, assessing and controlling the risks of infection in the workplace. London: HMSO; 2003. (http://www.doh.gov.uk/acdp/infections_oct03.pdf)
  8. Department of Health. Resistance to Antibiotics and other Antimicrobial agents: action for the NHS following the Government's response to the House of Lords Science and Technology Select Committee report. Department of Health: 1999. (Health Service Circular: HSC (99) 049.)
  9. Department of Health. Hospital Pharmacy Initiative for promoting prudent use of antibiotics in hospitals. London: Department of Health; 2003. (Professional Letter. Chief Medical Officer: PLCMO (2003) 3. (http://www.doh.gov.uk/cmo/letters.htm)

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