Healthcare staff and patients must work together to fight ‘super-bugs'

Doctors, nurses and other hospital staff, patients and visitors all have a role to play in preventing and controlling healthcare associated infections [HCAIs]. While there is not a single solution, the most effective thing they can do is clean their hands. This is the message in a report¹ out today [Monday 20 February] from the BMA.

HCAIs including methicillin-resistant staphylococcus aureus (MRSA) and Clostridium difficile (C.difficile) contribute to the death of up to 5,000 people in the UK every year. These so-called ‘super-bugs’ cost the NHS up to £1 billion per year. A 15% reduction in the incidence of HCAIs would free up around £150 million every year for other NHS resources.

The report, Healthcare Associated Infections – a guide for healthcare professionals, is published by the BMA’s Board of Science. Key recommendations² include:
· Healthcare professionals must follow hygiene standards³ 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. Alcohol scrubs are a useful adjunct but are not sufficient in many situations.
· Healthcare professionals should only prescribe antibiotics when absolutely necessary. This means that patients should be educated that antibiotics are not the solution for every illness, and prescribers should not bow to pressure to provide antibiotics for viral illnesses.
· 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 professionals should not wear functionless clothing items such as ties as ‘super-bugs’ can be carried on them. Ties are rarely cleaned and are often worn every day.
· Health care settings must be kept clean and dust free. Clinical and non-clinical waste must be disposed of effectively and appropriately.

There are a number of reasons why HCAIs have increased so dramatically in recent years, for example:
· The use of medical devices such as catheters, tubes, drains and feeding lines breaches the body’s natural defences and creates a pathway for bacteria to enter a patient’s system. Life saving technology can become life threatening.

· The spread of HCAIs is facilitated by high bed occupancy rates. A reduction in total bed numbers and the increased throughput of patients to meet performance targets has resulted in higher bed occupancy, which is not consistent with good infection control.

· Poor standards of hygiene in healthcare settings contribute to the spread of HCAIs. There has been a great deal of concern regarding falling standards in hospital cleanliness and the introduction of compulsory tendering of cleaning contracts. The number of cleaners in the NHS fell over the last 20 years from 100,000 to a low of 55,000 in 2003-04⁴.

The BMA’s Head of Ethics and Science, Dr Vivienne Nathanson, said today:

“It is unlikely that any health service will ever be completely free of HCAIs but there is a lot more that doctors, nurses, cleaners, patients and their visitors could be doing to reduce infections spreading – the fact is around 15 to 30% of HCAIs are preventable. A lot of the solutions like hand-washing may sound simple. While strict guidelines are in place about how health professionals need to wash their hands there are barriers to compliance. One of the major barriers to doctors following these guidelines is time and the pressure to treat patients and meet targets. Another can be the layout of clinical areas and access to washing facilities.”

She added:

“Patients have a role to play too. There is no point demanding antibiotics for a cold, they won’t help you but they will help create ‘super-bugs’ ".

Ends

Notes to editors:
¹ The report is available at : http://www.bma.org.uk/ap.nsf/Content/HealthcareAssocInfect
² All recommendations are listed on page 27
³ The guidelines for the standard principles of hand hygiene can be found on page 10 of the report
⁴ Davies S (2005) Hospital contract cleaning and infection control, London, UNISON

(8/3/06)