Reducing HCAIs 2013: Addressing the challenges

The Health Protection Agency coordinated the fourth National Point Prevalence Survey (PPS) on healthcare associated infection and first national PPS on antimicrobial use (AMU) in England. The aims of the PPS were to determine the burden of HCAI and AMU in acute hospitals and to use the results to identify priority areas for the future.

Key points from the survey included:

• The prevalence of healthcare-associated infections (HCAI) was 6.4% in 2011 compared to 8.2% in 2006;
• The most frequent HCAIs detected were respiratory tract, urinary tract and surgical site infections;
• The prevalence of antimicrobial use (AMU) was 34.7%. This is the first time AMU was measured nationally. This provides a baseline for future monitoring; and
• The prevalence of HCAIs, AMU and device use was highest in intensive care units, which relates in part to the complexity and vulnerability of patients in this setting.

The data collection was undertaken by hospital teams between September and November 2011;

• 103 organisations surveyed 52,443 eligible patients (50,778 from the NHS and 1,665 (3.2 per cent) from the independent sector. 
• The average age of all patients was 69 years old. 
• A total of 4,372 (out of the 52,443, eight per cent) children under 16 years of age were also surveyed. The average age in this group was one month.

This survey, part of a Europe-wide PPS initiative set up by the European Centre for Disease Prevention and Control, was the first time that all participating European Countries have used the same definitions and methodology in their surveillance, providing a true indication of the extent of the problems faced.

The survey also revealed that the most antibiotic use, accounting for 53 per cent in hospitals, was in patients receiving treatment for infections which commenced in the community. These figures are worrying in light of what has been described as the biggest threat to health care – antimicrobial resistance. Professor Dame Sally Davies, Chief Medical Officer for England, stated that;

“Antibiotics are losing their effectiveness at a rate that is both alarming and irreversible – similar to global warming. I urge patients and prescribers to think about the drugs they are requesting and dispensing. Bacteria are adapting and finding ways to survive the effects of antibiotics, ultimately becoming resistant so they no longer work. And the more you use an antibiotic, the more bacteria become resistant to it.”

The World Health Organization recognised this impact and threat to public health, calling the world to action and placing this at the forefront of its work for 2011. World Health Day, held on the 7th April 2011, was conducted under the theme ‘No action today – no cure tomorrow’ highlighting the urgent and consolidated efforts that are required to avoid regressing to the pre-antibiotic era.

The British Society for Antimicrobial Chemotherapy established back in September 2010 the Urgent Need Initiative to examine opportunities for and barriers to the regenerations of antibacterial drug recovery and development. A direct outcome from the initiative was Antibiotic Action, the forum through which BSAC will call all parties as well as governments, healthcare professionals, industry and charities identifying and implementing solutions to stimulate and regenerate the discovery and development of antibacterial drugs.

With the threat of AMR growing it is of vital importance that all infections associated within the health care sector are eliminated as soon as possible. As stated within the data recorded in the PPS, great improvements have been forged but more must still be done:

• A total of 3,360 patients were diagnosed with an active HCAI with 135 patients having more than one
• Overall, 6.4% of people in hospital had an HCAI
• The most common types of HCAI were respiratory (including pneumonia and infections of the lower respiratory tract) (22.8 per cent), urinary tract infections (UTI) (17.2 per cent), and surgical site infections (15.7 per cent)
• The HCAI prevalence in independent hospitals was 2.2 per cent and 6.5 per cent in NHS organisations. Independent sector organisations and NHS Trusts however, are not comparable. The independent sector hospitals have a much smaller inpatient bed base with primarily elective admissions; shorter lengths of stay and much of their activity is conducted as day cases
• The prevalence of HCAI was highest in those patients aged 1-23 months at 8.2 per cent followed by patients aged 65-79 years of age at 7.4 per cent. This reflects the vulnerability for HCAI at the extremes of age
• When comparing ward specialties, HCAI prevalence was highest in patients in intensive care units (ICUs) at 23.4 per cent followed by surgical wards at eight per cent. These figures also reflect that the highest rates of infection occur in those patients who have devices or have had procedures performed
• Since the last PPS in 2006 there has been a eighteen fold reduction overall in MRSA bloodstream infections - from 1.3 per cent to less than 0.1 per cent in patients; and a five fold reduction in C. difficile infections (from two per cent to 0.4 per cent)

Reducing HCAIs: Addressing the challenges, will examine current policy, question Government direction and provide an invaluable platform for key stakeholders to listen, discuss and debate the fundamentals of patient safety, antimicrobial resistance and infection control, whilst sharing best practice and successes to date.