Efforts made by hospitals across the UK to cut down on healthcare associated infections such as MRSA and C.difficile will need to be echoed in primary and community care settings following the publication of new guidelines.
The National Institute for Health and Clinical Excellence (NICE) has updated its infection control documentation to spell out the measures that should be taken by all health workers involved in the care of patients. As well as hospitals, it also applies to services provided in the community, including GP practices, nursing and care homes and in patients’ own properties.
It states that, as a minimum, all healthcare workers should be educated about standard principles of infection prevention and control. They must also be trained in hand decontamination, the use of personal protective equipment, and the safe use and disposal of sharps.
Equally, patients and carers should be educated about the benefits of hand decontamination and how to do so properly.
Practices must also ensure that healthcare workers can access appropriate supplies of materials for hand decontamination, sharps containers and personal protective equipment.
In terms of medical equipment, the guidance looks at key infection risk areas such as long-term urinary catheters, enteral feeding systems, and vascular access devices. For catheters it states that equipment must be selected in line with the patient’s individual characteristics, with gender, age, known allergies, preference, recent history and reason for catheterisation all taken into consideration. Where vascular access devices are concerned, patients should be talked through the risks, healthcare workers should be specially trained, and the skin should be thoroughly decontaminated at the insertion site. And the guidance for enteral feeding includes the need for follow-up training after insertion; the use of ready-to-use feeding systems rather than those that need decanting, diluting or reconstitution; and the disposal of disused feed after 24 hours.
Kent GP, Dr Julian Spinks, who helped to develop the guidelines, which were last updated in 2003, said: “At a time where increasingly complex procedures are being provided in primary care, infection control is becoming more and more important.
“This guideline provides information about effective and practical measures that primary care clinicians can take to reduce the burden of healthcare associated infection and forms an important part of the armoury for those of us who wish to provide high-quality care in the community.”
Christine Carson, programme director at NICE's Centre for Clinical Practice, said there was a shift towards care outside of hospital settings, but that infection control was just as important in community settings.
She added: “These issues should be at the top of the agenda for anyone who provides care for a patient, regardless of setting and regardless of whether they are a healthcare professional, an informal carer, or a family member.”
It is estimated that 300,000 patients every year acquire an HCAI as a result of care within the NHS. These cost the health service approximately £1billion. An estimated £56m of this is incurred after patients are discharged from hospital into the care of their GP.