HPA takes tough line on potentially-lethal hospital bugs

Improved cleaning, isolation of patients and protective clothing for healthcare workers are just a few of the recommendations being put forward in an effort to reduce outbreaks of the potentially life-threatening GAS infection in UK hospitals.

The Health Protection Agency (HPA), together with the group A streptococcal (GAS) working group has this week launched new guidelines for the prevention of infection in acute care settings, including high-risk maternity units.

A bacterium occasionally found in the throat and on the skin, GAS may be carried for long periods of time without causing any illness. However, it is spread by direct person-to-person contact and can lead to a range of infections, from mild sore throats and skin infections to rare and sometimes deadly invasive diseases.

Although cases of hospital-acquired GAS infection are rare, it’s important that appropriate control measures are implemented quickly if a case is identified to reduce the risk of further spread to other patients

Although general guidelines exist aimed at reducing the likelihood of infections in healthcare settings, the new publication will give hospitals clear, evidence-based advice on how to minimise the risk of GAS outbreaks. It is also expected the guidance will be relevant to other settings including care and nursing homes.

Dr Joe Kearney, chairman of the GAS working group, said: “While most GAS infections are relatively mild, they can on rare occasions become very serious. These new recommendations are specifically aimed at assisting healthcare workers in controlling the spread of these infections. They have been drawn up with expert colleagues from a wide range of organisations, including a patient support group, to ensure that we have developed comprehensive advice for managing GAS infections in hospitals and other acute healthcare settings.

“Although cases of hospital-acquired GAS infection are rare, it’s important that appropriate control measures are implemented quickly if a case is identified to reduce the risk of further spread to other patients.”

There are three main routes of transmission of GAS infections in healthcare settings – patient to patient, from healthcare worker to patient and vice versa, and from the immediate hospital environment. It is thought that by addressing these key areas, hospitals can help to eliminate the spread of the bug and reduce instances in general.

The guidance also provides clear recommendations on how to manage and investigate outbreaks when they do occur, including isolating the patient in a room with its own toilet and washbasin; requiring all healthcare workers to wear protective aprons and gloves, as well as visors where the transmission of droplets is likely, such as when wound dressing or during suctioning; and cleaning the room and all furniture and equipment daily. This cleaning should be with detergent and water followed by a hypochlorite or combined product. Communal showers, baths and other facilities should also be cleaned between patients, whether they are directly affected or not. This is thought to be particularly important in the case of maternity units, where the cause of infection has often been found to be connected to washroom and other communal settings.

These new recommendations are specifically aimed at assisting healthcare workers in controlling the spread of these infections

The guidance states: “The guideline recommends that all cases of GAS infection potentially acquired in hospital or through contact with healthcare or maternity services should be investigated. Healthcare workers, the environment, and other patients are possible sources of transmission. Screening of epidemiologically-linked healthcare workers should be considered for healthcare-associated cases of GAS infection where no alternative source is readily identified. Communal facilities, such as baths, bidets and showers, should be cleaned and decontaminated between all patients, especially on delivery suites, post-natal wards and other high-risk areas. Continuous surveillance is required to identify outbreaks which arise over long periods of time.”

The guidelines do not cover diagnosis or treatment of infections, which is usually via antibiotics.

To see the full guidance, click here