The Government’s ‘war on superbugs’, including a number of measures to tackle infection, was formally announced in early November and should be welcomed as a step towards improving health outcomes and relieving financial pressure on the NHS.
However, if the Government is really serious about reducing infection in the NHS, then the implementation of this policy should be based on the latest technology and evidence-based research.
The problem
Patients today have a 6.4% chance of contracting an infection in UK hospitals, despite the World Health Organization (WHO) saying that half of infections are preventable through effective hand hygiene.
The importance of washing hands in hospitals has been stressed time and time again, but we’re still not getting it right.
The importance of washing hands in hospitals has been stressed time and time again, but we’re still not getting it right
This is partly due to the fact that the current system for monitoring hand hygiene compliance is flawed and fails to record the true level of compliance on any given hospital ward.
Direct observation of hand hygiene compliance leads to the Hawthorne effect - the alteration of behaviour by a study’s subjects due to their awareness of being observed - which artificially inflates compliance by more than 50% and dramatically reduces the incentive for improvement.
Although under the current observation system, wards often record 90-100% compliance rates, typical compliance today in UK hospitals is actually between 18-40%.
Inaccurate audit data does not support infection prevention and control (IPC) professionals and NHS staff in driving improvements.
Political attention
The need to improve mechanisms of infection control is no fringe issue, and is consistently raised right at the very top of the political ladder.
Health Secretary, Jeremy Hunt, recently spoke on The Andrew Marr Show about the need to declare a ‘war on superbugs’, and Andrea Jenkyns, Conservative MP for Morley and Outwood and Health Select Committee Member, raised the issue with the Prime Minister herself at Prime Minister’s Questions on Wednesday 16 November.
Resisting help
The debate around infection control takes place against a backdrop of the growing threat from anti-microbial resistance (AMR), which was highlighted by former Treasury Minister, Lord O’Neill, in his report on Tackling Drug Resistant Infection last year.
Indeed, results of the global WHO survey on AMR confirm that resistance is very frequent.
Improving transparency
The Government’s plans to improve transparency on infection control by forcing hospitals to publish staff hand hygiene figures is a step in the right direction.
Electronic monitoring can provide an accurate real-time dashboard on hand hygiene, comparing rates across different wards
Starting this year, hand sanitiser usage will have to be monitored and reported to the Care Quality Commission (CQC), enabling it to scrutinise hand hygiene compliance and drive up standards. However, uncertainty remains regarding the method of monitoring that underpins the figures, as this could be through manually checking dispensers, electronic monitoring, or by other means.
This is not merely a superficial question: ensuring accurate and timely data requires an appropriate method of data collection, without which the Government will not achieve its objective of infection reduction.
Monitoring
If staff are to be required to weigh or count cartridges used in hospital hand sanitiser dispensers, this will be a time-intensive task and will distract already-pressured staff from their patients. Furthermore, it is also prone to inconsistent recordings.
Therefore, the new policy needs to factor in aspects such as patient bed numbers and staffing levels, for instance.
The Carter Review, which lays out the blueprint for a more-efficient NHS, points us in the direction of how we can more accurately monitor hand hygiene – technology.
Electronic monitoring is a simple and effective mechanism of achieving this, which can encompass both the number of hand hygiene opportunities, as well as some estimation of the volume of hand sanitising alcohol or gel per event.
In Lord Carter’s own words: “The best-performing hospital systems around the world have real-time monitoring and reporting at their fingertips enabling them to make decisions on a daily, weekly, monthly basis to improve quality and efficiency performance.”
Electronic monitoring can provide an accurate real-time dashboard on hand hygiene, comparing rates across different wards.
Technology can better record hand hygiene compliance
The evidence
This argument is backed up by the evidence.
Recent research, published in the American Journal of Infection Control, showed the direct correlation between using electronic hand hygiene data to improve compliance with the WHO’s Five Moments, which defines the key moments for hand hygiene, and significantly reduced hospital onset MRSA infections.
The findings were promising. Hospital-onset MRSA HCAI rates decreased by 42%, hand hygiene compliance rates increased by 25.5%, and total costs of care avoided were approximately $434,000.
If done properly, the announcement will enable the NHS to improve people’s health and reduce costs
This has very important implications for the UK, where there were 301 trust-assigned cases of MRSA in 2015, which cost the NHS an estimated £7.5m.
In England alone, approximately 300,000 patients develop an HCAI every year, with 5,000 of those cases proving fatal – despite the fact that many of these could be avoided by better hand hygiene.
In addition to the human cost, each year HCAIs are estimated to cost the NHS up to £1billion.
A number of NHS trusts are now undertaking cutting-edge research to demonstrate the potential of electronic monitoring in the UK, with the early results being promising.
This could be really good news for patients and the NHS.
Moving forward it is vital that we use the latest research to inform the detail when putting the Health Secretary’s new policies into practice.
If done properly, the announcement will enable the NHS to improve people’s health and reduce costs.
However, a failure to effectively use the evidence could leave this as just another missed opportunity.
Let’s make sure we get it right.
