The Keogh Review, published last week, comes at a time when continuing measurable improvement is still considered a focus of NHS England.
The Infection Prevention Society (IPS) welcomed the review including its emphasis on maintaining the highest standards of infection prevention and control (IPC) in healthcare.
IPC was highlighted as a concern in four of the 14 trusts included in the review. Many of these concerns relate to patient safety, such as a lack of consistent application of IPC standards, lack of auditing, lack of local ownership, lack of awareness of the importance of infection prevention and a lack of campaigning. IPS fully supports these points as they are all fundamental to the prevention of healthcare associated infection (HCAI) in all settings.
Other supported key recommendations:
- A need to triangulate staffing levels and HCAI risk;
- Surgeons taking ownership of surgical site infections;
- The urgent need to move towards realistic, accurate, reliable hand hygiene monitoring/compliance reporting, using validated tools;
- The need to routinise hand hygiene, with an emphasis (that is not reinforced through any of the reports) on the point of care;
- The need for hand hygiene products to be available in a reliable way, however, the emphasis (that is not reinforced through any of the reports) must be on point of care.
Individual trust reviews also included a number of IPC concerns that might adversely affect best practice, as IPS suggests that they distract from the fundamentals of infection prevention that our specialism aims to promote.
IPS has outlined these other findings/concerns and balanced these against other infection prevention recommendations, in an attempt to ensure that they do not become an unnecessary distraction:
- Over emphasis on hand hygiene practice at ward entrances - at the expense of highlighting point of patient care as the place where transmission is most likely to cause harm to patients;
- Over-emphasis on bare below the elbows - without a concurrent emphasis on reliable compliance results for hand hygiene practice at the point of patient care (based on the evidence-based “WHO 5 Moments for Hand Hygiene”);
- Over-emphasis on staff uniforms as a key vector of microbial transmission, in particular, reference to nurse buckles as a source of cross infection – against the evidence base for personal protective equipment use, uniform cleaning and hand hygiene as per the 5 Moments;
- The suggestion to enhance patient-visitor communication, when visiting is restricted due to infection risk, through use of Skype and Face-time - with no qualification as to what infections would constitute such potentially psychologically harmful approaches; this needs to be further defined.
IPS will continue its work with policy makers, regulators, patient organisations, fellow societies, NHS organisations and academia to provide the leadership and expert advice that will help to build the right culture and a safe environment and to promote best practice.
This will be done with the support of our patrons: Professor Tricia Hart, CEO of South Tees Hospitals NHS FT and Professor Didier Pittet, University Hospitals Geneva and expert advisor for WHO Clean Care is Safer Care Patient Safety Programme.
Read the Keogh review here