VOL: 99, ISSUE: 37, PAGE NO: 56
Carol Pellowe, MA, BA, RN, RNT, is deputy director, Richard Wells Research Centre, Thames Valley University, London
Robert Pratt, CBE, FRCN, is professor of nursing, Thames Valley University, and director, Richard Wells Research Centre;Nicky Robinson, PhD, BSc, is head of the Centre for Complementary Healthcare and Integrated Medicine, Thames Valley University
The National Institute for Clinical Excellence recently published guidelines for preventing health care-associated infections (HAIs) in primary and community care (NICE, 2003). These were commissioned by the Department of Health and NICE to complement previously published guidelines for preventing HAIs in hospitals (Pratt et al, 2001). The new guidelines aim to facilitate a seamless approach to using the best evidence for infection prevention practices as patients transfer between primary and secondary health care services. This article discusses the need for the guidelines and describes the methods used to develop them.
About nine per cent of patients admitted to NHS hospitals in England acquire an HAI, resulting in 100,000 infections and 5,000 deaths annually (Department of Health, 2001; Taylor et al, 2000). These infections cost the NHS about £1bn a year, but 15-30 per cent of them are preventable (Taylor et al, 2000).
Clinical governance is the framework through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding standards of care. Its key components are a series of quality attributes that are generated from an organisational culture working towards continuous quality enhancement.
NICE was established ‘to provide patients, health professionals and the public with authoritative, robust and reliable guidance on current best practice’ (www.nice.org.uk). Because the Richard Wells Research Centre at Thames Valley University had developed the DoH guidelines for preventing HAIs in hospitals, it was commissioned to extend this work to develop the new NICE guidelines for preventing HAIs in primary and community care. The centre was supported by a multiprofessional guideline development group and the NICE National Collaborating Centre for Nursing and Supportive Care.
The guidelines have been published in three formats. The full version, including a discussion of all the evidence considered, will appear shortly as special supplements in the Journal of Hospital Infection and the British Journal of Infection Control. The full version with supplemental evidence is also available on the Richard Wells Research Centre website, where individual sections can be downloaded (Pellowe, 2003). NICE has published the key recommendations for health care professionals and a special version for the public, both of which are available on the NICE website.
Patients in the community often need to manage much of their own care, or rely on unqualified helpers such as family members, neighbours or volunteers. As a result, each guideline section includes recommendations on the education of patients, carers and health care professionals. These should be included in discharge planning processes so patients are safely cared for on return home.
Evidence on preventing HAIs continues to evolve and is reviewed every two years. For example, the evidence for the DoH guidelines for preventing HAIs in hospitals (Pratt et al, 2001) is being reviewed and updated. Also, the recommendations for the NICE guidelines may lead to adjustments to the DoH recommendations. Almost all of the standard precautions described in the DoH guidelines are similar to those in the new community and primary care guidelines.
The development team also identified areas where new evidence is needed, especially in caring for patients who use medical devices. Given the diversity of care settings, and the variations in practice and supplies, there is a need to pursue new evidence to improve understanding of how to prevent HAIs.
Preventing HAIs in hospitals