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War declared on killer bugs

If there is one health topic that is guaranteed to simultaneously frighten patients, provoke dramatic media headlines and stimulate politicians, it is healthcare-associated infections

Marilyn Eveligh
Consultant Editor

Quite when it changed from being healthcare-"acquired" infections to healthcare-"associated" infections, I can't remember. But whatever the acronym, HCAIs include MRSA and Clostridium difficile. The "killer bug", "superbug" and "deadly hospital infections" media descriptors add to the frenzy of fear and misinformation.
The government are going to great lengths to address this huge public concern. Over the past two years, I can list numerous initiatives: local action plans for MRSA and C difficile; targets and surveillance reporting; handwashing policies for staff and visitors; "bare below the elbow" uniform policies; antibiotic prescribing policies; hospital deep cleans; isolation nursing for infected patients; significant incident sharing, such as the Stoke Mandeville report; increased control by ward matrons; and greater power to the healthcare regulators such as the Healthcare Commission. Bet you have an initiative going on in your locality.
One of the first actions by the new Secretary of State for Health, Alan Johnson, was to allocate £50m for frontline staff to tackle HCAIs. Cascaded to operational level, this meant that acute hospitals were allocated funds based on bed count (around £500,000), ambulance trusts received £20,000, and PCTs were allocated £50,000. Building modifications, staff training and measures to raise public confidence are predictable choices for spending. Frontline staff were to be included in the decision-making as to where the biggest impact can be made. Were you?
Based on anecdotal evidence from around the country, it appears community care nurses have had minimal information about this allocation, and GP staff have rarely been included in highlighting concerns and determining spend.
Does this matter? Isn't the issue with the hospitals? Don't we only have the occasional case? In fact, HCAIs impact on the whole healthcare family. We have a responsibility to control the spread of these infections and a role to educate and dispel disproportionate concerns - including those of healthcare staff. There are examples where patients with MRSA have blocked hospital beds when nursing homes have refused to accept them, have been refused leg ulcer dressings by GP surgeries, and their attendance at rehabilitation programmes has been challenged.
It is estimated that one-third of the population harbour MRSA in their noses - it is companionably around us. Hand hygiene, adherence to universal precautions and good environmental standards will prevent transmission. Yet there is a wide variation in the fabric of GP surgeries. Many buildings are old and adapted, with floor covering, washing facilities and cleaning regimes more like a domestic dwelling than a clinical facility. Few presently reach the robust NHS Estates standards.
Knowledge and implementation of infection control measures are likely to be an increasing challenge for primary care as patients shift from secondary care. Earlier hospital discharge mean that patients come home with indwelling devices such as catheters, tracheostomies and enteral feeding lines, the chronically sick and vulnerable are now managed by practices and community teams, and more surgical procedures will take place in primary care.  
Primary care needs leaders that identify infection control risks, change clinical practice and raise standards - ready for the inevitable healthcare shift. This is a role for nursing; and not only specialist nurses - but all nurses. And general practice needs nurses to ensure sound standards are in place. 
After you have read this edition of NiP, plan to do three leadership things:
1.     Monitor your surgery against the Infection Control Guidance for General Practice* endorsed by the RCGP/Infection Control Nurses Association, or any local requirements.
2.    If you have carpets in your surgery, ensure they are vacuumed daily as recommended in the above. 
3.     Explore how the £50,000 HCAI funding is being spent in your PCT, so that you can raise your knowledge - and prime yourself for infection control leadership.