Opinion Former Article

MRSA Action UK: Study shows over a third of patients in acute care received antibiotics last year

The Health Protection Agency preliminary findings from research conducted in 99 acute hospital trusts and 5 independent sector organisations during September and November last year, has revealed that over a third of patients received antibiotics, with over half being administered for community acquired infections.

The study showed that 6.7% of patients acquired a healthcare associated infection. Respiratory tract infections accounted for 22.8% of infections, with the second highest proportion being attributable to urinary tract infections at 17.2%. Surgical site infections accounted for 15.7%, however other research shows that around 60% can be contracted post-discharge, so this is a conservative estimate.

Intensive care unit patients are higher risk, as are those with invasive devices. 7.3% of patients contracted bloodstream infections, showing the need for broader surveillance.

The estimated cost to NHS hospitals of caring for people that acquire a healthcare associated infection has been estimated conservatively at over £1 billion a year. Published evidence suggests that at least 20% of these infections are avoidable and infection prevention and control strategies provide cost-effective solutions to deliver better outcomes for patients. Successful strategies to reduce MRSA and C.diff by 70% over the last five years, is estimated to have saved the NHS between £45-£59 million.

There are no national surveillance systems to determine the number of more common healthcare associated infections, such as pneumonia and urinary tract infections, so this point prevalence, or ‘snapshot’ survey has been invaluable in determining the wider picture and highlighting areas that need further exploration.

The Department of Health and the Advisory Committee on Antimicrobial Resistance and Healthcare Associated Infections have developed a strong antimicrobial stewardship strategy and have promoted stewardship teams in NHS organisations, with over 90% of trusts engaged with pharmacists to develop and reinforce prescribing policies which will be underpinned by performance indicators and competencies.

MRSA Action UK’s view is that prevention is always better than cure, and this survey has highlighted the need to focus on sustained education of all clinical staff on the methods of prevention of avoidable infections. We believe a consistent approach to competencies in device insertion, using aseptic non-touch techniques, coupled with rigorous approaches to monitoring of hand hygiene compliance, and strategies to remove the bio burden of harmful bacteria from the environment in clinical settings with targeted cleaning, underpinned by environmental testing, could also significantly reduce the risks of infection to patients.

We welcome the antimicrobial stewardship strategy, and we believe this has to be combined with encouraging antibiotic discovery. The establishment of sustainable research and development will require incentives that reduce the regulatory barriers and development costs to assure adequate return on investment with pharmaceutical companies. The key component is a streamlined regulatory and approval process to facilitate the introduction of new safe and effective antibiotics and collaborative working. Antimicrobial resistance featured in the findings and will continue to develop. We face a global problem with health tourism, and this has been highlighted more recently with the development of NDM-1 and the effect this has on bacteria. Working in collaboration with other governments, the European Union and the World Health Organisation is needed for our future safety.

The report is available on the Health Protection Agency website at http://www.hpa.org.uk/Publications/InfectiousDiseases/AntimicrobialAndHealthcareAssociatedInfections/1205HCAIEnglishPPSforhcaiandamu2011prelim/

Derek Butler
Chair
MRSA Action UK
http://mrsaactionuk.net
email: derek.butler@mrsaactionuk.net
telephone: 07762 741114


References:

House of Commons, P.A.C. Improving patient care by reducing the risk of hospital
acquired infection: a progress report. 2005

Plowman, R., et al., The socio-economic burden of hospital acquired infection, L.S.o.H.a.T.M. Public Health Laboratory Service, Editor. 1999

Harbarth, S., H. Sax, and P. Gastmeier, The preventable proportion of nosocomial infections: an overview of published reports. Journal of Hospital Infection, 2003. 54(4): p. 258-66; quiz 321

Health Protection Agency, H. Epidemiological data on Healthcare Associated Infections. 2011 8 February 2011]

NAO report examines performance and value. Health Estate, 2010. 64(9): p. 23-7

[tags: MRSA, antibiotic resistance, Health Protection Agency, Healthcare Associated Infections]

 

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