Economic crisis threatens efforts to reduce HAIs

Cuts to health budgets around the world already having an impact on infection prevention and control

The economic crisis in Europe could threaten the success of efforts to reduce the prevalence of infection, experts have warned.

At the Infection Prevention 2012 conference held in Liverpool, UK, recently, Dr Anna-Pelagia Magiorakos, a senior expert in antimicrobial resistance and healthcare acquired infection at the European Centre for Disease Prevention (ECDC) in Sweden, warned that cuts to health budgets around the world were already having an impact on infection prevention and control. And she said the problem could deteriorate further as investments in vital equipment and staffing levels are reduced.

“A lack of funds affects the purchase of equipment in hospitals and restricts efforts," she told the conference. "What we have observed is that infection control is perhaps more lax due to the lack of investment in equipment.

“With a lack of equipment and a lack of staff, it is not a very pretty picture.”

The problem is further compounded by the continued overuse of antibiotics and the lack of information sharing between various countries.

She said: “It is difficult to keep up to speed with what every different country is doing and to have the same rules and controls and infection control strategies across them all.

The way forward to ensure infection control across Europe is to have a systematic review of all available data and to look at developing guidance and indicators on this issue

“What we need to do is get to the stage where a patient who transfers across borders comes with information about what they might be carrying if that is possible. I realise the burden is quite large and this is not always possible, but it creates a very big problem for continued infection control.”

With a more joined-up approach in mind, the ECDC is involved with a number of pan-European programmes, including co-ordinating the collection of HCAI data from different countries; a study on antimicrobial use in European hospitals and long-term care facilities; and a systematic reviews of peri-operative antibiotic prophyliaxis. Magiorakos said: “The way forward to ensure infection control across Europe is to have a systematic review of all available data and to look at developing guidance and indicators on this issue.”

This approach was also advocated by Claire Kilpatrick, a consultant on patient safety at the World Health Organization (WHO). She called for health organisations across England to work more closely together to drive down the prevalence of healthcare associated infections such as MRSA and C.difficile. A national drive across Scotland had showed that, when health boards worked together with the same aim in mind, improvements could be made to infection control processes, she said.

Kilpatrick has worked closely with Scottish trusts since they began to take a closer look at infection prevention 11 years ago. For the past eight years, health boards have had dedicated ‘cleanliness champions’ and for the past five years there has been a national campaign aimed at improving hand hygiene.

Another key driver for the joined-up approach seen north of the border was ministerial pressure through a Government call to action and WHO’s Clean Care Is Safe Care campaign. She told the conference: “In Scotland there were two big drivers for change – coming both nationally and internationally. It was about clearly demonstrating what had been happening in terms of infection prevention and what needed to be improved. A multi-faceted approach was absolutely critical and we needed to have all health boards working together.”

We have found there are definite advantages to this kind of joined-up approach to the issue of infection control and prevention

Studies were carried out on trends across the country relating to outbreaks and incidents of MRSA, with researchers looking at existing guidance as well as issues such as antibiotic prescribing, improvement tools, monitoring, education and training, and targets. This information was collected across all health boards so a picture of the entire country could be created.

“While Scotland might be smaller in size, there are very rural areas and it is challenging. But it was important that this was a central government-led project," she told the conference. “It will be harder in England, but we have found there are definite advantages to this kind of joined-up approach to the issue of infection control and prevention.”

Key findings to come from the Scottish project include a need to carry out regular evaluation and provide feedback that is reliable and delivered at the right time, a need for better education and training to help drive the necessary culture change needed, and innovative ways of raising awareness.

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