Infection prevention is everyone's business

Reducing healthcare associated infections (also known as HCAIs) is a key priority for us at NHS London. We expect all London hospitals to be as clean and safe as possible and that they are doing everything they can to make sure staff have the skills, the knowledge and the resources to ensure that healthcare can be provided in an infection-free environment.

The clean hospitals programme was a government initiative aimed at improving standards of cleanliness across the NHS. It gives more control to front line staff around cleanliness issues and highlights that cleanliness is everyone's responsibility. This was part of an overall strategy to reduce HCAIs, and was linked to guidelines to improve clinical practice (High Impact Interventions) audit programmes to monitor practice (Saving Lives) and an Improvement Team based at DH who worked with trusts across the country. NHS London's role in this strategy is to provide local support for trusts and PCTs to reduce rates of infection and to achieve national targets for meticillin resistant Staphylococcus aureus, (MRSA) and Clostridium Difficile (C diff) reduction.

In 2011 national mandatory surveillance of two further organisms, meticillin sensitive Staphylococcus aureus, (MSSA) and Escherichia coli (E coli) was introduced. Currently the data collected is being evaluated to establish if there are any links between these infections and treatments given either as an in or out-patient, as there is evidence that many of these infections are developed in patients who have had no treatment. No targets have been set for either of these infections, but trusts are reviewing previous treatment practices to identify if there are any patterns or lessons to be learnt to improve practice.

What are we doing?

Healthcare organisations in London have HCAI targets to achieve. There are national targets and more stretching local (London) targets. NHS London monitors performance against these targets closely and intervenes when organisations are at risk of not meeting them. Of course it is not all about targets and our HCAI lead works with trusts to ensure that best practice is being followed at all times and that healthcare facilities are clean and fit for purpose. London has also adopted a zero tolerance approach to avoidable infections and all organisations are working to drive down infection rates.

Good hygiene practices, education and training to promote clinical skills all help to reduce the number of cases of HCAIs. We organise training events and seminars and liaise closely with the Health Protection Agency to share best practice. We also communicate regularly with Senior Infection Control Nurses and Directors of Infection Prevention and Control to encourage new ideas and good practice and to ensure good leadership is in place. We also review the results of Care Quality Commission inspections and support organisations where the need for improvement has been identified.

Progress so far

London has shown significant reductions in the numbers of infections over time. Over the last 5 years, MRSA bloodstream infections have fallen by 85%, and continue to do so. There were 67% fewer C difficile infections in 2010/11 than there were in 2007/08 and again these numbers continue to fall. As this improvement continues, and the numbers of both infections get smaller, the targets for both become more challenging and therefore the speed of reduction slows, and there is still a way to go before we can confidently say that there are no avoidable infections, but we are definitely getting there.