Healthcare associated infections: A guide for healthcare professionals
September 2007 update
In February 2006 the BMA produced the report Healthcare associated infections: A guide for healthcare professionals. This report focuses on good practice in infection prevention and control, and specifically the responsibilities healthcare professionals have in managing and reducing the incidence and spread of healthcare associated infections (HCAIs) in all clinical settings. The following is a brief update to the 2006 report.
In September 2007, Health Secretary Alan Johnson outlined a series of measures to help reduce healthcare associated infections in hospitals, including new guidance on clothing. This will mean that hospitals will adopt a new "bare below the elbows" dress code i.e. short sleeves, no wrist watch, no jewellery and allied to this the avoidance of ties when carrying out clinical activity. The traditional doctors' white coat will not be allowed. The new clothing guidance will ensure good hand and wrist washing.
The guidance can be found at: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_078433
An update on figures for Europe (2005) on the number of invasive Staphylococcus aureus isolates, and the proportion resistant to methicillin (MRSA) can be found at:http://www.rivm.nl/earss/result/Monitoring_reports/Annual_reports.jsp
Panton-Valentine Leukocidin
Panton-Valentine leukocidin (PVL) is a toxin produced by some strains of Staphylococcus aureus and which destroys white blood cells. Both methicillin sensitive (MSSA) and methicillin resistant strains of S. aureus (MRSA) can produce PVL, and <2% of clinical isolates of S. aureus carry the PVL toxin. [see reference 1] A new pattern of disease due to PVL-positive strains of S. aureus is emerging in the UK and world-wide. Infections caused by PVL affect the skin, causing celluitus and pus-producing skin infections (including boils, abscesses, and carbuncles). [see reference 2] In rare cases, PVL infections can lead to septic arthritis, bacteraemia (blood poisoning) or necrotising pneumonia (a severe, life-threatening form of pneumonia). [see reference 3, 4 and 5] As the majority of the PVL-positive S. aureus strains identified in the UK are MSSA, most cases can be treated. Community-associated MRSA (CA-MRSA) are more likely to produce PVL than healthcare-associated MRSA. Interim guidance prepared by the Health Protection Agency (HPA) on the diagnosis and management of PVL-associated Staphylococcal infections can be found on the Department of Health (DH) website.
epic2 Guidelines
The first national evidence-based guidelines for preventing healthcare associated infections in NHS hospitals in England were published in 2001. [see reference 6] These guidelines were reviewed in 2005 and the epic2 guidelines were subsequently published in 2007. The updated guidelines provide comprehensive recommendations for preventing HCAIs in hospitals and other acute settings based on best currently available evidence. [see reference 7] They outline the broad principles of best practice which need to be integrated into local practice guidelines and key audit criteria have been included to monitor implementation. See the epic2 guidelines.
Health Act 2006
Code of practice for the prevention and control of healthcare associated infections
The purpose of the Code is to help NHS bodies plan and implement how they can prevent and control HCAIs. It sets out criteria by which managers of NHS organisations are to ensure that patients are cared for in a clean environment and where the risk of HCAIs is kept as low as possible. The prevention and control of HCAIs is important for all parts of the NHS, independent and voluntary sectors. It is essential to be alert to the possibility of HCAIs in both patient and healthcare workers to ensure a quick and early diagnosis, followed by treatment and containment as appropriate. Effective action relies on an accumulating body of evidence that takes account of current clinical practices. This evidence-base should be used to review and inform practice. All staff should demonstrate good infection control and hygiene practice. Further information on the Code of practice for the prevention and control of healthcare associated infections can be found on the DH website.
References
- Holmes A, Ganner M, McGuane s, Pitt TL, Cookson BD, Kearns AM. Staphylococcus aureus carrying Panton-Valentine Leukocidin genes (PVL) in England and Wales: frequency, characterisation and association with clinical disease. Journal of Clinical Microbiology 2005; 43:2384-2390.
- Reichert B, Birrell G. Severe non-pneumonic necrotising infections in children caused by Panton-Valentine Leukocidin producing Staphylococcus aureus strains. Journal of Infection 2005; 50:438-442.
- Kravitz GR, Dries DJ, Peterson ML, Schlievert PM. Purpura fulminans due to Staphylococcus aureus. Clin. Infect. Dis. 2005 ; 40:941-947
- Gillet Y, Issartel B, Vanhems P, Four net J C, Lina G, Bes M, Vandenesch F, Piemont Y, Brousse N, Floret D, Etienne J. Association between Staphylococcus aureus strains carrying gene for Panton-Valentine leukocidin and highly lethal necrotising pneumonia in young immunocompetent patients. Lancet 2002; 359:753-759.
- Klein JL, Petrovic Z, Treacher D, Edgeworth J. Severe community-acquired pneumonia caused by Panton-Valentine Leukocidin-positive Staphylococcus aureus: first reported case in the United Kingdom. Intensive Care Medicine 2003; 29:1399.
- Pratt RJ, Pellowe CM, Loveday HP et al (2001) The epic project: developing national evidencebased guidelines for preventing healthcare associated infections, phase 1: guidelines for preventing hospital-acquired infections. J Hosp Infect 47 (suppl): S1-82.
- Pratt RJ, Pellowe CM, Wilson JA et al (2007) epic2: National Evidence-Based Guidelines for Preventing Healthcare-Associated Infections in NHS Hospitals in England. J Hosp Infect 65 (suppl): S1-64.