Infection prevention

‘An appropriate response’

The question…

• Which is better

– Measures to prevent infection

Or

– Allowing infection to develop then treating

What has made the biggest impact on health in the last century?

• Vaccination• Safer workplaces• Prevention and control

of Infectious diseases• Road safety• CV disease prevention

• Nutrition• Maternal and infant

health• Family planning• Fluorination of drinking

water• Tobacco control

CDC. Ten great Public Health Achievements – United States, 1900-1999. JAMA 1999; 281: 1481-3.

What has made the biggest impact on health in the last century?

• Vaccination• Safer workplaces• Prevention and

control of Infectious diseases

• Road safety• CV disease prevention

• Nutrition• Maternal and infant

health• Family planning• Fluorination of drinking

water• Tobacco control

CDC. Ten great Public Health Achievements – United States, 1900-1999. JAMA 1999; 281: 1481-3.

Infection prevention

• Sanitation• Vaccination• Prophylaxis• Processes to prevent HCAI

Semmelweis

Hand-washing reduces puerperal fever (!)Ideas rejected by medical communityA man before his time

Is trying to prevent HCAI worthwhile?

• Impact of HCAI• Hand washing• CLABSI• CAUTI• VAP• SSI• Cost-effectiveness

Impact of HCAI

• 10% of hospitalised patients develop infections• In the UK– 100000 HCAIs– 10000 deaths– Cost of 1 billion pounds

UK national audit office. The management and control of hospital acquired infection in acute NHS Trusts in England. London: the stationery office, 2000.

Service delivery

• Increased length of stay• Increased re-admissions• USA – hospitals no longer paid for the

following conditions– CAUTI– CLABSI– SSI post cardiac surgery

Hand-washing

• Hand hygiene data for staff, visitors and patients showed significant correlation with MRSA transmission (p<0.001)

• Evaluation of the UK ‘clean your hands campaign’

• Three-fold increase in soap/alcohol rub procurement

• Falling rate of – MRSA bacteraemia (1.88

to 0.91 cases per 10 000 bed days)

– C. Difficile infection (16.75 to 9.49 cases)

CLABSI

• Common, costly and potentially lethal• US – estimated 80,000 infections/year– 28,000 deaths– Average cost $45,000

• Before, during and 18 months after intervention• Mean rate decreased from 7.7 (per 100

catheter days) to 1.4 (p,0.002)

CAUTI

• 30-40% of all nosocomial infections• 95% associated with indwelling catheter• Around 10% of catheterised patients in ICU

will develop UTI• Results in – prolonged ICU stay; 26 vs 13 days (p<0.001)– Prolonged hospital stay; 49 vs 29 days (p,0.001)

VAP

• Incidence of 1-4 per 1000 ventilator days• Cause of significant patient – Mortality (>10%)– Morbidity– Cost

SSI

• SSI in 2-5% of patients undergoing in-patient surgery

• Each incident associated with 7-10 additional in-patient days

• 2-11 X increased risk of death

Achievable?

• SENIC project, 1985– 6% of infections could have been prevented with

minimal infection control measures– 32% could have been prevented with a well

organised programme

• Evaluated effectiveness of a programme to reduce HCAI over 4 years

• 19% reduction in selected HCAIs saving $9m• Total cost of the programme $6.7m

• Thought to be preventable• 65%–70% of cases of CLABSI and CAUTI • 55% of cases of VAP and SSI