Monday, 6 April 2009

The alternative summit

While Obama was travelling between No 10, Buckingham Palace and the American Ambassador’s residence as Winfield House as part of the G20 Summit, an alternative gathering was taking place in the Palace of Westminster. Dr Brian Iddon, MP for Bolton South East convened a small group to consider Healthcare Associated Infections : are we doing enough?

In addition to the kidney community, this brought together representatives and key opinion leaders from diabetes, cancer, muscular skeletal conditions, infection prevention and most importantly, patients and their experience.

The kidney – healthcare associated infection story goes back decades of course. To the Hepatitis B outbreaks of the late 1960s and early 1970s. More recently it has linked with the preparation and choice agenda and the push for improvements in vascular access for haemodialysis.

Ginny Edwards (Head of Targeted Support in the HCAI and Cleaner Hospitals Division at the Department of Health) gave an overview of progress to date – emphasising the improvements but also the need not to be complacent.

From the kidney team, Roger Greenwood (Consultant Renal Physician, Lister Hospital, Stevenage) highlighted the central role of nursing staff in infection control and explained the importance of vascular access. Fiona Loud (Chair of the Kidney Alliance), explained the feelings and concerns of service users. The anxiety poor environments cause and the need for honestly and transparency in discussions between staff and patients. Richard Fluck (Consultant Renal Physician, Derby City Hospital and Department of Health Renal HCAI lead) provided the data, a 62% reduction in MRSA bloodstream infection in the last 3 years but still an 800 times higher risk of MRSA in those dialysing via a line. The variance between units demands more attention and action to drive up quality further. Tim Statham (CEO, National Kidney Federation) spoke eloquently about the role of the public in promoting a zero tolerance to infection and to breaches of infection control measures. It is difficult for a patient to stop nurse and even more difficult to stop a doctor or professor to point out that their hands need to be washed. But such an intervention should be met with thanks for pointing it out, because it’s an important break in protocol, rather than smiles or resentment. Clearly it would be even better if patients, relatives and the public don’t need to police infection control!!

There were interesting observations from our colleagues in other disciplines including the psychological impact of HCAI which Joerg Huber (Principle Lecturer, Roehampton University) noted had been studied in diabetic foot disease. Given the use of lines and the neutropenia, low white count, in cancer, it is perhaps surprising that HCAI have had a relatively low profile in cancer care, Ian Beaumont (Campaigns Director, Bowel Cancer UK) commented.

David Jenkins (Medical Microbiologist and Lead for Infection Control at the University of Leicester Hospitals) gave a detailed account of measures taken systematically to reduce all HCAI across his organisation. He commented on the surveillance measures that were brought in on the day of this meeting (link to Q & A about infection control- chris winearls). There were a range of other interesting, some surprising and, at times, challenging statements from the invited guests and audience.

Returning for a moment to the G20, regulation does have a part to play and of course the Care Quality Commission came into operation on 1 April 2009 but as with banking, regulation alone is unlikely to solve our HCAI problems.

Nigel Edwards (Director of Policy at the NHS Confederation) pointed out that “shooting the CEO” pour encourager l’autres is not a tried and tested technique to win wars or manage healthcare organisations. A detailed systematic approach to understanding the problems and drivers of infection coupled with ownership and responsibility for HCAI by the individual clinical teams does however work. Lots of nods from the kidney team.

If the lessons we have learned by stepping up and tackling the problems through research, audit, sharing best practice, working with our patient groups and providing accurate data so that HCAI can be part of the annual quality report in every kidney unit can help other areas of clinical care to frame their approach then we should share our knowledge. But we must remember why we have made such progress – we tolerated infection; and we must not be complacent – kidney patients are still very much at risk of infection.

Nick Bosanquet, (Professor of Health Policy, Imperial College, London), concluded proceedings drawing parallels between the various clinical areas. Nick highlighted and congratulated the approach that kidney services working with kidney patients had taken and Nick will be be part of the team writing up the proceedings. I will bring you up to date with that and any suggestions that flow in my blog when the report is available.

Something of interest that I have come across recently was an item featured on HealthExec TV by North East Essex Provider Services. They have developed an electronic patient questionnaire able to capture feedback of patient experience in real time. Part of it relates to whether the patient had observed the healthcare staff handwashing. Take a look at the demonstration video on the HealthExec TV website at