Infection Prevention and Control

Debate between Jim Shannon and Jack Lopresti

Tuesday 15th May 2018 Westminster Hall

[Jim Shannon]

What my hon. Friend says is wise—we always hear very wise words from him, no matter what the debate. If we have best practice in Middlesex, Edinburgh, Cardiff, Newtonards, Bangor or Belfast—wherever it may be—let us replicate it everywhere else. My hon. Friend is absolutely right.

It is true that here in the UK we have made good progress in reducing the number of healthcare-associated infections over the past 10 to 15 years. The introduction of mandatory reporting of infections in the early 2000s has certainly helped to track the trends. When we look at some of the things we have done, there is good news. In 2003-04 the average quarterly count of MRSA bacteria was 1,925, but by 2008 it had reduced by 57% to 836—a significant reduction. Although that should be a cause for celebration, rates of healthcare-associated infections remain stubbornly high. Today’s debate is really about getting to the stubborn hard-core hygiene-related infections that do not seem to want to move.

The results of the most recent point-prevalence survey show that the number of patients contracting an infection in hospital is staggering. Every one of us knows how important the matter is. When my dad was in hospital for a time, he was always catching infections there. I am not saying that that was the fault of anyone, but I had thought that the possibility of infection would be greater at home—in hospital you expect it to be lower. Unfortunately, in the cases that I am aware of of people going into hospital with an illness, the rate of infection is high. People worry about that. My constituents worry about it, and I believe that everyone else’s do as well.

One in every 16 patients contract an infection in a UK hospital. That is only 6.4%, but it is 6.4% too many. There are 5,000 patient deaths every year from healthcare-associated infections. That is the thrust of the matter. If we are having deaths in hospital due to these infections we need to address the issue, and I look to the Minister for some thoughts on how we can do that. I am confident that he will come back with something that will help us in our debate.

The human cost of infection goes without saying. However, healthcare-associated infections also have a significant financial cost, which cannot be ignored. The health issues are one consideration, but the financial spin-off is also great. If we can address the infections early on, we can reduce the financial implications and also the deaths and infections. At a time when the health service is facing an unprecedented strain on services, reducing that financial burden is all the more pressing. It is estimated that hospital-acquired infections cost the NHS in excess of £l billion a year, which is 0.8% of the health service’s total budget. That is not an insignificant amount; £1 billion would change a lot of things for the health service and also, I believe, for people’s lives. That amount includes the immediate costs of treating patients in hospital, and also downstream costs due to bed-blocking—we all know the problems with bed-blocking. The costs are especially relevant, given the challenging winter that the NHS has just come through, with hospital capacity reaching 100% in some cases.

If I ask my constituents back home, where we unfortunately have a non-functioning Assembly, what the key issue is for them, they will say that it is health, and it will continue always to be health. If I may make a political statement, but not for any reason other than to illustrate the point: if Sinn Féin were to grasp what is important—and health is one of the things we can agree on—we could move forward together.

[Jack Lopresti (Filton and Bradley Stoke) (Con)]

I congratulate the hon. Gentleman on securing this important debate. I spent some time in hospital a few years ago and it was a positive experience with a happy outcome—and I escaped infection. Does the hon. Gentleman agree that it is important to get right locally the fundamentals of fighting the global threat of anti-resistance to so-called superbugs?

[Jim Shannon]

The hon. Gentleman is absolutely right; we have got to get it right in our own hospitals and across the NHS and the whole United Kingdom of Great Britain and Northern Ireland, and then we can look further afield to other countries. He reminds me that last year I had occasion to be in hospital three times for various operations. I never had any infections. I had nothing but the best care. The surgeon’s knife went in the right direction and removed what had to removed. It was important to do that. The important thing is that we have hospitals and an NHS that are excellent. When the NHS works well, it is the best in the world, but sometimes we need to think about things.

The cost of infections to the NHS includes the immediate costs of treating patients in hospital, bed-blocking and so on. There are also issues with hospital capacity, which has reached 100% in some cases. The World Health Organisation estimates that 50% to 70% of hospital-acquired infections are transmitted by hands, so improving hand hygiene must play a central role in any strategy to reduce hospital infections. It would be remiss of me not to note the work carried out by the Secretary of State to improve patient safety in the NHS—let us give credit where credit is due. In November 2016, there was a commitment to halve gram-negative infections by 2020. The Secretary of State announced he would appoint a new national infection prevention lead, Dr Ruth May. Both are important steps in bringing down infection rates and show a commitment to do so.

Given that 50% to 70% of hospital infections are transmitted by hands, I was encouraged to see alongside those measures a commitment for the NHS to publish staff hand hygiene indicators for the first time. If hand hygiene is done—it should be, and perhaps there are indications of places where it has not been—then publishing hand hygiene indicators will allow benchmarking between hospitals and help drive up standards of hand hygiene. If we can have a system that can help drive hand hygiene, we should have it. Perhaps the Minister can respond to that point in his summing up.

The policy should not be implemented by weighing or counting cartridges used in hospital hand sanitiser dispensers. If it is done by the number of cartridges used, we might be under the impression that things are going the right way, but there has to be a wee bit more to it than that. Without factoring in patient bed numbers and staffing levels, the information is, I gently say, somewhat meaningless in showing hand hygiene compliance levels. The intention is right, but other factors need to be looked at.

The Secretary of State is a strong proponent of the use of reasonable technology in the NHS. Like me, he believes it has the power to radically change how we deliver care. Electronic monitoring technology can monitor hand hygiene to deliver real-time, accurate data to drive behavioural change. We want to see behavioural change where staff are not as active on hand hygiene as they should be.

Electronic monitoring is an innovative practice that is used internationally. Studies from a hospital in the US have shown that following the adoption of the technology, hand hygiene compliance improved by 30%. If we use that methodology, hopefully we can replicate what has happened in the US and reduce infections. That 30% increase corresponded with a 29% decrease in the number of MRSA infections, saving that one hospital more than $400,000. Here in the UK, electronic monitoring is being piloted at a number of hospital trusts in what the Care Quality Commission describes as “outstanding” and “innovative” practice. It goes back to what my hon. Friend the Member for Upper Bann (David Simpson) said in his intervention: where we see good things happening, we should be doing those things across the whole United Kingdom. My hon. Friend the Member for East Londonderry (Mr Campbell) also referred to that.

If the results from the US are replicated here in the UK—they can be—the national adoption of electronic monitoring technology could see 30,000 fewer infections, saving the NHS more than £93 million. More importantly, it would mean less infection, fewer people staying in hospital and fewer deaths. Dr Ruth May, the national infection prevention lead, said that,

“the collection, publication and intelligent use of data…will ensure organisations improve infection control and help…poor performers get the support they need”.

Those are very wise words. While I welcome the announcement of the hand hygiene indicator policy, it appears that progress on its implementation has stalled. I suppose that is the point I am coming to and the reason for this debate. The Department of Health and Social Care has missed its own deadline to publish the data by the end of 2017. Data is so important in drawing up a strategy, policy and vision of how we can address the issue.

We have been collecting mandatory data on the number of healthcare-associated infections, such as MRSA and Clostridium difficile, since 2004. When hand hygiene is so critical to reducing the number of healthcare-associated infections, it is difficult to see why it has taken more than 14 years to publish data on staff hand hygiene—data that we are yet to see. I find that incredible. I spoke to the Minister last night, so he knew I would raise this issue. The key issue for me is how we use the data we have to make a policy and a strategy from which we can all benefit. To mark World Hand Hygiene Day, the World Health Organisation is calling on Health Ministries worldwide to make hand hygiene a marker of care quality. If we do that right, we will be going in the right direction.

Will the Minister consider making hand hygiene a national marker of care quality? Will he, on behalf of the Secretary of State, outline who is responsible for the implementation of the policy? Will he set out a clear timeline for the collection and publication of this data, which is critical to driving up hand hygiene standards in hospitals? Someone walking through the door of any hospital will always first notice the smell. They will probably notice the warmth of the hospital, because it is there to care for patients and those who are ill. They will also see nurses running about with their gloves on. Hand hygiene is important for them, but we need to drive it a wee bit harder from the ministerial point of view and the local hospital point of view, to ensure that it happens.

Publishing data on hand hygiene compliance is a simple first step in improving hand hygiene, which is essential to raising standards of infection prevention and control in the NHS. It will save lives and money, and we cannot afford further delay. The UK and the NHS have been at the forefront of worldwide infection prevention and control strategies since the early 2000s. While a good deal of progress has been made since then—we welcome that progress, some of which has been significant—there is much work to be done to realise the Secretary of State’s ambition: that the NHS will be the safest health service in the world. We should strive to be the best. In many cases, we are the best, but we can certainly do better. The role of good hand hygiene in reducing hospital-acquired infections and improving patient safety cannot be overstated. We must also acknowledge that the current method of direct observation in monitoring hand hygiene in hospitals is no longer fit for purpose, and that technology can and should play a role in changing behaviours.

I look to the Minister for his response. I thank all Members for taking the time to come to Westminster Hall on a Tuesday morning to make a contribution. We look forward to those contributions.