Infection Prevention and Control

George Howarth Excerpts

Tuesday 15th May 2018 Westminster Hall

[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.

[Mr George Howarth (in the Chair)]

I do not propose setting a time limit on speeches. It might be helpful by way of guidance to suggest that if everyone speaks for no more than 10 minutes, it should be possible to accommodate everyone who has indicated that they want to speak.

--- Later in debate ---

[Justin Madders (Ellesmere Port and Neston) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Howarth. I congratulate the hon. Member for Strangford (Jim Shannon) on securing this extremely important debate and on his insightful contribution. He has a reputation for being one of the most prolific Members of this House, both here and in the main Chamber. He has pursued this issue assiduously during his time here, and his comments made clear his commitment to improving patient safety. His contribution was wide-ranging and fecund, and he highlighted the good timing of the debate, given that 5 May is World Hand Hygiene Day. There is a particular focus this year on sepsis, to which a number of hon. Members referred. We should reflect seriously on the staggering figures they mentioned: there are 30 million infections worldwide a year and 44,000 deaths in this country, and we could save between 5 million and 8 million lives a year through greater awareness and control. We all want to tackle sepsis very seriously.

The hon. Gentleman was right to say that there will not be any political disagreement today, as we all want the very best outcomes in this area. He was right that good progress has been made, particularly over a longer period, but it could be argued that we have plateaued. The infection rate remains too high. I am sure that we all agree that the figure of 6.4% across the NHS is far too high. He talked about the human and financial cost—he mentioned the figure of £1 billion. He made the fair point that this has downstream effects, as beds are occupied unnecessarily. It is always regrettable if any patient is in a bed because of something avoidable, particularly given that the number of beds across the NHS is at an historic low.

I was pleased to hear from the hon. Member for Morley and Outwood (Andrea Jenkyns). She has spoken on a number of occasions about this important subject, and she spoke again about the personal tragedy of her father’s death. She has been a consistent and vigorous campaigner on the issue since she came to this place. This is the first time I have heard in such detail the appalling circumstances surrounding her father’s death and the basic hygiene breaches that took place. I doubt that any member of the public, let alone any trained medical professional, would consider what happened there to be acceptable. That highlights the difficulties we sometimes face in tackling these issues.

The hon. Member for Amber Valley (Nigel Mills) made a considered and thoughtful speech about a wide range of issues. He referred to the World Health Organisation’s figures, which suggest that about half of the associated deaths in this country are preventable. He was right to say that in no other area would we be prepared not to tackle such a figure with great vigour. I agree with him that staff are not deliberately flouting hygiene standards, but the pressure of work sometimes means that standards slip. From the vacancy rates referred to by the Scottish National party spokesperson, the hon. Member for Central Ayrshire (Dr Whitford), and from regular staff surveys, we know how much pressure staff are under in the NHS. The hon. Member for Strangford highlighted accurately the difficulties with the existing audit processes and how they are not necessarily the best. He summarised perfectly the false comfort that we derive from the belief in 100% compliance rates. We know from what we have heard today that when audits are not taking place, compliance is considerably less than 100%.

The hon. Member for Moray (Douglas Ross) had clearly done a lot of important and excellent research to come up with all those statistics across a whole range of environments. He showed that there is no uniform picture in tackling infection control and suggested that the condition of the buildings might sometimes be an impediment to best practice. He rightly said that that is an area where many things can be learned from across the border, or indeed across the world—best practice should be disseminated.

The hon. Member for North East Derbyshire (Lee Rowley) talked about the need to reduce hospital admissions as one way of reducing infection rates. He mentioned anaemia in particular: apparently 4 million people have an iron deficiency and anaemia is the fourth most common cause of admission. He also mentioned sepsis and the possible gap in understanding or focus in the NHS, although we have heard today that a lot of awareness-raising is going on in that area.

It has been almost two and a half years since we last discussed this issue—January 2016—so today’s debate provides us with a useful opportunity to take stock of progress. We heard about a number of recent positive initiatives but, as the hon. Member for Strangford said, levels of healthcare-acquired infections remain stubbornly high, and in some cases they are increasing. Reductions in the rates of MRSA and C. diff are welcome, but the increase in MSSA and E. coli over the past five years is worrying. Furthermore, about one in every 16 patients will still acquire an infection while being cared for by the NHS in England, and every one of those infections requires additional NHS resources and, more importantly, leads to great patient discomfort and reduces patient safety.

According to the most recent figures from Public Health England, the fatality rate is 28.1% for MRSA cases, 19.7% for MSSA, 14.7% for E. coli and 15.1% for C. diff. We cannot overstate the seriousness of acquiring one of those infections. Furthermore, the Department of Health and Social Care reported recently that, sadly, E.coli infections led to the death of more than 5,500 patients in 2015, at an estimated cost to the NHS of £2.3 billion. The impact on patients and their families is devastating, while the growing threat of antimicrobial resistance adds to the significance of the issue.

In the US and Europe alone, antimicrobial-resistant infections are estimated to cause more than 50,000 deaths a year, and that figure is projected to increase significantly, as we have heard. A report by the World Health Organisation states that resistance is frequent among bacteria isolated in healthcare facilities, with antibiotic-resistant bacteria causing over half of all surgical site infections. We cannot overstate the importance of tackling the issue.

Healthcare of course carries inherent risks, and even if we were to take every possible preventative step, it would still be possible to acquire an infection. However, as I mentioned last time we discussed the matter, it has been estimated that about 30% of infections could be avoided by better application of existing knowledge and good practice. Much of that improvement could be realised through improved hand hygiene practices. Although we have known that for decades, the method of monitoring hand hygiene in hospitals remains outdated, inaccurate and, as we heard from the hon. Member for Morley and Outwood, flawed.

The monitoring method relies on direct observation by nurses, which leads to compliance rates being overstated and takes up hours of nursing time when staff on the wards are already overstretched. Staff naturally wash their hands much more frequently when being observed directly, which results in clearly overstated compliance rates of 90% to 100%. Academic research has found that typical compliance is actually between 18% and 40%. The international best practice to which the hon. Member for Strangford referred demonstrates that electronic monitoring of hand hygiene can decrease the risk of infection by 22%, which would not only save the NHS money, but save lives. We therefore welcomed the November 2016 commitment by the Secretary of State that staff hand hygiene indicators would be published for the first time by the end of 2017. However, as we heard, that deadline has elapsed and we seem to be no nearer to seeing implementation. Will the Minister tell us when we can expect to see the detail of that long-overdue improvement?

On 19 March, in a written response, the Minister mentioned that Public Health England had carried out some initial analysis with the available data, but that the data was incomplete, so it does not truly reflect hand gel usage. I accept that it might not provide an accurate representation of the NHS as a whole, but will the Minister set out what the analysis that he has received has found, and whether any of that information might be useful in the interim until the full dataset is available? Two ongoing pilots into the use of electronic monitoring technology within the NHS have also been mentioned. Has he made any assessment of those pilots? What plans do the Government have to look at universalising good practice, if it is shown to be as effective as early reports suggest?

As with any type of infection, healthcare-acquired infections can trigger sepsis, particularly in people who are already at risk—for example, those with chronic illnesses such as diabetes, or those who are immuno- compromised, such as those receiving chemotherapy. The majority of cases do not derive from a hospital setting, but with 150,000 cases a year and 44,000 deaths, many of them preventable, sepsis is a critical safety issue for the NHS. The challenge is to recognise it in its early stages, before multiple organ failure sets in, and to implement rapid treatment. If it is left untreated for hours, the chances of death increase rapidly. Sepsis in its early stages is often dismissed as something less serious, so I ask the Minister to advise us on what processes are in place to monitor patients at risk from sepsis. What steps will he take to ensure that treatment is started without delay?

In conclusion, around the world and in this country we spend vast sums of money on researching innovations to tackle illnesses and improve our welfare, but tackling hospital-acquired infections better would potentially put us in a position to prevent thousands of unnecessary deaths each year through the most basic of steps and the dissemination of best practice.

[Mr George Howarth (in the Chair)]

Before I call the Minister to respond to the debate, I remind him gently that it is customary to leave a short period at the end of the debate for the mover of the motion to wind up.