Infection Prevention and Control

Jim Shannon Excerpts

Tuesday 15th May 2018 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I beg to move,

That this House has considered raising standards of infection prevention and control in the NHS.

This issue has been brought to my attention by a number of health organisations, and by lobby groups within the House as well. We are very aware that 5 May marked World Hand Hygiene Day and I am very glad to have secured this debate, to draw attention to the importance of infection prevention and control in the NHS and, in particular, the role of good hand hygiene in raising standards.

The first time the matter came to my attention was when my brother Keith had a serious motorbike accident some 12 years ago. Whenever we visited him in the Royal Victoria Hospital, we were told by the nurses to wash our hands: “Everything has to be very, very hygienic in here.” We washed our hands almost to the point of obsession because in that ward people were between life and death, and infection could have meant the end of a life.

This year, World Hand Hygiene Day focused on raising awareness about sepsis. We all know about sepsis through our constituents and the stories in the press as well. The World Health Organisation estimates that sepsis affects some 30 million patients worldwide every year. In response to a business question that I put to the Leader of the House, she suggested I seek a debate in Westminster Hall on the matter. As I am not very often here, I thought I would introduce a debate myself for a change—it would perhaps be an occasion. Here in the UK, there are 44,000 deaths from sepsis every year and it is a priority area for the Secretary of State. Effective hand hygiene plays a key role in reducing the risk of healthcare-associated infections such as E. coli, which are a major risk factor for developing sepsis.

I told Professor Didier Pittet, director of infection control at the World Health Organisation, that a debate on infection control was taking place in Parliament—I wished to inform him about what we were doing.

[David Simpson (Upper Bann) (DUP)]

I congratulate my hon. Friend on obtaining the debate. Yes, he is not often here and it is good to see him speak. On infection control, when we go to hospitals it is amazing to see patients standing in their dressing gowns, outside the front doors, smoking—human rights and all the rest of it—some of them running about with a drip in. All that infection is brought back in. Does my hon. Friend agree that something surely needs to be done from that end as well?

[Jim Shannon]

My hon. Friend is right. I hope that hospitals will take note of what is said in this debate and take action accordingly. It is all very well a visitor washing their hands almost to the point of obsession—every time they go out and come back in again—but hopefully that same level of hygiene control is being done by the hospital as well.

When I notified him of the debate, Professor Didier Pittet said:

“In the early 2000s, the NHS was the first ever health system to use a hand hygiene promotion strategy modeled on the World Health Organisation’s. This strategy went on to be active in 186 of the 194 UN member states. I call for the UK and the NHS in particular to reinvigorate hand hygiene promotion as the main strategy to reduce infections. The WHO hand hygiene promotion strategy saves between 5 and 8 million lives in the world every year, and will save hundreds of thousands in the UK.”

So, the importance of the debate is clear.

I spoke to the Minister before the debate and gave him a copy of my speech, to make him aware of what we are trying to do and the questions I want to ask him. I have absolutely no doubt that the shadow Minister and all of us here will be saying the same thing. We are looking for the same thing. There are some pilots in place and some recommendations coming from across the NHS, and we want to look towards those as well.

[Mr Gregory Campbell (East Londonderry) (DUP)]

My hon. Friend talks about similarities and about issues being the same. Does he agree that, on the various standards—all of which are improving all of the time across the United Kingdom—we should all strive for best practice, with the most successful practices being replicated right across the United Kingdom in all the devolved institutions?

[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.

[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 ---

[Lee Rowley (North East Derbyshire) (Con)]

It is a pleasure to serve under your chairmanship, Mr Howarth. I, too, congratulate the hon. Member for Strangford (Jim Shannon) on securing the debate. As my hon. Friend the Member for Moray (Douglas Ross) said, the hon. Gentleman has attended some of the debates that I have led in previous months, so I am grateful for the opportunity to speak in a debate that he has introduced. I know the topic is important to him, and he made a great and passionate case when introducing the debate.

Like my hon. Friend the Member for Amber Valley (Nigel Mills), I am not sure whether I can do justice to some of the issues that have been outlined. I do not wish to repeat things that have been said in a far better way than I could say them—I am by no means an expert in this area. My hon. Friend the Member for Morley and Outwood (Andrea Jenkyns) and I have known each other for many years. I know how difficult it was a number of years ago, with the loss of her father, and what a passionate advocate she has become for infection control and resolving some of the issues that have been mentioned. I cannot hope to match some of the discussion that we have had today.

As a relatively new Member of Parliament, I have been surprised in the 10 months since the election by the number of people who have come to my surgery to raise these sorts of issues. I am not new to politics—I was a councillor for eight years before becoming a Member of Parliament—and perhaps because previously I was looking at a different section of government and how it operated, but I was taken aback by the harrowing stories and challenges that many constituents have highlighted and have been willing to share with me.

There are a couple of issues in particular that have come through. The first is anaemia and the second is sepsis, which the hon. Member for Strangford has raised, and I have tabled some parliamentary questions on them. On anaemia, the best way to prevent infection is to prevent people from going into hospital in the first place. We need to reduce admissions, but it is a challenge to achieve that in our health service. One reason why many people are admitted is that they have undiagnosed illnesses, they experience problems and they automatically go to A&E. They present in a way that could be avoided.

The Anaemia Manifesto Steering Committee estimates that around 4 million people live with iron deficiency. It can be a secondary diagnosis, which means that people present with symptoms that they think are something else, but which in fact are anaemia. That costs the NHS up to £50 million every single year. Recognising and acknowledging that, and doing more work on anaemia, might help to address some of the admissions issues we have. Anaemia is the fourth most common cause of admissions for people over 75. It is, by common consent, an underdiagnosed and undertreated condition, and addressing that could be a route to reducing infections, by reducing the number of people in hospital in the first instance.

Sepsis has been discussed. I have heard about a number of cases about sepsis in my surgery: a lady with a young child whose life has been completely changed as a result of contracting sepsis, and who now has a completely different outlook and different requirements in how she lives her life, because of the limitations that sepsis has created; and a family who lost their mother to a sepsis infection that was not identified early enough. I could see the pain on their faces when they were talking about this hugely personal challenge that they had faced and which was created by sepsis.

There is recognition of the problem, and the Department of Health and Social Care is doing an incredible amount to raise sepsis awareness, and to move forward the acceptance that more needs to be done, but there remain challenges in diagnosis, in ensuring effective monitoring when people are in hospital, and in appropriate and adequate treatment. I am aware of the sepsis action plan and the public information campaigns on sepsis that are under way and which no doubt will continue. My parliamentary question was answered a number of months ago; it remains the case that there is a gap in understanding and focus in the health service on sepsis. I am sure that the Department of Health and Social Care and the Minister are seeking to close that gap as quickly as possible, but there is more work to be done, particularly with more than 100,000 cases a year and the deaths that the hon. Member for Strangford has outlined.

[Jim Shannon]

I thank the hon. Gentleman for his kind comments earlier. To underline the number of deaths, Northern Ireland had a peak in 2008 of 191 deaths where C. diff was mentioned on the death certificate. That has been reduced to 67. It comes down to the hard core of problematic infection that is still there. That is where we are looking for some direction from the Minister.

[Lee Rowley]

I absolutely agree. I think everybody would recognise that there is more work to be done.

I will not take up any more time. I welcome the commitment from the Government on matters such as sepsis. There is acknowledgment across the House and from the Government, I hope, that there is more to be done in this area—there is public concern and a desire for public focus—and that process is already under way. I hope it can be restated and redoubled. We all recognise that there is further progress to be made so that we are not here in five or 10 years’ time, debating the same subjects, listening to the same stories in our surgeries.

--- Later in debate ---

[Jim Shannon]

I thank all hon. Members for their significant and helpful contributions. The shadow Minister mentioned that everyone was on the same page and saying the same thing. I love debates of this type, because they show that we can all work in a cross-party way and make significant and helpful contributions. Let me look at the thrust of what we are trying to achieve. We are trying to bring deaths down—we have got them down to a certain level—and to implement a constructive strategy and policy to move forward with diagnosis and monitoring. Members also referred to the desire for increased public focus, and to the failure of buildings.

I am sure Members will not mind me saying that we are blessed to have the hon. Member for Central Ayrshire (Dr Whitford) here. I think we all acknowledge that she brings a wealth of knowledge to this place. I say that sincerely—I mean it, as I think we all do. We can all benefit from what she knows and from what is being done in Scotland.

The Minister told me before the debate that he was standing in for a colleague. He stood in very well, and I thank him for his constructive responses to every one of our comments. Much progress has been made. We are encouraged that a strategy is in place to try rigorously to reduce infection. Members’ contributions were all helpful, constructive and positive, and I hope that the debate leads us to where we all want to be, with disease reduced and perhaps someday done away with in all hospitals. The Minister referred to a shared objective. Yes, everyone in the House has a shared objective, and we all hope that together we can make it happen. I thank each and every Member for their contribution, and I wish them well.

Question put and agreed to.

Resolved,

That this House has considered raising standards of infection prevention and control in the NHS.