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NICE has yesterday (9 November) published its quality improvement guide on the prevention and control of healthcare associated infections (HCAIs) in secondary care settings. Produced in partnership with the Health Protection Agency (HPA) as part of a pilot project, the guide identifies the organisational characteristics, arrangements and practices that describe excellence in care and practice to prevent and control HCAIs.

HCAIs can cause significant morbidity to those affected and incur considerable costs for the NHS. In 2009/10 there were nearly 2000 reported incidences of methicillin-resistant staphylococcus aureus (MRSA) and over 25,000 reports of clostridium difficile infection (CDI) at a cost to the NHS of around £260 million1 . In addition, in 2009, 77 trusts reported 831 outbreaks of norovirus, the majority of which led to some form of ward closure2 . A range of policies and measures introduced by the Department of Health have been successful in helping the NHS reduce rates of MRSA bloodstream infections and CDI, but HCAIs remain a significant financial burden for the NHS and as a result, infection prevention and control continues to be a key priority for the NHS.

The quality improvement guide is aimed at trust boards and senior management in secondary care settings including commissioners, auditors, managers and providers. The guide consists of eleven quality improvement statements describing a level of excellence in infection prevention and control at a management or organisational level. Evidence of achievement markers accompanying each statement allow trust boards to assess their compliance or progress towards each statement. In addition, the guide provides practical examples of the types of management and structural processes and associated interventions that need to be in place in order to reduce harm from infection.

Quality improvement statements in the guide include:

• Trusts have a surveillance system in place to routinely gather data and to carry out mandatory monitoring of HCAIs and other infections of local relevance to inform the local response to HCAIs.
• Trusts ensure there is clear communication with all staff, patients and carers throughout the care pathway about HCAIs, infection risks and how to prevent HCAIs, to reduce harm from infection.
• Trusts ensure standards of environmental cleanliness are maintained above the national minimum requirement.
• Trusts work proactively in multi-agency collaborations with other local health and social care providers to reduce risk from infection.

Professor Mike Kelly, Director of the Centre for Public Health Excellence at NICE, said: “There have been major improvements within the NHS in infection control, particularly in relation to Clostridium difficile and MRSA bloodstream infections, in the last few years, but HCAIs are still a very real threat to patients, staff and visitors. Indeed, evidence suggests there is wide variability in Trusts’ success in reducing the impact of HCAIs. Therefore, it is important that there is advice in place that can help Trusts achieve excellence in management and organisational practices in order to prevent and control infections. Based on the best available evidence in this area, the guide illustrates how secondary care organisations can take a whole system approach in tackling the problem. The guide is aspirational and aims to engage Trust boards and clinicians to improve the quality of care and practice in the area of infection prevention and control over and above current mandatory standards.”

Dr Bharat Patel, Lead Consultant Medical Microbiologist at the Health Protection Agency and member of the Topic Expert Group said: “This guide represents aspirational quality improvement statements in infection control and achieving these standards is something that all Trusts should aim for. It complements the existing guidelines on the prevention of healthcare associated infections and offers practical suggestions on how Trusts can best manage eleven key areas of quality improvement.

“The HPA has collaborated closely both with members of the expert group and colleagues from NICE on the production of these statements. We are confident that all Trusts will find them invaluable in planning and implementing their strategies to preventing healthcare associated infections.”

Professor Roger Finch, Consultant in Infectious Diseases, Nottingham University Hospitals Trust and Chair of the Topic Expert Group which developed the advice, said: “The control and prevention of healthcare associated infections is essential to ensuring patient safety. The nature of HCAI is complex and demands leadership and systems that are supportive and continuously refined. These quality improvement statements take an organisation-wide approach to support hospital Trusts achieve excellence and meet the high public expectations of healthcare delivery.”

Cheryl Etches, Director of Nursing and Midwifery, Royal Wolverhampton Hospitals NHS Trust and member of the Topic Expert Group, said: “The NICE guide is a useful and important set of principles that are aimed at supporting Boards in delivering their infection prevention responsibilities. It should be used to offer assurance to Boards of their strategic direction on this subject and also to drive a culture of continuous quality improvement. Irrespective of where an organisation is on their HCAI improvement journey they can use the guide to agree their next steps to improvement.”

Paul Unsworth, Area Director London, NHS Institute for Innovation and Improvement and member of the Topic Expert Group, said: “I am delighted NICE has developed this guide. Healthcare associated infections are unacceptable, avoidable and can be significantly reduced as demonstrated by the recent reductions in MRSA bacteraemias and Clostridium difficile. If implemented, this quality improvement guide, to hospital clinicians, managers, patients, carers and commissioners of healthcare, will result in a better understanding of what infective organisms exist in hospitals and the community and will be a crucial step in taking the initiative to collectively reduce the spread of infections throughout hospital, community and social care.

Graham Tanner, Chair, National Concern for Healthcare Infections and patient/lay member on the Topic Expert Group, said: “This quality improvement guide provides an opportunity to demonstrate that the NHS can deliver exemplary services for patients. The quality improvement statement relating to NHS Trusts working proactively with multi-agencies to reduce HCAIs within local health and social care organisations is of particular importance. This will support the development of integrated health and social care services, support development of patient centred care and potentially provide substantial cost savings to the NHS."

The quality improvement guide will be available on the NICE website at http://www.nice.org.uk/guidance/phg/hcai/QualityImprovementGuide.jsp from Wednesday 9 November.

For more information please call the NICE press office on 0845 003 7782 or out of hours on 07775 583 813, or email pressoffice@nice.org.uk

Notes to Editors

About the guide

1. The quality improvement guide will be available on the NICE website at http://www.nice.org.uk/guidance/phg/hcai/QualityImprovementGuide.jsp from Wednesday 9 November. For an embargoed copy, please contact the NICE press office.
2. The following tools to support implementation of the quality improvement guide are also available on the NICE website:
   • a costing report
   • a template for establishing local costs and savings
   • a learning and development resource for Board members (publishing on 25th January 2012)
3. For more information about the Health Protection Agency, please visit http://www.hpa.org.uk/
4. The NICE clinical guideline (2003) on infection control, prevention of healthcare-associated infection in primary and community care can be found at http://guidance.nice.org.uk/CG2
   This guideline is currently being updated and publication is expected in March 2012. Please see http://www.nice.org.uk/guidance/index.jsp?action=byID&o=12146 for further details.