Infection prevention and control

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The NHS in Cornwall and the Isles of Scilly and the UK Health Security Agency (UKHSA) are extremely well prepared for outbreaks of new infectious diseases. The NHS has put in place measures to ensure the safety of all patients and NHS staff while also ensuring services are available to the public as normal. Read the latest guidance on COVID-19 for healthcare professionals

What is infection prevention and control?

Our infection prevention and control programme is led by our nurse consultant directors of infection prevention and control. Healthcare associated infections (HCAI) can occur as a result of healthcare or contact with healthcare environments. HCAIs arise across a wide range of clinical conditions and can affect people of all ages. They can worsen existing or underlying conditions, delay recovery and adversely affect quality of life. They can occur in otherwise healthy people, especially if invasive procedures or devices are used. Healthcare workers, family members and carers are also at risk of acquiring infections when caring for people.

A number of factors can increase the risk of acquiring an infection, but high standards of infection prevention and control practice, including providing clean environments, can minimise the risk. It is estimated that 300,000 patients a year in England acquire a HCAI as a result of care within the NHS. More than four million people in Europe acquire a healthcare-associated infection (HAI) every year, of whom approximately 37,000 die as a direct result of the infection, for further information please see 2016 point prevalence survey for healthcare associated infections, antimicrobial use and antimicrobial stewardship in England.

Collaboration

Close collaboration with local acute and community trusts as well as neighbouring trusts and commissioners ensures monitoring and improvement is shared.

Commissioning expectations

We expect the services we commission to comply with specific regulations. In relation to infection prevention and control the expectation is that services will be delivered as set out in The Health and Social Care Act 2008 Code of Practice on the prevention and control of infections and related guidance, more commonly known as The Hygiene Code.

All services registered with the Care Quality Commission are required to declare compliance with a specific standard relating to infection prevention and control and this relates directly to the Hygiene Code.

In addition to these standards there are additional annual improvement expectations relating to some infections. These are set by NHS England and included in our contracting processes.

Hospitals

Our local hospitals all have their own infection prevention and control teams and details of their work can be found at the links below:

We engage with the infection prevention and committees and/or steering groups of these organisations.

Expectations specific to infection prevention and control are embedded within our contracts with providers and evidence of compliance is checked every month.

Antimicrobial resistance

Antimicrobial resistance (AMR) arises when the micro-organisms which cause infection survive exposure to a medicine that would normally kill them or stop their growth. This means that the treatments usually used to treat infections caused by a resistant organism will not be effective.

Many of the medical advances in recent years, for example organ transplantation and cancer chemotherapy, need antibiotics to prevent and treat the bacterial infections that can be caused by the treatment. Without effective antibiotics, even minor surgery and routine operations could become high risk procedures if serious infections can’t be treated.

The UK government published a 20-year vision for AMR in January 2019. Some key information from this document is shown below.

No poverty: AMR strikes hardest on the poor; treatment of resistant infections is more expensive.
Zero hunger: Untreatable infections in animals threatens sustainable food production for growing populations.
Good health and wellbeing: Antimicrobials are fundamental components of all health systems.
Clean water and sanitation: Reduces infections and antibiotic residues from multiples sources contaminate water.
Decent work and economic growth: Cost of AMR is predicted to be US $100 trillion by 2050, driving an extra 28 million people into poverty.
Responsible consumption and production: It is crucial to balance access and conservation of antimicrobials with innovation, to contain AMR.

The World Bank estimates that an additional 28 million people could be forced into extreme poverty by 2050, through shortfalls in economic output, unless resistance is contained.

The 20-year vision for AMR

By 2040, the vision is of a world in which AMR is effectively contained and controlled through strong mitigation.

The UK is determined to sustain its efforts to:

combat resistance
taking local, national and global one-health approaches across humans, animals, the environment and food

This is in line with global ambitions and in collaboration with other nations, partners and the international community.

In our vision, stakeholders at local, national and global levels are:

collectively strengthening policy and practice
ever improving understanding through research and surveillance
developing effective regulation and advocacy to contain and control resistance

In the UK, we will contribute to the global effort through:

a lower burden of infection, treatment of resistant infection and minimised transmission in communities, the NHS, farms, the environment and all other settings
optimal use of antimicrobials and good stewardship across all sectors, including access to the safe and effective medicines that have been manufactured responsibility or all who need them, achieving usage levels, by sector, as good as the best countries in the world where comparable data is available
new diagnostics, therapies, vaccines and interventions in use, and a full AMR research and development pipeline for antimicrobials, alternatives, diagnostics, vaccines and infection prevention across all sectors

Local AMR work

In response to the first UK national strategy in 2013 a Cornwall antibiotic resistance group (CARG) was convened.

Purpose of the group

Responsible for ensuring implementation of UK 5-year AMR national action plan, specifically supporting delivery of 3 main strategic aims.
Reports to health and wellbeing boards via health protection committee.
Also reports into various committees within each stakeholder organisation. For example the medicines optimisation programme board.

Work streams

Education and engagement with the public.
Education and engagement with healthcare workers and vets.
Comprehensive stewardship programme for all sectors.

Primary care

GP practices in Cornwall and the Isles of Scilly have been implementing the TARGET antibiotics toolkit:

Treat
Antibiotics
Responsibly
Guidance
Education
Tools

The toolkit aims to help influence:

prescribers and patients personal attitudes
social norms and perceived barriers to optimal antibiotic prescribing

It includes a range of resources that can each be used to support prescribers’ and patients’ responsible antibiotic use. Therefore helping to fulfil continuing professional development (CPD) and revalidation requirements.

Quarterly antibiotic prescribing data is sent out to GP practices, including data for individual prescribers. This data helps them to monitor their total antibiotic items and numbers of broad spectrum antibiotics that should be kept to a minimum because of AMR.

Education

An e-learning healthcare module on reducing AMR was launched in November 2015.

This module was designed to support all health and social care staff, both clinical and non-clinical, in a variety of settings. The module can help you understand the threats posed by AMR, and ways to tackle this major health issue. This programme has been developed by Health Education England in collaboration with Public Health England and NHS England.

Antimicrobial prescribing and stewardship competencies

The antimicrobial prescribing and stewardship competencies can be used by any independent prescriber and can help with the professional development of prescribing antimicrobials. There are 5 competencies:

Infection prevention and control.
AMR and antimicrobials.
Prescribing antimicrobials.
Antimicrobial stewardship.
Monitoring and learning.

Care home resources

The infection prevention and control team at NHS Cornwall and Isles of Scilly provides a service for the care sector. Find out more on our care home resources page.

General practice resources

NHS Cornwall and Isles of Scilly provide data and learning opportunities for primary care. The resources on our general practice resources page may be useful.

Hand hygiene

Washing your hands is one of the easiest ways to protect yourself and others from illnesses such as food poisoning and flu. Washing your hands properly should take about as long as singing Happy Birthday twice (around 20 seconds). Use the following steps from the World Health Organisation while you hum:

Wet your hands with water (warm or cold).
Apply enough soap to cover all over your hands. You can use alcohol-based hand rub if you don’t have immediate access to soap and water.
Rub hands palm to palm.
Rub the back of your left hand with your right palm with interlaced fingers. Repeat with the other hand.
Rub your palms together with fingers interlaced.
Rub the backs of your fingers against your palms with fingers interlocked.
Clasp your left thumb with your right hand and rub in rotation. Repeat with your left hand and right thumb.
Rub the tips of your fingers in the other palm in a circular motion, going backwards and forwards. Repeat with the other hand.
Rinse hands with water (warm or cold).
Dry thoroughly, ideally with a disposable towel.
Use the disposable towel to turn off the tap.

How often should we wash our hands?

We should wash our hands:

after using the toilet
after handling raw foods like chicken, meat and vegetables
before eating or handling ready to eat food
after having contact with animals, including pets

Why is it so important to wash hands properly?

Washing your hands properly removes dirt, viruses and bacteria to stop them spreading to other people and objects, which can spread illnesses such as food poisoning, flu or diarrhoea.

Washing your hands with soap and water is sufficient to remove dirt, viruses or bacteria and it can reduce the risk of diarrhoea by nearly 50%.

Who is most at risk from the effects of poor hand hygiene?

Children are particularly at risk of picking up infections and spreading them to other people. It’s especially important to make sure that hands are washed when you’re visiting someone in hospital or other healthcare setting, to help prevent the spread of infection.

Hydration

Dehydration is a state in which our bodies do not have enough water. NHS England defines dehydration as a relative deficiency of fluid that causes adverse effects on function and clinical outcome. Dehydration can be mild, moderate or severe.

Several poor health outcomes are associated with avoidable dehydration including some infections.

Dehydration should always be considered as a cause for any of the following:

dry mouth, feeling thirsty
headache, poor concentration, unexpected confusion, increasing agitation
feeling dizzy when standing up
lethargy, malaise, increasing sleepiness
noticeably drier inelastic skin
dark concentrated urine
reduced urine output

Are you drinking enough?

A good rule is to drink enough fluid so that you’re not thirsty for long periods, and to steadily increase your fluid intake when exercising and during hot weather. Passing clear urine (wee) is a good sign that you’re well hydrated.

Try to drink six to eight glasses daily of fluids such as water or diluted squash. These are much more effective than large amounts of tea, coffee or fizzy drinks, which contain caffeine.

Links to patient information leaflets

Climate and sustainability and infection prevention and control

Climate change and sustainability are interconnected with infection prevention and control (IPC). As climate change and pollution influence the spread of infectious diseases, sustainable practice in healthcare and community settings are vital to minimising that risk. Adopting eco-friendly strategies, such as reducing waste consumption, and reusing and recycling where appropriate are all simple actions that can make a genuine difference. By integrating sustainability into IPC, we ensure a healthier future for both people and the environment.

Resources

It’s important to include the planet in your risk assessments, and we have just finished putting together our first IPC-related climate and sustainability bite-sized guide to help you. This quick-reference guide delves into the reduction of PPE, use and correct management of waste, reusing items to reduce plastic waste, recycling where possible and the consideration of more climate-friendly cleaning products when appropriate.

The Greener NHS is a great website that contains more detail on how climate change poses a major threat to our health as well as our planet. It includes ideas on how individuals, organisations, and suppliers can take simple action, and provides various case studies on what is already happening across the NHS to tackle climate change.

If you work in primary care, check out the Cornwall Greener Practice website, for more information on greener primary care practices. Set up by volunteer Cornwall, this team is run by a passionate group of individuals to create transformative change on climate, health and nature.

Information about what Cornwall and Isles of Scilly are taking action with, including the integrated care system (ICS) green plan, and further case studies can be found here.

If you have any questions or would like to discuss climate, sustainability and IPC, please get in touch through our generic email: ciosicb.ipc@nhs.net