Cuts pose risk to infection control gains, nurses warn

A survey of more than 500 healthcare professionals working in infection prevention and control found more than three quarters were worried financial pressure and subsequent staff cuts would leave them struggling to improve patient outcomes in future.

More than 40 per cent of respondents reported cuts to investment in infection prevention and control in the last year, while almost half expected the resources available in terms of finances and staffing to fall over the next 12 months.

The survey was carried out by the Infection Prevention Society, the Royal College of Nursing and the Patients Association.

A report on the survey describes the situation as “deeply concerning” and warns the “inroads” made in reducing levels of Clostridium difficile and MRSA could be “reversed significantly” as a result.

RCN nurse adviser on infection prevention and control Rose Gallagher said: “This is infection control practitioners telling us about their concerns and we need to listen to them.”

Research by the Health Protection Agency has found there was an 18-fold overall reduction in MRSA bloodstream infections between 2006 and 2011, from 1.3 per cent of patients to 0.1 per cent. There was also a five-fold reduction in C difficile infections, from 2 per cent to 0.4 per cent.

However, Ms Gallagher told HSJ’s sister title Nursing Times the system should not become complacent, as evidence from abroad showed it was important to keep the focus to maintain improvements.

She said the RCN was concerned focus would be lost due to the current reorganisation of the NHS, particularly if the clinical commissioning groups that are taking over from primary care trusts did not keep up the pressure on service providers.

In addition, the Health Protection Agency, which has led much of the improvement work, is moving into the newly created body Public Health England under the reforms.

Many survey respondents gave examples of infection prevention teams being lost altogether or seeing an unsustainable increase in workload as a result of reorganisation.

One told how their team had been expected to cover a much larger area without extra staff when their organisation expanded due to a merger. In the community, respondents reported the loss of PCT teams responsible for driving improvements in infection control in care homes.

Infection Prevention Society president Julie Storr said there was widespread concern about the impact of restructuring on the commissioning of infection prevention and control services.

“Together with the RCN, IPS is concerned at the potential impact this restructuring might have and we seek assurance that robust systems for commissioning will be in place to mitigate any risks to patients,” she added.

A Department of Health spokeswoman said: “Thanks to the hard work of NHS staff, C difficile and MRSA infections are at the lowest recorded level since records began, and we are determined that the NHS continues this downward trend in infections.

“This survey shows that 99 per cent of those responding saw an improvement in patient experience, safety and outcomes in relation to infection prevention in the last five years.”

She added: “Infection prevention is not about trading off quality of care with financial efficiencies – the two can and should go hand in hand. Reductions in infections over the past few years has led to decreases in treatment costs as well as reducing the discomfort caused by these avoidable infections.”

Call to look beyond C difficile and MRSA

The report calls on the Department of Health to look beyond its focus on C difficile and MRSA to take action on common categories of infection such as respiratory tract infections, catheter associated urinary tract infections and surgical site infections.

In total 85 per cent of respondents identified recognition of wider infection prevention and control issues as one of the main priorities for driving improvements in future.

The report said a “shift” in focus would lead to a “more general reduction in conditions such as sepsis, where rates have increased dramatically”.

Ms Gallagher said although sepsis could occur without any association with infection control issues, many cases in hospital could have been prevented with better infection control.

She added: “To be organism specific is not the right approach. We need to link infection prevention and control to practice wherever possible.”