Healthcare-associated infection in acute hospitals: what makes a difference? Exploration of national English data

Abstract number: O133

Cookson B., Mears A., White A., Phillips E., Sedgwick J., Jenkinson H., Devine M., Bardsley M.

Objectives: To investigate the practice-related factors linked to Healthcare Associated Infection (HCAI) rates in English acute hospitals.

Methods: A questionnaire tool was developed using expert input to cover what were considered to be important elements related to the management and control of HCAI. Questionnaires sent to all trust directors of infection prevention and control and chief executives in all acute hospital trusts in England for further distribution and completion by the relevant healthcare workers in the trust. Other data were collected for responding trusts from the Patient Environment Action Team (PEAT) and the Clinical Negligence Scheme for Trusts (CNST)). Infection outcomes comprised the mandatory surveillance data for meticillin-resistant Staphylococcus aureus (MRSA) bacteraemias and Clostridium difficile associated diarrhoea (CDAD. Univariate and multivariate analyses were performed.

Results: Trust level data were received from 155 of the 173 acute NHS trusts in England. A lower MRSA infection rate was linked to hand hygiene performance measures and isolation practices, whereas a lower rate of CDAD was linked to cleanliness (PEAT Scores), good practice in antimicrobial prescribing and surveillance of infections. Lower rates of MRSA and CDAD, were related to strategic, planned interventions such as the inclusion of infection control (IC) in the staff development programme. However, certain interventions, for example increased levels of training, were related to a higher infection rates. There are many aspects of the outcome data that will be described as possible confounding factors to such studies in England.

Conclusions: The associations we have found between lower rates of MRSA and CDAD have "face value" in that they can be supported by evidence from the infection control literature. We have, however, found relationships between interventions and higher infection rates that are counter-intuitive and may represent examples of what we are calling 'reactive practice' to higher rates of infection. Whilst it is interesting to hypothesise that these interventions may be swift and simple to introduce and may not be sustained compared to more strategic and planned interventions linked to lower infection rates, this will have to be confirmed by further studies over time.

Session Details

Date: 19/04/2008
Time: 00:00-00:00
Session name: 18th European Congress of Clinical Microbiology and Infectious Diseases
Location: Barcelona, Spain
Presentation type:
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