Why isn't infection prevention prioritised?

Every time we prevent an infection we go some way to reducing the use of antibiotics. To tackle the root of antimicrobial resistance, first and foremost we must, therefore, prioritise effective infection prevention. Of course, effective infection prevention also saves lives, reduces length of stay in hospital as well as costly consumables required to treat infection.

Strategic action needed 

Yet although infection prevention and control is one of the most simple and effective ways to tackle the problem of AMR – as well as benefitting patients, staff and healthcare providers – it is not being prioritised. The government’s five year AMR strategy emphasised the fundamental importance of infection prevention, but this is not accompanied by clear strategic action to develop and support the IPC services needed to achieve this goal.

Worryingly, the last few years have seen reduced investment in the infection prevention and control workforce, resulting in a loss of experience and leadership.

For example, a survey of the Infection Prevention Society’s members carried out last year showed that almost a third (30 per cent) have seen a reduction in the IPC services where they work. This is particularly true in primary and community care settings, where community infection control services have been significantly depleted. Some services are now dependent on a single IPC professional.

This is of particular concern given the current IPC challenges in the UK. Bloodstream infections caused by E coli are now recognised as a major public health problem. They have become the most common cause of this serious infection – the number of cases has increased by 30 per cent since 2012.

The last few years have seen reduced investment in the infection prevention and control workforce, resulting in a loss of experience and leadership

Annually, there are now eight times more cases of E coli bloodstream infections than MRSA bloodstream infections at the peak of the problem with this infection in the mid 2000s.

The strategies successfully used to drive reductions in MRSA were primarily focused at acute care settings where most of the infections were acquired. Interventions focused on patient management and treatment were effective and were coordinated and supported by large IPC teams.

The same approach will not be effective against E coli bloodstream infections because they predominantly affect elderly people living in the community. Most are caused by infections of the urinary tract, which also drive a high proportion of antimicrobial prescribing in primary care.

Resistance to some of the antibiotics commonly used to treat urinary tract infections has emerged, resulting in frequent treatment failure and repeated courses of different antimicrobial agents.

The prevention of urinary tract infection in frail elderly people both living at home and in long term care is, therefore, critical to both reversing the increase in E coli bloodstream infections and reducing AMR. Key strategies include preventing elderly people becoming dehydrated, improving the diagnosis and treatment of urinary tract infections, and establishing systems to minimise the use of urinary catheters.

The lack of IPC resources to tackle these issues in community care settings seriously hampers any prospect of addressing the problems. In addition, the data on cases of bloodstream infection is held by acute care services where the patients present for treatment. Currently, there are insufficient IPC resources and few established communication systems to support sharing of data on cases with sparse community based infection control teams.

We must invest in the development of a specialist infection prevention workforce across the healthcare economy

More generally, it is difficult to recruit into senior infection prevention roles, as these are primarily filled by nurses, and we know there is a UK wide shortage of qualified staff. Major cuts in Health Education England funding to support continuing professional development has exacerbated the problem, since IPC practitioners require specialist training to be competent in their role and acquire the skills required to lead complex, trust wide IPC services.

Although the government recently indicated that continuing professional development funds will increase, they are spread very thinly across the healthcare workforce. In addition, the 17 per cent increase in the national budget for continuing professional development, announced by Health Education England over summer, does not come near to replacing the 60 per cent cuts between 2015 and 2017.

Infection prevention and control is a constantly changing field, with healthcare professionals required to deal with various new threats. Healthcare staff need to have access to best practice guidance on their prevention and management and robust governance systems to assure patient safety.

It is also vital that we build and maintain safe environments for delivering care, and procure clinical devices and equipment which best enhance patient safety. To achieve this, we must invest in the development of a specialist infection prevention workforce across the healthcare economy.

Effective infection prevention offers a win win for patients, staff and healthcare providers. Ensuring well equipped, well resourced and well educated infection prevention teams must be the cornerstone of our approach to tackling AMR.