Whilst there has been considerable efforts put into preventing avoidable infections in hospitals, the public are still largely unaware of the simple actions that can be taken to reduce the burden of avoidable infections in the wider community.

Resistant pathogens continue to concern many in the field of microbiology, but not all healthcare professionals are in tune with the need to inform their patients on the sensible use of antibiotics. Posters in surgeries are few and far between, workplaces, supermarket notice boards, schools and public transport could all help spread the word.

There are some NHS Hospital Trusts and Strategic Health Authorities that have taken the initiative to raise awareness, but with cuts in budgets for many this has been a lower priority, despite the fact that preventing infections is far more cost effective than trying to manage the consequences of contracting them in the first place, which can often be fatal.

The Swine Flu epidemic has served to heighten the need for information and more needs to be done to raise awareness not only of the need for those at higher risk to come forward for vaccination, but also to take the necessary precautions to help prevent and fight infections like the Swine Flu.

With cases of flu in England and Wales soaring by 45% in a week, Swine Flu reaching epidemic proportions in under-fives and 39 dead from flu, 36 from the H1N1 virus, it’s time for the government to put promised resources into a public information campaign.

The previous administration was criticised by the present Health Secretary Andrew Lansley for making promises it didn’t keep, the Labour government stepped down the resources that were earmarked for raising awareness by curtailing the “cleanyourhands” campaign and ignored the research findings that they themselves commissioned proving the need for a public information campaign. We had hoped the new administration would heed our warnings, but to date little has changed as the campaign has not come to fruition.

By Derek Butler Chair MRSA Action UK www.mrsaactionuk.net

A key driver in this is the provision of meaningful and easily accessible information. An open, transparent NHS is a safer NHS. Dr Foster’s Hospital Guide, published today, is a welcome source of information about standards in healthcare services, which patients and purchasers of healthcare services can use.

In particular, the guide highlights high levels of “adverse medical events”, the widespread under-reporting of incidents and too many hospitals with death rates higher than one would expect.

Safe care saves lives and saves money. Adverse events like high levels of infection, blood clots or falls in hospital, emergency readmissions and pressure sores cost the NHS billions of pounds every year. There is a serious human cost too, with patients ending up injured, or even dead. Most are avoidable with the right care.

So what are we doing about it? For a start, the NHS consists of many highly skilled, dedicated and motivated people. We will free them from central control while holding them to account for the quality of care they deliver. Soon, GPs will be responsible for designing and paying for local health services, working with their colleagues across the NHS to get the best results for their patients.

We will shine a bright light on NHS performance. A new culture of openness and transparency will transform patient care. Everyone – patients, the public and other clinicians – will be able to see just how well a particular organisation, team or even an individual is performing. This will create a huge incentive for ever higher levels of quality and patient safety.

We have already published hospital infection data for MRSA and C-difficile online, updated weekly for all to see. And we are planning to publish regular data on other potentially fatal infections too. We are also changing the way we collect and publish mortality statistics so that they act as an early trigger for unsafe care.

In the coming years, we will add significantly to this, making it much easier for patients and their doctors to choose the best and safest care. Our plan to deliver a payment system linked to the result of treatments will encourage hospitals to improve the quality of care they deliver for patients – like our 30-day readmission tariff – and should help drive up even higher the standards of care in hospitals.

And we will focus on outcomes: reducing avoidable deaths, continually cutting infections, treating patients safely and successfully and then getting them back home. This already happens in heart care where publishing data on outcomes has been critical to taking our results well above those elsewhere in Europe. We want to see this happen across the board.

The NHS deals with nearly a million patients a day. No one can guarantee that nothing will ever go wrong. But we can eliminate the culture of blame and secrecy that can compound the initial mistake and stops lessons being learned.

I never want anyone working in the NHS to be afraid of coming forward when they believe patient safety is compromised. We will strengthen the whistleblowing rights of staff and place a duty on their employer to support and investigate their concerns.

I want the NHS to give all patients care that compares with the very best in the world. To help it achieve this, a new range of quality standards – designed by the professions themselves and monitored by the independent Care Quality Commission – will set out what safe, high-quality care looks like. But the standards will not dictate how this is to be achieved. This government will never undermine the clinical judgment of health professionals.

Where the NHS embraces a culture of transparency, of learning from its mistakes and constantly striving for higher performance, it is a world-beater.

There are real centres of excellence – the challenge now is to achieve that excellence across the whole of the health service.

The interview was carried at: http://www.guardian.co.uk/andrew-lansley-doctor-foster-comment

Ms Gibb went to court after the Department of Health withheld a six-figure severance payment she had agreed in return for her resignation days before a report into the outbreak was published by the Healthcare Commission.

The judge said the trust had offered to compensate Ms Gibb, who was paid £150,000 a year, so it could “sacrifice on the altar of public relations a senior official who had done nothing wrong”. Its decision was one that “the Department [of Health] does not appear to have cavilled at,” he added.

But when the department later disallowed most of the payment, worth £250,000, it triggered the court action by Ms Gibb.

Lord Sedley said: “The effect of unwarranted departmental interference has been to trap the trust between a rock and a hard place and to expose it, in its attempt to escape, to heavy legal costs.” He added: “It seems that the making of a public sacrifice to deflect press and public obloquy, which is what happened to the appellant, remains an accepted expedient of public administration.”

The Healthcare Commission inquiry into the outbreak, published in October 2007, was highly critical of the trust’s leadership but pinned much of the blame on the Trust’s board – all of whom resigned following its publication.

The Commission’s report said the trust should review its leadership and the trust ordered its legal advisers to report on allegations against Ms Gibb. But no adverse findings were discovered and a decision was made not to remove her by the trust’s Remuneration Committee.

That decision was reversed at a meeting of the committee in September 2007, when it was decided to pay off Ms Gibb before publication of the Healthcare Commission report in October. It was agreed that she would receive £75,000 in lieu of notice and £175,000 compensation.

But the trust rescinded the agreement after being ordered by the director-general of NHS Finance, Performance and Operations to withhold the £175,000 compensation payment, which has since increased to £190,000 with interest.

The Court of Appeal yesterday ordered the trust to pay Ms Gibb the full amount of the compensation plus the costs of the court hearings.

Lord Sedley concluded: “Perhaps those responsible will now reflect that, since such blame as the report allocated was subsequently accepted by the trust’s board – all of whom resigned following publication of the report – there had been no good reason to dismiss the CEO; and that all this money, both compensation and costs, could have been spent on improving hygiene and patient care in the trust’s hospitals.”

Patients and relatives affected by the superbug reacted angrily. Former Bucks Fizz singer Cheryl Baker, whose mother-in-law Doreen Ford died at Maidstone Hospital in 2008 aged 77 after contracting clostridium difficile, called on Ms Gibb to give the money to the families whose loved ones died.

From: http://www.independent.co.uk/payout-for-hospital-chief-after-90-superbug-deaths

Of particular concern was the state of ambulances, which were inspected for the first time. Investigators found dirty forceps stored in some vehicles as well as bloodstains.

The Care Quality Commission (CQC) used its sweeping powers last year to assess how well NHS trusts were coping with hospital infections – which affect 300,000 patients a year.

Of the 167 trusts inspected, 42 were found by the commission to be in “breach” of NHS registration requirements by not meeting standards.

All 11 ambulance trusts in England were assessed – and four found to have violated the terms of their NHS contracts.

Things were so bad that ambulance services in the north-west, east of England and east Midlands received formal warnings for the state of vehicles and stations.

The CQC, derided by critics as a toothless watchdog for “naming and shaming but not paining”, revealled that it has been granted the power to impose tough sanctions that could see failing hospitals warned, prosecuted, fined up to £50,000 and ultimately closed down if they fail to comply with the regulator’s edicts.

As a test-run of this regime the commission was authorised to examine the risks in the NHS of healthcare- associated infections and the results revealed that a minority appeared to take a cavalier approach to safety.

The reasons for failure were worrying: 36 trusts were not providing areas to decontaminate instruments; in three trusts there was a failure to regularly flush unused water outlets – crucial for the control of legionella infections; and 13 trusts were criticised for not keeping clinical areas clean.

Nigel Ellis, the CQC’s head of national inspection, said: “Good infection control takes constant vigilance – and meeting that every day, for every patient, is an ongoing challenge for the NHS.

“We have found evidence of a direct risk to patients and have intervened using our new enforcement powers to ensure swift improvements were made.”

Of these failing trusts, five had to be issued with a warning notice – the first step towards losing the right to operate in the NHS. Investigators pinpointed several serious transgressions, especially in ambulances.

In the north-west vans were stocked with dirty neck braces that were continually reused despite health guidelines urging disposal after one patient’s use.

At Stockport ambulance station, vehicle interiors were “seen to have stains (which appeared to be bloodstains) on the walls as well as visible dirt on the floor and walls”.

In Essex “hand wipes were not available” and “poor levels of cleanliness” were found in 22 out of 23 vehicles inspected. Ambulance equipment in the East Midlands was singled out for being “visibly dirty, including suction units, defibrillators and the tips of forceps”.

The hospitals highlighted for poor practice were both foundation trusts: Basildon and Thurrock university hospitals, and the world-famous Alder Hey children’s foundation trust in Liverpool.

In Basildon, where the commission’s old ratings system had come under fire last year for labelling the hospital “good” weeks before it emerged that dozens of patients might have died after receiving substandard care, investigators found a dismal scene: “Procedure trays used by staff to carry equipment when they take blood samples or give injections had blood spattered on them … a commode soiled under the seat.” Out of date equipment was also found in the emergency stores.

In Alder Hey, one of Europe’s largest children’s hospitals, the inspection revealed dirty toys, hair stuck to medical equipment and “nappy changing mats stored on the floor next to a toilet … and a dirty baby bath was inside the full-size bath”. The water “ran brown” from taps in rooms ready for patients to be admitted.

The commission said the threat of further measures had pushed the offenders into cleaning up their act. Hospitals and ambulance trusts were forced to set up better procedures, buy new equipment and “deep clean” wards and vehicles – or face a rolling wave of inspections. The last of the conditions imposed for infection control was removed only last December.

Under the new regime CQC can send teams of investigators, accompanied by groups of patients, to hospitals to see whether they match “client” expectations. The bolstered regime is capable of 2,000 unannounced visits a year – three times the current level. “We want to put the patient at the heart of what we do,” said Dame Jo Williams, acting chair of the commission. “Doesn’t matter if it’s the health service, the banking system or Tesco, there is something about the way you are treated as a patient or a client or a customer.”

From: http://www.guardian.co.uk/quarter-nhs-trusts-failing-hygiene-tests

Female staff who follow the Islamic faith will be allowed to cover their arms to preserve their modesty despite earlier guidance that all staff should be “bare below the elbow”.

The Department of Health has also relaxed rules prohibiting jewellery so that Sikh members of staff can wear bangles linked with their faith, providing they are pushed up the arm while the medic treats a patient.

The Mail on Sunday reported the change had been made after female Muslims objected to being required to expose their arm below the elbow under guidance introduced by Alan Johnson when he was health secretary in 2007.

The rules were drawn up to reduce the number of patients who were falling ill, and even dying, from superbugs such as MRSA and Clostridium difficile.

Revised guidance which relaxed the requirements for some religions was published last month.

Some Muslim staff and those from other groups may be allowed to use disposable plastic over-sleeves which cover their clothes below the elbow and allow the skin to remain covered up.

Derek Butler, chairman of MRSA Action UK, said: “My worry is that allowing some medics to use disposable sleeves you compromise patient safety because unless you change the sleeves between each patient, you spread bacteria.

“Scrubbing bare arms is far more effective.”

From: http://www.telegraph.co.uk/health/healthnews/7576357/Muslim-staff-escape-NHS-hygiene-rule.html