Objective Four of the Australian strategy focuses on infection prevention and control across all sectors. Since the days of Ignaz Semmelweis (pioneer of hand disinfection in 1840s Vienna which saved the lives of women affected by nosocomial puerperal sepsis), consistent practice of infection prevention and control has been one of the most important, challenging (and neglected) aspects of healthcare. Controlling the spread of microbes is an essential companion to antimicrobial stewardship; both represent public health endeavours that bring individual and collective benefit (see Tragedy of the Commons) particularly with the waning of antimicrobial effectiveness.
What does this mean for Hunter New England and other NSW LHDs?
Basic infection prevention strategies are not yet utilised by all clinicians every time they interact with a patient (See recent post Ten Infection Control Commandments ) . This leads to increased risk of infection for patients, demonstrated in healthcare associated infection surveillance data.
Continuing focus on these basics is essential:
- Hand hygiene (disinfection with alcohol hand rub) before and after every patient contact – HNE has high rates of staff compliance with the WHO / Hand Hygiene Australia 5 Moments of Hand Hygiene standard (86% in early 2015). However medical practitioners generally lag behind nurses and midwives by 10% or more.
- Asepsis during invasive procedures on wards or manipulation of IV fluids/medications. Local auditing of these procedures at most facilities commenced in 2014.
- Invasive device management – avoidance of unnecessary use, regular (every nursing shift) monitoring for complications and device removal as soon as clinically indicated
- Cleaning of equipment / management of potential fomites BEFORE use on patients
- Adoption of safer clinician dress codes that reduce capacity of clothing to cause cross -transmission of organisms (eg. the bare-below-elbows standard)
- Detection of patients who are colonised or infected with multi-resistant organisms (MRSA, VRE, CRE) and management under contact precaution (transmission-based precautions)
- Surveillance and reporting of healthcare infections across all 42 facilities in HNE