There is no single, simple or cheap way to preventing the dreaded hospital-acquired infections, writes Hilary Humphreys
Within recent years, hospital infection has become a major issue for the health service in Ireland. This has arisen because of the increasing "consumerisation" of healthcare. Patients legitimately ask more questions about the quality of the care they receive and have greater expectations.
There is also increasing concern about MRSA and, most recently, Clostridium difficile. However, hospital-acquired infection is not new and has been around for as long as hospitals.
When a patient is admitted to hospital there is always a potential risk that even the most routine of procedures could result in a complication. No procedure, no drug and no aspect of healthcare is without some risk.
However, if the admission is appropriate, that risk will be more than counter-balanced by the benefit for the patient and their family in terms of improved health. Hospital infection is an example of a healthcare complication which affects a small minority of all patients admitted to hospital.
For those who are affected, however, the consequences can include potential death, acute and chronic illness and have financial consequence for the patient, his or her family, the healthcare service and society as a whole.
Today, we are stretching ever further the boundaries of healthcare with major and welcome new developments. These include chemotherapy for previously untreatable cancers, organ support to keep patients alive while in intensive care and a greater range of transplant procedures to replace failed organs.
But at the same time we expose a new group of vulnerable patients, who previously would have died, to the possibility of acquiring hospital infections. In addition, the increasing longevity of patients, and the use of some drugs that weaken the body's own defences against infection, means that there is a continuous need to improve our preventative measures as we potentially expose more patients to infection.
Last year most acute hospitals in Ireland took part in the Hospital Infection Society Prevalence Survey of hospital infection which was carried out in Britain and the Republic.
In the Republic about one in 20 patients (5 per cent) had a hospital infection. Of these, 10 per cent were due to MRSA. The remaining nine out of 10 hospital infections were caused by other microbes, mainly bacteria.
The majority of hospital infections are treatable and while there is considerable scope for improving our approach to preventing hospital infection in Ireland, we will never achieve a zero rate for these infections.
What is not clear at present, due to inadequate information, is exactly how much of the 5 per cent of hospital acquired infections is preventable.
There is no single, no simple and no cheap solution to preventing and controlling infection in hospitals, especially as this issue has been largely ignored in our health system until recently.
The Department of Health and Children and the Health Service Executive have now prioritised this area for attention and action, and this is indeed welcome.
However, we have an enormous amount to do if we are to equal the success of countries such as the Netherlands, Switzerland, Denmark and the other Scandinavian countries, and also if we are to meet the expectations of the public.
These countries have invested in preventative measures for 30 years and more and their efforts have been accompanied by the evolution of a culture that recognises infection prevention as intrinsic to all healthcare delivery.
Any strategy to minimise infections in hospital must include the education of all healthcare workers on what is appropriate practice, as well as the education of patients, visitors and the public.
It must also enhance the professional practice of all healthcare workers such as in the area of hand hygiene (hand washing) and in the use of disposable aprons and gloves. The introduction of national and local surveillance data is essential to provide up-to-date information so that early interventions can be made.
Hygiene in hospitals is important too as our hospitals must not only look clean but have minimal numbers of microbes on the floor, on the beds or anywhere else. Recent hygiene audits have been welcome as they have at long last prioritised this area within our health system.
We must also make significant investments in terms of appropriate facilities and personnel. The practice of housing six complete strangers in a room together, sharing a bathroom and shower, harks back to an era when patient privacy was not considered important and when patients were less complicated in terms of their susceptibility to developing infection.
Current recommendations emphasise the need for more single rooms and artificially ventilated facilities to prevent the likelihood of infections spreading by air. Indeed, future hospitals are likely to have at least a half or more of all beds in the form of single rooms with appropriate isolation facilities.
We need a hospital capital development programme to ensure this occurs. Moreover, many of our hospitals do not have the relevant expert personnel such as microbiologists, infection control nurses and others to support the change necessary.
While it will never be possible to prevent all infections, it is clear that we can do much better in Ireland and it is probable that we can reduce rates of infection significantly. New developments may not immediately result in fewer hospital infections in the short term, especially as our health system functions at or near full capacity.
But even the prevention of one infection should be seen as a success for the patient, who is discharged from hospital well, the healthcare worker who can take pride in the quality of the service delivered to the patient, and the health service generally.
Hilary Humphreys is professor of clinical microbiology at the Royal College of Surgeons in Ireland and a consultant microbiologist, Beaumont Hospital, Dublin.