Introduction

Healthcare associated infections (HCAIs) are those associated with healthcare delivery in any setting. This may include in hospitals, long-term care facilities such as nursing homes or a person’s own home.[i] For an infection to be ‘healthcare-acquired’, the patient must neither have had the

infection, nor have been incubating the infection, prior to attending the health care setting[ii], or prior to the healthcare professional visiting the patient in their own home.

Despite recent successes in reducing incidence rates, HCAIs remain a cause of significant illness and early mortality.

“Infections prolong hospital stays, create long-term disability, and increase resistance to

antimicrobials, represent a massive additional financial burden for health systems,

generate high costs for patients and their family, and cause unnecessary deaths.” ²

 A significant proportion (at least 20%) of HCAIs are preventable.[iii] There is considerable evidence that infection prevention and control strategies are cost-effective.[iv]

HCAIs pose a particular risk to individuals in poor health or with weakened immune systems, due to frailty in old age, medical interventions such as surgery or chemotherapy and existing medical conditions. Their impact for individuals is broader than the physical implications. They can cause individuals and their families to lose confidence in the carers and organisations that should be supporting them through illness.¹

It has been estimated that in developed countries up to 10% of hospitalised patients develop infections every year.¹ In the UK it has been estimated that 300,000 HCAIs occur annually.[v] The cost to NHS hospitals of caring for people that acquire an HCAI has been estimated conservatively as over £1 billion a year. Of this £56 million (5.6% of total NHS costs) is estimated to occur following discharge from hospital.⁵

Under the Health and Social Care Act 2012 all providers of health and social care services must declare themselves compliant with the Essential Standards of Quality and Safety and its supporting document ‘The Code of Practice on the prevention and control of infections and related guidance’.[vi]

Infection prevention and control is the responsibility of all organisations and staff involved in the provision of health and social care. Patients also have a responsibility to understand and maintain good personal hygiene practices. The Community Infection Prevention and Control Service is commissioned to provide comprehensive specialist advice, support and local surveillance relating to infection prevention and control to community-based services

A Health Needs Assessment was completed for both Nottinghamshire County and Nottingham City in 2014, to inform a full service review for Community Infection Prevention and Control (CIPC). Findings from the needs assessment are summarized and updated within this chapter.

The full needs assessment completed by Nottinghamshire County Council Public Health is available here

Unmet needs and gaps

• Nationally and locally, risk of HCAIs in community is increasing due to shift in care provision from acute hospital to a variety of community settings including “care at home”.
• Nationally and locally, anti-microbial resistance is an ongoing significant risk to public health.
• A substantial number of preventable infections, including E.coli bacteraemia, may be linked to catheter care in community. However the extent of unmet need has not been established. The number of catheters used in community settings and the quality of catheter care is unknown.
• There is limited local surveillance data for HCAIs, which limits evaluation of local trends and service effectiveness.
• National surveillance data does not allow comparison with other areas, as it does not take into account variation in population demographics

Recommendations for consideration by commissioners

The recommendations arising from the Health Needs Assessment are provided below. Many of these are being addressed following the recommissioning of the Community Infection Prevention and Control Service in 2014.

Strategic Recommendations:

• 1. Agree and communicate clear leadership, roles, responsibilities and structure for an integrated Infection Prevention and Control function (Addressed)
• 2. CIPC services should be commissioned in line with current and future need, with greater provision made for Mansfield and Ashfield and Nottingham City (Addressed)
• 3. Commissioned capacity should plan for a widening of IPC focus beyond MRSA and CDI targets.
• 4. Review, via the IPC forum, NHS England Local Area Team and CCG prescribing leads, the implementation of prescribing guidelines on antibiotic prescribing.

Service Recommendations :

• 5. Local Surveillance should be included within CIPC contract (Addressed)
• 6. Establish the level of need due to catheter associated UTIs in community and develop a work plan to address this.
• 7. Review education and training approaches to better reach new target audiences (Addressed)
• 8. A comprehensive IPC support package should be offered to all care providers, including care in the home, learning disabilities residential units and residential care homes (Addressed)
• 9. Embed risk assessment for infection control within the standard care processes of healthcare professionals in community settings.

Commission MRSA screening and decolonisation appropriate to the need of the local population (Addressed)