HCAI

At the beginning of August, I didn't know what HCAI stood for. I certainly do now: healthcare-associated infections. As mentioned previously, this is big business in the NHS. As usual, there are mountains of paperwork associated with this, including lots of webpages which, if you have loads of free time on your hands and not a lot to do, you could trawl through. However, we have exams, therefore we need a concise summary of what is important to us as anaesthetists/intensivists for the Final FRCA. Below is an account which summarises and provides links to important guidelines/publications:

Saving Lives - Clean Safe Care
- In a nutshell, the aim is to reduce HCAIs and provide safe, clean, reliable healthcare.

Important Publications
- Winning Ways (Chief Medical Officer, Dec 2003): strategy for reducing HCAIs in UK.

- Towards cleaner hospitals & lower rates of infection (DoH, July 2004) - 6 elements:
1) Being open with the public i.e. regular publication of infection data
2) Giving power to the patients e.g. cleanyourhands campaign.

***On September 2nd, the NPSA released a Patient Safety Alert 'Clean Hands Save Lives'. The four page document can be downloaded from here.***

3) A matron's charter - ten principles for delivering cleaner hospitals
4) Independent inspection to measure progress
5) Learning from the very best i.e. home & abroad
6) Harnessing the latest research & technology

-Saving Lives (June 2005): a delivery programme for acute hospitals to reduce HCAIs using Essential Steps to Safe, Clean Care e.g. reducing MRSA strategies, preventing inter-patient contamination, urinary catheter care, enteral feeding infection risk education.

- Also of relevance to anaesthetists/intensivists are: High Impact Interventions (or Care Bundles). Important ones include:

a) CVC care
b) Peripheral intravenous cannula care (also see later)
c) Care for ventilated patients
d) Reducing the risk of Clostridium.difficile

- Going Further Faster II (June 2008): applying the learning to reduce HCAI and improve cleanliness. A long document incorporating recent national guidelines/aims in infection control.

In my trust, there is a new policy which aims to ensure that all peripheral cannulae are sited in an aseptic manner. There is also routine use of Visual Infusion Phlebitis charts/scoring. Information can be found here and here.