Responsibility for HCAI Prevention and Control

RESPONSIBILITY FOR HCAI PREVENTION AND CONTROL

The responsibility for infection prevention and control is shared across all who have a role in the delivery of health and social care, from the most senior managers to the most junior members of staff at ward or unit level—often described as the ‘board to ward’ approach. Clinicians (doctors, nurses and other professional colleagues) have a personal and professional responsibility for the care of their patients. Their responsibility for patient safety includes minimizing the risk of infection by implementing best clinical practice protocols, antibiotic stewardship, etc., and delivering the highest standards of clinical care and treatment for those who develop an infection, to treat those infections and minimize the risk of transmission to others.

Health and social care service managers and overseeing boards have an overarching responsibility for providing the corporate environment in which infection prevention and control has a high priority and all staff know what is expected of them. They need surveillance data and performance audits, coupled with inclusion of infection prevention and control in the individual performance review and personal appraisal of all their staff. In this way, infection prevention and control becomes embedded in the culture of the healthcare organization.

Governments, departments of health and health service national managers are the third party in this partnership. They are responsible for making HCAI prevention and control a top priority throughout health and social care services and holding local managers and boards to account for delivery of a high quality and patient care—and low rates of HCAI. They use performance management arrangements to require high standards from healthcare providers and can set targets for HCAI reductions (or ceilings for those with good records). They decide which HCAIs should be subject to mandatory surveillance. Governments also have the ultimate authority in terms of legislation that may be used to support HCAI prevention and control. The UK government was the first to use this type of legislation in relation to healthcare in England. The Health Act 2006 implemented a statutory code of practice for the prevention and control of HCAI.

This code of practice required all NHS bodies to:

• have appropriate management systems for infection prevention and control.

• assess the risks of acquiring HCAI and take actions to reduce such risks.

• provide and maintain a clean and appropriate environment for healthcare.

• provide information on HCAI to patients and the public.

• provide information when patients move from one healthcare body to another.

• ensure co-operation between organizations

• provide adequate isolation facilities.

• ensure adequate laboratory support.

• adhere to policies and protocols applicable to infection prevention and control.

These clinical care protocols included:

• standard(universal) infection control precautions

• aseptic technique.

• major outbreak protocols.

• isolation of patients.

• safe handling and disposal of sharps.

• prevention of occupational exposure to blood-borne viruses including prevention of sharps injuries

• management of occupational exposure to blood-borne viruses and postexposure prophylaxis.

• closure of wards, departments and premises to new admissions.

• disinfection policies.

• antimicrobial prescribing policies.

• reporting of HCAI to the Health Protection Agency as directed by the Department of Health.

• policies for the control of infections with specific alert organisms.

The code of practice also required NHS bodies to ensure (as far as reasonably practicable), that healthcare workers are free of and/or protected from exposure to communicable diseases during the course of their work, and the staff are suitably educated in the prevention and control of HCAI. The latter duty within the code of practice reinforced an essential element for all approaches to prevention and control of HCAI—a requirement for education and training of all healthcare workers on the principles of infection prevention and control and the part they need to play.

The combination of all these elements represents the fact that there is personal and corporate responsibility for HCAI prevention and control at all levels in any health and social care system.