The Pharmaceutical Journal
Vol 279 No 7464 p142
11 August 2007

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Tackling hospital infections

Health care-associated infections continue to pose a significant problem to acute trusts, as discussed in this week's News feature (p149). Clostridium difficile infected 55,634 patients aged over 65 years last year and almost 6,400 patients a year still contract meticillin-resistant Staphylococcus aureus bloodstream infections.

It is distressing to health professions and the public that a patient can be admitted for a routine procedure and acquire a life-threatening infection.

The Government has shown its willingness to tackle the problem by, for instance, the inclusion in the Health Act 2006 of the Hygiene Code. This sets out the statutory duties of NHS managers to ensure patients are cared for in a clean environment, where the risk of health care-associated infections is kept as low as possible.

And the Healthcare Commission has shown its readiness to enforce the provisions of the code, as it did when Barnet and Chase Farm Hospitals NHS Trust was issued with the first infection control improvement notice following an unannounced spot check last month. Initiatives such as these are beginning to have an impact, but more needs to be done.

In 2004, the Government set a national target of a 50 per cent reduction in the occurrence of MRSA bacteraemia by 2008. There is still a lot of work to do if that target is to be met.

Pharmacists working in infection control undoubtedly have a part to play and the importance of their input has increased significantly over the past decade. In 1998 the Department of Health’s Standing Medical Advisory Committee recommended that hospital pharmacists should play an important role in improving antimicrobial prescribing.

In 2003, the Chief Medical Officer for England included support by clinical pharmacists for prudent antibiotic prescribing in hospitals as an action point in his blueprint for working practice changes to reduce health care-associated infections and, in the same year, he pledged £12m over three years to support the development of clinical pharmacy activity around antimicrobial prescribing.

Although some positions have fallen by the wayside since the money from this windfall ran out, the funding did allow forward-thinking trusts to invest in services, reap the benefits and subsequently continue to fund infection control pharmacist positions themselves, including, in the case of Southampton University Hospitals NHS Trust, a consultant pharmacist position.

However, if pharmacists are to continue to develop their roles in infection control, more evidence of the impact of their interventions will be needed. And not just evidence that some interventions by pharmacists can reduce infections — pharmacists will need to know not just what works, but what does not work and what works best.

Studies need to be designed so that they produce high-quality data which can be meaningfully compared with data generated by other studies. And pharmacists, alongside other colleagues in infection control, need to focus their attention not just on working hard to tackle infections but also on working more wisely, from a solid evidence base.

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