Prevention of infection in human hospitals is not only a key political imperative in the United Kingdom but is also a key priority worldwide under the World Health Organization's first global patient safety challenge to ensure safer cleaner care. A UK-wide prevalence survey of hospital-acquired infections in 2006 showed that for hospitals in England there was a prevalence rate of 8.19% with the commonest types of infections being gastrointestinal (22%), urinary tract (19.7%), pneumonia (13.9%) and surgical site (13.8%).

Human healthcare-associated infections, as with animal infections, are caused by a variety of microorganisms; however, meticillin-resistant Staphylococcus aureus (MRSA), Clostridium difficile (CDI) and norovirus have recently received much attention due to increased awareness by the public and the media. Prevention and control of these and other organisms require an approach that considers both organisational and clinical aspects. An effective infection control programme in human hospitals comprises the following elements:

 Board to ward organisational commitment:

 An organisational culture that regards infections as unacceptable and not as the norm

 Clarity amongst all staff of their roles and responsibilities to prevent infection

 Clinical and managerial leadership

 Monitoring of key performance indicators

 Surveillance, incident investigation and feedback:

 Surveillance of healthcare-associated infection with in-depth analysis

 Root cause analysis of all MRSA bacteraemias and healthcare-associated infection deaths

 Organisation learning from the above, feedback to staff and implementation of actions that arise

 Antimicrobial prescribing:

 Up-to-date prescribing protocols

 Monitoring of prescribing compliance

 Consistency of clinical practice:

 Auditing of hand hygiene compliance

 Implementation of high impact intervention care bundles for: intravenous lines; urinary catheters; ventilated patients; surgical procedures; Clostridium difficile infection (CDI)

 Screening: MRSA screening and follow-up for key risk groups

 Environmental:

 Isolation of infected patients with systems to address failures

 High standards of cleanliness with appropriate monitoring

Microorganisms in a hospital setting are transmitted by the following routes:

 Airborne

 Direct and indirect contact

 Faecal-oral

 Percutaneous (or blood to blood)

Prevention of infection is aimed at breaking the chain of infection, most commonly by preventing transmission from one patient to another.

Clinical prevention of infection in human hospitals follows a standard precautions approach that involves taking a standard set of preventative measures and applying these to all patients regardless of their infection status.

The key elements of standard precautions are:

 Hospital environmental hygiene:

 A visibly clean hospital environment

 Increased levels of cleaning for outbreaks and specific organisms

 Adequate decontamination of shared equipment

 Appropriate handling of waste and linen

 Aseptic technique for invasive procedures

 Hand hygiene:

 Use of alcohol hand gel or hand washing where appropriate

 A good hand decontamination technique

 Hand care and maintenance

 Protective clothing:

 Gloves

 Aprons

 Eye protection

 Face masks

 Safe use and disposal of sharps:

 Avoidance of use

 Prevention of injuries

 Safe disposal

 Management of injuries

The principles of infection prevention that apply in human hospitals are equally applicable to prevention of infection in veterinary sciences and can be used as a basis on which veterinary practices and hospitals can base their infection prevention policies and procedures.

References

1.  Ayliffe GAJ, Fraise AP, et al. Control of hospital infection--a practical handbook (fourth edition). Arnold: London, 2000.

2.  Coia JE, Duckworth GJ, et al. Guidelines for the control and prevention of MRSA in healthcare facilities. Journal of Hospital Infection 2006; 63: s1-s44.

3.  Perry CM. Infection prevention and control (essential clinical skills for nurses). Oxford: Blackwell Publishing, 2007.

4.  Pratt RJ, Pellowe CM, Wilson JA, et al. Epic2: National evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. Journal of Hospital Infection 2007; February 2007; S1-S64.