England to adopt NHS Scotland’s National Infection Prevention and Control Manual
All health and social care providers to have board-level leadership with a combined IPC and antimicrobial stewardship role
The optimal facilities and infrastructure required to reduce transmission and enhance IPC in hospitals to be reviewed
The government has published a new five-year action plan to tackle the growing problem of Antimicrobial Resistance (AMR) alongside a 20-year vision for AMR in 2040.
AMR poses a major threat to healthcare in the future. It could negatively impact on our ability to treat diseases and carry out routine operations. Experts also predict it will exacerbate global health inequalities, with the poorer communities suffering more than wealthy nations.
This year’s annual report of the Chief Medical Officer, Dame Sally Davies (Health 2040 – Better Health Within Reach) states the one prediction about which there appears to be more certainty than any other – even more so than the future consequences of major issues of today such as obesity and technology – is around AMR. A shocking headline proclaims: “There is a strong probability that AMR will be a significant killer in 2040.”
That, of course, is if we do nothing about it.
“We are now certain that without significant action, AMR will have a substantially damaging effect upon future health and the global economy,” Dame Sally Davies confirms.
AMR infections are estimated to cause 700,000 deaths each year globally. That figure is predicted to rise to 10 million, alongside a cumulative cost of $100,000 trillion by 2050 if no action is taken. A 3x rise in global antibiotic consumption is predicted by 2030. No new class of antibiotics has been discovered and made available for routine treatment since the 1980s.
Infection prevention and control (IPC) is one of the core components of the government’s new five-year plan detailed in ‘Tackling antimicrobial resistance 2019-2024’, which also recognises that the built environment has a huge role to play. The plan describes health facilities as “often a reservoir for infection and resistance.”
“The Chief Medical Officer’s 2011 report on infections and AMR (published in 2013) stated that the design, construction and maintenance of healthcare facilities have a substantial bearing on the risk of developing an HAI.
“Evidence shows that drug-resistant Gram-negative infections pose a huge threat to global health; and that research and clinical efforts should be directed at reducing their burden as a matter of priority.
“There is growing recognition that hospitals can act as major nodes of transmission of these infections. This makes understanding exactly how the built environment spreads infection (and AMR), and how it can be designed to limit such spread, critical.”
In the UK the biggest drivers of resistance are a rise in the incidence of infections, particularly Gram-negatives, the importing of resistant infections through international travel and antimicrobial use. Targets for the new five-year plan include to halve healthcare associated Gram-negative blood stream infections and to reduce the number of specific drug-resistant infections in people by 10% (by 2025).
One of the most worrying trends is the rise in Carbapenemese-producing Gram-negative (CP-GN) infections because these cannot be treated with key antibiotics (ie carbapenems) and there are few treatment alternatives. People travelling to regions with a high prevalence of these organisms (CPOs) are at greater risk of their gut being colonised by these organisms. This makes them more likely to acquire a drug-resistant infection themselves and, importantly, to spread it to others when they return home.
The plan therefore states that identifying where and how these infections occur and taking preventive action is essential to maintain the effectiveness of our “go-to” antibiotics. To do this the plan pledges stronger surveillance of CP-GN infections, which are difficult to monitor; a systematic approach, which includes “a focus on hospitals as amplifiers of transmission;” and a better understanding of how the built environment favours the spread of AMR and how it can be designed to limit this spread.
Actions
Training and education of professionals will be supported with more targeted communications for health and social care. This will focus particularly on improving behaviour around hand hygiene.
Professional networks will be utilised to continue to advocate improved standards of practice.
NHS organisations in England will adopt NHS Scotland’s National Infection Prevention and Control Manual (NIPCM), which was published in 2012. This will end the current approach whereby every organisation writes its own standards adhering to the Health and Social Care Act and reduce variations in practice.
Variation/fragmentation between individual organisations and across the four nations will be reduced further by ensuring a whole system approach through cross-organisational bodies and/or a specialist IPC workforce to offer support and guidance
Research will identify how to optimise use of the built environment and act on the findings to inform policy and investment.
More in the plan
The plan also covers the use of antibiotics in animals, the food chain, the role of the pharmaceutical industry and research.
Click here to download the full report.
