The improvement in care and outcomes will be highlighted at the ISICEM event in Brussels by Professor Robert Masterton from the Institute of Healthcare Associated Infection, at the University of West of Scotland, University Hospital Crosshouse in Scotland.
In his presentation ‘Recent infection control developments in the ICU’, Prof. Masterton will point out that improvements have arisen because of changes made in practice and technology.
‘On the practice side the biggest change has been the introduction of standardised pathways of care, where we do the same thing every time to the patient,’ Prof. Masterton told European Hospital. This has been conducted in a number of ways, by the introduction of an integrated care pathway and care bundles - a group of three to five evidence-based interventions which, when performed together, have a better outcome than if performed individually. ‘What each of these do is ensure a consistent high quality of care,’ he explained. ‘However, that has required quite a lot of change because it is not how we have been used to working, so there have been professional cultural changes.’ The second significant change has been through the introduction of technology with new techniques, which have enabled clinicians to reduce infection risks faced by ICU patients. He suggested these centre around devices such as intravascular catheters, with upgrades to existing impregnated catheter devices and tracheotomy tubes that can contain a variety of compounds, such as anti-bacterial agents, to stabilise the condition and aid recovery for the most poorly patients. Some of the compounds are antiseptic, he explained, but they combine with techniques such as the biopatch, which has seen a reduction of intravascular line testing for catheter-related blood infections.
Professor Masterton pointed out that, whilst these changes have been implemented in recent years, the benefits are now beginning to become apparent, but the combination of practice and technical changes has been crucial. ‘It’s not possible to separate the practice changes from the technology; both have happened together, and what we see in the intensive care unit is the combined effect of each of these things – and that has been phenomenally successful.
‘We now have some units that report no ventilator-associated pneumonia for hundreds of days at a time. If you go back 10 years, over half the patients in the ICU could have ventilator-associated pneumonia. Now, with changes in technique and technology, that has been reduced to zero.’ There also has been a ten-fold reduction in catheter-related blood stream infections. However, not all ICUs within the NHS are implementing these techniques at this stage, and Professor Masterton said further research is still needed to clarify the level of benefit. ‘Part of the difficulty is that we do not know what the best combination of technology and technique is; we do not know how these individual elements come together in the best way.’
One line of research that he is pursing is how the environment contributes to infections – and improved cleaning has emerged as a key factor in seeing a reduction in healthcare-related infection. ‘What we would encourage ICUs to do is combine changes in technique with changes in technology to reduce infection control risks and occurrences. There is good evidence out there about that.
‘What ICUs need to do is adopt bundles of care that will enable them to reduce infection control and use good techniques every time.’
Today based at the Institute of Healthcare Associated Infection University of the West of Scotland University Hospital Crosshouse in Kilmarnock, from April 2011 to May 2013 Professor Robert Masterton was Medical Director and Consultant Microbiologist at Ayrshire & Arran NHS Board, working part time on secondment in his professorial role. His healthcare background is broad, having worked as a general practitioner, hospital specialist and, more recently, in senior general and medical NHS management roles. The professor has also worked on a several UK guideline groups and chaired the UK Working Party that published Hospital Acquired Pneumonia guidelines in 2008. His research interests span Healthcare Associated Infection, infection control, antibiotic management and policy and antibiotic use in variety of clinical conditions.