Responsibility for managing healthcare-associated infections: where does the buck stop?
The prevention and control of healthcare-associated infections (HCAIs) requires a tripartite partnership between clinicians and carers, managers and government/Department of Health (DoH) across the whole health and social care community. Mandatory surveillance of meticillin-resistant Staphylococcus aureus bacteraemia and Clostridium difficile infection has shown a significant fall from peak numbers in 2003/04 and 2006, respectively, and there is now a zero tolerance approach to preventable infections and poor practice. Success so far has been based on senior management commitment, enhanced real-time surveillance, implementation of clinical protocols (high impact interventions, prudent prescribing), improved hand hygiene and environmental cleaning, and training and audit, backed up by a heightened performance management focus through targets and legislation (Code of Practice). DoH improvement teams have supported National Health Service trusts in implementing change. Responsibility for managing HCAI is a combination of managerial responsibility based upon compliance assurance that procedures and protocols are being implemented and personal professional responsibility of all clinicians and other healthcare workers.
Duerden
B I
BI
Department of Health, Wellington House, 133-155, Waterloo Road, London SE1 8UG, UK. brian.duerden@dh.gsi.gov.uk
D016470:Bacteremia / Q000453:epidemiology / Q000517:prevention & control; D016360:Clostridioides difficile; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D017053:Infection Control / Q000331:legislation & jurisprudence / Q000379:methods / Q000592:standards; D055624:Methicillin-Resistant Staphylococcus aureus; D011159:Population Surveillance / Q000379:methods*; D010818:Practice Patterns, Physicians' / Q000592:standards*; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000517:prevention & control; D013222:State Medicine / Q000331:legislation & jurisprudence*; D006113:United Kingdom / Q000453:epidemiology