A Healthcare-associated infection (HCAI), also referred to as ‘nosocomial’ or ‘hospital’ infection, is an infection acquired by a patient during their care in a hospital (or other healthcare facility) which was not present at the time of admission. HCAIs can affect patients in any type of setting where they receive care and can also appear after discharge. It is a recurring global problem and represents the most frequent adverse event during care delivery. Based on data from a number of countries, the World Health Organisation estimates that each year, hundreds of millions of patients around the world are affected by HCAIs. The burden of HCAIs is much higher in low-income and middle-income countries than in high-income ones. In Africa, the prevalence of HCAIs is 19 per cent, compared to nine per cent in the UK and six per cent in the US.
Every day HCAIs (including MRSA, Clostridium difficile, pneumonia, ecoli) result in prolonged hospital stays, long-term disabilities, increased resistance to the drugs used to treat patients, massive additional costs and in some cases, unnecessary deaths. Ten per cent of all patients with an HCAI will die as a result. In fact, in the US, HCAIs are the fourth leading cause of death.
Yet its true global burden remains unknown because of the difficulty in gathering reliable data: most countries lack surveillance systems for HCAIs, and those that do have them – the vast majority of which are high-income countries – struggle with the lack of uniformity and complexity of criteria for diagnosing it. Despite this, in 30-70 per cent of cases, patients can be prevented from contracting HCAIs.
An innovative software solution developed 10 years ago by leading British healthcare software provider ICNet International has addressed this problem. ICNet is dedicated to improving patient safety, ameliorating healthcare worker efficiencies and delivering cost-effective innovative products. This reduces HCAIs through its management of, and surveillance software for, surgical site infections, infection prevention and antimicrobial stewardship. This software saves time, aids effective action and puts healthcare workers in control of their data.
With offices on five continents, ICNet has a global reach. HCA International’s private hospitals – The Portland Hospital, The Wellington Hospital, The Lister Hospital, London Bridge Hospital, The Princess Grace Hospital and The Harley Street Clinic – have been quick to invest in such state-of-the-art technology. At HCA International, the ICNet infection surveillance system brings together all of the patient’s microbiology and surgery data with patient demographics and ward status, linking key information into one real-time system which is required for proactive infection prevention activities. The software also exports key advice to HCA’s electronic patient record system, helping to engage all clinicians in the hospital network in the role of infection prevention. ICNet can be accessed by the Infection Control practitioners in any ward, in any hospital, at any time. The system allows flexibility for the individual, as well as the analysis of individual hospitals and the group as a whole.
Automated software systems such as ICNet give hospitals a chance to reduce the likelihood of outbreaks by 20 per cent. This is a major plus, as each outbreak costs, on average, £400,000 and damages the hospital’s reputation.
The UK has seen significant reductions in the past 10 years in incidences of MRSA and Clostridium difficile. Investment in ICNet automated technology throughout many NHS Acute Trusts has played its part in achieving this reduction, along with national education efforts and clean hands campaigns. Dr Christine McCartney, Executive Director for the Health Protection Agency’s Healthcare Associated Infection and Anti-Microbial Resistance Programme, said: ‘With funding available to NHS Trusts, many Infection Prevention teams chose to implement a programme of automated surveillance technology to improve their data quality and target their resources more effectively.’
Overseas reactions to the HCAI problem have been mixed, but no country has a unified system and most are reluctant to face up to the fact that up to one in ten patients entering hospital acquire an infection. In 2010, the Scottish e-Health programme wanted to be sure they were on the right track by installing and investing in a national infection control case management and surveillance programme. They therefore commissioned an independent report by Deloitte into the effectiveness of upgrading four regions to the latest ICNet technology which, by this time, had been rolled out to every continent of the world. Scotland has thus set an example in high quality care by prioritising investment.
In Germany there has been a recent installation of the ICNet software in Greifswald University Hospital. Dr Nils-Olaf Hübner, scientific coordinator of HICARE – a project aiming to develop an intervention strategy against the spread of multi-resistant pathogens – explains, ‘Integrating the ICNet solution into our HICARE project will help us to improve identification and tracking of multi-resistant organisms. The more we know, the better we can react.’
Leading private hospital group, Mediclinic Southern Africa, has confirmed that there has been a positive reduction of HCAIs at its hospitals since they installed ICNet. Briette du Toit, Infection Prevention and Control Specialist at Mediclinic Southern Africa, says: ‘With 52 hospitals covering such a large geographical area, ICNet really helped me to understand what is happening in each hospital. I am able to monitor trends and alert organisms and assist with potential outbreaks. The alerts we receive through the system have been invaluable and have helped us to control potential outbreaks, saving us time and of course enhancing patients’ quality of life. Since using ICNet we have seen a reduction in HCAI rates which is quite significant, particularly when considering the resistant organisms that are emerging.’
The University of Leicester Hospitals Trust is among several British healthcare organisations to have adopted the programme. There, Liz Collins, Senior Infection Preventionist, explained: ‘ICNet supports the work of the Infection Prevention team by retrieving data from multiple systems, which saves time, because we used to search for this information. We are able to respond more quickly as microbiology results come through automatically, so we no longer have to wait until we are notified by a microbiologist.’
In 2011, the UK National Institute of Clinical Excellence issued guidelines on reducing HCAIs which recommend the use of fit for purpose, integrated technologies, which ‘allow data from multiple sources (epidemiological, clinical, microbiological, surgical and pharmaceutical) to be combined in real time and capture surgical-site and post-discharge infections.’ ICNet is the only supplier globally which has been passed as fit for purpose by the UK Department of Health.
ICNet is utilised by the majority of NHS acute facilities in the UK, making standardisation and benchmarking between NHS ICNet users meaningful for epidemiological analysis. This also means that the ability of the technology to reduce infections can be easily shared for the benefit of the wider healthcare system. ICNet can facilitate reports to national public health bodies, consequently strengthening a country’s ability to understand the burden of infection and invest in strategies to reduce them. ICNet’s software seems to be a British solution to a global problem.