The nadir that brought about national infection prevention and control policy

As part of a wider research project to understand and assess the current important national infection prevention and control (IPC) policy documents, a mini review of the history of the nadir of IPC that preceded and generated their introduction was needed. This narrative considers the famous and infamous events in the UK history of IPC from the early 2000s onwards, describing the prevalent context before the Departments of Health were activated to change the system. Despite an absence of numerical data on clinical outcomes and mortality, pressure built on the NHS Departments of Health as the media and the public became increasingly concerned about hospital-acquired infections (HAIs). Although there had been several publications before the National Audit Office (NAO, 2000) report on HAI, this report (from personal recollection) lit the proverbial blue touch paper when the media frequently repeated a statement therein which estimated that in the UK per annum, ‘5,000 deaths (1% of all deaths) might be primarily attributable to hospital acquired infection, and in a further 15,000 cases (3% of all deaths) hospital acquired infection might be a substantial contributor. a proportion of these deaths is avoidable’ (NAO, 2000). To emphasise, these were not UK data but extrapolated US data. The statement was preceded by a ‘data warning’: ‘. equivalent data are not available for the UK, and whilst accepting the difficulties in extrapolating [data] from one system of health care to another. a crude comparison indicates. ’ (NAO, 2000). Any emphasis on the data being non-UK, was met with more incredulity that nosocomial death rates in the UK were uncollected and thus unknown. The situation was amplified with large, high-profile outbreaks in the early to mid-2000s (Healthcare Commission, 2006,2007; Health Protection Scotland, 2003). Regardless of the availability of accurate data, the media sustained the pressure with exposés, e.g. secret swabbing of various hospital surfaces that erroneously found superbugs. Even though Goldacre (2005) demonstrated that the media knew the science and scientist were flawed, the mud stuck. Furthermore, sustained high-profile publicity greeted the data that were available (largely methicillin-resistant Staphylococcus aureus [MRSA] rates and Clostridium difficile [CDI] rates) which were inexorably going upwards (Health Protection Agency, 2009a, 2009b). All of which generated a general atmosphere of patients being afraid, not of the care required, but of the consequences of untreatable infections acquired in hospitals (King’s Fund, 2008). There was no escaping the facts: HAIs were real, increasing and patients were suffering. Before the major outbreaks and government interjections, no one was explicitly responsible for IPC outcomes (there were no Directors of Infection Prevention and Control or Infection Control Managers). Officially, it seemed the buck stopped nowhere. Also lacking were explicit specifications of what an IPC-safe environment should include, and what IPC data indicated significant issues or safety. In addition, other competing priorities for which there were targets, took precedence, e.g. time spent in Accident & Emergency before admission. Further compounding the situation was the environment. Much of the built healthcare environment was dated and unable to cope with the demands of advanced interventional healthcare. The basics were also deficient; The nadir that brought about national infection prevention and control policy