NEW approaches to preventing infections in patients in intensive care units in Wales are bearing fruit –- and Gwent hospitals are leading the way.

NOT so long ago, certain types of infections were regarded as a likely consequence of a stay in hospital.

But while superbugs, the potentially fatal likes of MRSA and Clostridium Difficile, and the efforts to tackle them have perhaps rightly hogged the headlines in recent years, another battle has been raging on the infection control front.

It concerns prevention of bloodstream infections triggered through the use of central venous catheters, or central lines.

These devices, small tubes inserted into a vein to deliver medication or fluids, are a vital part of the treatment process for many patients. However, they carry a small risk of infection as they can allow bacteria into the bloodstream.

This can add to a patient’s length of stay in hospital while an infection is treated, and for critically ill patients, those in intensive care units, it can present a dangerous added complication to already serious problems.

Now however, such infections are considered avoidable, and a new approach to prevention has brought a significant fall in infection rates in intensive care units across Wales.

Most importantly, that reduction is being sustained.

Figures from Public Health Wales’ Welsh Healthcare Associated Infection Programme, for 2007-2011, show central linerelated blood stream infections have fallen to a rate of less than one case per 1,000 catheter days in 17 intensive care units across the country. Catheter days are a measure of the days patients have such devices inserted.

This rate has been maintained in Wales for three years and some units have gone more than two years without a central line infection.

Infection control experts in Gwent have been at the forefront of moves to reduce central line infections through 1,000 Lives Plus, a Wales-wide improvement programme supporting NHS organisations and staff to deliver the highest quality, safest healthcare.

At the Royal Gwent and Nevill Hall Hospitals, there are 14 intensive care beds and ten high dependency beds, and the last central line infection in critical care across Gwent occurred in February last year.

“The vigilance of frontline staff in our intensive care units have been key in reducing these infections,”

said lead infection control nurse Liz Waters.

“(The need to treat) infections can dramatically increase the length of time a patient spends in hospital, so it is in everyone’s best interest to do all we can to avoid them developing in the first place.

“We are totally committed to promoting a culture where infections are viewed as avoidable rather than as a possible complication of a hospital admission.”

Basic principles are helping to reduce risks

REDUCTIONS in central line-related bloodstream infection rates have been driven through the introduction of care bundles.

These are groups of care procedures, based on the latest evidence, that when used together bring better outcomes for patients, and they are based on very basic principles.

In intensive care, two care bundles focus on procedures for keeping infections fromequipment use at bay, improved care, and early intervention before a patient’s condition declines.

An insertion care bundle for central lines includes ensuring hand hygiene is excellent, the skin has antiseptic applied to destroy germs, and the device is inserted in the best possible position.

Once inserted, a maintenance care bundle ensures staff reviewon a daily basis whether the device is still needed, and that it is removed as soon as the patient’s clinical condition allows, rather than it being left in, in case it might be needed again later.

Hand hygiene before and after insertion, and during maintenance, remains a basic care standard and health board audits have shown more than 95 per cent compliance in care bundle use in intensive care units.

Equally important has been a change in attitude towards central line-related infections, nowseen as avoidable rather than inevitable, to the extent that the rare development of such an infection is now often regarded as an adverse incident demanding investigation.

Chris Hancock, programme manager for 1000 Lives Plus, said central line-related blood stream infections in critically ill patients, are now“a rare, rather than common event in Wales”. “By reducing the use of central lines and improving our maintenance of them when they are needed, we can ensure we are doing all we can to reduce the risk of infection.

This ensures we avoid complications in already seriously ill patients and results in less time spent in hospital.”