National evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals

The Journal of Hospital Infection (JHI) has just released the awaited epic3 guidelines on infection prevention and control for a range of healthcare professionals. They are freely available online on ScienceDirect and on the journal's website.

The guidelines were commissioned by the UK Department of Health and have been developed after a systematic and expert review of all the available scientific evidence. They update and supersede the previous guidelines on this topic published in 2007.

Infection prevention and control came to the public awareness after the rise of MRSA and C. difficile in particular in the middle of the last decade. Since the publication of the 2007 guidelines, more resistant organisms have emerged, some of which are now almost untreatable by antimicrobials. This is actually no great surprise, as the development of resistance to antibiotics is an inevitable consequence of evolution- microbes have been producing chemical weapons to destroy each other since the dawn of life on earth. Resistance means survival. There are no really new antimicrobial agents under development, and for the first time, we are facing a world where more bacterial infections may be untreatable. Contrary to popular belief, we always had several treatment options available to treat MRSA.

Microbiologist Dr Jenny Child, Editor in Chief of The Journal of Hospital Infection, said "It is difficult to stop the rise of increasingly resistant organisms. What we can do however is prevent them spreading between patients and becoming established among the resident microbial flora- the bacterial population in our hospitals. Infection prevention and control has never been more important than it is now."

It is no coincidence that the very first of the seven key action points outlined in the UK 5-year Antimicrobial Resistance Strategy 2013-1018, produced earlier this year by the DoH and DEFRA, is about improving and control.

In her Forward to the epic3 Guidelines, which will accompany the January 2014 printed issue of The Journal of Hospital Infection, Professor Dame Sally Davies, NHS England's Chief Medical Officer, said, "In March 2013, my Annual Report on 'Infection and the rise of ' highlighted the need for to understand and put into practice the principles of infection prevention and control in order to improve patient outcomes. These updated guidelines underpin and provide the knowledge base to inform this understanding".

"The guidelines provide the evidence base for many elements of clinical practice that are essential in minimizing the spread of antimicrobial-resistant organisms, and maintaining high standards of infection prevention and control that can be adapted for use locally by all healthcare practitioners. The principles set out in these guidelines also provide the evidence base to support elements of the implementation of the 5-year UK Antimicrobial Resistance Strategy," Davies added.

Lead author of the epic3 guidelines, Professor Heather Loveday of the University of West London explained, "The updated guidelines were developed by a nurse-led multidisciplinary group of researchers, infection prevention specialists, clinicians and lay representatives following a systematic review of evidence in each of the guideline areas. The guideline recommendations provide the best available scientific evidence for preventing healthcare infections in hospitals, focusing on standard principles for infection prevention and the prevention of infections associated with short-term indwelling urethral catheters, central vascular devices and new recommendations for preventing infections associated with peripheral vascular devices. Evidence-based are only of use when translated into local policy and protocols by infection prevention teams and implemented consistently by all healthcare professionals in order to reduce variation in patient care"

More information: Foreward by Dame Sally C. Davies, dx.doi.org/10.1016/S0195-6701(13)00400-3

"epic3: National Evidence-Based Guidelines for Preventing Healthcare-Associated Infections in NHS Hospitals in England" by H.P. Loveday, J.A. Wilson, R.J. Pratt, M. Golsorkhi, A. Tingle, A. Bak, J. Browne, J. Prieto, M. Wilcox, dx.doi.org/10.1016/S0195-6701(13)60012-2

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