Idea behind infection control
A large study performed in the US (SENIC study) in the eigthies showed that 30% of the infection obtained in the hospital is preventable. Another important conclusion of this study is that the prevention is better when great effort is put on infection control.
Advances in medical technology have led to significant changes in infection control. Patients stay in the hospital shorter and many go to nursing homes early. There, they can also get infected from bugs that live in that environment. Therefore, the term of hospital acquired infection should be precisely change into healthcare associated infection. Advances in medical technology has led to a widely used material implanted in the body (prostheses, catheter) and these materials are prone to infection.
Professionals
By Belgian law, it is obligatory that a professional in infection control to have an extra education next to their basic education. For the medical doctor, it means that they need to do an additional master. The duration of this master is 1-year while the most students do it part time. In total 60 ECTS are needed to obtain this master. It is strived to have 1 infection control specialist who is medical doctor for every 1000 beds and 1 nurse infection control specialist for every 250 beds.
The budget for infection control is regulated by federal law and for 1 fte medical infection control professional a budget of about 75.000 euro is reserved each year. This is not much in comparison to what a medical specialist can earn in a year.
Health care associated infection (HCAI) control issues
In Belgium, like in many other countries, the five most common infection acquired in the hospital are: urinary tract infection, surgical site infection, venticular associated pneumonia, sepsis and C. difficile associated diarrhea.
The source of infection in health care facilities are the human (either patients or professionals) and the environment (medical instruments, computers). The way of transmission of the bugs are mainly by hands, but can be also by air. An important factor in preventing transfers of bugs is therefore the so-called handhygiene. Years in the past Semmelweis showed that hand is a transmission way of infection in childbed fever. Yet, only in about 60% occasion medical professional performed proper hand hygiene.
In my opinion, there are 2 big problems in infection control. First, the image of infection control specialist as hospital police, and second, the lack of scientific based policy. I believe to handle the first problem, communication is needed. The clinical doctors and nurses are busy and they might not have time for extra approach, but we all want that patients get better. To handle the second problem, I think more researches and collaboration are needed. Research to find evidence and collaboration to put evidence into practice.
Benchmarking
I would also like to discuss this issue. Benchmarking in infection control means comparing the numbers of HCAI between hsopitals. Although this seems to be a good idea, this can work wrongly and can lead to a panic in the media and that patients will avoid hospital with high HCAI number. Yet, the numbers of HCAI depends on the patient population and the hospital. It can be expected that hospital that perform a lot of abdominal surgery will have more surgical site infection than a hospital with no abdominal surgery. The numbers should be compared by professional only and and therefore I believe it is better not to publish the HCAI numbers publicly.
A large study performed in the US (SENIC study) in the eigthies showed that 30% of the infection obtained in the hospital is preventable. Another important conclusion of this study is that the prevention is better when great effort is put on infection control.
Advances in medical technology have led to significant changes in infection control. Patients stay in the hospital shorter and many go to nursing homes early. There, they can also get infected from bugs that live in that environment. Therefore, the term of hospital acquired infection should be precisely change into healthcare associated infection. Advances in medical technology has led to a widely used material implanted in the body (prostheses, catheter) and these materials are prone to infection.
Professionals
By Belgian law, it is obligatory that a professional in infection control to have an extra education next to their basic education. For the medical doctor, it means that they need to do an additional master. The duration of this master is 1-year while the most students do it part time. In total 60 ECTS are needed to obtain this master. It is strived to have 1 infection control specialist who is medical doctor for every 1000 beds and 1 nurse infection control specialist for every 250 beds.
The budget for infection control is regulated by federal law and for 1 fte medical infection control professional a budget of about 75.000 euro is reserved each year. This is not much in comparison to what a medical specialist can earn in a year.
Health care associated infection (HCAI) control issues
In Belgium, like in many other countries, the five most common infection acquired in the hospital are: urinary tract infection, surgical site infection, venticular associated pneumonia, sepsis and C. difficile associated diarrhea.
The source of infection in health care facilities are the human (either patients or professionals) and the environment (medical instruments, computers). The way of transmission of the bugs are mainly by hands, but can be also by air. An important factor in preventing transfers of bugs is therefore the so-called handhygiene. Years in the past Semmelweis showed that hand is a transmission way of infection in childbed fever. Yet, only in about 60% occasion medical professional performed proper hand hygiene.
In my opinion, there are 2 big problems in infection control. First, the image of infection control specialist as hospital police, and second, the lack of scientific based policy. I believe to handle the first problem, communication is needed. The clinical doctors and nurses are busy and they might not have time for extra approach, but we all want that patients get better. To handle the second problem, I think more researches and collaboration are needed. Research to find evidence and collaboration to put evidence into practice.
Benchmarking
I would also like to discuss this issue. Benchmarking in infection control means comparing the numbers of HCAI between hsopitals. Although this seems to be a good idea, this can work wrongly and can lead to a panic in the media and that patients will avoid hospital with high HCAI number. Yet, the numbers of HCAI depends on the patient population and the hospital. It can be expected that hospital that perform a lot of abdominal surgery will have more surgical site infection than a hospital with no abdominal surgery. The numbers should be compared by professional only and and therefore I believe it is better not to publish the HCAI numbers publicly.
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