A paradigm shift in thinking

I’m pleased to see that the Hywel Dda Health Board’s new strategic direction for the management of Healthcare Associated Infections is available to view on their Internet site.  The paper that outlines the proposals is

“Reducing HCAI through a paradigm shift in thinking: The Law of Multiple Small Positive Returns”

I wrote this paper for the board’s Quality and Safety Committee, which considered them in June, following a series of meetings that started in December 2013.  The Quality and Safety Committee is one of the Statutory Committees of the board and the complete suite of documents are available via this hyperlink

The paper reflects our concerns that the bulk of healthcare associated infections come into the acute hospitals from the community and that if we are to make a difference, we need to free up members of our infection control team and release them to work in the community.  Traditionally, infection control teams have principally worked in hospitals.  However, as the paper seeks to explain, if we want to see less infections in the hospital, we need to work with our community colleagues with the aim of preventing infections before they occur.  When we looked at serious infections admitted to our hospitals, as measured by bacteraemia (bacteria found in the blood), over 80% occurred in people over 60 (and given that I am in that population, you could say I have a vested interest!.)

Blood cultures ariving in our laboratories have the patients location recorded on the request form.  When we looked at the 2013 data, we found 48% were taken by our Accident and Emergency Departments, which by default, meant they had indeed come from a community source. For the commonest infection organism, E. coli,  56% came from this source.   However, when we then requested the patients notes on the E. Coli positive patients for December, we found that over 80% were newly admitted with their infections.

So, the paradigm shift we are making is to increase our engagement in the community, working with our GP’s, their teams and the community nursing homes.  The “Law of Multiple Small Positive Returns” is based on my assertion that we can use a complexity science approach to addressing these infections by always seeking to identify and take action on positive steps to influence management.  On a personal level, I am increasing the amount of comments I add to reports from the laboratory particularly about urine sample results.  This is because one of the commonest organisms causing Urinary Tract Infections (UTIs) is E. coli and my concern is that is we don’t manage urinary infection correctly, this may be why we see E.coli as the major bacteria from blood cultures.