An improvement resource to help health and social care economies reduce the number of GNBSIs, with an initial focus on Escherichia coli (E.coli).

Contents

• Evidence and resources
• Essential standards
• Antimicrobial stewardship
• Focus of infection
• Patient Information
• Education and training
• Local examples
• Incentives
• Surveillance
• Prevention of sepsis
• Monitoring E.coli
• Online GNBSI reduction toolkit

• Preventing healthcare associated Gram-negative bloodstream infections – We’ve developed this resource with Public Health England and colleagues across the health economy, including those working on the front line.

We’re focusing on reducing healthcare associated E. coli bloodstream infections because they represent 55% of all Gram-negative BSIs.

As approximately three-quarters of E. coli BSIs occur before people are admitted to hospital, reduction requires a whole health economy approach.

Tools for local teams

We’ve made suggestions rather than prescriptions about how to reduce these infections and pulled together a collection of tools for local teams. We recognise that effective prevention of infection is multifaceted and requires strong leadership, effective training programmes, and evidence-based guidelines and interventions.

If you notice there are resources missing please let us know nhsi.improveipc@nhs.net.

• Gram-negative BSI system overview tool – This tool has been designed to allow organisations or systems to assess the overall approach to reducing E.coli blood stream infections (BSIs) and the engagement with the wider health economy in delivering a reduction. It is also intended to assist organisations or systems to produce a focused and effective action plan for reducing E.coli BSIs.

We would welcome any feedback on the content and utilisation of the tool by emailing the our IPC email address: nhsi.improveipc@nhs.net.

Essential standards

• Guidance on the definition of healthcare associated Gram-negative bloodstream infections – The guidance explains, for the purposes of the NHS ambition to reduce healthcare-associated Gram-negative BSIs, how these infections will be defined according to where they are detected (community or hospital settings), and key healthcare-associated risk factors.
• WHO guidelines on hand hygiene in healthcare – Provides healthcare workers, hospital administrators and health authorities with a thorough review of evidence on hand hygiene in healthcare and specific recommendations to improve practices and reduce transmission of pathogenic microorganisms.
• Care Quality Commission: regulations for service providers and managers – safe care and treatment – The intention of this regulation is to prevent people from receiving unsafe care and treatment and prevent avoidable harm or risk of harm.
• NICE guidelines: Prevention and control of healthcare-associated infections (pathway) – This pathway covers the prevention and control of healthcare-associated infections in primary, community and secondary care.
• Guidelines for preventing healthcare-associated infections (Epic3) – Use these national evidence-based guidelines for preventing healthcare-associated infections.
• Infection prevention and control commissioning toolkit – Royal College of Nursing guidance to support nursing staff and anyone involved in the commissioning or assurance of health and social care services.

Antimicrobial stewardship

• Antimicrobial prescribing and stewardship competencies – For all independent prescribers to help improve the quality of prescribing practice.
• Antibiotic Guardian – A Public Health England campaign to encourage healthcare staff and patients to take action and slow antibiotic resistance. Make a personal pledge about action you’ll take to prevent infections and make better use of antibiotics.
• Treat antibiotics responsibly, guidance, education, tools (TARGET): antibiotic toolkit for primary care – Influence prescribers’ and patients’ personal attitudes, social norms and perceived barriers to optimal antibiotic prescribing used by the whole primary care team within the GP practice or out-of-hours setting.
• NICE guidelines: Changing risk-related behaviours in the general population (NG63) – This guideline covers making people aware of how to correctly use antimicrobial medicines (including antibiotics) and the dangers associated with their overuse and misuse.
• NICE guidance: Antimicrobial stewardship – quality standard (QS121) – Covers the effective use of antimicrobials (antibacterial, antiviral, antifungal and antiparasitic medicines) to reduce the emergence of antimicrobial resistance. It’s relevant for all care settings, all formulations of antimicrobials.
• NICE guidance: Prescribing antibiotics – Summarises the evidence base to support medicines optimisation.
• NICE guidelines: Systems and processes for effective antimicrobial medicine use (NG15) – This guideline covers the effective use of antimicrobials (including antibiotics) in children, young people and adults.

Focus of infection

Urinary tract

• Health Education England (HEE) and Public Health England (PHE) film on treatment of urinary tract infections (UTIs) in older adults – HEE has commissioned an educational film, in collaboration with PHE’s Primary Care Unit, on the treatment of UTIs in older adults for all out of hospital health and social care workers, introducing resources that can be used to diagnose, manage and prevent UTIs in out of hospital settings.
• Excellence in continence care – Evidence-based resources, research and practical guidance for commissioners to understand continence needs within their local population.
• NICE guidelines: Urinary tract infections – Evidence-based statements to deliver quality improvements in urinary tract infections (UTIs).
• Prevention of recurrent urinary tract infections in women – BMJ article that assesses the efficacy of different antibacterial regimens and non-antibacterial alternatives in the prevention of recurrent uncomplicated urinary tract infections in women.

Catheter associated urinary tract

• Preventing urinary tract and catheter infections  – Tools to support the system to consistently manage and remove urinary catheters.
• Guide to preventing catheter-associated urinary tract infections – Information, guidance and case studies to help prevent catheter-associated urinary tract infections.
• Catheter care: Royal College of Nursing guidance – Publication aiming to encourage widespread adoption of the National Occupational Standards across all NHS and independent healthcare sectors, by enabling a full understanding of the standards and providing quality care for patients.
• NICE clinical guidance: Clinical audit tool – catheter maintenance (CG139) – Use as a starting point for a local clinical audit project that aims to reduce infection by improving catheter maintenance.

Skin or soft tissue

• Stop the Pressure campaign – An improvement resource for health professionals and patients to access current information for the benefit of all at risk of pressure ulcers.
• The management of patients with venous leg ulcers – RCN report that provides a reference for health professionals requiring information about current recommendations on the assessment and management of leg ulcers.
• Wound management products and elasticated garment – Suggestions for choices of primary dressing depending on the type of wound.

Intravascular associated infection

• Standards for infusion therapy – This document has been developed to support the care of adult patients undergoing infusion therapies.

Surgical site infections

• Surgical site infection surveillance service (SSISS) – This service allows hospitals to record incidents of infection after surgery, track patient results and review or change practice to avoid further infections.

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Patient Information

• NHS choices: urinary tract infections – Information on urinary tract infections in adults.
• Leaflets to share with patients – To be shared with patients during the consultation – the leaflets aim to improve the patient’s confidence to self care and the prescriber’s communication with patients and carers.
• Antibiotic Guardian: resources for the public – Information on antibiotics and hand washing tips to share with patients.
• The Sepsis Trust – A charity that is helping the NHS to change the way it deals with Sepsis, increasing public awareness and supporting those affected by Sepsis.

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Education and training

• Core Skills Training Framework – Use to recognise training to a standard, trust that information and reduce duplication of training.
• Outcome competences for practitioners: infection prevention and control – Will assist practitioners to continually increase their existing knowledge, understanding and skills to deliver improved quality of care for patients by relieving the burden of disease and avoidable illness through healthcare associated infections.
• NHS e-learning portal – Access e-learning projects covering urinary tract infections, sepsis, skin and soft tissue infections, antimicrobial resistance, and clinical and medical leadership.
• An introduction to reducing antimicrobial resistance: e-learning module – Aimed at all health and social care staff this learning e-learning module contains resources to support awareness and education of clinical staff on antimicrobial resistance in different care settings.
• TARGET Antibiotics: training resources for GP – Training resources to help fulfil CPD and revalidation requirements, including group training presentations and e-learning modules.

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Local examples

• Reducing catheter-associated urinary tract infections at a district general hospital – Chesterfield Royal Hospital developed an improvement strategy to reduce catheter-associated urinary tract infections after data revealed rates were double the national average.

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Incentives

• Reducing the impact of serious infections CQUIN – Resources to support delivery of the ‘Reducing the impact of serious infections (antimicrobial resistance and sepsis)’ CQUIN, parts 2c and 2d.
• Our Quality Premium – This was intended to reward commissioners for improvements in the quality of the services that they commissioned and for associated improvements in health outcomes and reducing inequalities.
• Local health and care planning: menu of preventative interventions – Outlines public health interventions that can improve the health of the population and reduce health and care service demand.

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Surveillance

• English surveillance programme for antimicrobial utilisation and resistance report – Includes national data on antibiotic prescribing and resistance, and hospital antimicrobial stewardship implementation.
• HCAI Data Capture System – Public Health England’s Data Capture System provides an integrated data reporting and analysis system for the mandatory surveillance of Staphylococcus aureus, Escherichia coli bacteraemia and Clostridium difficile infections.
• Safety thermometer dashboard – Data on catheterisation and urinary tract infections.
• Escherichia coli (E. coli): guidance, data and analysis – The characteristics, diagnosis, management, surveillance and epidemiology of E. coli.
• AMR local indicators – Reported figures that can be used to benchmark your performance.

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Prevention of sepsis

• NICE guidelines: Sepsis: recognition, diagnosis and early management (NG51) – Tools to help you put the guidance into practice. Includes a baseline assessment tool, educational resources, and algorithms for managing suspected sepsis in children, adults and young people.
• The Sepsis Trust – A charity that is helping the NHS to change the way it deals with Sepsis, increasing public awareness and supporting those affected by Sepsis.

Monitoring E.coli

• E. coli rates in 2016/17 by trust – This map shows the former clinical commissioning groups and NHS providers that reported the highest and lowest rates of E. coli bacteraemia in 2016/17.
• Trust level impact of E.coli BSIs – An indicative tool showing NHS providers and commissioners how many infections are happening, the length of time patients stay in hospital, how many deaths are associated with E. coli and the financial cost to the NHS.
• GNBSI reduction toolkit – Produced and published by us in 2020, the GNBSI toolkit is an online collection of guidance notes, action plans and resources you can use to shape your approach to reducing GNBSI.

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