NHS patients at risk of infection as inconsistent guidance leads

Patients are being put at risk of infection from Covid-19 by medics using protective clothing in the wrong ways, according to the head of the Infection Prevention Society.

The spread of Covid-19 within hospitals has become a major source of concern for health chiefs and members of the government’s scientific adversary committee, Sage, after studies showed hospitals had become centres of infection during the outbreak.

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Professor Jennie Wilson also criticised what she called “inconsistent” advice to doctors and nurses from NHS England and Public Health England as being partly to blame.

NHS England has said it believes up to one-fifth of patients may have caught the disease in hospitals.

Professor Jennie Wilson, professor of healthcare epidemiology at the University of West London, told the Health Service Journal (HSJ) that examples of poor practice in intensive care included clinicians wearing several pairs of gloves at once, or cleaning the same gloves with gels between patients.

She said: “PPE has been used to protect the staff, but the way it has been used has increased the risk of transmission between patients. The widespread use of PPE particularly in critical care environments has exacerbated the problem. Unless we tackle the approach to PPE we will continue to see this major risk of transmission of infections between patients.”

She said advice to clinicians had been inconsistent. Some guidance said gloves and gowns should be used only once while other rules failed to specify how long the PPE should be used for. There was also not clear advice on how to put on and take off protective clothing.

As a result of this combination, Professor Wilson said some staff had taken the guidance to mean that gloves and gowns must not be removed once in ICUs, which she said was leading to “hazardous” practices as they moved between patients.

She added there was a particular concern over the rise of antimicrobial resistance in intensive care units because of the use of antibiotics early in the pandemic.

The antibiotics were used to protect patients from secondary infections but Prof Wilson added: “Using broad spectrum antibiotics has always been a problem. You can generate antibiotic resistant strains in one patient using broad spectrum antibiotics but the bigger problem is if you transfer that to the other 10 patients in ICUs.

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“The management of one patient can result in harm to a lot of others if infection control is not right.”

A study at Chelsea and Westminster Foundation Trust found many Covid-19 patients received antibiotics whether or not they had confirmed secondary infections.

Out of 836 patients at West Middlesex and Chelsea and Westminster Hospitals between 20 February and 20 April, just 6 per cent had confirmed secondary infections but 80 per cent were given antibiotics.

Vanya Gant, consultant in microbiology and infection at University College London told the HSJ: “There has been a huge amount of effort and work which was beginning to really turn the tide on the rise and rise of antimicrobial resistance.

“I’m very concerned that it is possible Covid will contribute to some or most of its undoing. It may set the clock back to where we were a few years ago.

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