interviews

‘An incredible success story that absolutely does not get the attention it deserves’

Paul Weaving, associate director of infection prevention and control at North Middlesex University Hospital NHS Trust, talks to NHE about the change in mindset that no longer treats healthcare associated infections as inevitable.

North Middlesex University Hospital NHS Trust is an aspirant foundation trust, and as such has been putting on a programme of educational and engagement events for prospective members.

The most recent talk covered infection prevention, taking a step back to look at the big trends over the last 10-15 years. Paul Weaving, associate director of infection prevention and control at the trust, has worked there for two years but has worked in the field of infection prevention since 2000. It was at around that time that the issue began to rise up the political, NHS, and media agenda – especially because of the growing prevalence of MRSA. 

Those concerns led to the reintroduction of the matron role and, from 2005, trust-specific targets on things like MRSA bloodstream infections. Weaving said: “There was a lot of discussion and debate at the time about how appropriate this was as a target, and whether the target was achievable. There were questions about whether the NHS was being ‘set up to fail’, including from people in my own speciality, who really were not happy about being set that target. 

“It was quite quickly demonstrated very clearly that yes, it was [achievable] because the NHS managed a significant reduction. The original target was a 50% reduction in the number of MRSA bloodstream infections by 2007-8 against the 2003-4 baseline. That was achieved by the NHS as a whole and by almost all NHS trusts, including North Middlesex.” 

That success continued over the following years at the trust – in 2005-6, the first year of mandatory reporting, it had 30 MRSA bloodstream infections reported, which by 2008-9 had fallen to 10. 

Nationally and locally, Weaving said, it was achieved through “making sure that we actually applied the principles we were already fully aware of”.

Change in attitude 

He continued: “The biggest change I’ve noticed in the last 10 years is a change in attitude and an acceptance that ‘we can do this’.” 

Part of that has been within the infection prevention and control specialism, he said, which has evolved from a reactive service – “we got the lab results and then went to tell the ward staff what to do in response to that lab result” – to a proactive one. 

“There has been a real change in the attitude of the staff and organisationally. It’s now recognised that infections are all preventable and never inevitable. They are avoidable harm: it’s a patient safety issue and so needs to be treated seriously. 

“I don’t think it was ever not treated seriously, but there was much more a feeling of acceptance – people thought infections were inevitable. They looked at the fact that we were treating more older people, frailer people, doing more invasive and complex procedures, and infections were seen as an inevitable consequence of that. Now, there’s a widespread acknowledgement that actually infections aren’t inevitable.” 

Specific strategies introduced at North Middlesex included a new focus on aseptic technique training, partly in response to a ‘blip’ in MRSA bloodstream infection figures. An apparent rise in the numbers two years ago was found to be bogus, as half those recorded were not genuine – they were from contaminated blood cultures. 

Weaving said: “That showed us that we needed to pay some attention to the aseptic technique of the people taking the blood cultures, because they were managing to contaminate them as they took them.” 

Contaminated blood culture is an obvious consequence of poor aseptic practice, Weaving said – but the fact it was happening could have been an indicator of other problems too. “So, we put in place a programme of aseptic technique training, particularly for junior medical staff. Now all junior medical staff coming through the organisation get a talk from a member of my team at their induction, and we follow that up with additional training.” 

The hospital recorded six MRSA bloodstream infections in 2013-14, but none at all in 2014-15. “That was the first year since the mandatory reporting since 2005 we’d managed that. That’s the sort of thing we need to celebrate,” Weaving said. 

Another consequence of the change in attitude to infections is that a figure of zero is now the “expectation” from the Department of Health and the trust board. Weaving added: “If you’d said to anybody in my position 10 years ago that we need to have no MRSA bloodstream infections, the attitude would have been: ‘It can’t be done.’ “Now, probably about half the hospitals in England last year reported no MRSA bloodstream infections. 

“It’s an incredible success story that absolutely does not get the attention that it deserves.” 

Straightforward measures 

Clinicians have to take a lot of the credit, he says. They no longer see measures like implementing the EPIC guidelines – the main national guidelines for infection prevention – as yet another thing to have to do, but instead are actively speaking to Weaving and his team for advice. “Ten years ago that would have been unheard of. I won’t say there wasn’t the will, because there probably was, but there just wasn’t the acknowledgement or the knowledge that there were some very simple, straightforward things you can do to massively reduce the risk of patients getting an infection.” 

The trust is running a big staff- and patient-facing campaign, ‘Get a grip on infection’, with publicity messages everywhere on cleanliness, hand-washing, hygiene and so on. “That’s had quite an effect in terms of raising awareness,” Weaving told us.

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