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Frequently asked questions about healthcare associated infections (HCAIs)

Informing the public on how the Welsh Government are tackling healthcare associated infections.

What is being done in Wales to address HCAIs?

The Welsh Government is committed to tackling all Healthcare Associated Infections (HCAIs). Since the launch of the “Healthcare Associated Infections – a Strategy for Hospitals in Wales” in 2004, Wales has taken a generic approach to all HCAIs choosing not to set national reduction targets focussing on specific organisms. Instead, Trusts are required to set local annual disease reduction targets based on local risk assessments. The Welsh Government believes it is important to emphasise that infection control is the responsibility of all healthcare staff and that hygiene and infection control issues are embedded in the management agenda in hospitals.

There are a range of initiatives in place or currently in development which will assist in that fight.

In 2007, the Minister for Health and Social Services established a Task and Finish Group to consider re-empowering ward sisters within the NHS in Wales and to develop a plan to ensure that they have the authority, knowledge and skills to improve the hospital environment and standards of care. The report which contains 35 recommendations on aspects such as cleaning of the ward environment and accountability and responsibility for cleaning, was formally launched by the Minister on 26 June 2008.

In addition, the Minister for Health and Social Services is committed to producing a refreshed Hospital Strategy which will include new objectives for the NHS to complete over the coming years.

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What are Wales’ rates of Healthcare Associated Infections (HCAIs)?

The rates of HCAIs in Wales are collected and collated by the Welsh Healthcare Associated Infections Programme team at the Public Health Service. For details on the rates please visit Welsh Healthcare Associated Infections Programme website (external link)

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Are HCAIs mentioned on death certificates?

Doctors are required to complete the Medical Certificate of Cause of Death (MCCD) to the best of their knowledge and belief. Guidelines on completing death certificates are included at the front of every book of certificates. Certificates are not available without these instructions. The MCCD is set in two parts in accordance with the World Health Organization recommendations in the International Statistical Classification of Diseases and Related Health Problems (ICD).

As of November 2007, the Office of National Statistics Death Certification Advisory group revised their guidance for doctors certifying cause of death in England and Wales. The guidance advises that, if a healthcare associated infection was part of the sequence leading to death, it should be in part 1 of the certificate, and it should include all the conditions in the sequence of events back to the original disease being treated. If a patient had a healthcare associated infection which was not part of the direct sequence, but which they think contributed at all to the patient’s death, it should be mentioned in part 2

It is a matter of clinical judgement to decide whether a condition present or just before death contributed to the patients’ death.Therefore, it is very difficult to put a firm figure to the number of people who die from a healthcare associated infection due to:

  • People are often very sick with a number of other conditions so the contribution of a healthcare associated infection to the outcome in any particular case is uncertain.
  • The underlying cause of death is most often the disease or injury which led the person to be admitted to hospital, rather than the healthcare associated infection which may have complicated the course of the illness.
  • Clinical judgement will inevitably vary.

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