Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 323

In recent years, significant progress has been made in reducing hospital‐acquired infections (HAIs) across all age groups, not just in older people. This has partly been driven by regulatory and public pressure in response to a shift in societal attitudes about acceptable levels of risk, which have made HAIs a major organizational priority and a matter for statutory regulation. HAIs are relatively easy to measure and identify, so the impact of interventions for them can be easily assessed, unlike some other hospital‐acquired complications common in older people. There are now standard definitions for HAIs, an increasing trend toward mandatory reporting of infections, and, in most hospitals, infection control departments that independently monitor and act to reduce HAIs.

The underlying causes of HAIs are complex, ranging from individual actions or inactions, such as failures to follow rules and procedures, to systemic failures or problems with design and technology. Consequently, many interventions that have been successful in tackling HAIs are equally as complex and increasingly seen as part of more general quality improvement programs rather than solutions in isolation. For example, HAIs are one of the primary outcome measures of the Safer Patients Initiative,⁶⁹ a long‐term collaborative programme developed by the Health Foundation in partnership with the US Institute for Healthcare Improvement and 24 participating UK NHS Trust sites. This ongoing initiative focuses on reliability and safety of care through the application of continuous quality improvement techniques adapted from process industries and manufacturing.

Some of the other multifaceted interventions that have been shown to reduce the rates of HAIs include the use of care bundles to tackle central‐line infections and ventilator‐associated pneumonias in intensive care units or using combined approaches to improve hand hygiene in general wards. Other effective infection control measures have included advances in treatment, regularly updated antibiotic prescribing guidelines, and the use of other precautions such as minimizing ward transfers. The design of the hospital environment plays an important part in providing adequate isolation and cleaning facilities and allowing sterile practices to be carried out with minimal contamination. Other innovations include using decision‐support systems in antibiotic prescription and allowing patients to participate in infection control initiatives (although older people may be less willing or able to do this).