Governance and Risk Management:
Why they matter in infection control
March 2007
In this article...
The pressure on NHS Trusts in the UK to meet ever-increasing consumer demand is relentless and arises from a need to address capacity, choice and safety. The management of risk and demonstration of effective integrated governance are key deliverables for all NHS Trusts.
Political imperative
Safe care is a keystone to the concept of Integrated Governance, which involves managing risk in an increasingly commercial environment to create a sustainable business model. It is a co-ordinating principle, in that rather than replacing or superseding clinical or financial governance, it reiterates their fundamental importance and inter-dependence.
It requires the implementation of robust and effective systems of corporate and clinical governance and will require cultural change, rigorous financial management and an educative process to be undertaken right across the Trust. It requires strategies to monitor and develop the quality of governance collectively and at an individual level across the healthcare provider.
Infection control is an area of significant risk which serves as an illustration of how this will operate.
Infection control
MRSA and Clostridium Difficile are two pathogens which have received considerable media coverage recently. It is fast becoming unacceptable for a patient to go into hospital and acquire an infection, even if this is a scientifically acknowledged risk of healthcare. For this reason the Health Act introduces a new series of measures designed to engender safe healthcare in a clean environment where the risk of infection acquisition is minimized.
The Health Act 2006, which has been in force since October 2006, imposes on NHS Bodies a duty to comply with the Code of Practice on prevention and control of healthcare associated infection. It empowers the Healthcare Commission to review compliance with the Code and issue improvement notices where an NHS body is felt to be under-performing. If the terms of the improvement notice are not met, enforcement action may be taken through the intervention powers of the Secretary of State or Monitor.
Hygiene code
The cornerstone of this new law is the Code of Practice, the purpose of which is to set out the requirements by which the risk of healthcare associated infection is kept as low as possible.
Interestingly, the Code may impose requirements on NHS Trusts in respect of healthcare services that Trusts obtain from other sources even though it can only assert control by reference to the terms of a contract or service level agreement.
The Act does not give patients new rights directly. The purpose of the Act is to tackle perceived organisational and structural problems. That said, any failure to comply with the Code will still be usable in criminal or civil proceedings brought against the Trust or an employee of the Trust.
Importantly, visitors and staff as well as patients are within the umbrella of the Act. This widens the scope of the duty of infection control teams and Trusts and, in contrast to the law of negligence, it imposes a duty on NHS bodies to limit the risk of exposure which is directly or indirectly attributable to the provision of healthcare, so the Act is less concerned with the precise cause of an infection so much as whether there is a wider problem which might simply have increased the risk of an individual acquiring an infection.
Ongoing debate
There is considerable debate as to how effective infection control can be. Whatever the true scientific position, the Act makes it clear that it will no longer be acceptable to rely on arguments of under-funding or inadequate infrastructure to explain the inevitability of infection in healthcare. Infection control teams will have to show compliance with the new Code of Practice. This will require an ability to provide documentary evidence of a wide range of practices including rapid active screening, surveillance, audit and review of protocol and policy. The current version of the Code is occasionally vague in its stipulations but will essentially require Trusts to be able to show that they have understood and implemented it.Demonstrate compliance
On a more positive note this may mean that even where there is an outbreak of a pathogen at a hospital, demonstrable compliance with the Code will deter any intervention by the Healthcare Commission. Additionally, if a Trust can show compliance with the Code it will probably be able to prove in court that it has complied with the requirements of the Control of Substances Hazardous to Health Regulations.
One of the difficulties that infection control staff will face is that the Code frequently requires construction of policies which are based on best practice, or available guidance and which are reviewed regularly. This entails drawing on a wide range of complex documents which can cause a significant drain on infection control team resources. To help you, Bevan Brittan has compiled a single reference tool which categorises the requirements of the legislation set out in the Health Act 2006 and the Control of Substances Hazardous to Health Regulations and sets them in the context of the main requirements of mainstream centrally issued guidance. It is intended as a risk management tool, drawing on the experience of nearly 50 cases alleging failures in infection control in relation to MRSA acquisition but can equally be used as a checklist for review or compilation of infection control policies.
In addition, Bevan Brittan offers a formal review of infection control policy against legislative requirements based on an interview, completion of a questionnaire and preparation of a report. The purpose of this is to identify areas of infection control practice where a Trust may be at risk of failing to meet its statutory obligations under the Health Act, the Code of Practice on the prevention and control of healthcare associated infection and the common law generally.
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