Research and analysis

HPR volume 10 issue 39: news (11 November)

Updated 16 December 2016

1. Extension of surveillance and infection control measures for Gram-negative infections


The Department of Health is to reinforce and extend existing infection prevention and control (IPC) measures in NHS hospitals – particularly relating to Gram-negative and surgical site infections, and to sepsis in general. The new IPC measures, announced by Secretary of State for Health Jeremy Hunt at a meeting of health protection specialists in London this week, are intended to replicate the success achieved in reducing MRSA and Clostridium difficile infections in healthcare in recent years. The new action programme will apply similar IPC measures to Gram-negative infections, initially focussing on Escherichia coli bacteraemias.

Rates of E. coli bacteraemia – currently accounting for 65% of all Gram-negative infections in England – have increased by 20% over the last four years and the absolute number of reports is now more than double those of MRSA and C. difficile combined. Hunt announced that new data will be collected by PHE on E. coli rates in both hospitals and in the community.

Replicating a measure that has contributed to success in reducing MRSA and CDI infection rates – E. coli rates will be displayed on wards, making them visible to patients and visitors in the same way that MRSA and CDI rates are currently.

Among other IPC measures announced by the secretary of state is the collation of “indicators of hand hygiene” in hospitals – covering, for example, levels of hand gel use – to underline the importance of such hygiene measures for infection prevention.

The data will, for the first time, be shared with the CQC and thus help target inspections and reduce the high variation in rates of HCAIs, SSIs in particular, between different hospitals.

E. coli bacteraemia have been the subject of mandatory reporting since June 2011. Annual data and commentary are available via the E. coli: Guidance, Data and Analysis health protection collection on the PHE webpages of GOV.UK; data on the proportion of E. coli blood specimens resistant to key antibiotics are available at Clinical Commissioning Group level via the AMR Local Indicators pages of PHE’s Fingertips website).

2. Updated UK guidance on the prevention and management of meningococcal disease in higher education institutions

Public Health England and Universities UK – together with the Meningitis Research Foundation, Meningitis Now, NHS National Services Scotland, Public Health Wales and the Public Health Agency in Northern Ireland – have revised UK guidance on the prevention and management of meningococcal meningitis and septicaemia in higher education institutions (HEIs) [1].

The new guidance takes account of current epidemiology of meningococcal disease, in particular the increased incidence, and current outbreak of, a virulent form of MenW disease that underlines the importance of first-year HEI students getting their MenACWY vaccination. Students at HEIs are at increased risk of meningococcal disease compared to their non-student peers, particularly in their first year and in the first few weeks of the autumn term.

The pre-existing guidance has also been updated to take account of modern electronic forms of communication and social media, as well as structural changes in the NHS.

The guidance underlines the importance of three key areas of action: raising awareness, promoting immunisation and planning ahead. On awareness-raising, the guidance recommends:

• HEI students and staff should be informed about meningococcal disease and its common signs and symptoms. It is a potentially fatal and life-changing disease that can be difficult to diagnose, particularly in the early stages
• all students should know to tell someone if they feel unwell and have someone they can contact if they are feeling worse. If a student is ill someone should regularly keep an eye on them and medical advice should be sought immediately if someone has symptoms of concern, or their condition is worsening

On promoting immunisation, the guidance highlights many ways in which HEIs can alert new students to the importance of getting immunised with MenACWY vaccine, and describes the resources available to support this [2]. Efforts of HEIs in collaboration with their student health partners have already led to improvements in MenACWY vaccine uptake in their students.

On forward planning, the guidance states that HEIs have arrangements in place for responding to any case, or cases, of meningococcal disease among students. That includes having allocated staff responsibilities for responding to cases (or an outbreak) and managing communications, and providing support for students and staff affected.

2.1 References

1. PHE and Universities UK (November 2016). Guidance on the prevention and management of meningococcal meningitis and septicaemia in higher education institutions.
2. PHE webpages. MenACWY vaccination programme resources.

3. Zoonoses and routine GI infection reports in this issue of HPR

The following infection reports are published in this issue of HPR. The links below are to the relevant webpage collections or publications.

3.1 Zoonoses

• Common animal associated infections quarterly report (England and Wales): third quarter 2016

3.2 Routine GI infection reports

• Salmonella infections (England and Wales): September-October 2016
• Common gastrointestinal infections (England and Wales): laboratory reports, weeks 40-43/2016
• Less common gastrointestinal infections (England and Wales): laboratory reports, weeks 31-43/2016
• Suspected and laboratory-confirmed reported norovirus outbreaks in hospitals, with regional breakdown: outbreaks occurring in weeks 40-43/2016