The chain of infection is vulnerable at each of the three links in the chain. Sources of infection can be minimised by a high standard of cleaning (Dancer, 2008); cleaning and sterilising all surgical equipment; and controlling the standard of food given to patients. The introduction in April 2009 of MRSA screening of all patients admitted to hospitals in England for elective surgery has the potential to identify MRSA carriers on admission to hospital and allow the opportunity for decolonisation treatments. If successful, this policy would be expected to result in a considerable reduction in the potential sources of MRSA infection in English hospitals. Transmission of infections can be blocked by the provision of suitable protective clothing (including medical textiles) for both healthcare workers and patients; observance of the requirements for handwashing, especially by healthcare workers; and the isolation of MRSA carriers, and of C. difficile or MRSA infected patients. Improved host resistance to infection can be achieved by good nutrition; immunisation; minimising the use of invasive medical devices; the appropriate use of antibiotics; and education of both healthcare workers and patients. The chain of infection for C. difficile is shown in Fig. 6.1.
Under considerable political pressure to reduce the incidence of HAIs, many hospitals in England introduced a large number of improvements in their infection control measures from 2004 onwards. Since 2005/6 there has been a considerable reduction in the number of reported CDIs and MRSA bacteraemias but it is difficult to determine what contribution any individual infection control measure has made to this reduction. It would be very expensive and time consuming to set up a randomised clinical trial to obtain this information.
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