Preventing and controlling healthcare-associated infections.

“Nine in 10 hospitals failing on hygiene.” “MRSA deaths double in four years.” The thousands of newspaper headlines over the past 15 years in the UK have symbolised the nation’s fascination with healthcareassociated infections and increased the pressure for action. Moving beyond such headlines to develop clinical solutions was the focus of a conference hosted by The Lancet Infectious Diseases on Dec 11–12 in London, UK. Healthcare-associated infections are universal, but their global burden has yet to be ascertained. Given, though, that a quarter of operations done in a well-equipped rural hospital in Tanzania are linked to surgical-site infections, and millions of cases of hepatitis B annually are caused by unsafe injection practices, the burden is likely to be huge. What shocks most, though, is that the illness and deaths that result are largely preventable. What can be done to reduce healthcare-associated infections? Act quickly was a clear message from the conference. In the UK, a decade was wasted while meticillin-resistant Staphylococcus aureus (MRSA) took hold in hospitals. By implementation of a bundle of infection-control proce dures, mandatory reporting, legislation to intro duce a standard code of practice, and target setting, MRSA bacteraemias have halved in number in England since 2004. But communityassociated MRSA, which is now epi demic in the USA, is a growing problem elsewhere. Furthermore, in the UK new guidelines to counter the increasing threat of Clostridium diffi cile are written but await ministerial action. What else can be done? Antibiotic stewardship to prevent the generation of resistant microbial strains is needed. Hand hygiene can be improved with alcoholbased rubs, as advocated by WHO’s patient safety initiative. What hands touch, though, is also important and cleaning contaminated surfaces must be improved. Creating a safety culture within healthcare settings is crucial, so that all staff take some responsibility. With infection control and appropriate antibiotic prescribing integrated into healthcare settings, moving beyond doing no harm to improving health outcomes becomes more likely. ■ The Lancet For information about the conference, and speakers’ presentations see http://www. hai.thelancetconferences.com