The COVID-19 pandemic demonstrated to the world the impact of poor infection management strategies on our health systems, economies, and societies. With rises in previously eradicated infections such as polio1 , and increased cases of severe infections such as those caused by Group A Streptococcus this winter2 – it is evident that robust infection prevention and management strategies are needed in order to futureproof healthcare systems.
To tackle infection management, we need large-scale collaboration at all levels of the healthcare ecosystem, using learnings from the COVID-19 pandemic. The pandemic saw an unprecedented amount of collaboration between all healthcare players, from government through life science industry partners to all facets of the NHS, all with the collective goal to mitigate the harms of COVID-19 through managing cases well and preventing the disease from spreading. Therefore, the first ever infection-focused multi-stakeholder healthcare coalition, the Infection Management Coalition (IMC), was formed in January 2021 to work together to develop our own proposed solution to support the implementation of a more cohesive approach to infection management. The IMC is comprised of partners from all areas of the healthcare sphere, including patient organisations, professional societies, diagnostic experts, healthcare professionals, and the life sciences industry.
Prioritising infection management in the political agenda
The leading cause of hospitalisation and death worldwide is sepsis3,4 – an extreme immune response to an infection. In the UK, 245,000 people contract sepsis and 48,000 people die from it annually.5 Another significant and intrinsically interlinked issue facing infection management is the threat of antimicrobial resistance (AMR). In England, the estimated total number of severe antibiotic resistant infections increased by 2.2% from 2020 to 20216.
With the NHS facing issues ranging from long waiting times in A&E7 , treatment backlogs7, and staff strikes8,9, this will undoubtedly have a significant impact on infection management, with conditions like sepsis being diagnosed at later, more severe stages and increased misuse and overuse of certain antimicrobials due to further time pressures and stress10 on the healthcare system.
Given the continuous change in government in the past year, pushing for policy change and recognition of AMR as a pressing issue has been a challenge. A varying roster of government officials in the Department of Health and Social Care means the health issues prioritised are different and subject to frequent change. However, this is beginning to change with the launch of the AMR Nation Action Plan Open Consultation in November 2022, with the aim to build a five-year plan as part of the 20-year AMR strategy launched in 201911. This shows positive direction and action from the UK Government in tackling AMR and therefore the overarching issue of infection management. The recommendations, strategies, and policies developed as a result of the consultation response evidence will be important in our fight against AMR and the continuously rising and evolving infections.
The role of the IMC
The pandemic highlighted the importance of collaboration across all facets of the healthcare industry, and demonstrated that this type of collaboration can be successful. To properly address infection management holistically, it needs to involve all stakeholders across the health sector – from government, industry, charity, healthcare professionals to the general public and patients themselves.
Therefore, the IMC was formed. As part of our holistic approach to infection management, we created a Whitepaper that identified four main pillars as the backbone of our proposed strategy: outbreak and pandemic preparedness, infection prevention, rapid recognition & diagnosis, and antimicrobial stewardship.
Our recommendations are extensive, but we recognise that sustainable change takes place in incremental steps. The recommendations we believe that require most urgent attention are:
The Department of Health and Social Care (DHSC) to review death certification policy to allow for sepsis, infection and AMR to be registered as an actual cause of death
Integrated Care Systems (ICSs) to set out an infection management strategy and develop commissioning criteria for optimal infection management
ICSs and NHS England (NHSE) to collaborate and ensure greater integration of Point of Care diagnostics into the clinical space, with facilitation by laboratory teams
National Institute of Health and Care Excellence (NICE) to implement an aligned and holistic approach to appraise new anti-infectives and consider the clinical and economic value of diagnostics and therapeutics in partnership together.
We believe that by initially focusing on these priority recommendations we Infection Management Coalition can build a robust pathway to holistic infection management.
Next steps in infection management
As we look to 2023 and beyond, we at the IMC are focussing on driving forward our recommendations and enabling policy change. We can no longer afford to work in silos within the healthcare ecosystem and focus on the four pillars of infection management in isolation, but instead the four pillars should be considered simultaneously and with equal effort. To achieve this, we need better data, including a multi-faceted and extensive patient-level data set that collects outcome, demographic, and clinical data to give us a deeper understanding of the scale of the issue caused by severe infections and the need for appropriate, targeted treatment. This data would lead to improved identification and infection outbreak tracking and personalised care for all infected patients.
Additionally, the barriers between laboratory and clinical diagnosis of an infection need to be broken, which will have an associated positive impact on antimicrobial prescribing. Alongside an increased adoption of point-of-care testing, prescribers need to be able to quickly access intelligence surrounding the need for antimicrobials, patient risk, and possible sensitivities of any type of pathogen. Creating this hub of intelligence will allow clinicians and infection specialists to easily collaborate to ensure responsible prescribing and tailor specific care. The benefits to this collaborative system would be immense – resources could be used more equitably and accurately, patient safety will be enhanced, and insights can be obtained by broader stakeholders, including policymakers, to inform new legislation that would consistently better infection management practice.
If you are interested in what you have read here and want to learn more about tackling AMR, please join us at our IPC workshop on 26th April. You can find the IMC whitepaper here.
We look forward to attending and being a part of the IPC Conference 2023 and raising further awareness of the need to holistically address infection management and in turn tackling unnecessary deaths from sepsis, AMR and risk of future pandemics.
The IMC is a coalition of patient organisations, healthcare professionals, professional societies, and is sponsored by life sciences industry members (BD, bioMérieux, Inflammatix, Menarini, Pfizer Ltd, Pharmafilter, Roche Diagnostics, Shionogi) Pfizer Ltd. have undertaken final compliance review of this article. February 2023; PP-UNP-GBR-3732
Sagar Dugani, Jeremy Veillard, Niranjan Kisson. Reducing the global burden of sepsis. CMAJ. 2017 Jan 9;189(1):E2-E3. doi: 10.1503/ cmaj.160798. PMID: 28246252; PMCID: PMC5224944. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5224944/.
Chanu Rhee, Travis M Jones, Yasir Hamad, et al., 2019. Prevalence, Underlying Causes, and Preventability of Sepsis-Associated Mortality in US Acute Care Hospitals. JAMA Network Open. doi:10.1001/ jamanetworkopen.2018.7571. Available at: https://jamanetwork.com/journals/jamanetworkopen/ fullarticle/2724768.
