Abstract

There is increasing evidence, albeit hospital based, that healthcare-associated infections (HCAIs) are amongst the leading communicable and preventable cause of morbidity and mortality (Tulchinsky and Varavikova, 2009, NICE, 2011). With the multifaceted delivery of healthcare, the risk of infection increases (Apisarnthanarak et al., 2012). Hospices are unique settings (with extremely vulnerable patient populations), but operate within wider healthcare contexts – so what is their role in managing HCAIs?

The aim of this study, using a critical literature review, was to identify and discuss the current knowledge available about the management of HCAIs in hospices. The study was triggered by a number of incidents where patients were due to be admitted to the hospice as part of a stepped discharge from hospital. In each case the patient was being treated for infections with multi-drug resistant organisms (MDROs), but their infection status was not handed over. Preliminary discussions with infection prevention and control practitioners in other hospices suggested inconsistencies in the management of the HCAI risk.

Five key themes emerged from the study – the availability of current empirical knowledge, risks associated with HCAIs, the impact HCAIs and of infection prevention and control strategies on the quality of life for patients in palliative care, the ethos of palliative care, and screening.

The review found little empirical evidence that HCAIs are managed in hospices, and concluded that the management of HCAIs in hospices is a misnomer. The broad purpose of this study was not to judge infection prevention and control practices in hospices, but to trigger thought and debate, and to develop collaborative approaches to HCAIs.

The study recommends further qualitative research based on patient perceptions, on the impact of HCAIs, and on infection prevention and control strategies. This knowledge could be used to inform strategies and interventions for palliative care patients.