Chief Physician, Master’s Supervisor, Chief Medical Officer of Guangdong Provincial People’s Hospital
Expert member of the Expert Committee on Infection Prevention and Control in Medical Institutions, National Health Commission of the PRC
Member of the Committee on Infection Control Standards in Hospitals, National Health Standards Committee of the PRC
Expert of the Expert Advisory Group on Hospital Infection Quality Management and Control, Institute of Hospital Management, National Health Commission of the PRC
Director of Guangdong Hospital Infection Quality Control Centre
Director of Guangdong Clinical Laboratory Centre
Deputy Director of the Professional Committee on Hospital Infection Management, Chinese Hospital Association
Vice President of the Infection Management Quality Control Branch of the Chinese Geriatrics Society
Standing member of the Professional Committee on Hospital Infection Management, Chinese Society of Preventive Medicine
Director of the Guangdong Provincial Hospital Association Clinical Laboratory Management Committee
Director of the Committee on Microbiology and Immunity, Guangdong Preventive Medicine Association
Director of the Hospital Infection Quality Management Branch of the Guangdong Medical Safety Association
New Developments in Infection Control in China
In just 37 years since 1985, China’s infection control has developed rapidly and tremendously, since the initial establishment of the first small-team hospital infection management department led by Professor Xu Xiuhua to the holistic development of hospital infection prevention and control in the country. This sector has since emerged and evolved to incorporate an integrated and multi-dimensional approach to prevention and management of infections. In this interview with an expert, Professor Hou Tieying from Guangdong Provincial People’s Hospital shares the new developments in infection control in recent years.
The development of infection control with Chinese characteristics
Since 1985, China’s present day infection control strategy was developed through numerous trials and experiences: the global SARS outbreak in 2002 brought attention to the fact that infection control is not confined to hospitals, but must be dealt within the community ; the neonatal infection incident in 2008 caused by hospital infection prevention and control; and the launch of the National Action Plan to Contain Antimicrobial Resistance in 2016, which made infection control more effective. These steps have led to a gradual shift from basic work towards clinical involvement.
The Novel Coronavirus pandemic that swept the world in 2019 and in particular, created a record in 2020 of zero infections amongst the 42,000 medical personnel in China who helped combat the Novel Coronavirus pandemic, are the greatest demonstrations of China’s strong capacity to integrate resources and administrative management. It is, simultaneously, also the greatest test of China’s growth in infection control. These achievements are inextricably linked to years of hard work by infection control physicians and academics, such as Professor Yu Yunsong of Zhejiang University-affiliated Shaoyifu Hospital, Professor Hu Bijie of Fudan University-affiliated Zhongshan Hospital, Professor Wu Anhua of Central South University Xiangya Hospital, Professor Li Liuyi of Peking University First Hospital, Professor Liu Yunxi of the First Medical Centre of PLA General Hospital, and Professor Zong Zhiyong of the West China Hospital of Sichuan University.
With the development of science and technology, there are now many channels to obtain information and communication. We can have quick access to international literature, guidelines, or local research developments, to obtain the requisite experience and knowledge to develop infection control strategies and methods with Chinese characteristics that conform to the local situation. At the same time, the achievements, experiences, and developments in domestic infection control – such as the experience of preventing and controlling the novel coronavirus pandemic, and data from the recently developed information systems such as the national hospital infection surveillance network – can also be shared globally, for the benefit of other countries.
Infection control is not only a medical service, but must also be closely linked to clinical experience and management
For many years since the beginning of China’s infection control development, hospital infection control focused on nursing, concentrating on basic infection control such as cleaning, disinfection, sterilisation and preventive isolation techniques, and microbial testing. The increasing awareness towards infection control, specialists from many clinical departments, such as infectious diseases, respiratory medicine, intensive care medicine and haematology, have become part of the hospital infection management and control team. On the other hand, greater attention from clinical and hospital management has increased the importance of infection control in hospital management, incorporating it into the overall design and management system, including disease control which is largely related to infection control.
The role of the infection control physician has changed over time. They now play an important role in both hospital management and primary care. Therefore, infection control is not only a medical service, but also requires close integration between clinical and management aspects, so that infection control can be better implemented within hospital management for improved health outcomes .
“Precision infection control” is the way forward, and MDT collaboration is urgently needed
In 2016, the Chinese Society of Preventive Medicine’s 25th Annual National Hospital Conference on Infection set “Cultivating Microbial Thinking and Advocating Precise Infection Control” as its theme, with “precise infection control” as the future direction of development. For “precise infection control”, it is necessary to comprehensively consider various factors such as epidemiology, evidence-based medicine, microbiology, and molecular diagnostics. It is also necessary to implement appropriate infection prevention and control measures to avoid serious infection risks caused by inadequate prevention and control, and to prevent a huge waste of resources caused by excessive prevention and control. Firstly, staff working in the field of infection control must continuously educate themselves about various aspects including the pathogenesis of hospital-acquired infections and drug-resistant infections, diagnostic techniques for infectious diseases, and the management of specialised antimicrobial drugs. Furthermore, the multidisciplinary staff working in the field of infection control must improve their awareness of prevention and control and their professional expertise. Management should also mobilise every member of the team (including cleaning staff) to implement infection control measures effectively. In addition, we need to share data and experience to further advance the development of “evidence-based infection control”.
“Microbial thinking” plays a critical role and has value in infection control management.
The most important aspect of effective antibiotics use is to actively address the challenges posed by antimicrobial resistance, improve the scientific management of antimicrobial drugs and curb the development and spread of bacterial drug resistance. To this end, the National Health and Family Planning Commission and 14 other departments have jointly formulated a “National Action Plan to Contain Antimicrobial Resistance (2016-2020).
For outpatient use of antimicrobial drugs, most hospitals, with the exception of emergency and observation rooms, mainly rely on oral treatment. This is in line with the “Ten Core Messages for Rational Drug Use” published by the National Health Commission of the PRC, which states that oral drug use should be prioritised over intramuscular administration, and intramuscular administration over infusion. Outpatient antimicrobial treatment regimen remains largely empirical, and pathogen testing is only considered when there is poor efficacy and recurrent infections. However, as the patient has already been treated and may have been admitted several times at this point, it is questionable as to whether the pathogen test results are consistent with the initial test. Therefore, clinicians or infection control physicians must be ‘microbially minded’ and understand the characteristics, transmission routes, and pathogenic distribution of microorganisms in order to better guide clinical care and prevention and control hospital-acquired infections.
Clinical, management, and prevention skills are the main focus of training for young and mid-career staff.
As society and hospitals pay increasing attention to infection control, hospitals continue to be more demanding of their staff, in addition to microbial thinking. Staff are also required to have the capability for diagnosing, treating, and managing infectious diseases. Several institutions have also independently begun to set up programmes related to in-hospital infection management and other related disciplines, offering courses in infection, management, and preventive medicine, to strengthen the training of infection control professionals in school. The knowledge gained from these trainings must be applied in the clinical setting, to bring learning into practice.
In-service infection control staff training is not only about cultivating clinical thinking, but also about MDT and collaborative thinking. Management is crucial and all staff are required to understand and implement the rules and regulations, and to coordinate other staff from different departments. By controlling these aspects jointly and nurturing youth and middle-aged staff as the backbone of infection control, China’s infection control will be better able to advance and protect our healthcare system.