Do no harm

It is shocking that approximately three-quarters of Escherichia coli bloodstream infections develop before people are admitted to hospital (Public Health England (PHE) and NHS Improvement (NHSI), 2017). Additionally, gram-negative infections are thought to have contributed to about 5500 deaths in 2015 (PHE and NHSI, 2017), which highlights the imperative of reducing gram-negative bloodstream infections at every opportunity across all health and social care settings, including clients' homes visited by district nursing teams.

The PHE and NHSI (2017) emphasised the importance of essential practice standards to prevent sepsis, antimicrobial stewardship, a focus on infection prevention and management, and education, including of patients, so that antibiotic prescribing is limited to the treatment of diagnosed bacterial infections. Not all homes are clean and safe environments for nursing care but, increasingly, it is recognised that hospitals are sometimes contaminated environments, with Shek et al (2018) finding that 87.5% of freshly laundered curtains tested positive for methicillin-resistant Staphylococcus aureus (MRSA) by day 14 in their longitudinal study in a Canadian regional plastics/burns unit. Strangely, none of the rooms where the curtains were hung had been occupied by patients with MRSA, which confirmed that nurses and others are transmitters, despite being expected to adhere to professional practice standards, including exemplary hand hygiene. By day 21, the MRSA count on almost all curtains exceeded 2.5 CFU/cm, which is the requirement for food processing equipment cleanliness in the UK.