Intestinal Failure Unit

Leading the world in patient safety

Salford Royal’s specialist Intestinal Failure Unit is leading the world in patient safety.

Its latest study has seen the pioneering unit recording the lowest inpatient infection rate in the world for patients with type 2 intestinal failure – those who are acutely ill – who need intravenous feeding.

A common complication of this is a blood stream infection related to the catheter that is used to deliver nutrition into a vein in their chest. But a review of 509 patients treated at Salford Royal between 2011 and 2017 has shown the lowest rates of these infections ever recorded.

Central venous catheter (CVC) infections are highly dangerous and sometime fatal, so preventing them is a key target for the expert multi-disciplinary team at the unit. It was one of the first specialist centres of its kind in the world for patients whose intestines cannot absorb the nutrition that the body needs, because of conditions such as Crohn’s disease or other bowel illnesses, or complications from surgery.

Patients travel from all over the UK and beyond to be treated there and the study found that around a fifth of the 341 patients who had been transferred from other hospitals with a CVC in place arrived with a catheter-related infection. These hadn’t been recognised by the referring hospitals but were discovered because all such patients are tested for infections before the CVC is utilised at Salford Royal.

The study reported that with meticulous care and antibiotic treatment, the infection was cleared and the CVC able to be used again in more than 90 per cent of these cases. Following that, the in-patient IFU catheter related blood stream infection was just 0.04 per 1,000 catheter days, the lowest published worldwide.

Professor Simon Lal said: “Patients with type 2 intestinal failure are very vulnerable and these sometimes under-recognised infections pose a considerable risk. However, our unit’s dedicated and experienced team has demonstrated that it is possible both to identify and successfully treat patients who arrive here with a catheter-related infection and then to maintain extremely low levels of infection.

“We are now proposing that all dedicated intestinal failure units aim to class these infections as ‘never events’ – an NHS term for serious incidents that are entirely preventable because of comprehensive safety guidance.”

The work has been reported in the journal Clinical Nutrition – Ashley Bond, Antje Teubner, Michael Taylor, Cathy Cawley, Jacqui Varden, Arun Abrham, Paul Chadwick, Mattias Soop, Gordon Carlson, Simon Lal: Catheter-related infections in patients with acute type II intestinal failure admitted to a national centre: Incidence and outcomes