Improving patient care by reducing the risk of hospital acquired infection : a progress report twenty-fourth report of session 2004- 05 : report, together with formal minutes, oral and written evidence

Monograph

25, Ev 38p. : ill. ; 30cm.

<p><span style="font-size: 8pt;">The best available estimates suggest that each year in England there are at least 300,000cases of hospital acquired infection, causing around 5,000 deaths and costing the NHS asmuch as 1 billion. In 2000, our predecessor Committee drew attention to the seriousimpact on patients of the NHS’s lack of grip on the extent and cost of hospital acquiredinfection, such that it was difficult to see how the Department and NHS trusts could targetactivity and resources to best effect. They concluded that a root and branch shift towardsprevention was needed at all levels of the NHS, requiring commitment from everyoneinvolved and a philosophy that prevention is everybody’s business, not just the specialists.The Department told the Committee that it accepted that the incidence of hospitalacquired infection could be reduced significantly with associated cost savings and that awide range of action was already in hand to achieve this. Indeed they stated that tangiblemeasurable progress was already being delivered. Given such a categorical assurance theCommittee expects the Government to meet it.On the basis of a follow-up Report by the Comptroller and Auditor General,1 theCommittee examined the progress made by the Department of Health and NHS trusts inreducing the risks of hospital acquired infection. We found that progress in implementingmany of our predecessor’s recommendations had been patchy, and that there was a distinctlack of urgency on several key issues such as ward cleanliness and compliance with goodhand hygiene; and limited progress in improving isolation facilities or reducing bedoccupancy rates. Progress in preventing and reducing the number of such infectionscontinues to be constrained by a lack of robust data, limited progress in implementing anational mandatory surveillance programme and a lack of evidence of the impact ofdifferent intervention strategies.Rather than introduce mandatory national surveillance of all hospital acquired infections,as recommended by our predecessors, the Department focussed on mandatory laboratoryreporting of methicillin resistant Staphylococcus aureus (MRSA) bloodstream infectionsfrom April 2001. This surveillance, which covers less than 6% of infections, shows that thetotal number of reported Staphylococcus aureus bloodstream infections has increased by5% over the last three years, and that the proportion of these infections that is MRSA, at40%, is amongst the worst levels in Europe. </span></p><p><span style="font-size: 8pt;">Following our predecessor Committee’s 2000 Report, the Department issued guidance andinitiatives which emphasised the priority to be given to infection control, but at trust levelconflicts with other key targets and priorities have continued to stand in the way ofimproving prevention and control. Since publication of the Comptroller and AuditorGeneral’s 2004 follow-up report, however, Health Ministers have made it a top priority forNHS hospitals to improve cleanliness, and to lower both healthcare acquired infection andMRSA rates. In particular, they have introduced a target for all NHS trusts to reduceMRSA bloodstream infection rates by 50% by 2008; and established a “Towards Cleaner Hospitals and Lower Infection Rates Programme Board”, chaired by the Chief NursingOfficer, with representatives from key stakeholders to drive through the much neededimprovements.Whilst these initiatives may also impact on infections other than MRSA, they do not targetthe broader issue of multi-drug resistant infections which have a wide range of risk factorsand which require specific interventions other than improved cleanliness. It is also not yetclear how the 80% or so infections not covered by the Department’s current mandatorysurveillance programme will be measured and consequently managed. </span></p>