Press Release - Improving patient care by reducing the risk of
hospital acquired infection: a progress report
25 May 2004
There has been notable progress at trust level in putting
systems and processes in place and strengthening infection control
teams to improve the prevention and control of hospital acquired
infection, but the NHS still does not have enough information on
the extent and cost of hospital acquired infection. These are the
principal findings of a National Audit Office report, examining
progress since the NAO’s last report four years ago and against
subsequent recommendations by the Public Accounts Committee.
According to today’s report by head of the NAO Sir John Bourn,
progress in preventing infections and reducing their number is
dependant on changing staff behaviour, but change continues to be
constrained by the lack of data, limited progress in implementing a
national mandatory surveillance programme that meets the needs of
the NHS, and a lack of evidence of the impact of different
intervention strategies.
Robust comparable data (other than on Methicillin Resistant
Staphylococcus aureus (MRSA) bloodstream infections,
for which mandatory surveillance was introduced in 2001) are not
currently available for the NHS in England. This makes it is
impossible to quantify with any certainty if there have been any
changes in NHS trusts’ infection rates. But the limited information
that is available, from the voluntary reporting on surgical site
infection surveillance indicates that the degree of improvement has
been small, and the mandatory MRSA bloodstream infection
surveillance shows that the number of MRSA bloodstream infections
has continued to increase.
In its original February 2000 report, the NAO noted that
hospital-acquired infections were each year costing the NHS around
£1 billion and resulting in at least 5,000 deaths. According to
today’s report, these are still the best estimates available,
although the Office for National Statistics estimated that MRSA
alone was mentioned in 800 death certificates in 2002. Because of
the complexities involved in identifying costs, few trusts have
attempted to calculate their own costs nor have any attempts been
made to refine or validate the cost estimate as stated in the
original NAO report. Other countries have also had difficulties in
evaluating the economic impact of hospital acquired infection.
Increased demands on infection control teams, with more
surveillance and external inspections, has meant that there remains
a mismatch between expectations placed on the teams and resources
allocated to them. The increased throughput of patients has
generally resulted in higher levels of bed occupancy – which
complicates good infection control and bed management practices.
Some trusts are also concerned about the lack of suitable isolation
facilities, the increased frequency with which patients are moved
within hospitals and the fact that there are not enough beds to
separate elective and trauma patients.
The continuing problem of increasing antibiotic resistance and
the emergence of strains of multi-resistant bacteria have increased
the complexity of managing and controlling infection. The
Department of Health’s mandatory MRSA reporting system has revealed
an 8 per cent increase in the number of Staphylococcus
aureus bloodstream infections from 17,933 in 2001-02 to 19,311
in 2003-04. Of these, about 40 per cent are MRSA, making the UK’s
rate among the worst in Europe.
Even though the profile of hospital acquired infection is
increasing and guidelines on the measures required to contain the
problem have been published, there continues to be non-compliance
with good infection control practices. Hospital-acquired infection
is still perceived as a problem for the infection control team
alone and not enough staff accept personal responsibility for this
issue.
In consequence, many of the barriers to effective infection
control practice which the NAO identified in its original report
still apply. Considerable improvements could therefore still be
made in the following areas: the coverage of education and training
in infection control to all groups of staff, particularly doctors;
compliance with guidance on issues such as on hand hygiene,
catheter care and aseptic technique; antibiotic prescribing in
hospitals; hospital cleanliness; and consultation with the
infection control team on wider trust activities such as new build
projects.
Among the NAO’s recommendations are the following:
- that the Department of Health work with the Health Protection
Agency to expedite development of national mandatory surveillance
of hospital-acquired infection, in a way that meets the needs of
the NHS and provides robust comparable data;
- that the Department of Health continue to work with Royal
Colleges and professional bodies to ensure that infection control
is a key component in undergraduate training, and require induction
training in infection control to be made mandatory for all
staff;
- in conjunction with the Health Protection Agency, the
Department of Health should commission research on bed management
and isolation, and develop evidence based guidance to help trusts
balance bed management and infection control requirements;
- that NHS trusts should require consultation with infection
control teams to be a mandatory step in contract tendering
procedures for new build projects, and for cleaning, laundry and
catering services;
- that NHS trusts should increase public awareness of and
compliance with good infection control practice and encourage their
active participation in improving staff and visitor
compliance.
Sir John Bourn said:
"The Department of Health has made important progress in
raising the profile in NHS trusts of the control of
hospital-acquired infection, culminating in its key publication
Winning Ways. However, I am concerned that, four years on
from my original report, the NHS still does not have a proper grasp
of the extent and cost of hospital-acquired infection in
trusts.
"The war against hospital-acquired infection must be
pursued on many different fronts: ranging from tackling the factors
which inhibit good practice, including a more robust approach to
antibiotic prescribing and hospital hygiene, though instituting a
system of mandatory surveillance, to persuading all NHS staff to
take responsibility for, and contribute towards, effective
infection control."
Notes for Editors:
- Press notices and reports are available from the date of
publication on the NAO website,
which is now at www.nao.org.uk. Hard copies can be
obtained from The Stationery Office
on 0845 702 3474.
- The Comptroller and Auditor General, Sir John Bourn, is the
head of the National Audit Office which employs some 800 staff. He
and the NAO are totally independent of Government. He certifies the
accounts of all Government departments and a wide range of other
public sector bodies; and he has statutory authority to report to
Parliament on the economy, efficiency and effectiveness with which
departments and other bodies have used their resources.
- Winning Ways: Working together to reduce Healthcare
Associated Infection in England, a report from the Chief
Medical Officer, was published by the Department of Health in
December 2003.
Press Notice 49/04
All enquiries to Barry Lester, NAO Press Office:
Tel: 020 7798 7937
Mobile: 07748 181692