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Reducing Healthcare Associated Infections in Hospitals in England

The Department of Health has met its target to reduce MRSA bloodstream infections by 50 per cent by 2008 and has made encouraging progress towards its target to reduce Clostridium difficile infections, according to a National Audit Office report published today.  However, blood stream infections due to other causes may be increasing.  There is also no national data that captures information on some of the most common healthcare associated infections, such as urinary tract infections and pneumonia.

The Department introduced a target to reduce MRSA across all NHS trusts by 50 per cent by 2008 and C. difficile by 30 per cent by 2010-11.  MRSA had been reduced by 57 per cent by the end of March 2008 and C. difficile by 41 per cent.  While a quarter of trusts have reduced MRSA by more than 80 per cent, in 12 per cent of trusts there has been an increase in MRSA infections.  Twenty-nine per cent of trusts have reduced C. difficile by more than 50 per cent, but in 19 per cent of hospital trusts the numbers of C. difficile infections have increased.

Since the introduction of targets to reduce MRSA and C. difficile, the Department has spent some £120 million on central initiatives tackling healthcare associated infections.  There have also been unquantifiable administrative costs and local expenditure on the drive to reduce infection rates.  These central initiatives, together with action at trust level, have led to savings on treatment of between £141 million and £263 million, as well as reducing discomfort, disability and, for some, death that might have been caused by these avoidable infections.

The Department’s approach to reducing healthcare associated infections, comprising “must do” targets for reducing MRSA bloodstream and C. difficile infection rates, close performance monitoring of these targets, and support and guidance on infection prevention and control more generally, has been effective in helping trusts to improve cleanliness and compliance with infection prevention practices.  There has also been a perceptible change in trust leadership on infections in response to the challenges of reducing infection rates.  The impact has not, however, been the same in all trusts or, as far as the data from voluntary reporting shows, for other infections.

Following the Department’s intervention to improve recording on death certificates where MRSA or C. difficile was the underlying cause or a contributory factor, in 2007 around 9,000 people were reported by the Office for National Statistics as having died in such circumstances.  There is still no national information on deaths from other healthcare associated infections.

“The Department of Health’s hands on approach to what seemed, in 2004, to be an intractable problem, has been successful in reducing MRSA bloodstream and C. difficile infections. This is a significant achievement and a good example of what concerted effort can achieve. Inevitably, with a focused and centrally driven initiative of this kind, the improvements are not uniform across the NHS and we still don't know in any meaningful way what impact there has been on other healthcare associated infections. We have identified a number of key problems that need to be addressed such as: a lack of robust comparable data on other infection risks; increases in antibiotic resistance and poor data on hospital prescribing; and that compliance with good practice is still not universal.”


Amyas Morse, head of the National Audit Office

Notes for Editors

  1. The term ‘healthcare associated infection’ is defined as any infectious agent acquired as a consequence of a person’s treatment by a healthcare provider.

  2. The National Audit Office reported on healthcare associated infections in 2000 and 2004.  The reports are available on the NAO’s website Improving patient care by reducing the risk of hospital acquired infection: a progress report and The Management and Control of Hospital Acquired Infection in Acute NHS Trusts in England.

  3. In response to the 2004 NAO report the Department of Health committed to make control and prevention of healthcare associated infections a top priority and introduced a target to reduce MRSA by 50 per cent by 2008.  In 2007 a target was set for a 30 per cent reduction in the number of cases of C. difficile reported in 2010-11.

  4. In 2006 an English national prevalence survey found that eight per cent of patients had an infection acquired during their hospital stay.

  5. A detailed report on how other countries are tackling healthcare associated infections is available on the NAO website.  Also available on the website is the headline findings from the trust census, a report on the survey of nurses and doctors, a report on  international comparisons and a report on an analysis of  HPA surveillance data which were undertaken as part of the report. 

  6. Press notices and reports are available from the date of publication on the NAO website, which is at Hard copies can be obtained from The Stationery Office on 0845 702 3474.

  7. The Comptroller and Auditor General, Amyas Morse, is the head of the National Audit Office which employs some 900 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.

PN: 38/09