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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.

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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


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