Committee of Public Accounts

Press Notice No. 24 of Session 2004-05, dated 23 June 2005


Mr Edward Leigh MP, Chairman of the Committee of Public Accounts in the previous Parliament, said today:

“More than four years have passed since our predecessor Committee first highlighted the paucity of information on the extent and cost of hospital acquired infection. Today we find that little has been done to dispel this fog of ignorance. There is still no mandatory national surveillance and reporting scheme for all hospital acquired infections, the only mandatory reporting scheme for which data has been published is for MRSA bloodstream infections, which account for less than six per cent of all hospital acquired infections. These data show that our MRSA infection rate ranks among the worst in Europe.

“The much quoted figure of 5,000 deaths each year as a result of a hospital acquired infection is rough and ready and dates from the 1980s. It must be updated. The Department has now proposed changes that should ensure that deaths linked to hospital acquired infections are more readily identifiable. These proposals must be implemented without delay.

“The truth is that, over the last four years, there has been little serious and effective action to combat hospital acquired infection. It is astonishing that poor ward cleanliness, lax hand-washing practices, a shortage of isolation facilities and high bed occupancy rates are still plaguing NHS hospitals. I welcome the fact that the Department has sprung into action this year with a raft of initiatives. What I don’t want is for this Committee to return to this subject in four years’ time and find that the initiatives have not been translated into solid progress.”

Mr Leigh was speaking as the Committee published its 24th Report of the 2004-05 Session, which examined the progress made by the Department of Health and NHS trusts in reducing the risks of hospital acquired infection.

The best available estimates suggest that each year in England there are at least 300,000 cases of hospital acquired infection, causing around 5,000 deaths and costing the NHS as much as £1 billion. In 2000, the predecessor Committee drew attention to the serious impact on patients of the NHS’s lack of grip on the extent and cost of hospital acquired infection, such that it was difficult to see how the Department and NHS trusts could target activity and resources to best effect. They concluded that a root and branch shift towards prevention was needed at all levels of the NHS, requiring commitment from everyone involved 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 hospital acquired infection could be reduced significantly with associated cost savings and that a wide range of action was already in hand to achieve this. Indeed they stated that tangible measurable progress was already being delivered. Given such a categorical assurance the Committee expects the Government to meet it.

On the basis of a follow-up Report by the Comptroller and Auditor General, the Committee examined the progress made by the Department of Health and NHS trusts in reducing the risks of hospital acquired infection. The Committee found that progress in implementing many of its predecessor’s recommendations had been patchy, and that there was a distinct lack of urgency on several key issues such as ward cleanliness and compliance with good hand hygiene; and limited progress in improving isolation facilities or reducing bed occupancy rates. Progress in preventing and reducing the number of such infections continues to be constrained by a lack of robust data, limited progress in implementing a national mandatory surveillance programme and a lack of evidence of the impact of different intervention strategies.

Rather than introduce mandatory national surveillance of all hospital acquired infections, as recommended by the predecessor Committee, the Department focussed on mandatory laboratory reporting of methicillin resistant Staphylococcus aureus (MRSA) bloodstream infections from April 2001. This surveillance, which covers less than 6% of infections, shows that the total number of reported Staphylococcus aureus bloodstream infections has increased by 5% over the last three years, and that the proportion of these infections that is MRSA, at 40%, is amongst the worst levels in Europe.

Following the predecessor Committee’s 2000 Report, the Department issued guidance and initiatives which emphasised the priority to be given to infection control, but at trust level conflicts with other key targets and priorities have continued to stand in the way of improving prevention and control. Since publication of the Comptroller and Auditor General’s 2004 follow-up report, however, health ministers have made it a top priority for NHS hospitals to improve cleanliness, and to lower both healthcare acquired infection and MRSA rates. In particular, they have introduced a target for all NHS trusts to reduce MRSA bloodstream infection rates by 50% by 2008; and established a “Towards Cleaner Hospitals and Lower Infection Rates Programme Board”, chaired by the Chief Nursing Officer, with representatives from key stakeholders to drive through the much needed improvements.

Whilst these initiatives may also impact on infections other than MRSA, they do not target the broader issue of multi-drug resistant infections which have a wide range of risk factors and which require specific interventions other than improved cleanliness. It is also not yet clear how the 80% or so infections not covered by the Department’s current mandatory surveillance programme will be measured and consequently managed.

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