War on superbugs blighted by NHS monitoring failures

The NHS has been criticised for not knowing the precise extent and cost of hospital acquired infections in an audit report published today.

The National Audit Office (NAO) report, examining progress since the body's last report four years ago and against subsequent recommendations by the Public Accounts Committee, found that progress in preventing infections and reducing their number has been constrained by a lack of data, limited progress in implementing a national mandatory surveillance programme, 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, the NAO found.

The limited information available suggested 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.

The Department of Health’s mandatory MRSA reporting system has revealed an 8% 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% are MRSA, making the UK’s rate among the worst in Europe.

Latest data from the Department of Health and the Health Protection Agency show that reports of MRSA have increased by 3.6% in England over the last year.

Poor hygiene, increased throughput of patients leading to higher levels of bed occupancy, a 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, have blamed for the rise in infections.

Among the NAO’s recommendations are:

• the development of national mandatory surveillance of hospital-acquired infection;
• ensuring that infection control is a key component in undergraduate training;
• 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.

Health Secretary John Reid said that the NAO report was an "important reminder" that everyone in the NHS needs to keep infection control at the top of their agenda.

He added: "We want to give patients a greater role. And front-line staff like matrons will have more power to improve infection control. We are also making clear to hospital managers they will be judged on their performance in reducing MRSA infection rates.

"We will also be boosting the scientific research effort to ensure every possible means of detecting and destroying superbugs is fully explored."

Liberal Democrat Shadow Health Secretary, Paul Burstow, said that the government had "failed" to introduce the systems necessary to monitor hospital super-bugs.

"Worse still, four years after the NAO recommended it, it is still not possible to get an accurate take on which specialties within hospitals have the worst problems with infections," he said.

"Simply publishing crude league tables does not give doctors and nurses what they need to learn from mistakes and reduce infection in the future.

"It is typical of this government to go for headline grabbing naming and shaming but fail to do what is really necessary to turn the rising tide of hospital infections."

Speaking ahead of the NAO publication, Tory Shadow Health Secretary Andrew Lansley claimed that Labour mismanagement had only succeeded in producing a series of reports – not finding a solution to the problem. Mr Lansley added: "What is required is for hospitals to have the independence and responsibility needed to adopt good practice and to be accountable through patient choice."

(gmcg)