The NHS Confederation recognises the importance of tackling healthcare associated infection (HCAI) issues in the NHS and is working to support members in this. Infection control is top of the board agenda in the NHS.

Current position

• In September 2008 health secretary Alan Johnson paid tribute to NHS staff for halving MRSA blood stream infections across England.
• The Health Protection Agency's (HPA) quarterly figures (published in September 2008) showed that the number of MRSA infections had fallen by 57 per cent compared to the base level in 2003/04 when the Government's target was set.
• HPA figures released on 23 October 2008 showed that Clostridium difficile infection rates had fallen significantly over the previous quarter.
• The Healthcare Commission analysis of unannounced hygiene code spot checks (published on 24 November 2008) showed an overall picture is one of improvement on MRSA and C. Difficile.

The Department of Health announced a health infection strategy in January 2008 and we welcomed the extra funding dedicated for controlling infection. We have always been clear that a zero tolerance approach to infection must be embedded in the ethos of all NHS staff to ensure that infection rates continue to decline.

In January 2008, health secretary Alan Johnson updated Parliament on the progress of deep cleaning in acute trusts. He said that 80 per cent of trusts have started and that all other trusts have plans agreed to start in the next few weeks. He made clear that the needs of each hospital will vary according to local need and configuration of services, giving the example of a newly built hospital not requiring as intensive a programme as others.

HCAIs are widely recognised as an intractable problem for the NHS and the solutions will need everyone - including the local community - to work together. The hygiene code is helping boards take control of the problem.

The Healthcare Commission's Maidstone Hospital report in 2007 shows it is important to learn from those occasions when things go wrong and to make sure it does not happen again.

Consultation: healthcare associated infections regulation

NHS Confederation response

From April 2009, the Care Quality Commission will take over responsibility for health and social care regulation. It will continue to monitor NHS compliance on healthcare associated infections (HCAI) and will be able to use additional enforcement powers and take prompt action where patients are at risk. The recent DH consultation asked for views on the proposals for regulations on the registration requirement for HCAI the revised code of practice and enforcement policies. In our response we welcome the introduction of registration requirements as means to assure patients and the public about the services they receive and to support a level playing field. We raise some concerns about the enforcement powers, particularly in relation to imposing fines and suspending registration and the impact these might have on patient care. Please find our response under the publications section on this page and here.

See the Department of Health consultation page for further details.

What we are calling for

We want to see sensible HCAI surveillance measures and for the information from them to be made public. If targets are to be set in this area we want organisations to set stretching local targets and for these to be aggregated up to monitor national progress.

We will continue to work with the Health Protection Agency to expedite development of a national surveillance system for HCAI that meets the needs of the NHS and which provides robust comparable data to improve informed decision-making.

We regularly meet with key national agencies such as Department of Health and National Patient Safety Agency on the subject of quality and safety in the NHS and remain active in policy developments in this area.

Background information

Any HCAI is an extremely serious matter and it should be emphasised that these figures represent a very small proportion of the 10 million inpatients that the NHS treats in hospitals every year.

In February 2000 the National Audit Office report The Management and Control of Hospital Acquired Infection in NHS Acute Trusts in England (HC 230 Session 1999-00) noted that at any one time, 9 per cent of patients had an infection that had been acquired during their hospital stay. The effects varied from extended length of stay and discomfort, to, in around 5000 patients a year, death. These infections were costing the NHS as much as £1bn a year and around 15 per cent were said to be preventable by better application of good practice, releasing resources of £150m for alternative NHS use. The figure of 9 per cent was arrived at in studies published in 1981 and 1996, and this may be out of date. However, it is certain that many of these cases are due to bacteria which are increasingly difficult to treat due to the evolution of antibiotic resistance.

Not all HCAI is preventable, but up to 30 per cent may be. The problem of HCAI is not new - MRSA (methicillin resistant staphylococcus aureus) is a common antibiotic resistant form of staphylococcus aureus (SA). It first appeared in the 1960s and by 1997 was considered endemic in NHS hospitals. MRSA bacteraemia has been used as a 'marker' for HCAI, generally because good information about it is available. It is estimated that action to tackle MRSA will also have an impact on other HCAIs such as clostridium difficile.

The Department of Health with the (then) NHS Modernisation Agency promoted the Saving Lives website and service improvement tools for NHS organisations to better tackle HCAIs. The NHS Confederation supported these initiatives by publishing a summary briefing for members and offered workshops to members about the Saving Lives programme in January 2006. Our Saving Lives briefing, issue 123, published in October 2005 includes links to further tools for NHS organisations.

How we involve members

We hold topic specific seminars and meetings to inform our policy positions - invitations either appear in our email bulletin Interchange Alert or are sent out individually.

We work through member networks such as the Health Services Research Network (HSRN) to capture and share emerging research findings and new practice in tackling patient safety.

To become involved in our work programme on quality and patient safety please contact Claire Mallett.