NHS targets 'hitting superbug prevention'

Some NHS trusts are struggling to tackle hospital superbugs because of Government targets, a report out today said.

Almost half (45%) felt unable to reconcile managing infections like MRSA with the target for people to be seen at A&E within four hours, the Healthcare Commission report said.

Pressure to move patients to any available bed rather than the most appropriate bed or an isolation ward was one reason cited for the difficulties.

The study also found that 29% of trusts had problems in reconciling control of infection with waiting list targets.

And 36% said they had trouble reconciling cleanliness and infection control with the need to meet financial targets.

Three trusts said there was a lack of investment in cleaning, while 10 said their infection control teams suffered constraints owing to financial difficulties.

One example was constraints on introducing MRSA screening before surgery or being able to carry out proper surveillance of infections.

One trust told the watchdog: "Financial target means ward staff work under increasing pressure, damaged equipment is not readily replaced, delayed introduction of alcohol hand gels..."

A Healthcare Commission report into Stoke Mandeville hospital in Aylesbury, published last year, found that pressure to meet the A&E target led to the deadly spread of the Clostridium difficile bug.

That report said "the approach to the target for A&E led to some patients with infections being admitted to, or moved to, open wards rather than isolation facilities".

In today's report, the commission said trusts "must ensure that the safety of patients is never subordinated to other priorities".

The study found that 56% of trusts did not have a programme in place to check that policies to manage beds were in force.

And 46% of trusts said they had no programme to check that staff were adhering to policies for the cleaning of beds.

The commission carried out the survey at 155 out of 173 acute NHS trusts in England for today's report, which was commissioned by chief medical officer, Sir Liam Donaldson.

It was carried out before the introduction of the Hygiene Code, a compulsory set of requirements aimed at tackling the spread of hospital infections.

The Hygiene Code requires that trusts have a director of infection prevention and control (DIPC) who reports directly to the chief executive and is accountable to the trust's board.

Almost all (95%) of trusts had a director in place, the commission found.

It also found that those trusts that had "protected time" during which staff could concentrate on infection control had lower infection rates.

The Hygiene Code now stipulates that job descriptions for all staff must include responsibility for compliance with the code.

Although the survey was carried out before the introduction of the code, only 16% of trusts said they included that in all job descriptions.

Almost one in five (17%) of trusts did not include it in any job descriptions at all.

The report found that only 11% of trusts had ongoing programmes to train medical staff or non-clinical staff working in clinical areas.

It also found that 48% of trusts said they reported all incidents of healthcare-associated infection to the National Patient Safety Agency (NPSA), 6% said they reported "most" incidents, 26% reported "some" and 19% did not report any.

This is not a mandatory requirement but the NPSA regards it as good practice to report such incidents.

The release of the report comes just a few weeks after the commission issued its first warning to a hospital for breaching the Hygiene Code.

Barnet and Chase Farm Hospitals NHS Trust was given an improvement notice for not meeting standards on tackling bugs.

The commission's chief executive, Anna Walker, said today: "There is no universal 'quick fix' for reducing healthcare associated infection; it requires relentless attention to all aspects of recognised good practice, every moment, for every patient.

"The report that we have published today aims to provide advice on good practice, derived from our experience of trusts which are tackling infection control more effectively.

"Our analysis has shown that while safety is the responsibility of everyone, there must be a clear commitment from the trust's board to infection control, staff designated to infection control with the time to commit to it, regular analysis of what is happening in the trust by board and staff, scrupulous attention to cleanliness and policies on isolation, bed management and the prescribing of antibiotics.

"Trusts must also remember that amid the complexity and the array of competing priorities, the safety of patients is paramount.

"We've certainly seen progress since the survey was undertaken, with the implementation of the Hygiene Code that came into force on October 1 2006 and a concerted drive by trusts to get the basics in place."

Shadow heath secretary Andrew Lansley said: "Despite the encouraging decline in MRSA cases, it is unlikely that the Government will reach their target to reduce bloodstream infection rates by 50% in 2008.

"Meanwhile, that which isn't targeted by the Government often isn't dealt with, as demonstrated by the unacceptable increase in Clostridium difficile case.

"These figures are just the tip of the iceberg, because they do not include the number of infections in people aged under 65.

"The Healthcare Commission report highlights the importance of training, good management, bed occupancy, isolation facilities and hospital hygiene in tackling healthcare associated infections.

"But the Government's approach is still complacent, fragmented and limited."