Health: Infection rate in NHS hospitals is 10 times that in private sector

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Up to one in ten NHS patients now acquires an infection while in hospital. Roger Dobson examines the possible causes.

The pressure on beds in the wake of the National Health Service reforms may be one reason for a rise in the number of patients being infected in hospitals, according to specialists giving evidence to a House of Lords committee investigating the rise in resistance to antibiotics.

So-called hot-bedding, where the same bed could be occupied by different people in a 24-hour period, may be one of the main causes leading to an infection rate 10 times that in the private sector. Some specialists believe isolation wards are now needed for infected patients.

"There is a strong view now that hot-bedding, the pressure on beds and the necessity for mixed-specialty wards, are very difficult circumstances in which to conduct infection control," said Professor Mark Casewell of King's College School of Medicine and Dentistry in London, who is one of Britain's foremost experts on hospital infection control.

Patients occupying hospital beds are also more likely to be sicker and thus more open to infection than they used to be because of the rise in day surgery, which means less-serious cases no longer need accommodation.

New guidelines on the control of methicillin-resistant staphylococcus aureus (MRSA), one of the most dangerous infections, are being finalised and are expected to warn that more money is needed to counter the problem. "It has proved impossible to eliminate one of these MRSA strains from some of our hospitals," says Professor Casewell in his submission to the committee. He says this inability is "unique and unnerving".

An article in the British Medical Journal says the latest estimates are that 10 per cent of hospital patients will acquire an infection. The private health insurers Bupa says the infection rate in their hospitals, which have small wards and more side rooms, is less than 1 per cent.

In the report, consultant microbiologist Dr Keith Barker says there are a number of problems facing infection-control doctors: "The new NHS requires rapid turnover of patients and operates under considerable financial pressure. Patients are sicker and more vulnerable to hospital-acquired infection. They are slotted into any bed and there are insufficient ... side rooms in which to isolate patients."

He adds: "Levels of basic cleanliness and the general fabric of clinical areas can be poor ... In essence, the new management of the NHS negates effective infection control."

An emerging threat is that several organisms are increasingly resistant to antibiotics and Professor Casewell, in his submission to the Lords' committee, says: "The requirement for isolation wards for MRSA, as well as other transmissible infections, has never been greater but senior management and health ministers have yet to be persuaded of the costs benefits of this investment."

He says the ultimate costs of not controlling MRSA will be a strong resistance to all antibiotics: "In Tokyo we already have a hint of this with an organism that is halfway up the scale to being resistant to the last drug we have in the armoury."