'Complacent' NHS fails to beat superbugs

The NHS is losing the battle against soaring rates of hospital infections because of a combination of inertia and complacency, according to a scathing report.

Ministers, officials and NHS trust managers have failed to get to grips with the threat posed by bugs including MRSA (Methicillin-resistant Staphylococcus aureus) which are causing widespread suffering and deaths and undermining public confidence, the Commons Public Accounts committee says.

The indictment comes a day after The Independent revealed a second outbreak of a virulent new strain of Clostridium difficile at a hospital in Devon linked with 23 deaths. The new strain, C.difficile 027, is more virulent and harder to eradicate than existing strains and is the cause of an outbreak at Stoke Mandeville hospital in Buckinghamshire which began 18 months ago.

Edward Leigh, chairman of the committee, said the research on which the estimates of hospital infections were based was more than a decade old and the issue was shrouded in a "fog of ignorance".

"The truth is that over the past 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 with a raft of initiatives this year. 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," he said.

The committee found "a distinct lack of urgency" on key issues such as improving ward cleanliness and hand hygiene. In NHS trusts "conflicts with other key targets and priorities have continued to stand in the way of improving prevention and control". The MPs commend the Government target to halve MRSA rates by 2008 but warns that this does "not target the broader issue of multi-drug resistant infections which have a wide range of risk factors and require interventions other than improved cleanliness."

The Department of Health tried to open a chink of light in the gloom by releasing figures showing that MRSA rates may have peaked and are declining. The number of bloodstream infections with the superbug was down 6.1 per cent in 2004-05 compared with 2003-04, to 7,212.

However, though the overall figures are down, in almost 40 per cent of NHS hospitals MRSA rates went up. The Public Accounts Committee pointed out that cases of MRSA were a small proportion of the estimated 300,000 annual cases of infections acquired by patients after they arrive in hospital, leading to 5,000 deaths, which cost the NHS more than £1bn.

Jane Kennedy, the Health Minister with responsibility for hospital infections, welcomed the "helpful" report. She said the Government was the first to introduce mandatory surveillance for MRSA in 2001 and now had one of the most detailed surveillance systems for monitoring MRSA and other infections in the world.

Some hospitals had dramatically reduced their MRSA rates but progress in cutting rates "must happen across the NHS," she said. She rejected suggestions that pressure to meet government waiting-times targets was a factor behind high infection rates.

"That is an excuse, frankly. Some of the busiest trusts in the country have done best - it hasn't affected their ability to reduce their infection rates. I hear what they say but I have little sympathy for it."

The shadow Health Secretary Andrew Lansley, said: "This report condemns the complacency and lack of action by this Government in tackling hospital-acquired infections over the last five years."

How the Government has ignored expert advice

How the Department of Health has failed to act on hospital infections, as detailed by the Public Accounts Committee

1 The NHS does not know how many patients have died of hospital-acquired infections. The widely quoted figure of 5,000 deaths is based on US research from the 1980s. Evidence from a review of MRSA deaths shows a 15-fold increase since 1992.

Recommendation:

Deaths from hospital infections must be identified on death certificates and an audit carried out by 2006.

2 The figure of almost one in 10 hospital patients (9 per cent) estimated to acquire an infection while in hospital is at least 10 years old.

Recommendation:

Up-to-date information on current infection rates must be produced within the coming year.

3 Hospitals still lack a grip on the extent and impact of infections other than MRSA which is limiting the NHS's ability to tackle the problem effectively.

Recommendation:

The department must expand mandatory national surveillance.

4 Waiting-times targets can compromise infection prevention and control. Seven out of 10 trusts are still operating at occupancy levels higher than the 82 per cent level the Department of Health said four years ago it hoped to get down to by 2003-04.

Recommendation:

Trusts need to reduce bed occupancy and avoid moving patients too frequently.

5 Good infection control such as hand hygiene is still patchy. Alcohol rubs have been rolled out across the NHS but sustained compliance, especially among doctors is still poor.

Recommendation:

The department must develop ways of tackling poor hygiene.

6 Despite four years of research, no national infection control manual has been published, as recommended by the National Audit Office in 2000, with nationally accessible guidelines.

Recommendation:

The department must establish evidence-based guidelines and examples of good practice.

7 There is a mismatch between what is expected of infection-control teams and the resources available to them.

Recommendation:

Directors of infection control should be surveyed to establish what constraints they are under.

8 Despite a pledge by the Department of Health in 2001 that the need for isolation facilities was being addressed, only a half of trusts (56 per cent) have assessed their needs and a quarter have obtained the facilities.

Recommendation:

All trusts must assess their needs and draw up a timetable for meeting them.

9 One in eight infection control teams said its recommendation to close a ward had been refused by its chief executive.

Recommendation

Health authorities must ensure these incidents are recorded.

10 A matron's charter for cleaner hospitals and a model cleaning contract for the NHS have been introduced.

Recommendation:

The measures must be evaluated by an annual survey to check they are improving cleanliness.

11 The design of hospitals can help minimise infection rates.

Recommendation:

Health authorities must monitor whether infection control requirements are being complied with in new buildings.