About 5000 patients in England die each year from infections acquired in hospital, warned a report published last week. It recommended a major improvement in information systems in the NHS to track the problem and systematic use of measures to reduce transmission of infection among patients.
The report, published by the House of Commons public accounts committee, estimated that there are at least 100000 cases of hospital acquired infection in England each year. This costs the NHS as much as £1bn ($1.4bn) a year.
Members of the committee suggested that the NHS needed to tackle two key issues to improve the management of hospital acquired infection. Firstly, the NHS needed to develop systems to monitor the extent of hospital acquired infection and associated costs.
“Without robust, up to date, data it is difficult to see how the Department of Health, the NHS Executive, health authorities and NHS Trusts can target activity and resources to best effect,” argued the report. It noted that the lack of data mirrored other weaknesses in NHS information systems that the committee had seen in previous hearings.
The second issue identified by the report was the need for “a root and branch” shift towards prevention of infection at all levels of the NHS, based on the philosophy that prevention is “everybody's business, not just the specialists'.” Even simple measures, such as hand washing, were not being implemented sufficiently to prevent transmission of infection among patients.
Professor Brian Duerden, Professor of Medical Microbiology at the University of Wales College of Medicine and medical director of the Public Health Laboratory Service (PHLS), welcomed the report: “It moves the important issue of hospital acquired infection up the political agenda and places it firmly on the hospital management agenda.”
He explained why surveillance has previously been suboptimal: “One of the big problems has been a lack of consistent definitions for hospital acquired infections.” The laboratory service is currently working to develop clear diagnostic criteria, starting with bloodborne infections—particularly those caused by methicillin resistant Staphylococcus aureus (MRSA), which poses a major hazard.
Shorter hospital admissions, particularly day case surgery, have meant that many infections occur after patients have left hospital. Studies suggest that 50-70% of surgical wound infections occur after discharge.
The committee accepted an estimate from the NHS Executive that it should be possible to reduce hospital acquired infection by 15%, offering a potential saving of £150m. Members recommended improving surveillance of hospital acquired infection, with a national surveillance scheme for infections occurring after discharge and improved collection of data on infection within hospitals.
The report noted that only 139 acute NHS trusts in England were participating in the nosocomial infection national surveillance scheme in December, 1999. It suggested that this scheme should become mandatory.
The Management and Control of Hospital Acquired Infection in Acute NHS Trusts in England is available at www.publications.parliament. uk/pa/cm/cmpubacc.htm