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Health: Hospital-acquired Infections

asked Her Majesty’s Government what plans they have to reduce hospital-acquired infections. The noble Lord said: Healthcare-associated infections affect approximately 9 per cent of in-patients, cause at least 5,000 deaths per year and contribute to a further 15,000 deaths a year. Furthermore, 300,000 or more patients acquire non-fatal infections that prolong their stay in hospital. In England alone, this leads to a loss of 3.6 million bed days, at an estimated cost of £1 billion per year. Regular headlines in the media such as: "““How dare we let these dirty hospitals kill 8,000 a year?””," cause a great deal of public concern. It is not surprising, therefore, that patients are concerned about going into hospital for treatment for fear of catching these infections, which may prove fatal. There are several infective agents responsible for healthcare-associated infections. The two that are currently of major concern are meticillin-resistant staphylococcus aureus—MRSA—and Clostridium difficile, or C. diff. Others are glycopeptide-resistant enterococcus—GRE—which can cause blood poisoning; norovirus, which causes mild, short-lived gastroenteritis, the so-called winter bug; and various pseudomonas species, which cause a range of illness, mainly in the elderly. I have no doubt that unless we have a successful strategy for controlling healthcare-acquired infections, there will be other infective agents in the future, possibly even more deadly than the ones we have now. Government policy currently focuses on infections due chiefly to MRSA and, to a lesser degree, C. diff. Staphylococcus aureus is a common bacterium, found in skin or mucosa. MRSA is a variety resistant to antibiotics, including meticillin. About 3 per cent of people are carriers. Infections occur when bacteria enter the body or bloodstream, usually via a cut or catheter, commonly during surgery via wounds or ulcers. They can also do so via intravenous catheters or breathing tubes. They cause deep abscesses or septicaemia. Clostridium difficile, or C. diff, a bacterium found in the gut of 3 per cent of adults and nearly two-thirds of babies, is harmless in healthy people, but in ill, elderly patients, and in conjunction with antibiotic therapy, can cause severe colitis, perforation of the bowel and death. It is highly infectious and, importantly, spores shed in faeces are hardy and survive for long periods on surfaces such as toilets, sheets, beds and floors. Both MRSA and C. diff are transmitted from person to person and may be picked up from environmental contamination. From what I have just said about the nature of transmission of infection by these organisms, it is clear that simple measures of cleanliness—personal and environmental—judicious use of antibiotics, and a stringent policy of ““search and destroy”” can drastically reduce the incidence of such infections from 9 per cent of in-patients to as low as 1 per cent. The UK is one of the worst countries in western Europe for the incidence of MRSA and C. diff infections. So do we have a policy that will change that? To know whether we have an effective policy, we first need good surveillance. Since the introduction of mandatory reporting of MRSA and now C. diff infections acquired in hospitals, the surveillance of hospital-acquired infection is now reasonably good but not accurate. On the other hand, for healthcare-acquired infections acquired in the community setting, surveillance data are poor. That is particularly important, as more healthcare is now delivered in the community, so I ask what plans the Government have to collect information on community-acquired healthcare infections. Healthcare-associated infection as a cause of or associated with death is also poorly recorded on death certificates, as was the case in the Clostridium difficile outbreak in the Maidstone and Tunbridge Wells NHS Trust. The death certificates did not indicate that the patients had died of C. diff infections. What is the extent of MRSA and C. diff infections? For MRSA blood-stream infections—so-called bacteraemia—in the financial year 2006-07 the numbers were 6,381. Data from 2007-08 are not yet available, unless the Minister has them today. The trend has been downwards except for the last quarter, October to December 2007, which showed an increase of 0.6 per cent on the previous quarter. The Government have a target of halving MRSA blood-stream infections from 7,700 in 2003-04 to 3,850 or fewer in 2007-08, unless how the target was to be measured was not as I understood it. Will the Government meet that target? Maybe halving the rate of 2003-04 was ambitious, but it is important to maintain the pressure to drive down the rate. For C. diff, the surveillance data are difficult to interpret due to changes introduced over time. Between 2004 and 2006, the numbers of C. diff infections rose from 44,000 to 55,000. Quarterly data for October to December 2007 compared to the same period in 2006 showed a 26 per cent reduction. The Government introduced a target for C. diff in 2007 of reducing the number by 30 per cent by March 2011—nearly three years away—from baseline 2007-08. Again it is unclear how the target would be measured. I seek clarification from the Minister. Have we got the policies to achieve the targets and beyond? In 2002, we had the CMO’s Getting Ahead of the Curve strategy, and many other follows. In 2003 there was Winning Ways, in 2004 Towards Cleaner Hospitals, in 2005 Saving Lives, in 2006 Essential Steps to Safe, Clean Care, in 2007 Saving Lives: Reducing Infection, Delivering Clean and Safe Care, and in 2008 Clean, Safe Care: Reducing Infections and Saving Lives. They outline plans to introduce MRSA screening for patients but not staff, deep cleaning and additional specialist staff to tackle infection. In addition, we have the Health Act 2006, requiring NHS trusts to follow recommendations and the Healthcare Commission’s annual checks. There are also financial penalties and incentives. Certainly, there is no lack of commitment to tackle the problem of healthcare-acquired infections. So are the policies and strategies effective? Despite lack of strong evidence of environmental contamination and infection rates, the policy related to hospital cleanliness and deep cleaning is right. Clean hospitals instil public confidence and a culture of the importance of hygiene in staff. If there are any concerns, it is about whether deep cleaning is carried out in all areas of hospitals, how often it is and should be carried out, and what agents are used. Countries that have very low levels of healthcare-acquired infections have stringent policies for monitoring levels of environmental contamination and decontamination. While there might be contrasting views of deep cleaning as an effective strategy, there is no doubt that hand hygiene is the single most effective measure for controlling the transmission of infection in all healthcare settings. I declare an interest as chair of the National Patient Safety Agency, which is responsible for the cleanyourhands campaign. Hand washing with soap and water and use of alcohol gel after each and every patient contact have to be more actively enforced in healthcare, as they are in the food-handling industry. In my view, to cause a death by transmission of infection is in the same category as death caused by wrong diagnosis, treatment or bad surgery. The clinical professions need to accept greater responsibility. The policy of ““bare below the elbows”” may facilitate hand washing, but the removal of clean, hospital-provided white coats and nurses’ uniforms on a daily basis is a retrograde step. On the other hand, the wearing of operating-theatre and ward clothing in cafeterias and other public areas in hospitals should be prohibited with sanctions. The most recent government policy relates to the introduction of patient screening for MRSA for elective admissions in 2008—I do not know when in 2008—and for emergency admissions during the next three years. Countries that have low levels of infection have not only policies of screening all patients and staff but also low bed occupancy, low levels of workload for nursing staff and a strict policy of isolation of infected patients. Strategies that we are slowly beginning to adopt have still some way to go. The public are rightly anxious about healthcare-associated infections. Patients fear going into hospitals. Any Government who deliver clean hospitals, healthcare in a clean and safe environment and effective infection control policies, followed and adhered to by all, will remove healthcare and the NHS from politics. Would that not be a prize worth having?