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Health: Hospital-acquired Infections

I congratulate the noble Lord on securing today’s timely debate. As demonstrated by the passionate and well informed contributions, the topic is of great concern to many, particularly to him in his work as chair of the National Patient Safety Agency—and rightly so, as tackling healthcare-associated infections is a challenge for health services around the world and a priority for our NHS. The noble Earl is completely correct about the need for ownership of the problem. I would like to make the case that we are making good progress towards clean, safe care for patients in the NHS. That is evident in the latest Health Protection Agency data for January to March 2008, published today. Those figures show that MRSA blood-stream infections are down 33 per cent, and that C. difficile infections in the most vulnerable group—those aged 65-plus—are down 32 per cent compared to the same quarter last year. That is significant progress. The noble Lord’s work as chair of the National Patient Safety Agency has contributed significantly to that progress. The NPSA’s cleanyourhands campaign is a key element in preventing the spread of infections. It has been shown to make a real difference to hand hygiene, therefore making a real difference to patient care and literally saving lives. The NPSA also announced the 2008 hospital patient environment action team scores last Thursday. Thanks to the hard work of the NHS, 98.5 per cent of hospitals are now rated acceptable or above. But we cannot stop there. Trusts are required to deliver a 30 per cent reduction in the number of C. difficile infections by March 2011. The NHS is on course to hit the target to halve MRSA blood-stream infections by the end of March. We will know the result when the HPA publishes the data in October. However, the latest figures were over 49 per cent lower than the quarterly average in 2003-04, so we are fairly sure that the NHS will meet the target. However, there is no single solution for reducing healthcare-acquired infections, so we have introduced a range of measures. Our Clean, Safe Care strategy builds on comprehensive clinical guidance and gives an overview of all measures. Good hand hygiene, high standards of cleanliness, effective patient screening and sensible use of antibiotics are vital in the fight against infection, as noble Lords have mentioned. In the last year, we have introduced a ““bare below the elbows”” dress code to support hand hygiene, increased the number of matrons to over 5,000 and launched a new antibiotics campaign. All acute hospitals have been deep cleaned and we have doubled the department’s tailored support team for infections. We are now in the process of introducing MRSA screening across the country. I shall refer to that again when I answer specific questions. Those measures are backed by significant additional investment. On top of investment in recent years of over £100 million, the Comprehensive Spending Review settlement for future years includes £270 million a year by 2010-11 to tackle healthcare-acquired infections. That all supports the legal requirement for NHS bodies to maintain proper infection control. The new regulator, the Care Quality Commission, will have tough powers to investigate and intervene, strengthening the regulator’s role in ensuring the NHS meets the required standard. In the mean time, specialist teams from the Healthcare Commission continue to inspect all acute trusts every year. We are fighting infections on all fronts, but we should not lose sight of the fact that, for all the media hype, the probability of dying from a healthcare-associated infection is relatively low. As the Observer pointed out last Sunday in its feature on ““25 things you need to know for a healthy life””, people should not fear hospitals. I suspect that my civil servants would advise me not to use this statistic because I do not know what it is based on. However, that article stated that, "““for people under 65 at least, you've got more chance of dying from a lightning strike than MRSA””." The NHS treats around 1 million patients every 36 hours and admits 14 million people to hospital each year. If someone is admitted to an NHS hospital, his chance of acquiring an MRSA blood-stream infection or a C. difficile infection is less than half of 1 per cent. I now turn to specific points raised by noble Lords. The noble Lord, Lord Patel, asked about the plans we have to collect information on community infections. We have set the latest C. difficile targets across health communities to encourage an approach that encompasses primary care trusts, although we have no current plans to collect information about community-acquired infections. However, we will continue to consider that as we update our surveillance systems. The noble Lord, Lord Patel, suggested that the trend had slowed and we were not going to hit the target. We think the trend has now reversed and that we are on track to hit the MRSA target. The latest statistics show a 49 per cent decease compared with the 2003-04 baseline. However, his statistics were correct, which is why we take this issue so seriously. We are pleased that the action taken to date is having an impact and infection rates are falling. We focused on MRSA and C. difficile, but the measures introduced and promoted, such as good hand hygiene, will have an impact on other infections. The focus that we have encouraged on infection control should have an impact right across the NHS. The noble Lord asked why we were not screening staff for MRSA and other noble Lords may have mentioned that. The key point is that staff are usually healthy, so they are at less risk of getting or carrying an infection. The problem is not screening the staff, but is the practice—making people behave in a way that means that infections are not carried from patient to patient. He asked when we would introduce MRSA screening for elective care in 2008. We will introduce it by the end of March 2009. Hospitals are now working on how to deliver it. The noble Lord asked what we were doing to ensure accurate reporting on death certificates. In July 2005, the CMO issued advice to doctors reminding them to record infections accurately on death certificates. The number of death certificates mentioning C. difficile rose significantly the next year, as shown by the latest Office for National Statistics report. The noble Baroness, Lady Masham, made a good point about the need to make sure that children in schools were taught about the importance of hygiene. She is also right to point to the importance of combating sloppy practices. The key point about healthcare workers is their practice. The Health and Social Care Bill, which I think became an Act yesterday, makes the prevention of MRSA a priority. We must ensure that specialist hospitals are as rigorous as the best of the rest. The noble Baroness asked about guidelines on pneumonia. I am not sure which guidelines she referred to, but the suggestion sounded very sensible. We launched a new campaign about antibiotic prescribing in February this year and have highlighted it in department guidelines. C. difficile is not notifiable in England, but all cases have to be reported on the mandatory surveillance system, which gives real data to the Health Protection Agency and to trusts. The noble Baroness raised the issue of new ideas, and mentioned mattresses and so on. That is extremely important. We are always looking for new ideas. The Rapid Review Panel was set up in 2004 to review new healthcare-related infection technologies and to provide a prompt assessment of novel equipment and materials and other products or protocols which might be of value to the NHS in improving infection prevention and control, the idea being that you need to look at these things quickly and, if they are effective, roll them out across the piece. We are very much aware that we need to be on top of technology. The noble Lord, Lord Teverson, asked about antibiotic prescribing. Unfortunately, we are not yet at the stage where antibiotic prescribing across England represents what we recognise is the best practice in the best hospitals. However, we are working very hard to raise awareness. For instance, we are launching an extension of our antibiotic campaign with a poster competition in schools. So far as we are aware there is no read-across to animals. That was not in my brief, as they say. The noble Lord is right that the logistics of screening are significant. There is no question about that, as mentioned also by the noble Earl. Where are we now on screening? As I mentioned, all elective admissions will be screened by March 2009 and all emergency admissions by 2011. The reason for the time is because we know that the logistics of this need to be right. The noble Lord, Lord Teverson, mentioned bed occupancy. There used to be a correlation. However, we have issued guidance to infection control teams to talk to bed managers. Now we think there is no correlation. Trusts with high bed occupancy rates have reduced infection numbers as much as those with low bed occupancy rates. The noble Lord asked what we were doing to ensure that those in nursing homes were as protected as those in hospitals. We will produce guidance shortly for infection control in care homes. This consultation is due to start this summer. With the creation of the new regulator, it will be much easier to roll that out because we will have one regulator looking across the piece from healthcare to social care. The noble Earl, Lord Howe, asked about deep cleaning and whether it was a gimmick. We need to be clear that the cleanliness of our hospitals is a matter of utmost importance. Clean, tidy and safe hospitals and staff are very important to patients, and are what they expect. Deep cleaning is not different cleaning, but it was a way of galvanising hospitals. It is a concentrated programme, often using new equipment and specialist skills. We are not repeating the national deep clean, but the Healthcare Commission will be looking at this when it inspects. The noble Earl asked why we were screening for MRSA and not C. difficile. We have considered whether universal screening of patients for C. difficile was the best way forward. It would not have the same clinical benefits as MRSA screening, which is why we only target patients over 65 who have diarrhoea. We are keeping this clinical evidence under review and will act quickly to respond if there is any new and emerging evidence. Will MRSA screening be cost effective? Available evidence indicates that it can be cost effective due to reduced morbidity and lower NHS treatment costs, but there will be an inevitable start-up cost in the introduction of the service. I thank noble Lords for the many points they have raised. I apologise if I have missed anything. I will look at the record and certainly write to people. I hope I have demonstrated that the NHS is working very hard and making good progress. I assure noble Lords that we will continue to support and encourage the NHS to ensure that patients receive the clean, safe care that they deserve. [The Sitting was suspended from 2.55 to 3 pm.]