New legal code in U.K. to tackle healthcare-associated infections

MRSA rates show reduction but Minister says more must be done

July 24, 2006 — /GNN/ — London — According to Health Protection Agency (HPA) statistics published today, MRSA bacteraemia fell to the lowest winter total since mandatory recording began in 2001, representing 11.1% decrease on winter 03/04.

However, the figures revealed that more work is necessary to meet the challenge of other infections including Clostridium difficile, reports of which rose by 17.2%.

Health Minister Andy Burnham today gave notice that the new powers in the Health Act will be used to deal with organisations that consistently fail to follow the good practice set out in the Code of Practice for the Prevention and Control of Healthcare Associated Infection (HCAIs). Trusts will have a period of two months to adjust to the requirements of the Code but from then on improvement notices may be served on those who fail to implement it effectively.

Andy Burnham said, “Some trusts have managed to reduce their rates of infection significantly proving that it is possible to get a grip on this problem with focus and good management but elsewhere progress is not good enough and needs to improve.

“Clean, safe care is not an optional extra. We and the Healthcare Commission will not shy away from using the powers in the Health Act to ensure that trusts do everything possible to eradicate avoidable infection.”

Following the launch of the second year of the cleanyourhands campaign, Chief Nursing Officer Christine Beasley stressed the importance of good hand hygiene for all staff involved in patient care.

“I cannot emphasise enough that any avoidable infection is one too many, but we must recognise that in an organisation admitting 12 million people a year there will be a number of people who contract an infection.

“Effective hand hygiene is essential to improvement in HCAIs. Staff cleaning their hands at the point of care is fundamental to reduce risk and infection.

“Not all infections are avoidable, but we are determined to ensure that the NHS and staff in care homes have good hygiene and clinical procedures to prevent the ones that are.”

The Healthcare Commission also published its report on C. difficile outbreaks at the Stoke Mandeville Hospital today. The report noted significant failings in infection control on the part of the trust because of undue focus on the reconfiguration of services and its incorrect interpretation of national priorities.

Issuing a statement in response to the report Andy Burnham said, “What happened at Stoke Mandeville is inexcusable and must not be allowed to reoccur.

“There are many hospitals making excellent progress in decreasing rates of infection and maintaining first-rate standards of patient care. Guidance on the control of this infection has been issued to all Trusts by the Department and has been implemented successfully in other Trusts where outbreaks and increased numbers of cases have occurred.”

“Patient Choice means that people will not select treatment at hospitals that do not proactively reduce risk. Patients should be able to expect a good standard of care every time they visit a hospital – this is not optional. “

The Department and the Strategic Health Authority will continue to help the Trust make further improvements. However, as the conclusions have a wider applicability to the Health Service the Chief Medical Officer and Chief Nursing Officer will also consider the report over the summer to assess the how the recommendations might be implemented both locally and nationally.

Information on MRSA bacteraemia is currently published every six months and C. difficile infections are published annually. Andy Burnham today announced the plan to move to quarterly publication of data for both C. difficile and MRSA as soon it is practicable to do so. An announcement will be made in due course.

Notes to editors

1. The statistical data published by the Health Protection Agency today can be found at:

2. The Healthcare Commission report to the Secretary of State on C. difficile outbreaks at Stoke Mandeville can be found at:

3. The Health Bill received Royal Assent on 18th July 2006. The Code is expected to be published in the autumn, at which point it will come into force. However, Trusts will start to make declarations of compliance with the code as part of their annual assessment from April 2007.

4. The Healthcare Commission will be responsible for monitoring the Code and where it considers that an NHS body is failing to comply, the inspectorate would have a new power to issue an “improvement notice” stipulating the action that it considers the body should take, against a specified timescale, to meet the code.

The Commission may recommend how the NHS body should go about achieving compliance. If an organisation satisfies the inspectorate that they have taken appropriate steps, then there would be no further action. Where, in the opinion of the inspectorate, the organisation still fails in significant ways to comply with the Code, they would be reported to the Secretary of State, or to Monitor in respect of Foundation Trusts.

5. Improvement Teams work inside Trusts on local delivery and HCAI improvement.

The teams will not automatically work with trusts that have the highest number of MRSA infections. The latter are most likely to be large Specialist Trusts treating more sick patients, giving more complex treatment. This usually means that they are more likely to have more infections and does not mean they are performing worse than those with lower rates. Case mix is an important factor when looking at infection levels.

There are two levels of intervention:

Level 1: a full review of existing performance against action plans with a diagnostic, review and action planning period. This is followed by an implementation phase and monitoring of progress. The teams are multi-disciplinary and include specialist infection control reviewers and specialist managers.

Trusts associated with Level 1 include: Aintree, Sandwell, Northumbria, Kingston and North Staffordshire. Newly announced Trusts include: Wolverhampton, Hull and East Yorkshire, Pennine, United Lincolnshire

Level 2: A two-day onsite review of existing HCAI action plans and performance. This explores the local action plans for improvement with the Trust and offers a framework for generating greater improvement where existing systems are slow to yield results.

Trusts that have or will receive level 2 support include: Worthing, Barnet and Chase Farm, Taunton and Somerset, West Hertfordshire, South Tees, Tameside and Glossop, Bath, Wirral, St Mary’s Paddington

6. A performance improvement network (PIN) is open to all Trusts and is for sharing learning and spreading good practice. There are currently over 60 Trusts in Network, which meets quarterly. Any NHS organisation may join.

7. The London region hospitals contributing to the fall in MRSA bacteraemia numbers included:
– Barking Havering and Redbridge
– Chelsea and Westminster
– Guy’s and St. Thomas’ FT
– Lewisham
– Queen Mary’s Sidcup
– Queen Elizabeth Hospital
– St. George’s Healthcare
– Whipps Cross

The Yorkshire/Humberside Hospitals contributing included:
– Bradford Teaching Hospitals FT
– Calderdale and Huddersfield
– Leeds Teaching Hospitals
– Mid Yorkshire Hospitals
– Northern Lincolnshire and Goole Hospitals
– Sheffield Teaching Hospitals FT

For media enquiries please contact Michelle Hinds at the DH media centre on 0207 210 5375 or Amanda Waller on 0207 210 5436

For all other queries please contact the DH Public Enquiries line on 0207 210 4850


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