By Caroline Ryan
BBC News Online health staff
The cover of the National Audit Office report into the NHS's failure to measure the true extent of the hospital superbug crisis features 'Lady of the Lamp' Florence Nightingale.
Florence Nightingale recognised the importance of information
The NAO says it used her image not because it believes 21st century NHS wards resemble those of the Crimea, but because she was one of the first to highlight the importance of monitoring what happens in hospitals.
The NAO was investigating what progress the NHS had made in tackling hospital acquired infections such as MRSA since it first looked at the issue in 2000.
Despite the enormous interest in MRSA, it found that there was still a lack of information about how many patients are infected with that and other superbugs.
And it said, even where a hospital had succeeded in cutting rates, there was no adequate system for sharing that information with other trusts.
The Princess Royal Hospital in Haywards Heath, Sussex, is highlighted in the NAO report for its success in eradicating MRSA joint infections in its orthopaedic department.
Such infections mean the patient's new hip or knee joint has to be removed. They may then be given a further joint, or their existing bones may simply be fused together, severely affecting their ability to walk.
In the six months prior to changes being introduced in 2000, the cost of such infections to the hospital had been around £231,000, covering just the bed and feeding costs for nine hip replacement patients.
The care of one patient who spent 155 days in intensive care cost the hospital £67,000.
Infection control doctors and orthopaedic specialists worked together to look at ways they could reduce the rates of MRSA and other infections in the unit.
Since 2001, the hospital has screened all patients due to come in for orthopaedic operations. Those who test positive for infections are given treatment, such as oral antibiotics and skin cleansers.
In some cases, the infection is completely eradicated while in others, it is reduced to its lowest possible level.
Emergency patients are treated in a different ward, and nurses do not put dressings onto patients wounds while they are being washed or when the beds are being changed.
All these measures have helped the unit reach a 0% infection rate.
Dr Paul Donaldson, the Infection Control Doctor at the hospital, told BBC News Online: "Infection in a replacement joint is not good at all. So we brought in a zero tolerance approach.
"We haven't had an MRSA joint infection since 2001. Prior to that, we were maybe slightly above average.
"The changes mean patient care is better, and we can plan operations better too."
He added: "I'd like to think other hospitals might look at what we have done and see if it applies to their practice."
When Christine Perry, head of the Infection Control Nurses' Association, says sharing this kind of information is crucial.
She said: "The NHS is getting better, but sharing information is quite difficult. What you see in medical journals are the very scientific studies. What we need to see is the research which shows us what works in a hospital setting."
And she added: "I'm quite disappointed that John Reid, the health secretary, has announced he's going to fly people in from Holland. There's a lot of good practice here, and we need to learn from that."
The NAO says it is impossible to know how many people were infected each year, and how many died, making it harder to tackle the problem and reduce the numbers.
It has called for data collection on how many patients are affected by hospital acquired infections to be improved.
Experts currently use a 'guesstimate' that 5,000 deaths per year are caused by HAIs, and it is a contributory factor in around 15,000 more.
But those figures are based on US analysis, itself based on a 1970s study.
Ms Perry backed the NAO's calls, but said the failings came down to resources.
"To monitor infections properly, you need to employ staff to do it. It's very time consuming, and it needs more IT resources and support."
And she said hospitals needed to collect much more detailed data, so they knew which departments infections were more common in, and which particular patients were affected.
Ms Perry said nurses today - just like Florence Nightingale - recognised the importance of collecting data.
"Infection control nurses now tell us they see information as a key area. We need to know for example, not just how many MRSA bloodstream infections there are, but what parts of the hospital you're seeing them in most, and which patients are most likely to be affected.
She added: "Florence Nightingale recognised that when you want to make changes, you have to have the information to show whether what you're doing works."