Page last updated at 10:18 GMT, Tuesday, 23 December 2008

Q&A: Tackling hospital infections

Clostridium difficile
Clostridium difficile can be a threat to the sick
Richard Branson has accused the government of "tinkering" with hospital infections and has called for all hospital staff to be screened and treated for MRSA.

Figures show rates of MRSA are falling but as vice-president of the Patient's Association, Sir Richard says he wants to see a much "tougher line" including the sacking of managers who fail to enforce patient safety standards.

What are hospital infections?

Experts use the term healthcare-associated infection and it encompasses all infections that are caught in hospital or as a result of treatment.

MRSA and C. difficile are the two that have dominated the headlines in recent years.

MRSA is the antibiotic resistant form of Staphylococcus aureus - a bug that lives on the skin but can cause infection when it has the chance to enter the body, for example through a wound or during surgery.

C. difficile is a bacterium that lives in the gut of 3% of adults and 66% of infants where under normal circumstances it rarely causes problems.

However, use of antibiotics can disrupt the balance of bacteria in the gut enabling C. difficile to take over and cause what can be very severe diarrhoea.

It mainly affects the over 65s.

Both these infections have been at the centre of government policy to tackle healthcare-associated infections but they are not the only problematic infections in hospital.

For example, E. coli is the most common cause of bloodstream infections and cases of Listeria monocytoges, although rare are on the rise, particularly in older people.

What do the latest figures show?

Figures published by the Health Protection Agency in December show that there were 725 MRSA bloodstream infections reported in England during the July to September quarter of 2008.

This is a 13% decrease on the previous when 837 reports were received and a 33% reduction in the corresponding quarter of 2007 when 1,082 reports were received.

By summer 2008 the government had hit its target of halving cases of MRSA from the 2003/04 figures.

However the government's healthcare watchdog has warned that the figures mask large variation between different hospitals and some are not achieving the infection control they should be.

Cases of C. difficile also appear to be falling with 8,683 recorded in the over 65s in England between April and June 2008 - an 18% drop on the previous quarter.

Compared with the same period last year the number of cases fell by 38%.

What is the government doing to tackle the problem?

A spokesman for the Department of Health said they had introduced a "raft of measures" to tackle healthcare-associated infections, including more matrons to enforce hygiene standards and a "deep clean" of all hospitals in England.

A "Clean, Safe Care" strategy to tackle healthcare-associated infections in the NHS is backed by funding of 270m a year, he said.

There are also plans to introduce MRSA screening for all elective patients by March 2009, and for all emergency patients as soon as possible over the next three years.

In 2006, the hygiene code was introduced in response to a report from the Healthcare Commission warning of poor standards of cleanliness in a significant proportion of hospitals in England.

The hygiene code lists the actions that NHS organisations in England must take to ensure the risk of infection is kept as low as possible.

Compliance with the code has been monitored since 2007.

Is it enough?

While figures suggest that strategies employed to reduce rates of healthcare-associated infection have had an effect, experts routinely warn that more work is needed and it is vital not to become complacent.

There has been much debate about the validity of the approach taken so far and some steps such as the multi-million pound "deep-clean" initiative were criticised in some quarters for being little more than a publicity stunt.

News that the target to halve MRSA bloodstream infections had been hit was quickly followed by a report from the Healthcare Commission warning that a quarter of trusts were struggling to meet the hygiene code.

It also showed just over half of hospitals had managed a sustained reduction in MRSA rates.

Anna Walker, chief executive of the Healthcare Commission said more needed to be done with some trusts still having "some way to go" on the basics.

Recently there have also been warnings that too much focus on MRSA and C. difficile means hospitals are taking their eye of the ball when it comes to other infections, such as E. coli.

The Department of Health said it had taken "tough actions" which are "clearly making an impact".

What about screening NHS staff?

Sir Richard Branson has called for screening of MRSA among NHS staff.

One expert, Professor Mark Enright from Imperial College said the idea made sense but would be expensive to implement.

A spokesman for the Department of Health said professional guidance had not recommended routine screening of staff for MRSA.

But a hospital infection control team may advise screening if they have evidence to suggest that a staff member or members may be the source of linked cases of MRSA infection, he added.

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