The National Audit Office (NAO) has published its latest report – Reducing Healthcare Associated Infections in Hospitals in England. This report builds on earlier NAO reports into healthcare associated infection published in 2000 and 2004.
The report points to real progress in dealing with infection control issues in hospitals. But there are still problems to address, including the finding that doctors are less likely to comply with good infection control practice.
According to the NAO “There has been a perceptible change in leadership, performance management and clinical practice in most trusts. The impact has not, however, been the same for all trusts. A quarter of hospital trusts have reduced MRSA bloodstream infection rates by over 80 per cent, but 12 per cent had an increase in MRSA bloodstream infections. Twenty nine per cent of hospital trusts have reduced C. difficile infections by over 29 per cent, but 19 per cent have had an increase in C. difficile infection. Moreover there has not been the same impact on other avoidable infections, where there is still a lack of robust and comparable surveillance information. The information that is available suggests that other healthcare associated bloodstream infections, including ones due to other antibiotic resistant organisms, may have increased. Most staff and patients are less aware of the risks of acquiring these other infections. There is scope therefore for hospitals to improve infection prevention and control further and make savings by tackling other healthcare associated infections.”
Key recommendations for trusts and trust boards set down in the NAO report include:
– Hospital trusts should extend root cause analysis to all serious infection incidents. The Department, Health Protection Agency and National Patient Safety Agency should implement a system for collating and sharing the key lessons from trusts’ analyses in the same way as for other serious patient safety incidents.
– Primary care trusts should require all providers to put in place assurance systems which demonstrate how they are complying with good infection control practice, for example, clinical audit compliance and root cause analysis.
– Hospital trusts should require staff to report healthcare associated infections which contribute to death, significant disability or injury, for one or more patients to the trust’s patient safety incident reporting system.
– Hospital trusts should have processes to provide their board with assurance that infection, prevention and control is the responsibility of everyone in the trust. For example as required by the Code of Practice, all staff should have performance objectives for complying with good infection control practice.
– Hospital trusts should have processes in place to assure their boards that there is effective control over the appropriateness of the antibiotics being prescribed.
– Primary care trusts should monitor hospital trusts’ and other healthcare providers’ antibiotic prescribing and take action to address inappropriate use.
– Primary care trust commissioners’ contracts with healthcare providers should explicitly state expectations of quality and safety with respect to reducing the risk of all healthcare associated infections.
Download the NAO report Reducing Healthcare Associated Infections in Hospitals in England plus associated survey, research and other materials here.