NHS 'in the dark' over hospital infections

Trusts failing to deal with threat of superbugs on the wards, new report claims

NHS trusts are failing to monitor and record infections and could even be benefiting financially from outbreaks on the wards, a worrying new report reveals.

An 18-page study by The Medical Technology Group says trusts are failing to invest in improvements to infection prevention and control and are putting patients at risk.

With so much variability by trust and by region, there clearly needs to be a more-effective national strategy to combat healthcare acquired infections

On average, one in 12 hospital patients who enters hospital without an infection will acquire one during their stay. This will extend their time in hospital by an average of 10 days, costing the NHS an extra £5,200 per person affected.

But, even though mandatory reporting of infection rates in hospital has been introduced for some of the more-common bugs such as MRSA and C.difficile, across the board levels of reporting differ and the majority of trusts do not track the fallout, failing to record extra bed days or the financial impact.

Entitled Infection Prevention and Control: Combating a Problem That Has Not Gone Away, the report also reveals that, due to the way acute trusts are paid, some may even benefit financially from reimbursements when they treat a patient who has acquired an infection during their stay.

And the study looked at how many trusts sent board members to infection prevention and control committee meetings. The answers ranged from 0 to 24 meetings a year. Among those trusts that failed to send a director to any meeting were Airedale NHS Foundation Trust, Calderdale and Huddersfield NHS Foundation Trust, South Devon Healthcare NHS Foundation Trust, and Mid Essex Hospital Services NHS Trust.

There was also major variation in the ratio of infection control staff to patients, with the North East and East Midlands the two worst-performing regions, and London and the South West performing best. In London there is an infection control member of staff for every 71 inpatient beds, while in the East Midlands the figure was one person for every 161 beds.

Trusts were also asked for details of device surveillance, with the findings showing that, on average, each trust neglects device surveillance on nine wards, while seven trust, including Central Manchester University Hospitals NHS Foundation Trust and Heart of England NHS Foundation Trust, failed to carry out device surveillance on any of their wards.

The NHS is moving far too slowly. Better measurement of, and prevention of, healthcare acquired infections is vital and medical technology is key to this

But possibly the most-worrying finding was the evidence that seven trusts – West Middlesex, University Hospital Southampton, Torbay & South Devon, Plymouth, Northumbria, Doncaster & Bassetlaw and Barnsley – had received instructions to reduce expenditure on infection prevention and control over the past five years.

This comes as it is revealed that, as trusts are paid for each patient ‘episode’, they could be benefitting financially if people have to stay in hospital longer or have to be readmitted due to complications arising because of an infection.

The report states: “With so much variability by trust and by region, there clearly needs to be a more-effective national strategy to combat healthcare acquired infections (HCAIs).”

To address the problem, the paper makes a number of recommendations, calling for:

  • A mandatory requirement for trusts to record the number of cases and associated deaths from sepsis, catheter-associated urinary tract infections, catheter-related blood infections, ventilator-associated pneumonia and norovirus
  • A requirement for trusts to record the total number of nights patients stay longer in hospital each month due to a healthcare acquired infection
  • Trusts to no longer receive financial reimbursement for readmissions and bed days relating to a patient who acquired an infection within the hospital itself
  • Device surveillance to be mandatory for all hospital wards

And medical device manufacturers will play a vital role in the future success of infection control measures, say researchers.

The report calls on the Government to develop a strategy for using technology for infection prevention and control and set up links with industry to discuss future solutions.

The report began as effort to demonstrate the scale of problem by tracking the number of infections and deaths caused by infections. As data came in, we quickly discovered something more sinister

“The NHS is moving far too slowly. Better measurement of, and prevention of, healthcare acquired infections is vital and medical technology is key to this,” it states.

It adds: “The report began as effort to demonstrate the scale of problem by tracking the number of infections and deaths caused by infections other than MRSA, MSSA, E.Coli and C.difficile. As data from our Freedom of Information request came in, we quickly discovered something more sinister. “Most trusts are failing even to measure the total number of cases of, and deaths from, infections. They have no idea of the total number of extra nights each year that patients stay in hospital owing to an infection, or the total financial cost. This must change.” In July this year, Prime Minister, David Cameron, said of the rate of hospital infections in the UK: “Resistance to antibiotics is now a very real and worrying threat. If we fail to act, we are looking at an almost-unthinkable scenario where antibiotics no longer work and we are cast back into the dark ages of medicine where treatable infections and injuries will kill once again.”

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