That dirty hospitals are not a prerogative of the underdeveloped countries is old hat by now. There have been a barrage of reports highlighting hospital infection. Only a few days ago it was reported that a nurse blew up when a heart-attack patient in England complained he had been left lying in his own urine puddle for a few hours.
But some time governments in the developed world some time try to get their act together. Like in the UK now. The Healthcare Commission said it would carry out spot checks at 120 NHS trusts over the next year in its biggest ever programme of visits aimed at cutting rates of infection with the deadly superbugs MRSA and Clostridium difficile.
While Clostridium difficile [is a bacterium that causes diarrhea and more serious intestinal conditions such as colitis, .MRSA stands for methicillin-resistant Staphylococcus aureus. It is shorthand for any strain of Staphylococcus bacteria which is resistant to one or more conventional antibiotics. Experts have so far uncovered 17 strains of MRSA, with differing degrees of immunity to the effects of various antibiotics.
Two particular strains, clones 15 and 16, are thought to be more transmissible than the others, and account for 96% of MRSA bloodstream infections in the UK. At present, these strains are thought to be rare in other countries, but are spreading. Official figures published in the UK six weeks ago show Clostridium difficile causes 4,000 deaths a year and is still spreading despite all attempts to curb it. The bug causes severe diarrhoea which can lead to inflammation of the bowel, gas gangrene and death.
Some hospitals have infection rates six times higher than others. Inadequate infection control, poor standards of cleanliness and the misuse of antibiotics are blamed for the spread of the bug. Last year, cases of C-difficile rose by 8 per cent to a record 55,681 cases. The number of deaths has risen four-fold since 1999, although part of the rise is due to better reporting.
The Health Protection Agency, which released the figures, said that although the rate of increase had slowed, from 17 per cent the previous year, the results "clearly show the scope for improvement".
Cases of MRSA fell slightly with 1,652 bloodstream infections in the last quarter of 2006 but the HPA said it was too soon to tell whether the fall would be sustained.
A senior department of health official admitted in a leaked memo published last January that the Government's target to halve MRSA rates by 2008 might never be met. The latest move follows a pledge by David Nicholson, chief executive of the NHS, to make reducing hospital infections one of his top four priorities for the NHS this year. The Healthcare Commission warned in December 2006 that more than one third of trusts had failed to implement new guidelines on cleanliness.
An earlier survey by the Commission published last year found wide variation among hospitals. Under the Hygiene Code, trusts have 11 compulsory duties to prevent and manage healthcare associated infections. Inspectors will assess the cleanliness of wards, procedures for isolating infected patients, hand washing and the cleaning of equipment. Any trust found in breach of the code will be required to implement an action plan or face a public reprimand. The Commission has a new legal power to issue improvement notices to hospital trusts to enforce the Hygiene code.
Anna Walker, chief executive of the Commission said: "Visits will be unannounced so that we can see the hospital in action. What we want to know is whether trusts are taking infection control seriously. Is it a key part of their day-to-day business and could it effectively manage an outbreak should it occur?" She said most visits would be to hospital trusts, with up to two-thirds being inspected as part of the drive top improve hygiene standards.
"Boards at all acute trusts must take notice: chances are you're going to be assessed against the Hygiene Code, so make sure you're, ready. We would much prefer to find that everything is in place to protect patients and the public." Lord Hunt, a health minister, said: "Reducing healthcare-associated infections is a top priority for the NHS and all NHS bodies have a duty to comply with the Code of Practice. The Commission are empowered to issue improvement notices... but these rigorous checks will ensure that Trusts adhere to the Code and will help to give patients the assurance that... everything possible is being done to keep infections to a minimum."
Andrew Lansley, Tory shadow Health Secretary, said: "Anything that reduces the risk of patients contracting MRSA or C-difficile is welcomed, but it is odd that it has taken Gordon Brown 10 years to introduce these unannounced checks, especially as it's been a period in which the number of deaths from MRSA has quadrupled."