Battle against hospital acquired infections has been too limited, MPs’ report saysBMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b4680 (Published 10 November 2009) Cite this as: BMJ 2009;339:b4680
All rapid responses
We read with interest the article on hospital infections(1). Finally
a sensible comment by MPs regarding healthcare acquired infections (HCAIs)
as they realise that bacteria other than meticillin resistant
Staphylococcus aureus (MRSA) and Clostridium difficile (C.dif) exist.
Edward Leigh MP, quite rightly states that although the Department of
Health has made progress in reaching its targets regarding MRSA
bloodstream and C.dif infections, “it has taken its eye of the ball
regarding all other healthcare associated infections – which actually
constitute most by far (four-fifths) of all infections(2)”, something that
many doctors have been saying for a while.
What is it about MRSA and C.dif that has prompted action by the
government and the NHS, while they ignore infections caused by other
organisms? Surely the public “scare stories” promoted by the press over so
-called “superbugs”. It seems, however, that it is time to take a good,
hard look at the whole picture – prompted, no doubt, by the £1 billion
HCAIs cost the NHS per year – not to mention the element of patient
What has been done so far? The main response by the Department of
Health has been as follows:
Introduction of mandatory reporting of MRSA bloodstream and C.dif
infections in 2001 and 2004, respectively.
Several national initiatives aimed at reducing HCAIs, such as the Deep
Clean, modern matrons and the cleanYOURhands campaign.
Screening patients for colonisation of MRSA is currently being rolled out
in hospitals across the country so they can be pre-emptively treated.
On a “shop-floor” level, this has meant greater use of alcohol gel, a
ban on white coats, long-sleeves and wrist-watches, barrier nursing,
changes in practice to simple procedures, such as obtaining blood cultures
and prescribing antibiotics. Surely all of these measures should have an
effect on microbes other than MRSA and C.dif? It seems not, as Edward
Leigh also warns that “the best available evidence is that other just as
deadly but also avoidable infections, such as surgical site infections and
pneumonias, have increased”.
So we must ask the question – do these things work? Do trusts even
care, or are they only interested in hitting targets or in “being seen” to
be reducing HCAIs? Medics commonly discuss the next possible “infection
control drive” and whether there will be any evidence to back it up. A
common initiative being introduced in some trust involves forcing doctors
to wear a uniform, despite the fact that said uniforms are washed at home
in the same way as normal clothing. This seems to be an example of trusts
spending a lot of money based on little or no evidence.
However, reading Edward Leigh’s report, it is likely that the
Department of Health is likely to be forced to report on all HCAIs in the
future and this can only mean more infection control initiatives of this
1. BMJ 2009;339:b4680
2. Reducing Healthcare Associated Infections in Hospitals in England, 10
November 2009. www.parliament.uk/pac
Competing interests: No competing interests