Intended for healthcare professionals

Rapid response to:

Education And Debate

Problems in assessing rates of infection with methicillin resistant Staphylococcus aureus

BMJ 2005; 331 doi: (Published 27 October 2005) Cite this as: BMJ 2005;331:1013

Rapid Response:

Using measures of MRSA rates to drive improvement

Dr Spiegelhalter's article (BMJ volume 331 29 October 2005 p1013 -
1015) gives an excellent analysis of the problems involved in assessing
the performance of NHS trusts in achieving the Department of Health target
for reducing bloodstream infection rates from methicillin resistant
Staphylococcus aureus (MRSA). The Healthcare Commission has the role in
making these assessments as part of its annual health check. The numbers
of MRSA bloodstream infections could (and should) be reduced, but the
technical difficulties of assessment stem from the fact that the numbers
involved are actually low.

The purpose of assessing trusts using measures of MRSA rates is to
help drive improvement in Healthcare Associated Infection (HAI), and the
Healthcare Commission is working closely with the Department of Health and
the Health Protection Agency on this matter. We do, however, recognise
the complexities of assessing performance in this area, and it is for this
reason that we have commissioned Dr Spiegelhalter to advise us on the most
viable measurement technique.

The approach that we have adopted will use plans produced by
individual trusts to reduce their infection rates over a 3-year period.
The plans were instigated by the Department of Health and must produce
either a 60% reduction by 2007/2008, or reduce and maintain the number of
infections to a maximum of 12 per year. Counts of 12 infections or less
will be considered as meeting the target. For higher levels, statistical
analysis will be employed to determine if a trust’s number of infections
is significantly higher than that expected from its plan.

We believe that with Dr Spiegelhalter’s assistance we have developed
the optimum performance measurement technique for assessing the MRSA
target for 2005/06, and we will continue to work with him to improve on
the sensitivity of the measure.

Such work will also feed into our ‘national study’ on HAI that aims
to determine which aspects of performance are the most successful in
driving improvement in HAI, with particular regard to reducing MRSA rates.
The ‘national study’, which is currently being designed, will be published
next year.

Competing interests:
None declared

Competing interests: No competing interests

13 January 2006
Anne Maclaren
Head of Performance Rating
Healthcare Commission, EC18 TGY