A new report by the National Audit Office has applauded the Department of Health for beating its target of reducing the number of MRSA infections in the UK, but warns that other hospital-acquired infections (HAIs) could be on the rise.

The NAO’s progress report notes that the DH has made great strides in pulling back the incidence of the notorious superbug MRSA in UK hospitals, with the National Health Service reporting a 57% decline by the end of March last year, beating its own target of 50%.

In addition, rising rates of Clostridium difficile have also been turned around, with a 41% reduction achieved since 2006, and the incidence of surgical site infections has also fallen, it says.

These improvements have been driven by the government’s multi-pronged attack on HAIs, which the NAO estimates has cost somewhere in the region of £120 million - including a off investment of £63 million to fund a nationwide ‘deep clean’ of hospitals – since targets were put in place 2004. But it also estimates that these initiatives have helped to generate treatment savings of between £141 million and £263 million and, from the patient perspective, have reduced the discomfort, disability and death HAIs are associated with.

However, despite nationwide initiatives to address the issue, the report has found there is still significant variation in progress. For example, it says a quarter of trusts achieved improvements in MRSA rates of greater than 80% but, on the flip side, 12% of trusts still reported an increase in infections. And, while 29% have cut C. difficile by more than 50%, rates are still on the rise in 19% of hospital trusts. In addition, from a geographical point of view, the report found “marked regional variations” in progress, it said.

Furthermore, it seems that while overall progress is being made with MRSA and C. difficile, other common healthcare-associated infections - such as pneumonia, urinary tract and skin infections - could actually be on the rise, according to the report.

Whilst there are currently no national surveillance systems in force to capture HAIs other than MRSA and C.difficile, a voluntary reporting scheme for other bloodstream infections suggests that their incidence is climbing, with figures estimating a jump from 80,000 in 2003 to 105,000 in 2007 (although it stresses not all of these are acquired from healthcare).

But the NAO also points out that, aside from the real growth in prevalence of such infections, the higher numbers could, in part, have been bolstered by more efficient diagnoses and better reporting systems than before.

‘Cultural change’
The NAO claims there has been “a cultural change in the way that organisations tackle infection prevention and control and the priority that it is afforded”, and yet, as of April this year, 11 trusts still failed to meet the standards for HAIs necessary for registration with the new health regulator, the Care Quality Commission, which took over from the Healthcare Commission earlier this year.

According to Amyas Morse, head of the NAO, the DH’s “hands-on approach” to tackling HAIs has been successful in reducing MRSA bloodstream and C. difficile infections. However, she added that a number of key problems have been identified that must now be address in order to ensure further progress, such as: “a lack of robust comparable data on other infection risks; increases in antibiotic resistance and poor data on hospital prescribing; and that compliance with good practice is still not universal”.