The NHS in England could save an estimated £150m ($240m) and many hundreds of lives by tightening hygiene rules in hospitals and investing in infection control, according to the spending watchdog the National Audit Office. The money could then be ploughed back into patient care.
At least 100000 cases of hospital acquired infections occur each year in England, with an estimated 5000 deaths, all of which cost the NHS in the region of £1bn annually, states the report.
Better education of staff on the spread of infection, improved surveillance of patients who have had major surgery, and the involvement of senior clinicians and management in the control of infection could reduce this burden by 15%Sir John Bourn, head of the National Audit Office, told parliament.
At any one time 9%of patients in hospital are being treated for an infection they acquired there. Yet one in five trusts do not have an infection control programme, 40%are dissatisfied with their isolation facilities, and 60%have no defined budget.
Despite guidance from the Department of Health that chief executives should take overall responsibility for ensuring effective infection control, there is little evidence of their involvement. More than half were not aware of the resources spent on hospital acquired infection or the number of cases, says the report.
“Hospital infections are a huge problem for the NHS,” said Sir John. “They prolong patients' stay in hospital and, in worst cases, cause permanent disability and even death. By implementing the [National Audit Office's] recommendations, the NHS could make real improvements in the quality of care for patients and free up significant additional resources,” he added.
Among other recommendations, he said that hospitals should join the nosocomial infection national surveillance scheme, which collects statistics on infection rates to allow local comparisons to be made.
More research on appropriate staffing levels is also warranted. In some areas a single infection control nurse is expected to cover over 1000 beds—a number described by the report as “unacceptably high.”
Moreover, despite a recommendation by the Royal College of Pathologists that the ratio of infection control doctors to beds should be 1:1000, only 46 trusts out of the 219 studied by the report reached that standard.
David Davis MP, chairman of the Public Accounts Committee, commented: “There is clear evidence that in many cases investing more in infection control—for example, by funding more infection control nurses—would save both cash and lives. There would also be a dramatic improvement in the quality of care for many other patients.”
The Management and Control of Hospital Acquired Infection in Acute NHS Trusts in England is available through the National Audit Office's home page (www.nao.gov.uk).
BMJ. 2000 February 26; 320(7234): 534.
PMCID: PMC1117592
Copyright © 2000, British Medical Journal
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