Hospital Acquired Infections

Speech by Paul Burstow on Tue 13th Jan 2004

Mr. Paul Burstow (Sutton and Cheam) (LD): We have had a useful debate, and I congratulate the hon. Member for Norwich, North (Dr. Gibson) on securing it and allowing us to turn the spotlight on this important issue. Some hon. Gentlemen who have spoken today took the opportunity last week to raise a similar subject: performance measurement. This is a good opportunity to explore some of the issues that were mentioned then.

The hon. Members for Stevenage (Barbara Follett) and for New Forest, East (Dr. Lewis) and the right hon. Member for Hitchin and Harpenden (Mr. Lilley) referred to the teachings of Florence Nightingale. It is right to say that some of the hard-learned lessons that she taught have been forgotten and need to be relearned, and I cannot go without quoting one reference from her notes on health care:

"It may seem a strange principle to enunciate as the very first requirement in a Hospital is it should do the sick no harm."

What are we talking about today but health care-acquired infections? These are infections that people pick up in hospital at least in part because of actions or omissions by health care professionals. The hon. Member for Norwich, North and the chief medical officer are right to say that the problem is multi-factored; there is not one thing that we can put our finger on but a range of issues that contribute to the continued growth in the rates of MRSA infection and other forms of infection in our hospitals.

The hon. Gentleman made several points that I want to pick up on. He referred to the availability of antibiotics that are able to treat MRSA infections. That picks up on a point made by the right hon. Member for Hitchin and Harpenden. Will the Minister tell us what assessment the Department has made of the pipeline of antibiotics research and development work? How many projects are coming through that will continue to offer the NHS, and others, forms of antibiotic that are able to deal with the resistant strains of bacteria that are increasingly encountered in health care settings?

The hon. Member for Norwich, North referred to catheter care, which was also touched on by the hon. Member for Stevenage. It would be helpful if the Minister would describe the Government's position on the work that has been done to develop catheters that are much less likely to be agents for the spread of infection.

The most important point, among many, that the hon. Member for Norwich, North made was about who should take the lead responsibility for driving forward best practice and ensuring that it really is the norm across the national health service. He referred to collaboration on hand washing between the National Patient Safety Agency and the purchasing authority. Where do responsibility and leadership lie? Is it with the chief medical officer, the Health Protection Agency or the Minister? We must be clear where responsibility for action lies, particularly in respect of "Winning Ways", which was published by the CMO before Christmas.

The right hon. Member for Hitchin and Harpenden made several points. I shall pick up on some of them. He said that testing of doctors, who are, potentially, carriers of MRSA, was not now the norm. That was mentioned in the 2000 report of the National Audit Office. However, such tests do not only apply to doctors. Nursing staff are no longer subject to such surveillance. It would help if the Minister were to say why it was appropriate to cease to operate such a regime and whether it is being actively considered for the future. We will never eradicate infections in health care settings, but we can certainly do much more to minimise the chances of people picking them up.

I wish to discus several points from the CMO's report, which provides a helpful platform for moving things forward. Hon. Members have already referred to some figures, but I shall refer to a few more. In the last 10 years of the non-mandatory reporting system, there was a fiftyfold increase in reports of MRSA infections in hospitals. Once the mandatory system clicked in, it was unsurprising, perhaps, to learn just how much MRSA infection in the NHS had not been reported because people did not have to do so under the voluntary arrangements that had pertained.

The NAO reported that each year 100,000 people pick up infections in hospital. According to the former Public Health Laboratory Service, patients with health care-acquired infections stay in hospital on average 2.9 times longer—about 14 days extra—than those who do not pick up infections. That would imply that 1.4 million bed days are lost every year as a direct consequence of infections picked up in the NHS. I should be interested to know whether the Minister or his officials think that that is an accurate assessment. Just think of the cancelled operations, the many other lost opportunities to provide health care to our citizens and the delays and waits that patients suffer as a result. Of those who have health care-acquired infections, 10 to 13 per cent. die, compared with just 2 per cent. of those who do not. This is a serious life-or-death issue.

A couple of years ago, after the NAO report, I undertook a survey of the teams that are responsible for dealing with infection control in our hospitals to find out just what was happening on the ground. I found that 61 per cent. of respondents felt that they did not have adequate resources to do the job. Indeed, two thirds of them said that one real problem that was stopping them doing their job was that they did not have sufficient staff. Many highlighted the fact that they had few or no administrative support to underpin their work. The hon. Member for Stevenage mentioned the need for clear guidance from the Department on staffing ratios for infection control. It is worth bearing in mind that the NAO, when it did its work a few years ago, found one infection control nurse for every 535 beds and concluded that that was inadequate. My survey found similarly low rates.

More recently, the Infection Control Nurses Association said that it continued to be concerned about there being no guidance on staffing ratios. As a consequence, hospitals make things up for themselves. For example, the United Bristol Healthcare NHS Trust has 13,000 beds, but it has only three infection control nurses. Neighbouring Weston Area Health NHS Trust has 300 beds and—apparently—1.6 infection control nurses. There appears to be no rhyme or reason—no logic—behind how this is done. It appears to be determined by the priority that is assigned locally, rather than by guidance from the Department. It would be useful to know what plans the Government have in that regard.

I also tried to find out about whether the infection control teams were being properly integrated into the management of hospitals—that issue has been referred to by hon. Members. One in four teams said that they were not consulted about the letting of cleaning or catering contracts. They are key contracts, which can have a bearing not only on the general health and well-being of patients but on the spread of infections. Indeed, 30 per cent. of the infection control teams that responded to my survey said that they were not being involved in the crucial induction training of cleaning and catering staff.

I turn briefly to the patient environment action team initiative—the so-called clean hospitals programme. Ministers regularly cite it as part of their fight against infection in the national health service, but it is nothing of the sort. It should be prosecuted under trade descriptions legislation because the reality is that only one of the 19 categories that the PEAT team inspects is to do with cleanliness, and there is nothing that specifically addresses questions of infection and its management and control. We should examine the MRSA league table—which, apparently, might eventually be published. On the most recent MRSA figures, of the 21 acute trusts—excluding the specialist trusts—that have the highest incidence of MRSA, 17 are ranked green under the PEAT ratings, of which five were given a three-star rating under the star rating system, two are given a green or amber rating and two are amber. How can the PEAT rating be relied upon to give any indication of how effective a hospital is at dealing with infection? It is not a guide to whether the fight against infection is being prosecuted well within the NHS, and Ministers should stop giving the impression that it is—I can offer evidence of answers to parliamentary questions in which Ministers have done that. Perhaps we need such a measure, but it certainly is not the PEAT initiative.

I will conclude by asking a few questions. The issue of guidance and whether it is mandatory is exercising the Infection Control Nurses Association. In his report on infection control, published in December, the CMO stated:

"The Department of Health will publish further guidance on the roles and responsibilities of infection control teams."

When will that guidance be published, and will it be mandatory? Can the Minister tell us today what its status will be? Will there be further guidance as to the management role in respect of hospital-acquired infections? That is relevant to the point that the hon. Member for New Forest, East made.

Will further guidance be issued to primary care trusts to deal with issues of staffing and fighting infection within the community at the primary care level, not least given the fact that post-discharge surveys of the acute sector to find out how many people get infections after they have left hospital are very rare? There is inadequate data on that. There could be a significant problem that results in emergency readmissions to the NHS.

Finally, to pick up on a point made by the hon. Member for Stevenage, education and training are key factors in dealing with this issue. A few posters dotted around the hospital saying, "Now wash your hands" will never be enough. Is it being considered whether we should make training around infection control mandatory, as health and safety regulations and fire regulations are? Will the Minister consider including training on infection control in pre-registration programmes for all health care staff, not just doctors and nurses? That message must be drummed home time and again if we are to change behaviour, reinforce hygiene habits that protect the public by reducing MRSA rates, and save NHS resources and people's lives.

Use the following link if you want to read the debate in full:

http://pubs1.tso.parliament.uk/pa/cm200304/cmhansrd/cm040113/halltext/40113h03.htm#40113h03_head0