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Health: Hospital-acquired Infections

Volume 703: debated on Thursday 17 July 2008

asked Her Majesty’s Government what plans they have to reduce hospital-acquired infections.

The noble Lord said: Healthcare-associated infections affect approximately 9 per cent of in-patients, cause at least 5,000 deaths per year and contribute to a further 15,000 deaths a year. Furthermore, 300,000 or more patients acquire non-fatal infections that prolong their stay in hospital. In England alone, this leads to a loss of 3.6 million bed days, at an estimated cost of £1 billion per year.

Regular headlines in the media such as:

“How dare we let these dirty hospitals kill 8,000 a year?”,

cause a great deal of public concern. It is not surprising, therefore, that patients are concerned about going into hospital for treatment for fear of catching these infections, which may prove fatal.

There are several infective agents responsible for healthcare-associated infections. The two that are currently of major concern are meticillin-resistant staphylococcus aureus—MRSA—and Clostridium difficile, or C. diff. Others are glycopeptide-resistant enterococcus—GRE—which can cause blood poisoning; norovirus, which causes mild, short-lived gastroenteritis, the so-called winter bug; and various pseudomonas species, which cause a range of illness, mainly in the elderly. I have no doubt that unless we have a successful strategy for controlling healthcare-acquired infections, there will be other infective agents in the future, possibly even more deadly than the ones we have now.

Government policy currently focuses on infections due chiefly to MRSA and, to a lesser degree, C. diff. Staphylococcus aureus is a common bacterium, found in skin or mucosa. MRSA is a variety resistant to antibiotics, including meticillin. About 3 per cent of people are carriers. Infections occur when bacteria enter the body or bloodstream, usually via a cut or catheter, commonly during surgery via wounds or ulcers. They can also do so via intravenous catheters or breathing tubes. They cause deep abscesses or septicaemia.

Clostridium difficile, or C. diff, a bacterium found in the gut of 3 per cent of adults and nearly two-thirds of babies, is harmless in healthy people, but in ill, elderly patients, and in conjunction with antibiotic therapy, can cause severe colitis, perforation of the bowel and death. It is highly infectious and, importantly, spores shed in faeces are hardy and survive for long periods on surfaces such as toilets, sheets, beds and floors. Both MRSA and C. diff are transmitted from person to person and may be picked up from environmental contamination.

From what I have just said about the nature of transmission of infection by these organisms, it is clear that simple measures of cleanliness—personal and environmental—judicious use of antibiotics, and a stringent policy of “search and destroy” can drastically reduce the incidence of such infections from 9 per cent of in-patients to as low as 1 per cent.

The UK is one of the worst countries in western Europe for the incidence of MRSA and C. diff infections. So do we have a policy that will change that? To know whether we have an effective policy, we first need good surveillance. Since the introduction of mandatory reporting of MRSA and now C. diff infections acquired in hospitals, the surveillance of hospital-acquired infection is now reasonably good but not accurate. On the other hand, for healthcare-acquired infections acquired in the community setting, surveillance data are poor. That is particularly important, as more healthcare is now delivered in the community, so I ask what plans the Government have to collect information on community-acquired healthcare infections.

Healthcare-associated infection as a cause of or associated with death is also poorly recorded on death certificates, as was the case in the Clostridium difficile outbreak in the Maidstone and Tunbridge Wells NHS Trust. The death certificates did not indicate that the patients had died of C. diff infections.

What is the extent of MRSA and C. diff infections? For MRSA blood-stream infections—so-called bacteraemia—in the financial year 2006-07 the numbers were 6,381. Data from 2007-08 are not yet available, unless the Minister has them today. The trend has been downwards except for the last quarter, October to December 2007, which showed an increase of 0.6 per cent on the previous quarter. The Government have a target of halving MRSA blood-stream infections from 7,700 in 2003-04 to 3,850 or fewer in 2007-08, unless the target measurement was not as I understood it. Will the Government meet that target? Maybe halving the rate of 2003-04 was ambitious, but it is important to maintain the pressure to drive down the rate.

For C. diff, the surveillance data are difficult to interpret due to changes introduced over time. Between 2004 and 2006, the numbers of C. diff infections rose from 44,000 to 55,000. Quarterly data for October to December 2007 compared to the same period in 2006 showed a 26 per cent reduction. The Government introduced a target for C. diff in 2007 of reducing the number by 30 per cent by March 2011—nearly three years away—from baseline 2007-08. Again it is unclear how the target would be measured. I seek clarification from the Minister.

Have we got the policies to achieve the targets and beyond? In 2002, we had the CMO’s Getting Ahead of the Curve strategy, and many other follows. In 2003 there was Winning Ways, in 2004 Towards Cleaner Hospitals, in 2005 Saving Lives, in 2006 Essential Steps to Safe, Clean Care, in 2007 Saving Lives: Reducing Infection, Delivering Clean and Safe Care, and in 2008 Clean, Safe Care: Reducing Infections and Saving Lives. They outline plans to introduce MRSA screening for patients but not staff, deep cleaning and additional specialist staff to tackle infection. In addition, we have the Health Act 2006, requiring NHS trusts to follow recommendations and the Healthcare Commission’s annual checks. There are also financial penalties and incentives. Certainly, there is no lack of commitment to tackle the problem of healthcare-acquired infections.

So are the policies and strategies effective? Despite lack of strong evidence of environmental contamination and infection rates, the policy related to hospital cleanliness and deep cleaning is right. Clean hospitals instil public confidence and a culture of the importance of hygiene in staff. If there are any concerns, it is about whether deep cleaning is carried out in all areas of hospitals, how often it is and should be carried out, and what agents are used.

Countries that have very low levels of healthcare-acquired infections have stringent policies for monitoring levels of environmental contamination and decontamination. While there might be contrasting views of deep cleaning as an effective strategy, there is no doubt that hand hygiene is the single most effective measure for controlling the transmission of infection in all healthcare settings. I declare an interest as chair of the National Patient Safety Agency, which is responsible for the cleanyourhands campaign.

Hand washing with soap and water and use of alcohol gel after each and every patient contact have to be more actively enforced in healthcare, as they are in the food-handling industry. In my view, to cause a death by transmission of infection is in the same category as death caused by wrong diagnosis, treatment or bad surgery. The clinical professions need to accept greater responsibility.

The policy of “bare below the elbows” may facilitate hand washing, but the removal of clean, hospital-provided white coats and nurses’ uniforms on a daily basis is a retrograde step. On the other hand, the wearing of operating-theatre and ward clothing in cafeterias and other public areas in hospitals should be prohibited with sanctions.

The most recent government policy relates to the introduction of patient screening for MRSA for elective admissions in 2008—I do not know when in 2008—and for emergency admissions during the next three years. Countries that have low levels of infection have not only policies of screening all patients and staff but also low bed occupancy, low levels of workload for nursing staff and a strict policy of isolation of infected patients.

Strategies that we are slowly beginning to adopt have still some way to go. The public are rightly anxious about healthcare-associated infections. Patients fear going into hospitals. Any Government who deliver clean hospitals, healthcare in a clean and safe environment and effective infection control policies, followed and adhered to by all, will remove healthcare and the NHS from politics. Would that not be a prize worth having?

I thank my noble friend Lord Patel for this short but important debate. He chairs the National Patient Safety Agency, which campaigns to improve patient safety. What can be more important? One of its projects was cleanyourhands, a national campaign to promote better hand hygiene in hospitals that began in 2005. In 2007, the programme was extended to other providers such as care homes and community clinics. If the campaign does not exist in schools, it should. Children should grow up realising how dangerous it is not to wash their hands, especially when handling food after going to the lavatory. People from eastern Europe whom I employ at home seem to wash their hands much more than British people.

Washing one’s hands with soap and water is the best way of protecting patients, as the gel does not work on the highly infectious Clostridium difficile. I have heard of nurses who have gone from patient to patient while not washing their gloved hands. They think that washing is not necessary if they wear gloves.

The wife of a severely disabled man in Yorkshire who had had MRSA and is fed by a peg in his stomach asked a nurse whether her husband had had a check to see whether he still had MRSA. The nurse said, “Well, if he does have a check and it is positive, it will give us a lot more trouble as he will have to be barrier nursed”. I wonder how many such cases there are across hospital trusts. Infection control nurses should be able to take responsibility and have great support in stopping such dangerous attitudes among such lazy nurses.

Much has been done in the past few years and the Government have tried hard to reduce hospital-acquired infections, but there is much more to be done. One still hears of sloppy practices such as that described to me by the wife of a high-lesion tetraplegic man. Her husband had a chest infection and had gone into hospital. On the Friday, when he went home for the weekend, his sputum jar was sitting on a shelf by his bed, but when he returned on Monday morning it was still there and had not been emptied. In the old days, a sister on the ward would have seen that such things were done and jars not left unclean.

The grandson of one of my friends was admitted to the Freeman Hospital in Newcastle for a serious heart condition, aged one. The operation took many hours and was a success, but unfortunately he contracted MRSA. The family cannot praise the hospital team enough and, after many critical days, little George pulled through. Hospital infections put extra strain on everybody. In this case, a dedicated skilful hospital team and the family had much more anxiety due to MRSA. Does the Minister agree that prevention of hospital-acquired infection should be at the top of the agenda?

It is said that patients should be screened when they come into hospitals or care homes, but should not the medical and nursing staff be screened as well? If they are working with vulnerable patients, how many might become carriers and put patients at risk?

One often hears of bad practice such as clean laundry being brought in and left beside dirty laundry. Surely it is possible with such a large staff to put in a manager who could take responsibility for seeing that good practice takes place.

I am pleased to be associated with the National Concern for Healthcare Infections, which aims to raise awareness, and give support, on patient safety. It asked me to be its patron, and I accepted. Does the Minister agree with the guidelines to tackle hospital-acquired pneumonia? This is the most common hospital-acquired infection in intubated patients, increasing mortality by up to 75 per cent. When hospital-acquired pneumonia is caused by bacteria, treatment will always be with antibiotics. However, the increasing problem of antimicrobial resistance, largely due to inappropriate use of antibiotics, has made its management more complicated and has led to a rise in hospital-acquired infections as a whole.

A key driver in developing the guidelines was to minimise the number of preventable deaths from HAP due to any cause. The new guidelines set out the importance of prevention, diagnosis and early treatment and ensuring the right antibiotic is used at the right time. There should be fast-track testing and results, otherwise wide-spectrum antibiotics will continue to be used. What chance is there of this action happening?

Consideration needs to be given not only to acute NHS trusts which provide general facilities for the public, but to specialist hospitals which treat patients who are susceptible to many other infections, including campylobacter—with almost 50,000 patients affected in 2006.

Many impaired people are susceptible to the development of pressure sores. This presents another avenue for bacteria, such as MRSA, to enter the bloodstream or infect the skin around the lesion. As president of the Spinal Injuries Association, I know the terrible problems pressure sores can have for vulnerable patients treated in hospitals which do not have the correct equipment, such as turning beds and pressure-relieving mattresses. I hope that the new Care Quality Commission will include precautions being taken by healthcare establishments to prevent pressure sores in its assessment and inspection regime.

The terrible problems of the virulent strain of 027 Clostridium difficile have been highlighted by the Healthcare Commission’s reports on Stoke Mandeville Hospital, and Maidstone and Tunbridge Wells. Is C. difficile a notifiable condition? There is some confusion over whether notification is voluntary or statutory. Can the Minister make this clear?

Many infections put patients at risk, such as E. coli, Klebsiella, wound infections other than MRSA and many others. If infection prevention and control measures in hospitals are to be successful, this area of the budget should be ring-fenced, in terms of staff employed in infection control, developing general staff awareness and training in good practice for all staff who directly or indirectly come into contact with vulnerable people. Without adequate finance to support measures identified as the result of professional research, these initiatives will flounder.

Many projects need looking at. I have recently had correspondence with Dartex Coating about the product Silver 3, a coating for hospital mattresses for which it is claimed that tests have shown that it kills 99.9 per cent of MRSA within 24 hours. Dartex believes that Silver 3 can play a major role in combating hospital-acquired infections. I hope that more research will be done on these matters.

MRSA does not like cold conditions. Should hospital floors be washed with iced water? The elimination of hospital-acquired infections would improve the dignity of life for vulnerable patients as well as their quality of life, which can be shattered if they get an infection such as Clostridium difficile. The Darzi report stresses the quality of care. If this is to be taken seriously, infection control must be the top priority.

I also thank the noble Lord, Lord Patel, for giving me the opportunity to get involved in this subject, which I do not normally do. I come from a medical family; my father was a GP, my mother was a midwife and my brother is a GP. I was the black sheep of the family who went into commerce and then, even worse, into politics. At least I now have a chance to make a contribution to the area.

We are all aware as citizens of the astounding statistics, of which the noble Lord, Lord Patel, has mentioned a number: the 300,000 cases of hospital-acquired infection per annum; an estimated 5,000 deaths; the UK’s performance being the fifth worst of 29 European nations; and a potential cost of £1 billion to the NHS. Even more important, as the noble Baroness, Lady Masham, said, is the movement of resources and skilled people into coping with those areas rather than those with which they would rather be dealing. Statistics that came out today include some 10,000 C. difficile cases over a quarter year and, over the past four years, 200,000 cases of C. difficile and 20,000 cases of MRSA.

Although those statistics are staggering and abrupt in their own way, the issue is more important than that. These infections, in particular, bring real fear to those who must deal with the NHS and are not well. Over the past couple of years, people have, for the first time, hesitated about being admitted to hospital. We cite the statistics, but there are people who have decided not to have hospital treatment because of their concern about this area.

As people in politics and Parliament, we must ask ourselves whether that is because of the tabloid press scares, like the scare over street crime, which is a real issue in certain areas but does not necessarily affect where we are and our lives. Is people’s fear greater than the risk? I do not think it is, because even I know a person who died and other people who have been affected by these diseases. It is far less remote than many other things that we get involved in.

What are the issues here? One of the causes is the problem with cleanliness, but I have been aware for some time of the abuse and overuse of antibiotics. When I was a youngster, I was put on tetracycline—I can still remember its name and think it is an antibiotic, but perhaps it is not—for some three years, just in case I reacquired an infection that I had had earlier. I am sure that practice would not now be acceptable. We used antibiotics regularly in veterinary care. We fed animals antibiotics to make sure that they did not stand a chance of getting infections. Clearly, the mismanagement has meant, as the BMA put it in one of its documents, that life-saving technology has become life-threatening. Is the Minister confident that the management and use of antibiotics for humans and animals means that that is no longer a problem? We have that problem with malaria, in particular.

I am sure that my mother would have been concerned by the way that cleanliness got decoupled from medical care in hospitals and similar establishments. I am sure that the focus on that is much better because we have seen the improving figures on these infections over the past year. However, I question whether cleanliness is at the heart of medical as well as administrative practice. Having been in hospitals a number of times over the past year because of a family member, I was struck by how little the washes, which we do not think are completely effective, were used by visitors and medical staff when moving around hospitals.

Does the Minister believe that screening patients as they come in and isolating them if necessary is successful? Does it need to be applied more? Where are we on that?

My other concern, which comes from my management career, is about judging people against targets. It is right in principle, but there are unintended consequences of keeping targets in place for too long and managing people’s performance too carefully. One aspect of that is the bed occupancy rate. What are the Minister’s views on the correlation between hospital-acquired infections and bed occupancy rates? The evidence seems to show that where the rate is above 85 per cent there is a positive correlation with cases of infection. I should like to know whether the Government accept that correlation. If so, surely that means that we have to manage the whole area of bed occupancy, which in every other way is clearly a measure of a hospital management’s efficiency. It can be fantastic but, if patients are killed on the way, that is not quite so good. It is a question of how we should look at those sorts of targets.

A final area on which I should be interested in hearing from the Government is nursing homes and homes for the elderly. Those come outside the hospital arena and therefore may go slightly beyond the subject of the debate, but they carry the same importance in that they have many vulnerable people facing similar threats. What actions are the Government taking and what plans do they have to deal with the problem in that area, which is not highlighted much, or perhaps greatly understood, in the media? Does the Minister see that as a threat to the reputation of healthcare more generally in this country? Most of all, we all want to see hospitals where patients—you and I—can be confident that they are going to be healed and will not feel that they are risking their lives even more by engaging in their services.

I congratulate the noble Lord, Lord Patel, on having tabled this Question and on the extremely powerful way in which he spoke to it. It is a question of the first importance for healthcare in our country. If we want a comparison to put the matter into proportion, almost three times as many people are killed by hospital-acquired infections every year as are killed on our roads. The figures look as though they may be on a downward trend and some encouraging statistics have been released today, which no doubt the Minister will be able to refer us to in detail. However, over the 15 years from 1990, the graph showed a massive rise. The increase in C. difficile infections was fiftyfold, and looking simply at the five years to 2006, deaths from C. difficile went up by more than 400 per cent.

It would be unfair to accuse Ministers of having done nothing. They have actually done an enormous amount. The problem has been that the various levers that they have pulled to try to stem the tide have had only a minimal effect so far. In 2002, as the noble Lord, Lord Patel, said, we had Getting Ahead of the Curve—the first of a whole swathe of strategies and action plans to improve hospital cleanliness, all of them with wonderful, optimistic-sounding titles. There was Winning Ways—Working Together to Reduce Healthcare Associated Infection in England in 2003; Towards Cleaner Hospitals and Lower Rates of Infection in 2004; Saving Lives: A Delivery Programme to Reduce Healthcare Associated Infections including MRSA in 2005; Essential Steps to Safe, Clean Care in 2006; and, this year, Clean, Safe Care: Reducing Infections and Saving Lives. On top of all that, we have had national guidelines, sanctions and targets. Each of these in its own way has been of unimpeachable worthiness, yet last year’s annual health check by the Healthcare Commission found a lower level of compliance with the three main standards in the hygiene code than in the previous year.

The noble Lord mentioned the cleanyourhands campaign. Good hand hygiene has been described as the single most important measure for controlling transmission in healthcare settings. Contrary to all the sound and fury generated on the subject of ward cleanliness, it now seems that there is not a simple or direct association between the visible cleanliness of a hospital and its infection rates. Of course, that is not to say that cleanliness should count for nothing—of course, it should—but it is not the most significant driver, so it appears, in the direction of travel.

Still less is it the case that a hospital’s infection rates can be linked to whether it contracts out its cleaning, or indeed how much its cleaning budget amounts to. Despite that, we recently had the deep clean initiative. There is no evidence that the deep cleaning of hospitals is a cost-effective use of funds. To be quite brutal about it, it is a populist gimmick. Dr Stephanie Dancer, an expert in microbiology, warned last year that deep cleaning would have only a very short-term impact. She was right. The Countess of Chester Hospital, which spent £300,000 on a deep clean, suffered a C. difficile outbreak four days later, when 26 people became infected. When he made the announcement last year, the Prime Minister promised that deep cleaning would be repeated at least every 18 months, but we now know from Written Answers that there are no plans to repeat the first deep clean exercise and no plans to assess how effective the first deep clean actually was. Perhaps that is understandable, because it turns out that the majority of hospitals did not use the key products recommended by the Health Protection Agency, such as hydrogen peroxide vapour. No one should think that deep cleaning of itself will make more than a tiny dent in the statistics.

One real criticism that I have of Ministers is that at intervals they have been guilty of instilling false hope and false expectations in the minds of the general public. I know that at party conferences hyperbole tends to intrude, but last year, when the Prime Minister launched the deep clean programme, he said that it was intended to,

“make sure every hospital is clean and safe”.

He should not have said that. Not only was there no evidence base for saying it, but no work had been done to assess how the £62 million that it cost to carry out the deep clean might have been more effectively spent.

In January, the Prime Minister went on the “Andrew Marr Show” and made an impressive-sounding promise. He said:

“If you go to hospital, you will get screened by next year for MRSA or C. difficile”.

There was no correction of that story from any government source, but two days later the Health Secretary's infection control strategy reported on C. difficile and said this:

“Screening for colonised patients is inappropriate. (Most potential cases would not be identified …)”.

In other words, screening for C. difficile is not going to happen, because it is pointless. Mr Brown should not have said what he did.

By contrast, screening for MRSA in high-risk patients is potentially very worth while. The Government have proposed that MRSA screening should be introduced for all elective admissions in 2008, and all emergency admissions as soon as possible after that. The problem here is that screening in a hospital setting is logistically complicated. For a start, you need enough space in which to isolate the carriers. Many hospitals do not have that, in part because they are constantly chasing the 18-week target for referral to treatment and the four-hour A&E waiting time target. Beds get full. Again, we have had extravagant promises about isolation facilities, first of all in Winning Ways, and then from John Reid in 2004, who assured us that new hospitals being built had more isolation rooms than ever before. But what do we now find? Last November the Health Protection Agency reported as follows:

“Three quarters of trusts indicated that they had problems implementing isolation policies due to inadequacies in the number and fitness for purpose of isolation rooms”.

Isolation cannot just happen at the wave of a wand. As the MRSA working group pointed out, conventional screening takes three to five days. There are rapid screening techniques, but they are expensive and difficult to perform in large numbers. Reducing rates of MRSA by screening is going to be an uphill battle.

The noble Lord, Lord Teverson, referred to bed occupancy rates. I do not think that one can cite them as the prime or only contributor to rates of MRSA infection. But what high bed occupancy often means is that hospitals are left short-staffed and pushed for time, so that hand hygiene is not always maintained. Increasingly, hospitals have had to resort to hiring temporary staff, whose knowledge may be more limited and whose access to sufficient training may be constrained by lack of time and resources. Significant or not—I leave the matter open—it is a fact that the Netherlands, which has a low incidence of MRSA infection, has a bed occupancy rate of only 64 per cent.

The noble Baroness, Lady Masham, spoke of the need for good management and leadership in hospitals. She is right but, as she knows, the issue goes deeper than that. The noble Lord, Lord Patel, was kind enough to give me an article from the recent Bulletin of the Royal College of Surgeons of England, which is called “Changing the Mindset on Hospital Infections”. That title encapsulates it. If we are to crack the problem properly, everyone, from the ward to the board, has to buy into it and see it as their problem, not someone else's. I hope that we will hear from the Minister about some of the ways in which hospitals are moving towards the sea-change in attitudes that is needed if patients are once again to feel confident—as they have a right to do—that hospital is a safe place to be.

I congratulate the noble Lord on securing today’s timely debate. As demonstrated by the passionate and well informed contributions, the topic is of great concern to many, particularly to him in his work as chair of the National Patient Safety Agency—and rightly so, as tackling healthcare-associated infections is a challenge for health services around the world and a priority for our NHS. The noble Earl is completely correct about the need for ownership of the problem.

I would like to make the case that we are making good progress towards clean, safe care for patients in the NHS. That is evident in the latest Health Protection Agency data for January to March 2008, published today. Those figures show that MRSA blood-stream infections are down 33 per cent, and that C. difficile infections in the most vulnerable group—those aged 65-plus—are down 32 per cent compared to the same quarter last year. That is significant progress.

The noble Lord’s work as chair of the National Patient Safety Agency has contributed significantly to that progress. The NPSA’s cleanyourhands campaign is a key element in preventing the spread of infections. It has been shown to make a real difference to hand hygiene, therefore making a real difference to patient care and literally saving lives. The NPSA also announced the 2008 hospital patient environment action team scores last Thursday. Thanks to the hard work of the NHS, 98.5 per cent of hospitals are now rated acceptable or above. But we cannot stop there. Trusts are required to deliver a 30 per cent reduction in the number of C. difficile infections by March 2011. The NHS is on course to hit the target to halve MRSA blood-stream infections by the end of March. We will know the result when the HPA publishes the data in October. However, the latest figures were over 49 per cent lower than the quarterly average in 2003-04, so we are fairly sure that the NHS will meet the target.

However, there is no single solution for reducing healthcare-acquired infections, so we have introduced a range of measures. Our Clean, Safe Care strategy builds on comprehensive clinical guidance and gives an overview of all measures. Good hand hygiene, high standards of cleanliness, effective patient screening and sensible use of antibiotics are vital in the fight against infection, as noble Lords have mentioned. In the last year, we have introduced a “bare below the elbows” dress code to support hand hygiene, increased the number of matrons to over 5,000 and launched a new antibiotics campaign. All acute hospitals have been deep cleaned and we have doubled the department’s tailored support team for infections. We are now in the process of introducing MRSA screening across the country. I shall refer to that again when I answer specific questions.

Those measures are backed by significant additional investment. On top of investment in recent years of over £100 million, the Comprehensive Spending Review settlement for future years includes £270 million a year by 2010-11 to tackle healthcare-acquired infections. That all supports the legal requirement for NHS bodies to maintain proper infection control. The new regulator, the Care Quality Commission, will have tough powers to investigate and intervene, strengthening the regulator’s role in ensuring the NHS meets the required standard. In the mean time, specialist teams from the Healthcare Commission continue to inspect all acute trusts every year.

We are fighting infections on all fronts, but we should not lose sight of the fact that, for all the media hype, the probability of dying from a healthcare-associated infection is relatively low. As the Observer pointed out last Sunday in its feature on “25 things you need to know for a healthy life”, people should not fear hospitals. I suspect that my civil servants would advise me not to use this statistic because I do not know what it is based on. However, that article stated that,

“for people under 65 at least, you've got more chance of dying from a lightning strike than MRSA”.

The NHS treats around 1 million patients every 36 hours and admits 14 million people to hospital each year. If someone is admitted to an NHS hospital, his chance of acquiring an MRSA blood-stream infection or a C. difficile infection is less than half of 1 per cent.

I now turn to specific points raised by noble Lords. The noble Lord, Lord Patel, asked about the plans we have to collect information on community infections. We have set the latest C. difficile targets across health communities to encourage an approach that encompasses primary care trusts, although we have no current plans to collect information about community-acquired infections. However, we will continue to consider that as we update our surveillance systems.

The noble Lord, Lord Patel, suggested that the trend had slowed and we were not going to hit the target. We think the trend has now reversed and that we are on track to hit the MRSA target. The latest statistics show a 49 per cent decease compared with the 2003-04 baseline. However, his statistics were correct, which is why we take this issue so seriously. We are pleased that the action taken to date is having an impact and infection rates are falling. We focused on MRSA and C. difficile, but the measures introduced and promoted, such as good hand hygiene, will have an impact on other infections. The focus that we have encouraged on infection control should have an impact right across the NHS.

The noble Lord asked why we were not screening staff for MRSA and other noble Lords may have mentioned that. The key point is that staff are usually healthy, so they are at less risk of getting or carrying an infection. The problem is not screening the staff, but is the practice—making people behave in a way that means that infections are not carried from patient to patient. He asked when we would introduce MRSA screening for elective care in 2008. We will introduce it by the end of March 2009. Hospitals are now working on how to deliver it.

The noble Lord asked what we were doing to ensure accurate reporting on death certificates. In July 2005, the CMO issued advice to doctors reminding them to record infections accurately on death certificates. The number of death certificates mentioning C. difficile rose significantly the next year, as shown by the latest Office for National Statistics report.

The noble Baroness, Lady Masham, made a good point about the need to make sure that children in schools were taught about the importance of hygiene. She is also right to point to the importance of combating sloppy practices. The key point about healthcare workers is their practice.

The Health and Social Care Bill, which I think became an Act yesterday, makes the prevention of MRSA a priority. We must ensure that specialist hospitals are as rigorous as the best of the rest.

The noble Baroness asked about guidelines on pneumonia. I am not sure which guidelines she referred to, but the suggestion sounded very sensible. We launched a new campaign about antibiotic prescribing in February this year and have highlighted it in department guidelines.

C. difficile is not notifiable in England, but all cases have to be reported on the mandatory surveillance system, which gives real data to the Health Protection Agency and to trusts.

The noble Baroness raised the issue of new ideas, and mentioned mattresses and so on. That is extremely important. We are always looking for new ideas. The Rapid Review Panel was set up in 2004 to review new healthcare-related infection technologies and to provide a prompt assessment of novel equipment and materials and other products or protocols which might be of value to the NHS in improving infection prevention and control, the idea being that you need to look at these things quickly and, if they are effective, roll them out across the piece. We are very much aware that we need to be on top of technology.

The noble Lord, Lord Teverson, asked about antibiotic prescribing. Unfortunately, we are not yet at the stage where antibiotic prescribing across England represents what we recognise is the best practice in the best hospitals. However, we are working very hard to raise awareness. For instance, we are launching an extension of our antibiotic campaign with a poster competition in schools. So far as we are aware there is no read-across to animals. That was not in my brief, as they say.

The noble Lord is right that the logistics of screening are significant. There is no question about that, as mentioned also by the noble Earl. Where are we now on screening? As I mentioned, all elective admissions will be screened by March 2009 and all emergency admissions by 2011. The reason for the time is because we know that the logistics of this need to be right.

The noble Lord, Lord Teverson, mentioned bed occupancy. There used to be a correlation. However, we have issued guidance to infection control teams to talk to bed managers. Now we think there is no correlation. Trusts with high bed occupancy rates have reduced infection numbers as much as those with low bed occupancy rates.

The noble Lord asked what we were doing to ensure that those in nursing homes were as protected as those in hospitals. We will produce guidance shortly for infection control in care homes. This consultation is due to start this summer. With the creation of the new regulator, it will be much easier to roll that out because we will have one regulator looking across the piece from healthcare to social care.

The noble Earl, Lord Howe, asked about deep cleaning and whether it was a gimmick. We need to be clear that the cleanliness of our hospitals is a matter of utmost importance. Clean, tidy and safe hospitals and staff are very important to patients, and are what they expect. Deep cleaning is not different cleaning, but it was a way of galvanising hospitals. It is a concentrated programme, often using new equipment and specialist skills. We are not repeating the national deep clean, but the Healthcare Commission will be looking at this when it inspects.

The noble Earl asked why we were screening for MRSA and not C. difficile. We have considered whether universal screening of patients for C. difficile was the best way forward. It would not have the same clinical benefits as MRSA screening, which is why we only target patients over 65 who have diarrhoea. We are keeping this clinical evidence under review and will act quickly to respond if there is any new and emerging evidence.

Will MRSA screening be cost effective? Available evidence indicates that it can be cost effective due to reduced morbidity and lower NHS treatment costs, but there will be an inevitable start-up cost in the introduction of the service.

I thank noble Lords for the many points they have raised. I apologise if I have missed anything. I will look at the record and certainly write to people. I hope I have demonstrated that the NHS is working very hard and making good progress. I assure noble Lords that we will continue to support and encourage the NHS to ensure that patients receive the clean, safe care that they deserve.

[The Sitting was suspended from 2.55 to 3 pm.]