New strains of superbug hit unclean British public hospitals

Patients are being exposed to an unknown number of potentially lethal hospital superbugs because of the Government's failure to address a "fog of ignorance" in the NHS, a powerful group of MPs said yesterday. The Public Accounts Committee (PAC) has condemned the lack of adequate monitoring of hospital-acquired infections and the Government's reliance on "rough and ready" figures that are up to 20 years out of date. Infections picked up in healthcare environments are said to amount to at least 300,000 a year in England, with an estimated 5,000 deaths and costing the NHS as much as 1 billion pounds.

Only figures for MRSA - methicillin-resistant Staphylo-coccus aureus - are now published after mandatory surveillance. The committee said that this accounted for less than 6 per cent of all hospital- acquired infections (HAIs). The PAC said that four years had passed since it first highlighted the shortage of information about the bugs, yet a full surveillance programme had still not been put in place. Monitoring of four other infections has been introduced over the past two years, including the potentially fatal Clos-tridium difficile, but no findings have yet been published.

The Royal Devon and Exeter Hospital yesterday confirmed that a virulent strain of C. difficile was a factor in the deaths of 13 patients since the beginning of this year. The announcement came a week after it emerged that 12 people treated at Stoke Mandeville Hospital, Buckinghamshire, have also died from the infection. The Government recently introduced mandatory surveillance for the bug, as well as for glycopeptide-resistant enterococci and surgical site infections, but the measures still only cover 20 per cent of HAIs, MPs said yesterday. Their report, entitled Improving Patient Care by Reducing the Risk of Hospital-Acquired Infection, came as the Department of Health published new figures showing falling rates of the MRSA superbug.

The rate of MRSA bloodstream infections in English hospitals fell by 6.1 per cent in 2004-05 compared with 2003-04 - down 472 to a total of 7,212. While ministers hailed the rate as the lowest since mandatory recording began in April 2001, critics pointed out that MRSA prevalence in 40 per cent of hospitals had actually increased, despite the Government's efforts. The PAC said that it remained alarmingly unclear how the 80 per cent or so of infections not covered by current programmes would be measured and managed.

Edward Leigh, MP, the chairman of the committee in the last Parliament, said that more than four years had passed since the PAC first highlighted the shortage of information on the extent and cost of hospital-acquired infections. "Today we find that little has been done to dispel this fog of ignorance," he said. "There is still no mandatory national surveillance and reporting scheme for all hospital-acquired infections. The only mandatory reporting scheme for which data has been published is for MRSA bloodstream infections, which account for less than 6 per cent of all hospital-acquired infections. These data show that our MRSA infection rate ranks among the worst in Europe." Mr Leigh said that the much-quoted figure of 5,000 deaths a year from hospital-acquired infections was "rough and ready" and dated from the 1980s. "It must be updated," he said. "The Department [of Health] has now proposed changes that should ensure that deaths linked to hospital-acquired infections are more readily identifiable. These proposals must be implemented without delay."

The committee said that the national prevalence figure estimating that at any one time 9 per cent of patients have a hospital-acquired infection was at least ten years old, and a survey commissioned by the department should be published within the coming year.

The report found that progress in preventing and reducing infections continued to be constrained by the lack of robust data and limited progress in bringing in a national mandatory surveillance programme, as recommended by a previous committee.

The MRSA surveillance showed that reported S. aureus bloodstream infections rose by 5 per cent over three years, with the proportion that were resistant to the powerful antibiotic methicillin standing at 40 per cent. The report said that England had 70 times the MRSA proportion in Denmark and 40 times the proportion in the Netherlands and Sweden.

The MPs concluded that compliance with good infection-control practice such as hand hygiene was "patchy" and "poor", especially among doctors. They noted that the Government had made infection rates and hospital cleanliness a priority, with a number of schemes to tackle the problem. Jane Kennedy, the Health Minister, said that she welcomed the report but rejected the accusations that the ignorance over superbugs was not being addressed

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