Given the increased focus on NHS targets, especially those process targets that appear to be increasingly difficult to achieve, this blog focusses on two high profile healthcare associated infections (HCAIs) reduction targets . These targets, like many other targets, have consistently polarised views. With many believing that they were the best way to ensure that hospitals gave this significant patient safety issue the highest priority and others questioning the evidence for, and clinical validity, of the targets.
The HCAI targets, like most of the current NHS targets, were introduced by the Labour government of the 2000s. HCAIs develop either as a direct result of healthcare interventions, such as medical or surgical treatment, or from being in contact with a healthcare setting. The two most well-known HCAIs, largely because they are the subject of NHS targets, are meticillin-resistant Staphylococcus aureus bloodstream infections (MRSA) and Clostridium difficile (C. difficile).
At the start of 2000, HCAIs had a very low profile, and infection control was seen as the 'Cinderella service' of the NHS. Two National Audit Office (NAO) reports in 2000i and 2004ii changed that. They demonstrated that HCAIs were, in fact, a huge problem for the NHS. That at any one time around one in eleven hospital patients had an HCAI which not only prolonged patients' hospital stay but, in the worst cases, caused permanent disability and even death. The NAO identified a lack of robust aggregate data on the total number of HCAIs in England but estimated that there were at least 300,000 HCAIs a year and that they were costing the NHS over £1 billion.
The 2004 report concluded that progress in reducing healthcare associated infection had been patchy, and that there was a distinct lack of urgency on issues such as cleanliness and compliance with good hand hygiene; limited progress in improving isolation facilities or reducing bed occupancy rates; and that progress continued to be constrained by a lack of robust data other than on MRSA bloodstream infections and a lack of evidence of the impact of different intervention strategies.
Following these NAO reports, the Department of Health introduced a range of policies and measures designed to reduce rates of infection. For example:
Mandatory surveillance for MRSA was introduced in 2001 (accounting for some five – ten per cent of all infections) In 2004, a target to reduce MRSA bloodstream infections by 50 per cent by...