MRSA Action UK Meeting with the Department of Health and Health Protection Agency to discuss the Publication of Information on Healthcare Associated Infections

Wednesday, 13th May 2009

MRSA Action UK met with the Department of Health and Health Protection Agency to look at the publication and reporting of MRSA and Clostridium difficile.  Our recently published articles on the statistics published by the Health Protection Agency have aroused significant interest in the health community.  Of specific interest to our Charity and the people who we come into contact with, whether healthcare provider or patient, is the lack of understanding surrounding the targets and claims that all is well and we are overcoming the healthcare infections that blight so many of our hospitals and other care settings.

Confusion often arises over the proclamation of a continuing fall in the numbers of cases of MRSA and Clostridium difficile, and claims of zero MRSA, when patients are still succumbing to infections whilst in the care of the NHS, and in the private sector too. Whilst many Trusts are to be applauded in their work and efforts to drive down infections, the picture is not uniform across the country.

We would like to see regional reporting on targets, and information on surgical site infections published in the same way as the bloodstream infections. These are both mandatory schemes, however the surgical site data is harder to interpret as the frequency of its publication is less, and the data is not continuously collected, therefore it is difficult to make a choice about where you would go for surgery if you wanted to base your decision on the lowest risk of contracting an infection.

The Scorecard on the NHS Choices website does not go into enough depth; we believe the data should be made available at hospital level rather than Trust level. Even without hospital level data, the current system could be improved by graphing the data and comparing with the nearest geographical neighbour in the same way as Doctor Foster Health.

Future targets and reporting

The consultation on the MRSA Objective is under way, and discussions suggest it will not go beyond MRSA bloodstream infections at this stage, we believe it should be noted that evidence from patient groups show that the public want an overall reduction in all infections and they feel misled when headlines in local and national papers state "zero MRSA" in NHS Hospital Trusts, when in fact this only relates to bloodstream infections.

If we are looking at increasing public confidence then this should always be stated in media and press releases, particularly since the terminology "rate of MRSA cases" in the NHS Operating Framework may imply this means all MRSA infections.

If there is to be no split between avoidable and unavoidable infections as part of the MRSA Objective, MRSA Action UK would only support this stance on the proviso that there is a strong emphasis on the use of Route Cause Analysis supported by the Care Quality Commission's assessments. This will send a strong message to healthcare providers across the wider healthcare economy, as will the intention for the Care Quality Commission to increase the frequency of periodic reviews with a view to a quicker response in addressing areas of concern. This requirement should be set out in the NHS Operating Framework to focus providers' and commissioners' minds.

Whatever denominator is used to define the rate of MRSA, the numbers of cases will need to continue to be published. Bed day rates enables good time series analysis as this has been used in the past, however admissions should not be ruled out as it may be more attractive to "non-statisticians" for clarity. Showing the number of MRSA bacteraemias as a proportion of admissions (excluding zero days) would be a very clear way of presenting the data, and will help people who want to make a choice about where they are treated, people want to know the individual risk to them based on their own circumstances, this latter point also supports our view that data should be published at hospital level on the NHS Choices scorecard.

MRSA Action UK welcomes the opportunity to engage Primary Care Trusts, splitting between 48-hour cases would help to achieve this engagement, and give a fairer reflection on Trust performance. This approach has worked well for Clostridium difficile, enabling the picture to be seen in the wider community. Healthcare infections may have started in the Acute setting, but we are seeing rising trends in the community now, and this has to be addressed.

Other metrics can be used to look at performance with other providers, for example the use of performance measures being collected from Care Homes on residents healthcare infection status in care plans, whether these are admissions or discharges, this encourages partnership working and helps the NHS meet it's Constitutional obligation to provide all patients with a Care Plan.

Setting the correct target is important, many believed the 50% reduction set by John Reid in 2004 was impossible, but on a national basis this was achieved, albeit by only half of the NHS Hospital Trusts. Current poor performers should have to reduce their infections rates by 60% year on year, those in the median should reduce by 50% year on year, those who have fewer infections should reduce year on year, and those with zero bacteraemias should aim to maintain that position. A common sense approach to registration with the CQC and meeting those requirements would need to be taken. "No avoidable infections" is an Objective that all Trusts should be aiming for.

Despite the high risks of MRSA that is traditionally linked with Renal Units, many units have been able to substantially reduce the number of MRSA cases in the past few years.  There is a very strong case to support the publication of urinary and catheter infections, the Renal Units use of metrics to drive performance has to be applauded, which is why MRSA Action UK supports the wider publication of infection rates.  The UK arguably has the best data collection system in the world and we should use it to drive performance and drive down infection rates.

The meeting was extremely positive and the Department of Health will be looking to change way the commentary on the figures will appear, it will be clear that where Trusts are not performing the Department will be paying particular attention and making sure that Trusts are taking the necessary measures to improve.  The Department will be looking at simplifying the data and broadening the reporting to include surgical site, urinary and catheter infections, with the design of the data to be agreed.

With regard to NHS Choices data, there is a longer term goal to broaden to hospital reporting, however there is no reason why hospitals cannot publish their data, and make this available at the Reception, and this is beginning to happen.  There would be a priority put on the publication of the mandatory reporting on surgical site infections, and to broaden the reporting on urinary and catheter infections at Trust level, this will be a more open and accountable way of letting the public know infection rates in hospital and will enable better performance management with more of a focus on reducing all avoidable infections.