A clean sweep

Pity the new chief nursing officer, lumbered with curbing the health service's burgeoning rates of MRSA and other hospital-acquired infections. If ever there was a problem unsusceptible to the efforts of even the most Stakhanovite individual, this is it.

Yet urgent and concerted action is certainly needed. In England, 100,000 patients a year pick up infections in hospital and 5,000 die as a result, with MRSA the most common cause. Cases have increased by 600% in a decade and by 3.6% last year alone. These rates are among the worst in Europe.

This is despite a string of initiatives since 1988, when the Department of Health issued its first national guidance on infection control in hospitals. More followed in 1993, 1995, 1996, 1997 and 1998. In 1999, NHS trusts were told to meet 15 new standards on infection control. But two landmark reports by the National Audit Office - in 2000 and 2004 - have highlighted lax progress.

Only last December the chief medical officer launched another major initiative - to ensure every trust appointed a "bug-buster" tsar in a "call to arms" against poor hospital hygiene. This summer the health secretary, John Reid, said patients should get specially programmed bedside telephones to complain about cleaning, and should challenge doctors and nurses on whether they have washed their hands. He also revealed that search parties would be sent into hospitals unannounced every three months to check cleanliness. Last month, the National Patient Safety Agency proposed placing alcohol rubs beside every hospital bed to encourage staff to clean their hands.

Every exhortation is a little shriller than the last. And still infection rates rise inexorably.

Putting a newly promoted civil servant in charge of reversing the trend may tap fresh enthusiasm, but will bring no ready solution. Curbing MRSA is a complex task that will rely on action by many people at many levels.

First, long-ingrained staff attitudes must change across the NHS. MRSA is not just a problem in acute hospitals: the Commission for Health Improvement found cause for concern about infection control in all types of NHS organisations with patient contact. And infection control is not merely a responsibility for doctors and nurses: portering and domestic staff, ambulance crews and receptionists need to understand its importance too.

So do managers. CHI found that where trusts had infection control policies, staff often failed to implement them, especially for handwashing, sterilisation and disinfection. Good practice might exist in one part of a trust without being adopted by the organisation as a whole.

Replacing the NHS's dilapidated building stock is vital. Once a ward has become infected with MRSA it can be hard to eradicate. NHS hospitals are short of single rooms in which to isolate infected patients - a technique widely and successfully used in European hospitals. Bromley hospital halved its MRSA rate when it moved to new premises with more single rooms.

Ministers have a part to play too - apart from banging the table and demanding action. Evidence suggests infection control is adversely affected by other NHS policies and priorities. Increased throughput of patients to meet performance targets has raised bed-occupancy to levels incompatible with good bed-management practice. Overcrowded wards and the need to move patients frequently are another hazard.

New treatment centres to separate emergency and non-emergency patients, more investment in new equipment and increased staff numbers may all, in time, help ease MRSA rates. But that won't be before the next election, and other policies - such as payment by results, which offers incentives to treat ever greater numbers - may further conflict with infection control aims.

The chief nursing officer may soon want to negotiate a change in her job description.

· Peter Davies is a freelance writer specialising in health. You can contact him at petergdavies@ntlworld.com