Healthcare Associated Infections (Hansard, 25 March 2003)

§ Baroness Andrews
My Lords, the National Institute for Clinical Excellence has developed evidence-based guidelines for preventing healthcare-associated infections in primary and community care. These guidelines are currently out for consultation and are due to be published in the summer.

§ Baroness Gardner of Parkes
My Lords, I thank the Minister for that reply. I am sure that the guidelines will be carefully thought out before being issued. Obviously, that is a long, slow process. But what if there is an emergency? I refer in particular to SARS—severe acute respiratory syndrome—the current deadly form of pneumonia of which there are believed to be three cases in the United Kingdom already. How does the department react quickly when it wants to avoid cross-infection or transmission of any particular disease?

§ Baroness Andrews
My Lords, we have robust and well tried procedures which can be brought into action immediately to alert public health professionals and GPs. The Department of Health and the Public Health Laboratory Service (PHLS) have issued information and advice on management and reporting of suspected cases to all GPs, trusts and public health professionals through the rapid public health link system. That happened on Thursday 13th March. We also issued advice on SARS to the public and to travellers to south-east Asia. Full information and advice has been kept up to date on the PHLS website. Doctors can refer to that as often as they want. It is continually updated. I stress that that is a unique situation and an emergency situation whereas the NICE guidance to which I referred concerns chronic conditions. As the noble Baroness said, the guidance is very much concerned with controlling MRSA and preventing healthcare-associated infections.

§ Lord Ashley of Stoke
My Lords, is my noble friend aware that the real significance of MRSA is that it is by definition resistant to antibiotics? Therefore, every case should be reported wherever it occurs, in or 644 outside hospital, and guidelines should be provided. Is my noble friend disturbed that two weeks ago today a Minister told this House that there were no centrally held records or statistics of the incidence of MRSA in care homes? When will that be rectified?

§ Baroness Andrews
My Lords, we have taken a major step forward. For the first time, MRSA is now subject to mandatory surveillance. We have one year's worth of data on MRSA in hospitals. We shall have a further year's data very soon which will enable us to make comparisons. But, as the noble Lord points out, we have not yet extended that system to care homes. We do not believe that there is a great deal of MRSA infection in care homes. The guidelines to which I referred will certainly be beneficial to care homes. I am sure that they will profit from improved hygiene techniques as a result of the guidelines.

§ Lord Clement-Jones
My Lords, does the Minister agree that MRSA and other hospital-acquired infections are a major cause of delayed discharge in acute hospitals? Does she further agree that it would be far better to tackle, and make a national priority out of tackling, MRSA and other hospital-acquired infections, as has occurred in Scotland, rather than passing punitive legislation such as the Community Care (Delayed Discharges etc.) Bill?

§ Baroness Andrews
My Lords, I assure the noble Lord that we have made the control of infection and of MRSA a priority. I referred to the development of surveillance. In 2000, the Chief Medical Officer published an action plan and a strategy for the control of infections which is now generating action plans. The Minister has recommended that MRSA control and infection control become two new performance indicators which will be introduced in July. I do not agree with the noble Lord that we have not made this a priority area.

§ Lord Walton of Detchant
My Lords, has the noble Baroness any new and encouraging up-to-date information about new antibiotics and antibacterial agents to which the MRSA agent may be sensitive?

§ Baroness Andrews
My Lords, the treatment of MRSA depends on the type of antibiotics used. Some antibiotics are successful. The most useful thing I can say to the noble Lord is that we have put out a call for research. We have allocated another £2.5 million for research. We shall be looking at ways of treating infections as a result of that.

§ Lord Chan
My Lords, although we are interested to hear that a report will be published soon, will it include preventive measures such as pharmacists giving expert advice to doctors, particularly in primary but also community and secondary care, on the correct and safe use of antibiotics in order not to make the situation of resistant MRSA worse?

§ Baroness Andrews
My Lords, there is a strong case for our continually emphasising the point about prudent prescribing. I am sure that pharmacists have a role to play. The latest information we have indicates that there has been a decline in the prescribing of antibiotics which is good news. A public education campaign with a cheerful character, Andybiotic, is appearing in surgeries to help people to understand why they should not ask for an antibiotic every time they visit the surgery. GPs will give a non-prescription pack to patients explaining why antibiotics have not been recommended and referring to a better method of treating, for example, a severe cold or severe cough.

§ Lord Roberts of Conwy
My Lords, is the noble Baroness aware that some hospitals have a worse reputation for MRSA than others? Have the Government considered setting up special teams to visit such hospitals to deal with the prevalence of MRSA?

§ Baroness Andrews
Yes, my Lords, it is true that some hospitals are worse than others. It is an interesting fact that they do not correlate with hospitals or trusts that under-perform or even hospitals that are dirtier than others. I am pleased to say that we have made extremely good progress in terms of improving cleanliness. The Commission for Health Improvement makes regular inspections and clinical audits, and it is its task to advise on such issues if it comes across outstanding cases, such as that described by the noble Lord.

§ Lord Rea
My Lords, despite part of her last answer, does my noble friend agree that the state of cleanliness and waste disposal in many hospital wards is deplorable? That is probably a factor in the spread of M RSA in some cases. Does she not regret the day when the ward cleaning staff were taken out of the direct control of sisters and matrons and contracted out and privatised?

§ Baroness Andrews
My Lords, what is important, frankly, is not who does the cleaning but how well it is done. We know that an incredible effort has been made, and all credit to the staff involved. Two years ago, in August 2000, the standards of cleanliness were unacceptable in one in three hospitals. Now we have none in that category, but many more assessed amber and many more green and therefore attaining the very highest standards.

§ Baroness Masham of Ilton
My Lords, is the Minister aware that, at a wheelchair service unit, the physiotherapists were returned a cushion from the community with a note stating that the patient died of MRSA, and they did not know what to do with it? How long does MRSA infection stay virulent?

§ Baroness Andrews
My Lords, I am afraid that I am simply not qualified to answer that question. If the noble Baroness would like to give me further details, I shall certainly see whether we can find out.