NHS infections: do 'filthy' hospitals cause 5,000 deaths a year?

17 April 2014

"One in 16 pick up a bug in FILTHY hospitals: NICE blames staff hygiene and dirty equipment for thousands of deaths"

Daily Mail, 17 April 2014

Estimates on the rate of infections related to hospital care made headlines in the Mail and the Guardian today.

The Mail said that in guidance released today the National Institute for Health and Care Excellence (NICE) had blamed hygiene failings for the infections, and that these caused thousands of deaths.

But hygiene was not the only area the guidance focused on, and figures the Mail used for the number of deaths are almost two decades old.

Around one in 16 patients at English hospitals pick up infections associated with their care — but we don't know how much of this is caused by bad hygiene

Research by the Health Protection Agency (HPA) in 2011 found that 6.4% of patients treated in NHS and independent hospitals in England picked up a 'healthcare-associated infection' (HCAI). These included respiratory, urinary, and bloodstream infections.

The prevalence of infections has fallen since the HPA's last study in 2006, although it cautioned that changes in how it collected the data mean that the results might not be comparable.

Today NICE referenced the findings as it issued its quality standards on reducing infections.

Some of the guidance related to hygiene; it said that staff should clean their hands before contact with patients and should always use sterile equipment. But it also made recommendations on how and when to use equipment such as catheters, and when to use antibiotics given the growing resistance of some infectious bugs to them.

Neither it or the HPA report made comment on the extent to which infections and related deaths are caused by shortcomings in hygiene.

Infections may have caused 5,000 deaths annually — in 1995

The Mail says:

"It is estimated the infections cause 5,000 deaths annually and contribute to another 15,000."

It takes the figures from a 2009 report by the National Audit Office. But while the report does discuss the estimates, it is to make the point that national data on the number of deaths is poor - the figures come from a 1995 report by a working group of the Department of Health.

This report undertook what it calls a "crude comparison" of data from the USA in the mid-1980s and data from the UK.

Back then, the proportion of deaths in the USA that were primarily attributable to HCAIs was 1%, and the proportion of deaths in which they were a substantial contributor was a further 3%. When applied to the number of deaths in the UK at the time this produced an estimate of 5,000 and 15,000 deaths respectively.

It's not clear that the infection rate in the UK is likely to be similar to that of the USA, and particularly not that of the USA in the 1980s. So the numbers tell us very little on the number of deaths in the UK caused by all infections.

The ONS does collect data on the number of registered deaths which mention MRSA and C. Difficile, two illnesses that are often transmitted in healthcare settings, on the death certificate. In 2012,  MRSA was involved in 292 deaths and C. Difficile in 1,646. But not all of the deaths will have come about after infection in a healthcare setting.

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