The Queen's speech called time on poor infection control in hospitals. Simon Lindsay looks at the effects of the new measures on those managing healthcare services
22 July 2005
Reform of the existing framework of laws for dealing with healthcare associated infection was heralded by the Secretary of State for Health on 16 May, meaning potential criminal responsibility for hospital managers where patients acquire an infection while under the care of the health services.
Currently, a patient who acquires an infection in hospital or a healthcare setting has a potential avenue of redress through negligence, or reliance on a statutory framework such as the Control of Substances Hazardous to Health Regulations, the Occupier's Liability Act 1957 or the Health and Safety at Work Act 1974. There has been a comprehensive array of guidance issued by the Department of Health, the Chief Medical Officer, National Institute for Clinical Excellence, the NHS Litigation Authority, the National Patient Safety Agency and others over the past five years.
But proving that a hospital failed to meet the required standard of infection control can be difficult. Proving that this caused a patient to acquire an infection can be more so. So patients can be left without redress when they develop potentially fatal infections during medical treatment. That may explain the dissatisfaction over the existing legal framework.
The Queen's speech introduced measures to improve the quality of health services and hospital hygiene through the Health Improvement and Protection Bill. What form the new measures will take is unclear, particularly as the implementation phase of the comprehensive guidance on infection control supervised by the Department of Health gets underway. A key feature of the proposals, however, may be that individual managers in hospitals could face criminal responsibility for failing to adequately control exposure to pathogens such as MRSA, and possibly
even corporate manslaughter charges under new legislation.
A stronger legal framework is now needed, at least according to the secretary of state, and it seems that personal accountability will be a key part of it, alongside compensation. MRSA featured on over 800 death certificates as a cause of death in 2002. Other healthcare associated pathogens probably account for significantly higher numbers of fatalities. However, there are cogent arguments to assert that infective pathogens in healthcare cannot be eradicated and only barely controlled.
In this respect there are few absolute principles which withstand all scrutiny; even the National Audit Office will concede that there is no evidence base to link unclean hospitals to infection acquisition. The prospect of calling NHS staff to account in all these cases is daunting, not just because of the numbers potentially involved, but also because of the evidential difficulties that will emerge.
It may just be that patience with the initiatives introduced over the last five years has run out and a system with teeth is now needed. But it remains to be seen whether using the law to punish hospital managers will be a more effective means of achieving what has not been achieved in the US, Japan and Europe.
In one area where managers in the UK have been outstandingly successful is in monitoring and reporting the incidence of healthcare associated infection. In this country the efficacy of the bacteraemia surveillance programme is recognised as being among the best in the world. Similar results will need to be demonstrated in implementation of infection control policy, otherwise some managers, including senior board executives, may wish they had not been so successful.
Simon Lindsay is partner at Bevan Brittan solicitors - a corporate member of the BIFM
MRSA: the nurses' viewpoint
A report from the Office of National Statistics (ONS) has revealed that the number of MRSA-related deaths has doubled in the past four years.The number of death certificates which mentioned MRSA went up from 487 in 1999 to 955 in 2003. The higher number is probably likely to improved levels of reporting due to greater public awareness, said the ONS. Chief nursing officer Christine Beasley added: "By improving reporting like this, it will help us identify avoidable factors and learn useful lessons".
Dirty uniforms are contributing to the spread of MRSA according to Royal College of Nursing (RCN) general secretary Beverly Malone. The government should take urgent steps to ensure hospital nurses never travel to and from work in their uniforms, she said.
Speaking at the RCN's annual congress in Harrogate, where she launched a campaign aimed at ending the scourge MRSA, Malone said all nurses should be given enough uniforms to guarantee they can wear a clean one for every shift. Hospitals should also provide adequate changing and laundry facilities."If a nurse working a five-day shift has only been provided with two or three uniforms that he has to launder at home then the implications for infection rates are obvious. Nurses should not have to take soiled uniforms back home."
Meanwhile, a woman who claims that poor hospital hygiene resulted in her catching MRSA has begun a legal battle for compensation. Elizabeth Miller has lodged a court summons against Greater Glasgow NHS Health Board in one of the first cases of its kind in Britain.
And the GMB union has called for a public inquiry over deaths related to MRSA at Derriford Hospital, part of the Plymouth Hospitals NHS Trust. Derriford leads the league table for MRSA-related deaths with nearly two a month. The union has blamed outsourcing of facilities services - housekeeping was contracted out 10 years ago to ISS Mediclean. The number of housekeeping staff has been falling ever since, according to the union.