Just over six per cent of patients in Welsh hospitals have a healthcare associated infection at any one time. This is lower than in England and Scotland, but higher than Northern Ireland and the Republic of Ireland. Although the availability and reliability of the data varied, reported rates of MRSA infections of the bloodstream in Wales showed a significant fall between 2005 and 2006 for the first time since recording began in the early 1990s. And, despite a rise in cases between 1993 and 2005, the incidence of C. difficile has stabilised over the last two years. However, cases of MRSA bloodstream and C. difficile infections represent only a small proportion of infections in Wales.

Since the Assembly Government published its strategy: Healthcare Associated Infections - A Strategy for Hospitals in September 2004, Welsh trusts have developed frameworks - including action plans and targets - to meet good practice standards. For example, many have appointed infection control leads in each of their directorates and all trusts have established infection control committees and screen patients for infections.

However, the report also highlights areas of weakness. Prevention and control is still not always seen as the personal responsibility of all NHS staff, including clinicians, and there continues to be problems with hygiene, cleanliness and housekeeping processes. There is also some confusion about cleaning arrangements, with doubts over responsibilities in certain areas, and problems with the recruitment and retention of cleaning staff. And pressures on beds can sometimes result in patients being admitted to hospital areas that should be closed following outbreaks of diarrhoea and vomiting.

The report makes a number of recommendations for improvement, including:

• infection control responsibilities should be specified in job descriptions;
• NHS trusts should make cleaners part of specific ward teams;
• the Assembly Government should require trusts to measure the cost and impacts of infections;
• trusts should review the capacity and workload of infection control teams; and
• the Assembly Government should ensure that healthcare associated infections are adequately covered in higher and further education programmes for doctors, nurses and other healthcare professionals.

Auditor General for Wales, Jeremy Colman, said today:
“It is unacceptable to the public that patients should run the risk of acquiring infections as a result of their interaction with the NHS. Everyone in the NHS should be taking personal responsibility to minimise infections. Simple, but important, steps need to be taken and the recommendations in my report point to a number of ways to tighten prevention and control. Improvements are already evident since the Welsh Assembly Government launched its strategy, but further work is needed - particularly around education, guidance, measurement and evaluation.”

Notes to Editors:

• This report examines whether NHS trusts in Wales are doing the right things, consistent with the Assembly Government’s strategy, to minimise levels of healthcare associated infections. It describes the current position in terms of infection rates and also identifies the steps trusts have put in place to manage the risk of infection.
• Detailed infection control performance information, relating to each trust in Wales can be found on our website http://www.wao.gov.uk/ to help the public understand the position within their local trust.
• The report also identifies 15 case studies of good practice, which can also be found on The Good Practice Exchange area of our website, to facilitate the transfer of such good practice.
• The publication of this report coincides with a review by Healthcare Inspectorate Wales - Report on Infection Control - Findings and Themes. The report provides an overview of unannounced spot checks at five hospitals (within four NHS Trusts) and four independent healthcare providers, and is available on the website http://www.hiw.org.uk/
• The Assembly Government’s Strategy: Healthcare Associated Infections - A Strategy for Hospitals in Wales can be found on the Welsh Assembly Government’s website  http://new.wales.gov.uk/topics/health/protection/communicable-disease/healthcare-associated/whaisg-terms-reference/strategy/?lang=en
• The Wales Audit Office is independent of government and is responsible for the annual audit of some £19 billion of annual public expenditure. Its mission is to promote improvement, so that people in Wales benefit from accountable, well-managed public services that offer the best possible value for money. It is also committed to identify and spreading good practice across the Welsh public sector.
• The Wales Audit Office was created in April 2005 through the Public Audit (Wales) Act, 2004, which expanded the functions of the Auditor General for Wales and enabled the transfer of staffs from the Audit Commission in Wales and National Audit Office in Wales to his employment.