Work centred on healthcare-associated infection

Healthcare-associated infections (HCAIs) are infections that occur as a result of healthcare, either in hospital or in other care settings. Each year, there are about 62,000 cases of the ‘superbugs’ MRSA and Clostridium difficile. Other types of infection also pose a risk to patients.

The need to reduce HCAIs remains one of the most pressing safety issues facing the health service in England.

The hygiene code

The Department of Health published The Code of Practice for the Prevention and Control of Healthcare Associated Infections (the ‘hygiene code’) on 1 October 2006 under the Health Act 2006. It makes explicit each trust’s statutory duty to protect its patients, staff and others from HCAIs.

The hygiene code covers cleanliness and all other aspects of infection prevention and control. Using this, trusts can ensure that responsibility for reducing rates of HCAIs begins at a board level and continues through all levels of the organisation (known as a ‘board to ward’ approach).

To learn more on HCAIs, click on the links below:

National study of healthcare-associated infection

Outbreaks of Clostridium difficile

Cleanliness of hospitals in England

Our inspection programme on HCAIs

In April 2008, the Healthcare Commission launched its largest programme of unannounced inspections to check that all acute NHS trusts in England are compliant with the hygiene code. The Secretary of State for Health asked that we inspect all 170 acute trusts annually, following our inspection programme of 120 acute trusts in 2007/08. We aim for these inspections to help tackle HCAIs and to protect the safety of patients.

Our inspections are unannounced, to ensure our assessors see the hospital as a patient or visitor would see it. Each inspection gives a ‘snapshot’ of how well a trust is working to reduce the risk of patients getting a HCAI. We assess a trust’s compliance with certain duties of the hygiene code. This is a different approach to that used for our core standards assessments (used for the Annual Health Check), where our assessors seek to understand how the trust has assured itself that it meets standards.

Our assessors for the inspection programme on HCAIs look at the trust’s systems and how these help them to ensure good practice. They also test implementation. For example, if we discover dirty commodes on a ward, we ask what risk this poses to patients, which of the trust’s systems might be failing and why.
The hygiene code applies to all NHS trusts. In addition to our inspections of acute trusts, we are also inspecting over 20 non-acute trusts in 2008/09, to get a better understanding of how this part of the NHS is performing against the hygiene code. These non-acute trusts include mental health care providers, ambulance services and primary care organisations.

Providers of independent healthcare and social care will also be expected to comply with the hygiene code in the future.

By 1 April 2009, all NHS trusts may be required to submit applications for HCAI registration with the Care Quality Commission. Further details will be released in October 2008.

How we act on our findings

Following inspection, the lead assessor will write up his or her findings and provide these to the trust to check the factual accuracy. Following this, the findings are reviewed by a national panel in our quality assurance process, to ensure that each and every inspection is fairly and consistently reported.

We publish a summary report on our website that clearly shows whether or not the trust has breached the hygiene code.

If our assessors have serious concerns regarding a breach of the hygiene code, they will tell the trust before they leave. However, some breaches may not become apparent until all of the evidence has been examined after the inspection and the report scrutinised by the panel. We always report breaches of the hygiene code in our published reports. And we always give recommendations to trusts on how to solve breaches.

We have the power to issue an improvement notice if we have strong concerns that a trust is breaching a duty in a way that could place patients at increased risk of HCAIs (this is called a material breach).

To learn more about our systems for HCAI inspections, please click on the links below.

See the evidence tables our assessors use to report findings from an inspection:
Evidence tables for hygiene code inspections

View our policy statement for this inspection programme:
Healthcare associated infection inspection programme - policy statement (pdf 65kb) (opens new window)

Results of our inspections

To see the results of our inspections, please click on the link below:
Inspection reports and improvement notices

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