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The recent release of data from the first two years of the UK's Department of Health methicillin-resistant Staphylococcus aureus (MRSA) surveillance system in England (http://www.doh.gov.uk/cmo/mrsadata/) can be adequately summarized in a single piece of advice — if you need to go to hospital, even for routine procedures, choose your healthcare provider carefully.

Hospital-acquired infections are on the rise in the United Kingdom and cost the National Health Service (NHS) up to £1 billion a year, including the loss of 3.6 million 'bed' days. The particularly worrying trend, however, is the increase in hospital infections that are resistant to commonly used antibiotics. Research has shown that you are more likely to acquire an antibiotic-resistant infection in a UK hospital than anywhere else in Europe — data from the first six months of 2001 revealed that 46.1% of all S. aureus infections in the United Kingdom were antibiotic resistant, compared with just 3% in Iceland, Sweden and Denmark. Within the United Kingdom, there are widely differing rates of MRSA infection between hospitals, with an almost eightfold difference between the best and the worst. This is perhaps unsurprising as a recent National Audit Office report highlighted the fact that many NHS hospitals do not implement proper infection control policies, even to the extent of neglecting to promote the crucial importance of hand washing to hospital staff. Added to these deficiencies, the recent report of an MRSA isolate with transferable high-level resistance to vancomycin (one of the very few antibiotics still available that has activity against MRSA) is a worrying development with potentially far-reaching implications for hospital-infection control.

Considering the immense scale of the problem, we welcome the recent publication of an action plan developed by the Chief Medical Officer for England, Sir Liam Donaldson, to tackle infections in hospitals (http://www.doh.gov.uk/cmo/hai/index.htm). The principal measures outlined in the plan, to be implemented at national, regional and local levels, include the appointment of a director of infection control for every NHS trust hospital, a promotion to encourage hand washing and a reduction in the use of invasive medical procedures most likely to result in infection. In addition, an extra £3 million is being made available to fund research into hospital-acquired infections. The rationale behind Donaldson's plan is admirable in its simplicity — if some hospitals within the NHS are capable of attaining an acceptable level of infection control, there is no reason why all hospitals should not achieve similar standards. And therein lies the problem — the NHS in England is the largest organization in Europe with more than one million employees and annual running costs of more than £50 billion, which are projected to rise to £69 billion by 2005.

With an organization of this size, the introduction of procedures across the entire system is logistically and bureaucratically very difficult, and is further complicated by the fact that measures to control hospital-acquired infection must be implemented at the very front-line of patient care as this is where infection occurs. The creation of another senior management position within the management-laden structure of the NHS misses the point, and does not tackle the underlying reasons for the high prevalence of healthcare-associated infection.

The number of different antibiotics available in our arsenal to treat healthcare-associated infections is dwindling, as is the time available to deal decisively with the high level of such infections in NHS hospitals. Effective action that rapidly reduces the incidence of hospital infection requires the creation of an infection control culture in the NHS and that responsibility for its implementation is given to the staff on the wards — in other words, eliminate top-down management pronouncements and the creation of more committees, more targets and more regulatory constraints, and instead start ensuring that senior nursing personnel have the authority and the resources to tackle the issue of ward and staff hygiene directly.