Select Committee on Public Accounts Forty-Second Report


Figure 1: Summary of data presented to the Committee as the most comprehensive data available on extent, cost and impact of hospital acquired infection

Figure given to Committee How comprehensive is the figure—what is included and what is excluded What else is known about the figure
At least 100,000 cases of hospital acquired infection each year in England and Wales(i) Figure taken from a study of the control of hospital acquired infection (Glynn et al., 1997)(i) which looked at patients who acquired pneumonia, bloodstream or urinary tract infections within four main specialties in 19 hospitals. Data were then extrapolated to allow for the fact that surgical wound and skin infections were excluded, resulting in the 100,000 estimate. Figure excludes infections presenting post discharge and infections in all other specialties. The authors of the Socio-economic burden study estimate,(ii) based on extrapolating the results from one hospital, that 320,994 adult non-day case patients admitted to eight specialties in 1994/95 acquired one or more hospital acquired infections as in-patients. This figure is still likely to be an underestimate as the study only covered 70% of adult non-day cases and excluded day cases, children, neonates and infections that presented post-discharge.
Between 50 and 70 per cent of surgical wound infections occur post-discharge. (iii) Figure is derived from a review of international literature by Holtz et al., 1992. (iii) The Department commissioned PHLS to evaluate post-discharge surveillance methods for surgical wound infections. Phase 1was completed in 1997, Phase 2 ran from September 1998 to December 1999. The study's preliminary findings appear to support the 70 per cent figure (Report expected July 2000).
Around 5,000 UK deaths might be primarily attributable to hospital acquired infection. In a further 15,000 deaths, hospital acquired infection might be a substantial contributor.(iv) The SENIC study (Haley et al.,1985) (iv) estimated that in the early 1980s hospital acquired infection was amongst the top ten cases of deaths in America. There are no equivalent data available in the UK. The 5,000 and 15,000 figures were included in the Department's 1995 guidance with the caveat that "equivalent data are not available in the UK, and whilst accepting the difficulties of extrapolating from one system of health care to another, a crude indication suggests¼." The Department acknowledged that the figures are likely to be underestimates but that they simply do not have any alternative estimates(v) (Q5-6).The Socio-economic burden study (Plowman et al., 2000)(vi) estimated that, in the study hospital, patients with a hospital acquired infection were 7.1 times more likely to die in hospital than uninfected patients (after controlling for characteristics such as age, sex, diagnosis, admission specialty and types of pre-existing illness).
Hospital acquired infection in England may be costing the NHS as much as £1,000 million per year.(vi) Figure is derived from the Socio-economic burden study (Plowman et al., 2000)(v) Study patients were recruited from one hospital and covered adult, non-day patients admitted to eight specialties. The results were extrapolated to calculate a national estimate of costs. The estimate does not take into account the costs due to infections that might have occurred in a further 30 percent of all adult non-day cases, nor does it include day cases, children or neonates. The figure is accepted as the most comprehensive estimate of costs currently available, while acknowledging the problems of deriving an exact estimate on the basis of findings in one hospital. However, the figure is likely to be an underestimate as it is based on only 70 percent of the hospital's adult non-day case patients.

Source: National Audit Office

(i)Glynn et al (1997). Hospital acquired infection surveillance policies and practice - study of the control of hospital acquired infection in 19 hospitals in England and Wales. London: Public Health Laboratory Service
(ii)Letter to Committee
(iii)Holtz TH, Wenzel RP (1992). Post-discharge surveillance for nosocomial wound infections; A brief commentary. American Journal of Infection Control 20(40) 206 -213.
(iv)Haley et al (1985). The efficacy of infection surveillance and central programs in preventing nosocomial infections in US Hospitals (SENIC) American Journal of Epidemiology 121: 182-205
(v)Qs 5-6
(vi)Plowman et al (2000) The socio-economic burden of hospital acquired infection. London: PHLS.

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Prepared 23 November 2000