Clostridium difficile (C. difficile), methicillin-resistant Staphylococcus aureus (MRSA) and Escherichia coli (E. coli) are bacterial infections which commonly occur as a direct result of healthcare interventions (such as medical or surgical treatment), or from being in contact with a healthcare setting. They are the most well-known healthcare-associated infections (HCAIs). HCAIs pose a serious risk to patients, staff and visitors, can incur high costs for the NHS and cause significant morbidity to those infected. As a result, infection prevention and control is a key priority for the NHS.
In 2007 the levels of hospital associated infections, which includes C. difficile, became a major national concern in particular following the Healthcare Commission’s investigation into Maidstone & Tonbridge.
In 2007, the levels of healthcare-associated infections including C. difficile became a major national concern, in particular following the Healthcare Commission’s investigation into Maidstone & Tonbridge Wells NHS Trust (Healthcare Commission, 2007). Action to address these problems was far reaching and included new legislation as well as focussed investment, regulation and performance monitoring against targets. Since this focus in 2007, the total number of C. difficile infections decreased year-on-year to reach a low of 13,362 cases in 2013/14.
In 2014/15 there was a slight increase from the previous year in C. difficile infections, a 4% increase for hospital-onset cases and an 8% increase for community-onset cases. Since then, the number of C. difficile infections has fluctuated. In 2017/18, there were 4,739 hospital-onset cases and 8,547 community-onset cases.
In 2007, the level of healthcare-associated MRSA infections also became a major national concern, similar to C. difficile. The reduction in the number of MRSA cases has followed a broadly similar trajectory to that of C. difficile. Between 2007 and 2014, there was an 82% reduction in total cases (a 90% reduction in hospital-onset cases and a 70% reduction in community-onset cases). Despite this reduction, the number of MRSA cases increased slightly in 2015 and has fluctuated since then. In 2017/18, there was a 12% increase in community-onset cases, but a 13% decrease in hospital-onset cases compared to the previous year.
Enhanced surveillance of E. coli bacteria has been mandatory for NHS acute trusts since June 2011. Following a worrying increase in E. coli infections, the government launched an initiative in April 2017, to reduce Gram-negative bloodstream infections by 50% by 2021. E. coli represents 55% of all Gram-negative bloodstream infections, and reducing the number of E. coli infections is an important safety issue. Preventing bloodstream infections would also reduce the need to prescribe antimicrobials, which is a key way of reducing the rise in antibiotic resistance.
Between 2012 and 2017, the total number of E. coli infections increased by 27%, from 32,309 to 41,060. The number of community-onset cases increased by 35%, but the number of hospital-onset cases only increased by 2%. The increase is likely to reflect higher rates of blood culture testing as awareness of sepsis risk has increased.
About this data
The bacterial infections are deemed to be hospital-onset if the following rules are met:
- the location where the specimen was taken is given as 'acute trust' or is not known;
- the patient was either an 'In-patient', 'Day-patient' in 'Emergency assessment' or is not known;
- patient's specimen date is on, or after, the third day of the admission (for MRSA and E. coli) or the fourth day of the admission (for C. difficile), where the day of admission is day 1.
If the above rules are not met, then cases are deemed to be community-onset.