Editorial

SAGE Publications, Los Angeles, London, New Delhi and Singapore 10.1177/1469044607088259 4 British Journal of Infection Control MARCH 2008 VOL. 9 NO. 2 he challenge of healthcare associated infections (HCAI) such as bacteraemia caused by Meticillin resistant Staphylococcus aureus (MRSA) and diarrhoeal disease and colitis caused by Clostridium difficile has made the prevention and control of these infections a top priority for the NHS. The increasing incidence of MRSA bacteraemia during the 1990s to reach a peak of 7,700 cases reported in England in 2003–04 was the trigger for the first ever infection reduction target for the NHS (to halve MRSA bacteraemias by 2008). The subsequent recognition that the number of C. difficile cases had reached more than 55,000 in England by 2006 brought this infection into the scope of a targeted reduction. The reduction in MRSA bacteraemias since the implementation of the target to 6,381 for the year 2006–07 and 1,303 for the first quarter of 2007–08, together with at least a levelling off in the previously increasing rates of C. difficile infection, encourage me to believe that the NHS is now focusing rightly on this key aspect of patient safety. In this respect, one of the aims is a sea change in the mindset that has prevailed throughout health services for the last 30 years. During that time the focus was on creating systems to deliver specialist clinical care where infection was at best regarded as an inconvenient nuisance to be sorted out by infection control staff. The aim now is to create a safe environment for patient care in which infection risks are minimised and then, within that environment, deliver excellent specialist clinical care. This requires a tripartite partnership, each with essential contributions to make. Clinicians are responsible for the safe care of their patients and have a primary responsibility for the diagnosis, treatment, prevention and control of infection in their patients. However, they can only do this within the right corporate environment and with systems in place to make it happen; this is the responsibility of trust boards, chief executives and their executive teams with the Director of Infection Prevention and Control (DIPC) providing senior leadership. The third partner is the government and the Department of Heath, which must set standards, ensure that infection prevention and control is a priority for the NHS, set systems in place to monitor outcome, and use the tools of legislation and performance management to drive improvement. The tide began to turn with the publication of the Chief Medical Officer’s (CMO) strategy for infectious diseases (Getting Ahead of the Curve) in 2002 in which healthcare associated infections and antimicrobial resistance were identified as two of the four key priorities (Department of Health (DH), 2002). At the same time, the problem of HCAI hit the media headlines and became a major public and political concern. In December 2003, the CMO published the strategy for HCAI (Winning Ways) and six months later, as the National Audit Office produced a second report on hospital infections that was critical of slow progress by the Department of Health and the NHS, the action plan Towards Cleaner Hospitals and Lower Rates of Infection was issued setting out the key elements in setting the NHS on an improvement track (DH, 2003; National Audit Office, 2004; DH, 2004). This action plan announced the MRSA bacteraemia reduction target, and the management and monitoring of this target has been refined and strengthened over the three years. It clearly depends upon the mandatory surveillance reports being accurate and timely and it is now the responsibility of all chief executives to sign off their monthly data by the middle of the following month. The figures during the last year have been very encouraging but there is no room for complacency and pressure needs to be maintained to continue the reductions and Editorial Tackling healthcare associated infections in the NHS – progress so far