Background on HCAIs

Healthcare-associated infections (HCAIs) are infections that occur as a result of healthcare, either in hospital or in other healthcare settings. The Government brought in a new regulation regarding HCAIs in April 2009, to ensure that patients, workers and others are protected from the known risks of acquiring an HCAI. Trusts must meet this regulation to be registered with the Care Quality Commission.

About HCAIs

HCAIs are caused by a wide variety of micro-organisms, including bacteria from our own bodies. Some HCAIs are caused by 'superbugs', which have become resistant to the antibiotics used to fight them. Patients often recover from HCAIs with treatment, but an infection can lead to a longer hospital stay and suffering. HCAIs can sometimes contribute to, or cause, death. The Health Protection Agency estimated from survey data that about 8% of patients in English hospitals had an HCAI in 2006.

Highly publicised HCAIs are meticillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile. The number of cases of these two infections rose dramatically, starting in the 1990s. Overall, the NHS has made good progress in tackling both of these infections. There was a 34% fall in reported MRSA cases and a 35% fall in C. difficile cases between 2007/08 and 2008/09.

There are also other HCAIs that trusts should combat. NHS trusts providing healthcare can keep the risk of HCAIs as low as possible by following good practice in infection prevention and control.

Action to reduce HCAIs in England

In 2003, the Department of Health published guidance for NHS trusts on infection control and how to reduce HCAIs. In 2004, it also encouraged patients to be involved in the fight against infection. The following year, the Healthcare Commission reported that there was clear evidence of poor standards of cleanliness in a significant proportion of hospitals in England. In 2006, the Government set a target for the NHS to halve rates of MRSA by mid 2008 - this reduction has now taken place. It also published the first code of practice for the NHS regarding HCAIs in 2006.

The government regulation regarding HCAIs

From 1 April 2009, it became a requirement for all NHS trusts that provide healthcare to be registered with the Care Quality Commission and meet the regulation on HCAIs. From 1 April 2010, there will be a new set of regulations that NHS trusts must meet in order to remain registered, including the one on HCAIs. NHS trusts will be assessed against a revised code of practice on HCAIs.

To meet legal requirements, NHS trusts must ensure that patients, workers and others are protected against the identifiable risks of acquiring an HCAI.

Simplified wording of the regulation on HCAIs is below:

An NHS trust providing healthcare directly to patients must, so far as is reasonably practicable, ensure that patients, workers and others are protected against the identifiable risks of acquiring a healthcare-associated infection.
The means by which they should do this are:
- The effective operation of systems to assess the risks of infection and prevent, detect, treat, and control infection).
- The maintenance of appropriate standards of design, cleanliness and hygiene for premises and equipment.

Registration applies to all healthcare services that are provided by the following NHS trusts:

Acute trusts (both foundation and non-foundation trusts)
Ambulance trusts
Mental health trusts (including learning disability trusts)
Primary care trusts
NHS Blood and Transplant

From 1 October 2010, the regulations will also apply to providers of independent healthcare and adult social care.

Follow this link to find out more about the registration process.

The code of practice regarding HCAIs

To help NHS trusts that provide healthcare to ensure they follow good practices for infection control and meet the regulation, the Department of Health published an updated version of the code of practice regarding HCAIs in January 2009, under The Health and Social Care Act 2008. This is called the 'Code of Practice for the NHS on the prevention and control of healthcare associated infections and related guidance'.

The code of practice lists nine criteria that are used to judge whether an NHS trust is compliant with the government regulation regarding HCAIs (from 1 April 2010, there will be 10 criteria). These criteria are designed to ensure that patients are cared for in a clean environment, where the risks of HCAIs are kept as low as possible. They cover all aspects of infection control, not only cleanliness. Examples of good practices in the code of practice are:

Having staff members who are dedicated to overseeing infection control.
Providing the right kind of hand-washing facilities in the right places, and antibacterial hand rub.
Having arrangements for the thorough cleaning (decontamination) of instruments and other equipment.
Having enough isolation facilities, so the risk of infections spreading between patients is minimised.
Ensuring the prudent use of antimicrobial drugs, as some can increase the risk of patients acquiring an HCAI.

The Care Quality Commission uses criteria from the code of practice in unannounced inspections to monitor whether NHS trusts are continuing to comply with the registration requirements related to HCAIs.

Find out more about the inspection programme.

For a copy of the code of practice on HCAIs visit:

Department of Health's website (opens in new window).

People’s views on cleanliness and infection control

We use the views of the people to help shape our work. The Ealing Local Involvement Network (Ealing LINk) performed a survey in 2009 to collect people’s views about infection risks in healthcare and social care. This work was funded by the Care Quality Commission.