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 cleanliness and infection control 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 (C.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.

Registration requirements regarding cleanliness and infection control

All NHS trusts that provide regulated activities must be registered with the Care Quality Commission and to do so they must meet a range of government regulations, including one on cleanliness and infection control. To meet legal requirements, NHS trusts must ensure that patients, workers and others are protected against the identifiable risks of acquiring an HCAI.

To help NHS trusts 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 on 1 April 2010, under The Health and Social Care Act 2008. This is called the 'Code of Practice for health and adult social care on the prevention and control of infections and related guidance’.

The Code of Practice lists 10 criteria that are used to judge whether an NHS trust is compliant with the regulation regarding cleanliness and infection control. 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 conducts unannounced inspections, assessing trusts against aspects of the Code of practice, to monitor whether NHS trusts are complying with the registration requirements related to cleanliness and infection control. 

Find out more about the inspection programme.

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

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.

Read more on Ealing LINk