Care Quality Commission
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The Healthcare Commission today (Thursday) launches the biggest inspection programme ever carried out in NHS acute trusts to check whether they are meeting standards on infection control.

It will inspect all 172 acute trusts annually as part of a drive to: reduce death and illness from healthcare-associated infections (HCAIs); improve the experience of patients in hospital; and increase public confidence in the NHS. The programme was established at the request of the Secretary of State for Health.

The Commission this week wrote to all acute trusts, calling on them to ensure that they have the necessary systems in place to minimise the risk to patients of catching a HCAI such as MRSA or Clostridium difficile.

In particular, trusts should check they are meeting the 11 mandatory dutiesoutlined in the government’s hygiene code, which came into force as part of the Health Act 2006.

The Act gives the Commission powers to issue an improvement notice, requiring immediate changes to infection control practices. If a trust does not respond to the improvement notice, the Commission could recommend that the Secretary of State for Health take further action, and Monitor in the case of foundation trusts.

All acute NHS trusts will be inspected at some point during the next 12 months, with 25 trusts to be visited in the first two months. The Commission has written to these 25 trusts to request a range of documentation including hygiene code action plans, risk registers, a list of infection control policies, as well as minutes of meetings of the infection control committee and the trust board.

The Commission will use the information gathered, along with other information it collects throughout the year, to identify which duties of the hygiene code it will assess during the visits. In the first part of the programme, it will pay particular attention to cleanliness, isolation facilities and management systems.

This method of inspection allows the Commission to target their visits on particular areas of risk, without disclosing the exact date of the spot check. The visits will take place over one to two days, although it may be extended if necessary.

A team of assessors, including specialists in infection control, will carry out the inspections. External specialists such as microbiologists and infection control nurses as well as patient representatives, will also provide advice on various aspects of the hygiene code, accompanying the inspection team on visits where necessary.

During the inspections, the assessors will check the physical environment, interview staff, including cleaners, clinical staff and managers as well as observe whether policies are being put into practice.

Anna Walker, the Commission’s chief executive, said: “The hygiene code has been in place for 18 months now. Trusts know what they’ve got to do and previous inspections have shown that most trusts are working hard to ensure they are meeting all the requirements.

“There is a focus on infection control in the NHS unlike ever before. However, if we find any trust falling short of their obligation to protect patients from infection, we will use our powers to ensure improvements are made.”

The programme follows on from spot checks carried out at 120 acute NHS trusts last year. The Commission issued improvement notices to three trusts after it found they had breached the hygiene code.

Two of the improvement notices related to the use of bench top sterilisation equipment. These are small portable sterilisers used to decontaminate surgical instruments.

The Commission stressed that the use of bench top sterilisers is not prohibited, but trusts are required to ensure they have robust systems around their use as improper use can increase the risk of transmitting HCAIs.

Ms Walker added: "We know from our previous inspections that the key to preventing and managing HCAIs is good leadership and accountability by the board, combined with an effective infection control team.

“Also, trusts need to undertake a thorough assessment of all the risks, have proper procedures in place to reduce those risks and make sure that staff are trained to follow the procedures.”

The hygiene code applies across all of the NHS. The Commission is currently considering how it might assess whether non-acute trusts are meeting the requirements of code.

Notes to editors

The government introduced the hygiene code in October 2006. The code has 11
mandatory duties:

1. General duty to protect patients, staff and others from HCAIs.

2. Duty to have in place appropriate management systems for infection prevention and control.

3. Duty to assess risks of acquiring HCAIs and to take action to reduce or control such risks.

4. Duty to provide and maintain a clean and appropriate environment for healthcare.

5. Duty to provide information on HCAIs to patients and the public.

6. Duty to provide information when a patient moves from the care of one healthcare body to another.

7. Duty to ensure co-operation.

8. Duty to provide adequate isolation facilities.

9. Duty to ensure adequate laboratory support.

10. Duty to adhere to policies and protocols applicable to infection prevention and control.

11. Duty to ensure, so far as is reasonably practicable, that healthcare workers are free of and are protected from exposure to communicable infections during the course of their work, and that all staff are suitably educated in the prevention and control of HCAIs.

Information on the Healthcare Commission

The Healthcare Commission is the health watchdog in England. It keeps check on health services to ensure that they are meeting standards in a range of areas. The Commission also promotes improvements in the quality of healthcare and public health in England through independent, authoritative, patient-centred assessments of those who provide services.

Responsibility for inspection and investigation of NHS bodies and the independent sector in Wales rests with Healthcare Inspectorate Wales (HIW). The Healthcare Commission has certain statutory functions in Wales which include producing an annual report on the state of healthcare in England and Wales, national improvement reviews in England and Wales, and working with HIW to ensure that relevant cross-border issues are managed effectively.

The Healthcare Commission does not cover Scotland as it has its own body, NHS Quality Improvement Scotland. The Regulation and Quality Improvement Authority (RQIA) undertakes regular reviews of the quality of services in Northern Ireland.

For further information contact Megan Tudehope or 0207 448 0868, or on 020
7448 9439, or on 07941 156 827 after hours.

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