Healthcare-associated infection in acute hospitals: which interventions are effective? A. Mears*, A. White, B. Cookson, M. Devine, J. Sedgwick, E. Phillips, H. Jenkinson, M. Bardsley Healthcare Commission, London, UK Received 9 July 2008; accepted 12 December 2008 Available online 6 February 2009 KEYWORDS Clostridium difficile; Healthcare-associated infection; MRSA; Nosocomial infection; Reactive practice Summary This study investigated the potential factors linked to healthcare- associated infection (HCAI) rates in acute National Health Service hospitals, analysing mandatory surveillance data with existing data available to the Healthcare Commission, and supplemented by a bespoke questionnaire. A ques- tionnaire was developed to cover important elements related to the manage- ment and control of HCAI. Additional data were collated from other sources. Infection outcomes comprised the mandatory surveillance data, for both meti- cillin-resistant Staphylococcus aureus (MRSA) bacteraemia and Clostridium dif- ficile-associated diarrhoea (CDAD). The response rate was 90%. A lower MRSA rate was linked to hand hygiene and isolation and a lower rate of CDAD to clean- liness, good antimicrobial prescribing practices and surveillance of infections. Lower rates of both organisms were related to strategic planned interventions, such as the inclusion of infection control in the staff development programme. However, certain interventions, for example increased levels of training, were related to a higher infection rate. These findings for MRSA and CDAD are sup- ported by evidence from the infection control literature. We have found rela- tionships between interventions and higher infection rates that are counterintuitive and that may represent examples of what we call ‘reactive practice’ to higher rates of infection. Whilst it is interesting to hypothesise that these interventions may be swift and simple to introduce and may not be sus- tained compared to more strategic and planned interventions linked to lower infection rates, they most probably simply represent the beginning of a culture change and embedding of infection control practice. ª 2009 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved. * Corresponding author. Address: Healthcare Commission, Finsbury Tower, 103e105 Bunhill Row, London EC1Y 8TG, UK. Tel.: þ44 020 7448 4524; fax: þ44 020 7448 9050. E-mail address: alex.mears@healthcarecommission.org.uk 0195-6701/$ - see front matter ª 2009 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.jhin.2008.12.004 Journal of Hospital Infection (2009) 71, 307e313 Available online at www.sciencedirect.com www.elsevierhealth.com/journals/jhin