Managers could face prosecution without infection control

Why have I suddenly become interested in infection control? First, it would be impossible to miss the fallout from Maidstone and Tunbridge Wells. Second, as a doctor it is important to keep apprised of important clinical developments. And third, I now hold a rather large corporate indemnity policy working with 9,000 consultants and could end up in court.

Any doubting clinical or medical directors should have a quick look at the Corporate Manslaughter Act, which comes into force in April.

As a relative newcomer to the provision sector, the most striking question is how on earth has the UK got where it is. The mandatory screening programme for MRSA clocks around 7,000 cases a year and C difficile rates exceed 70,000.

Before we get into a row about the accuracy of the figures, let me quote from the chief medical officer's report published in June: 'An estimated 5,000 patients die each year as a result of a healthcare-associated infection. This equates to a death every two hours.'

As I sit on a train heading for Paddington, it does not take long to work out that this equates to a whole train carriage of people in less than six days and a mid-sized aircraft every 17 days.

Catastrophic losses

Without wanting to draw parallels to any specific travel disaster, it is fortunately infrequent for a whole train carriage or plane to suffer a complete and catastrophic loss of life. Would the public, regulators or indeed the Crown Prosecution Service take the same view if a major train crash happened every week or an aircraft fell out of the sky at least once a month?

Knowing that the Healthcare Commission was aware of the Maidstone C difficile issue for around a year and that the only fallout so far has been a series of resignations from the board and executive team and the dismissal of two nursing assistants only makes the situation more worrying.

So could this tale be any worse? Unfortunately, yes. Download the mandatory reporting Excel sheet for infections from the Department of Health website and look at the C difficile figures. Then rank hospitals according to the rate per 1,000 bed days and look for Maidstone at the bottom. You can look, but you will not find it. By my reckoning and excluding trusts without data, Maidstone was 27th from bottom.

Statistically, that means the Healthcare Commission has a problem at least as significant in 26 other establishments, assuming incidence and deaths occur roughly in the same proportion.

I think we need a sense of purpose on this issue that goes beyond hand-washing. The NHS is going to have to belatedly adopt search and control policies, to screen and exclude staff, to isolate patients until results are known. Clinical behaviour and antibiotic polices are going to need a quantum shift.

What needs to change depends on which comes first - clinical leadership, a technological solution, a prosecution or indeed the growth of informed patient power using resources such as the NHS choices website?

My view is that it can only be a matter of time before a prosecution is brought against managers and clinicians at a hospital trust. Or perhaps trusts will be prosecuted first under health and safety legislation like the Metropolitan Police.