A significant proportion of primary care trusts may struggle to hit a challenging new “zero tolerance” MRSA target, the NHS Confederation has warned.

Under the target, which the Department of Health has called an “objective”, PCTs will for the first time be directly accountable for MRSA rates in their local populations, including infections diagnosed within two days of admission to hospital.

By focusing on those who can improve the most, we will reduce the variation that exists

As revealed in HSJ the objective - also applicable to acute trusts - aims eventually to eliminate all avoidable MRSA infections.

Initially, organisations with higher MRSA rates than the national median will be told to reduce them to the median or by 20 per cent, whichever is greater. Those better than the median will have to reduce rates to those of the best performing quartile, or by 20 per cent, whichever is less.

Trusts in the best performing quartile will have their targets set locally with the aim of maintaining their performance and striving for further reductions.

DH inspector of microbiology and infection control Brian Duerden said: “By focusing on those who can improve the most, we will reduce the variation that exists.”

But PCT network director David Stout said many PCTs had so few cases they may struggle to consistently reduce their rates.

He said: “There’s quite a big chance [that it] might not take more than two to three cases to pull the rate in one direction.”

One of the DH documents accompanying the MRSA objective reveals a large cluster of PCTs with low numbers of cases that fall below the worst performing quartile and median rate. At the moment, trusts with fewer than 12 cases are not expected to reduce their infection rates but the new objective has removed this threshold.

The document says the “special circumstances of small organisations with low numbers of MRSA” should be “taken into account” in assessments.

The objective will be built into NHS contracts and the DH performance framework but will not be part of the Care Quality Commission’s registration requirements.

Taking effect from April, it is designed to tackle variations in performance after the last target to reduce MRSA by 50 per cent between 2003-04 and 2008 was hit nationally but not by every trust.

It is predicted to make a net saving of £160m over 10 years in avoided treatment costs and deaths.