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Author Ann Shuttleworth, BA, is clinical editor, Nursing Times.

Ann Shuttleworth describes how the Department of Health has made available a range of support tools and advice to help healthcare professionals reduce rates of healthcare-associated infections (HCAIs).

In 2004 the government announced ambitious targets for reducing HCAIs, particularly MRSA. Trusts were expected to halve MRSA infections from the 7,647 cases recorded in 2003–2004 by April 2008. Local targets have been set to reduce rates of Clostridium difficile by up to 25%.

To support this work, the DH has introduced initiatives to improve knowledge, skills and practice in infection prevention and control. It had already commissioned a nurse-led team to produce national evidence-based principles of good practice, which resulted in the epic guidelines. Published in 2001 and recently updated (Pratt et al, 2007), these gave practical advice on preventing and controlling HCAIs in hospitals.

They were followed by guidelines for primary and community care (Pellowe et al, 2003). To see the epic2 guidelines, visit the ‘Infection prevention and control’ section of

In 2007 the government supplied an extra £50m to fund projects to cut infection rates and improve cleanliness. Each strategic health authority received £5m to allocate to trust initiatives likely to reduce HCAI rates. Other support and advice to further reduce HCAI rates is also available.

The Saving Lives programme
This DH (2005) initiative has tools and resources to tackle HCAIs, including:
- The Clean, Safe Care website ( – an information hub, with links to tools and news about reducing HCAIs and offering a range of case studies illustrating good practice;
- An HCAI self-assessment tool aligned to the DH’s code of practice for prevention and reduction of HCAIs (DH, 2006a];
- Learning resources to support implementation of the code and an action plan to tackle HCAIs;
- High-impact interventions that link evidence, measuring tools and strategies for improving practice in seven procedures where risk of infection is high;
- Essential Steps to Safe, Clean Care (DH, 2006b), a recently revised programme aimed at primary care, mental health settings, ambulance trusts, care homes, residential homes, GP surgeries and independent settings.

Other sources of information and support
The National Patient Safety Agency’s cleanyourhands campaign ( offers information and tools to improve hand hygiene – the cornerstone of good infection prevention and control.
The DH revised the Saving Lives tools in June 2007 and has added new good practice guidance on taking blood culture, antimicrobial prescribing, screening for MRSA colonisation and isolation of patients with HCAIs.

Department of Health (2006a) The Health Act 2006: Code of Practice for the Prevention and Control of Healthcare–associated Infections. London: DH.

Department of Health (2006b) Revised Essential Steps to Safe, Clean Care: Introduction and Guidance. London: DH.

Department of Health (2005) Saving Lives: A Delivery Programme to Reduce Healthcare-associated Infection Including MRSA. Skills for Implementation. London: DH.

Pellowe, C.M. et al (2003) Infection control: prevention of healthcare-associated infection in primary and community care. British Journal of Infection Control; (Supplement) 4: 6, 1–100.

Pratt, R.J. et al (2007) epic2: National evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. Journal of Hospital Infection; 65S: S1–S64.

National programme to reduce HCAIs

This DH initiative aims to identify any new information and knowledge regarding what works in the prevention of healthcare-associated infections (HCAIs) and to share this learning as quickly as possible.

As a result of this knowledge-sharing, the Saving Lives tools have recently been updated and underpin the requirements of the DH’s code of practice. The tools are available at

Four themes have been identified that have a significant impact in HCAIs:
- Policy;
- Practice;
- People;
- Performance.

These themes identify what is needed in a trust to achieve sustainable reductions in all HCAIs.

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