HEALTH service chiefs were accused today of allowing hospital superbugs to run out of control.

A damning report from the National Audit Office blamed poor working practices and a continuing lack of cleanliness and hygiene for rising infection rates.

Numbers of hospital blood infections by the bug Staphylococcus aureus had gone up nearly 8% in England from 17,933 in 2001-02 to 19,311 in 2003-04.

Of these, about 40% were the potentially deadly MRSA (methicillin-resistant Staphylococcus aureus) strain that is resistant to most known antibiotics.

British hospitals are said to have one of the worst MRSA infection rates in Europe, outstripping countries such as Greece, Romania and Bulgaria.

Hospital acquired infections currently cost the NHS about '1 billion each year and led to at least 5,000 deaths.

No-one knows how many people are killed by MRSA, but the bug was mentioned in 800 death certificates in 2002.

The NAO said that despite new measures designed to bring infections under control, little had changed on the ground since it first reported on the problem in 2000.

Edward Leigh MP, chairman of the Commons Public Accounts Committee, said the picture was "bleak".

He added in a statement: "It is outrageous that, four years on from its original report, the NAO is still highlighting problems of poor hospital cleanliness, lax hand-washing practices among clinical staff, under-resourced infection control teams and a general culture among NHS staff of thinking that good infection control practice is somebody else's problem.

"People in hospital for treatment should not have to fear catching a possibly deadly infection while they are there. They should certainly not have to wait another four years for the NHS to stop sitting on its hands and start taking serious and effective action to improve hospital acquired infection rates."

Worst

The fact that MRSA infection rates in Britain were among the worst in Europe was "a matter of shame", he said.

The NAO said more had to be done to improve working practices in hospitals.

In particular, it called for obligatory induction training in infection control for all hospital staff - a step further than any taken by Health Secretary Dr John Reid in his new strategy for beating hospital superbugs, outlined on Monday.

Only a third of infection control teams questioned for the report thought standards had improved in more than half the clinical areas in their trust over the past two years.

Two in five believed it had improved in fewer than a quarter of clinical areas, and one in 10 thought there had been no improvement at all.

Almost a quarter of heads of orthopaedic services reported a decline in cleanliness standards, as did 19% of cardiovascular directors.

Hospitals in some other countries such as the Netherlands and Denmark were far more conscious of cleanliness than their English counterparts, said the report.

The NAO said there was still evidence that hospital staff in England were not complying with hand-washing guidelines.

But research had shown it was not simply a question of laziness or lack of awareness by staff.

Inadequate facilities, excessive workload and poor access to hand-hygiene agents all contributed to the problem.

A key obstacle to progress was the lack of information about the extent and cost of hospital acquired infections, said the report.

Mandatory surveillance of hospital bloodstream infections by MRSA was introduced in 2001. But other kinds of infection were not monitored, and there was no system of comparing MRSA rates in different hospital departments.

Eighteen per cent of infection control teams carried out no surveillance other than what was required for MRSA blood infections.

The evidence showed that MRSA infection rates were up to seven times higher in some NHS trusts than in others.

Increases

London hospitals recorded the highest rates, and year-on-year increases were seen in the South-East, North-West, North-East and West Midlands. Only the Eastern region showed decreases.

The report also highlighted the problem of hospital overcrowding, which contributes to the spread of infections.

Government figures showed that in 2002-03, 71% of trusts were still operating a bed occupancy level of more than 82%.

Orthopaedic and cardiovascular directors told the NAO their average occupancy rates were 89% and 91% respectively.

About half reported that patients were having to be moved within hospital more often, increasing the risk of infection.

Another issue addressed by the report was over-prescribing of antibiotics, which is known to encourage drug-resistant bugs.

GPs have reduced the number of antibiotics they prescribe, said the NAO. But there was little information available about the extent of antibiotic prescribing in hospitals.

However, 5% of infection control teams still had no written antibiotics policy.

Sir John Bourn, comptroller and auditor general of the NAO, said that the Department of Health had made important progress in highlighting the problem of hospital-acquired infection.

But he added: "However, I am concerned that, four years on from my original report, the NHS still does not have a proper grasp of the extent and cost of hospital-acquired infection in trusts."

As well as calling for compulsory infection control training, the NAO urged the Department of Health to speed up development of mandatory surveillance of hospital-acquired infection.

It also said infection control teams should have to be consulted before contracts are signed for hospital cleaning, laundry and catering services.

Health Secretary John Reid said: "It is clear from today's National Audit Office report that some parts of the NHS have to do more to control this threat and match the achievements of hospitals which maintain low MRSA rates.

"The NAO report is an important reminder that everyone in the NHS needs to keep infection control at the top of their agenda."

Plans

Dr Reid said the Government's plans, set out earlier this week, would help to bring all hospitals up to the level of the best.

Beverly Malone, general secretary of the Royal College of Nursing, said that nurses welcomed the opportunity to influence the cleanliness of hospitals.

"However they must have the authority and support to hold those responsible for cleaning to account if they are not achieving the highest standard of environmental and equipment hygiene."

Andrew Lansley, Conservative shadow health secretary, said: "After 20 separate initiatives since the last damning report from the NAO, it is scandalous that the same problems are being highlighted and that we are still unaware as to the true scale and cost of hospital acquired infections.

"Thousands of lives have been lost yet the Government's plans may amount to nothing.

"Hospitals need to be given real freedoms if hygiene levels are to improve: freedoms to introduce initiatives, improve facilities, and to balance competing priorities, such as waiting lists and safe bed occupancy levels, without risking the wrath of Whitehall."

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