Better risk management could cut MRSA infection rates

Institutions with the highest number of 'bed days' for riskier treatments, particularly surgery and gynaecology, have an increased likelihood of infection. But financial incentives could play a role in controlling MRSA infection rates, potentially slashing the incidence of infection by between 11 and 20 per cent, the study shows.

MRSA infection costs the NHS £1bn a year in terms of prevention, compensation payments and additional treatment. Deaths involving MRSA rose from 51 in 1993 to 1,629 in 2005.

All NHS hospitals carry insurance to cover them against claims for illness and injuries caused by medical treatment. As with other insurance settings, the cover it provides reduces the need to try to minimise exposure to claims, because the insurer, not the hospital, will be paying the claim. In the NHS, the insurer, the NHS Litigation Authority (NHSLA), overcomes this problem by outlining strict risk management standards. The standards are increasingly demanding and - if they can demonstrate compliance with them - hospitals are granted increasing discounts on the premiums they pay the NHSLA for their cover. If the financial incentives implicit in these arrangements are effective, hospitals attaining higher risk management levels could face lower MRSA infection rates.

The study, led by Paul Fenn, Norwich Union Professor of Insurance Studies in the Nottingham University Business School, involved Professor Alastair Gray from the University of Oxford and Professor Neil Rickman from the University of Surrey. The team looked at data from all NHS hospitals in the UK between 2001 and 2005, including MRSA infection rates, hospital size and mix of cases, bed utilisation rates and risk management levels. They found that the introduction of higher risk management standards, including hand hygiene and infection control measures, reduced the incidence of infection in hospitals by between 11 and 20 per cent after allowing for all other variations in infection rates.

Larger hospitals were found to have higher infection rates, particularly those with higher proportions of patients undergoing surgical or gynaecological treatment. And the "busier" the hospital - the closer it is to full capacity - the higher the incidence of MRSA infection.

Professor Fenn said: "Our research has demonstrated that hospital management has responded to financial incentives by adopting higher risk management standards, and where this happens, patient safety tends to improve."-University of Nottingham