Official Statistics

Annual commentary on MRSA, MSSA and Gram-negative bacteraemia and Clostridiodies difficile infections from independent sector healthcare organisations in England: April 2023 to March 2024

Updated 8 October 2024

This report includes surveillance data on meticillin-resistant Staphylococcus aureus (MRSA) bacteraemia, meticillin-sensitive Staphylococcus aureus (MSSA) bacteraemia, Escherichia coli (E. coli) bacteraemia, Klebsiella species (Klebsiella spp.) bacteraemia, Pseudomonas aeruginosa (P. aeruginosa) bacteraemia and Clostridioides difficile infection (CDI) from 27 independent sector organisations, 11 of which are groups of more than one hospital,the remaining 16 are single hospitals.

Occupancy data (inpatient bed-days plus discharges, see Appendix for further details) was available for 18 organisations. Individual rates for these organisations are included in the accompanying spreadsheet. Please note that there are caveats and problems of comparability with NHS data sets on HCAIs.

Main points

• 8 cases of MRSA were reported from April 2023 to March 2024
• 31 cases of MSSA were reported from April 2023 to March 2024
• 112 cases of E. coli bacteraemia were reported from April 2023 to March 2024
• 82 cases of Klebsiella spp. bacteraemia were reported from April 2023 to March 2024
• 47 cases of P. aeruginosa were reported from April 2023 to March 2024
• 78 cases of CDI were reported from April 2023 to March 2024

Cases of healthcare-associated infections (HCAIs) in independent sector healthcare organisations (ISHOs)

MRSA bacteraemia in ISHOs

A total of 8 cases were reported from April 2023 to March 2024 by the following organisations (as shown in Table 1 (T1) of the accompanying data set):

• Circle Health Group Ltd (1 case)
• HCA International (4 cases)
• The London Clinic (3 cases)

Among IS providers that submitted their modified inpatient bed-days data, the incidence rate of MRSA bacteraemia for April 2023 to March 2024 was 0.4 cases per 100,000 bed days plus discharges. The rate increased 33.3% when compared with the previous financial year (0.3 cases per 100,000 bed days plus discharges).

MSSA bacteraemia in ISHOs

A total of 31 cases were reported from April 2023 to March 2024 by the following organisations (as shown in Table 2 (T2) of the accompanying data set):

• BUPA Cromwell Hospital (6 cases)
• HCA International (14 cases)
• Nuffield (1 case)
• Ramsay Health Care UK (4 cases)
• Spire Healthcare (3 cases)
• The London Clinic (3 cases)

Among IS providers that provided their modified inpatient bed-days, the incidence rate of MSSA bacteraemia for April 2023 to March 2024 was 1.5 cases per 100,000 bed days plus discharges. This is a 16.7% decrease when compared with last year (1.8 cases per 100,000 bed days plus discharges).

E. coli bacteraemia in ISHOs 

A total of 112 cases of E. coli bacteraemia were reported from April 2023 to March 2024 by the following organisations (as shown in Table 3 (T3) of the accompanying data set):

• BUPA Cromwell Hospital (8 cases)
• Circle Health Group Ltd (1 case)
• HCA International (71 cases)
• Nuffield Health (8 cases)
• Ramsay Health Care UK (3 cases)
• Royal Hospital for Neuro-disability (4 cases)
• Spire Healthcare (4 cases)
• The London Clinic (13 cases)

Among IS providers that provided their modified inpatient bed-days, the incidence rate of E. coli bacteraemia for April 2023 to March 2024 was 5.4 cases per 100,000 bed days plus discharges. This is a 29.9% decrease when compared with last year (7.7 cases per 100,000 bed days plus discharges).

Klebsiella spp. bacteraemia in ISHOs

A total of 82 cases were reported from April 2023 to March 2024 by the following organisations (as shown in Table 4 (T4) of the accompanying data set):

• BUPA Cromwell Hospital (5 cases)
• Circle Health Group Ltd (2 cases)
• HCA International (61 cases)
• Nuffield Health (1 cases)
• The London Clinic (13 cases)

Among IS providers that submitted their modified inpatient bed-days, the incidence rate of Klebsiella spp. bacteraemia for April 2023 to March 2024 was 3.9 cases per 100,000 bed days plus discharges. This is a 38.1% decrease when compared with last year (6.3 cases per 100,000 bed days plus discharges).

P. aeruginosa bacteraemia

A total of 47 cases were reported from April 2023 to March 2024 by the following organisations (as shown in Table 5 (T5) of the accompanying data set):

• BUPA Cromwell Hospital (3 cases)
• HCA International (39 cases)
• Nuffield Health (1 cases)
• Spire Healthcare (1 cases)
• The London Clinic (3 cases)

Among IS providers that provided their modified inpatient bed-days, the incidence rate of P. aeruginosa bacteraemia for April 2023 to March 2024 was 2.2 cases per 100,000 bed days plus discharges. This is a 21.4% decrease when compared with last year (2.8 cases per 100,000 bed days plus discharges).

C. difficile infection (CDI) in ISHOs

A total of 78 cases were reported from April 2023 to March 2024 by the following organisations (as shown in Table 6 (T6) of the accompanying data set):

• BUPA Cromwell Hospital (4 cases)
• Circle Health Group Ltd (7 cases)
• HCA International (48 cases)
• Nuffield Health (5 cases)
• Spire Healthcare (6 cases)
• The Hospital of St John and St Elizabeth (2 cases)
• The London Clinic (6 cases)

Among IS providers that provided their modified inpatient bed-days, the incidence rate of CDI infection for April 2023 to March 2024 was 3.6 cases per 100,000 bed days plus discharges. This is a 5.8% increase when compared with last year (3.4 cases per 100,000 bed days plus discharges).

Data sources and methodology

Presentation of data

Counts and rates (per 100,000 bed-days and discharges) of MRSA, MSSA, E. coli, Klebsiella spp. and P. aeruginosa bacteraemia and CDI are presented by IS organisation for the 12-month period of 1 April 2023 and 31 March 2024.

An IS organisation can comprise a group of hospitals owned by one company or a single hospital. It is possible to identify a group versus a hospital using the ‘number of hospitals in organisation’ field in the HCAI data capture system.

The modified inpatient bed-days (bed-days plus discharges) are provided for the most recent financial year available (April 2023 to March 2024) as an indication of the size of each facility.

The hospital type (large hospital equals 50 beds or more, small hospital equals fewer than 50 beds, NHS treatment centre, diagnostic centre seeing mainly day case patients and women’s health) is listed for the hospitals within a group. This indicates the type of services provided (where a group comprises more than one hospital type, all types are listed). This is correct as of 2 September 2024 based on information supplied to UKHSA.

Additional information can be found in the accompanying spreadsheet. Some IS organisations included in the data tables may have not been reporting for the entire period. Such hospitals are included in the Appendix . Cases among renal patients have been excluded.

Interpreting the data

The data is available in the accompanying spreadsheet and show counts and rates of all reported cases of:

• MRSA bacteraemia by ISHO: April 2023 to March 2024 (Table T1)
• MSSA bacteraemia by ISHO: April 2023 to March 2024 (Table T2)
• E. coli bacteraemia by ISHO: April 2023 to March 2024 (Table T3)
• Klebsiella spp. bacteraemia by ISHO: April 2023 to March 2024 (Table T4)
• P. aeruginosa bacteraemia by ISHO: April 2023 to March 2024 (Table T5)
• CDI by ISHO: April 2023 to March 2024 (Table T6)

The data does not provide:

• a basis for comparisons between different IS organisations, due to their variable size and range (case mix) of patients seen
• a basis for reliable comparison of these infections between the NHS and IS organisations

A full discussion of these issues is presented elsewhere. The reasons behind this are discussed in Commentary on reporting of C. difficile infections and MRSA bacteraemia from the independent sector, published in 2009.

Specific data caveats

Below is a list of specific caveats to be considered in relation to the published data.

Data quality

Not all IS organisations have signed off their data or submitted data for the reporting period, potentially leading to unfinalised and inaccurate data. ISHPs that have not signed off their data for the time period are highlighted in the accompanying spreadsheet.

Duplicate entries

Data entered onto the DCS by the NHS and IS are collected in 2 parallel systems, with separate outputs. This means that data on a single case may be entered by either an NHS trust, an IS organisation, or both. Data has only been de-duplicated against the NHS data set for cases reported via the DCS. If a case is reported by an IS provider and an NHS acute trust, the IS case is excluded as a duplicate entry if:

• the NHS case was reported with a patient location of ‘NHS acute trust’, and the IS case was reported with a patient location that is not ‘IS provider’

• the NHS case was reported with a patient location of ‘NHS acute trust’ and the IS case was reported with a patient location of ‘IS provider’ but has a specimen date within 14 days (28 days for CDI) prior to the NHS case

Cases are only de-duplicated if they are reported by both IS providers and NHS acute trusts. Multiple cases reported only by one or more IS providers are not de-duplicated. Additionally, the NHS number (one of the variables used to de-duplicate records) is not always known for patients treated in the IS, so some duplicate records entered onto the DCS may not be identified.

Organisational changes

Some ISHOs included in the data tables may have not been open for the entire reporting period, whilst others may have closed over this time. This may reduce the count of these infections in such IS organisations, compared to those that were open for the whole period. However, this will also be reflected in their bed occupancy data, so any rate calculated still has validity over the shorter period. Such organisations are listed in the Appendix.

It should also be noted that there are 3 additional ISHOs included in April 2023 to March 2024 in comparison with the previous financial year. 2 did not submit bed occupancy data.

These additional ISHOs include:

• Cleveland Clinic London Ltd (did not submit denominator data)
• Daughters Of The Cross Of Liege (did not submit denominator data)
• NUPAS (did submit denominator data)

Background information

This report is the latest in a series of publications of healthcare-associated infections (HCAI) surveillance data on MRSA, MSSA and Gram-negative (E. coli, Klebsiella spp. and P. aeruginosa) bacteraemia and Clostridioides difficile (CDI) reported by independent sector (IS) healthcare organisations to UKHSA.

IS healthcare organisations providing regulated activities (see The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010) undertake surveillance on HCAIs and report identified cases to UKHSA as specified in the Code of Practice.

Patient-level data is provided to UKHSA via the secure Data Capture System (DCS) and the data for this publication was extracted on 2 September 2024.

Related statistics

HCAI statistics by the Private Healthcare Information Network (PHIN) 

For independent sector hospitals, it is mandated by the Competition and Markets Authority (CMA) that private healthcare providers must report HCAI cases to the PHIN and to UKHSA. The PHIN publishes their data sheets from data collected for privately funded care which excludes data for NHS care provided within an independent sector hospital setting.

The PHIN publishes data every quarter on a rolling 12-month period (for example, January 2022 to December 2022) while UKHSA publishes an annual report based on the most recent financial year (for example, April 2022 to March 2023). Data is not directly comparable due to variation in methods and definitions and difference in number of independent sector providers reporting data.

Further information and contact details

Feedback and contact information

Please contact independent.sector@ukhsa.gov.uk

Official statistics in development

It is our sole responsibility as the producer of official statistics to decide when to label a set of official statistics as ‘in development’ and when to remove that label. We will seek guidance on this from UKHSA’s Head of Profession for Statistics who may also approach the National Statistician for further guidance as required. We may also contact the Office for Statistics Regulation to discuss specific situations in our decision-making process to label these statistics as ‘in development’ or to remove that label from them. 

We will use our judgement, informed by consultation with our data providers and users, to decide if we will modify or stop producing these statistics for the next financial year. 

When doing so, we will consider the following criteria laid out by the Government Statistical Service (2019): 

• whether there is a defined and time-limited work programme either to develop new statistics or to improve existing outputs which falls within the remit of that programme 

• whether we are developing new statistics which have considerable immediate value to users 

• whether the statistics remain subject to testing of quality and ability to meet user needs 

• whether new methods are being tested and are still subject to modification or further evaluation

Appendix. Organisational changes among IS providers during the reporting period April 2023 to March 2024

This data was correct as of 2 September 2024 and as supplied to UKHSA.

Table 1. Hospitals that closed, opened, changed ownership or ceased during the reporting April 2023 to March 2024

IS organisation name	Site name	Status	Month
HCA International	The Harborne Hospital	Opened	January 2024
NUPAS	Battersea	Opened	January 2024
NUPAS	Blackpool	Opened	April 2023
NUPAS	Cannock	Opened	April 2023
NUPAS	Clapham Junction	Opened	January 2024
NUPAS	Harringay	Opened	January 2024
NUPAS	Kilburn	Opened	January 2024
NUPAS	Leeds	Opened	April 2023
NUPAS	Newton Drive	Closed	December 2023
NUPAS	Preston	Opened	February 2024
NUPAS	South Manchester	Closed	January 2024
NUPAS	Tameside	Opened	November 2023
NUPAS	Woolwich	Opened	January 2024
NUPAS	Burton	Opened	April 2023
Ramsay Health Care UK	Ramsay Glendon Wood Hospital	Opened	August 2023
Ramsay Health Care UK	West Valley Hospital	Closed	January 2024