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The Healthcare Commission is to carry out unannounced inspections at 120 NHS trusts over the coming year in its biggest ever programme of visits relating to healthcare-associated infection.

The Commission will check compliance with the Government’s Hygiene Code, which outlines 11 compulsory duties to prevent and manage healthcare-associated infections such as MRSA and Clostridium difficile.

The Commission will use data on rates of infection, as well as a range of other data it brings together, to identify trusts that may not be meeting requirements and carry out visits accordingly.

The Commission’s assessment managers will from today (Monday) visit about 10 trusts per month. Most visits will be to acute trusts, which provide services based in hospitals. This means up to two-thirds of all acute NHS trusts will be inspected as part of the initiative.

Assessment managers will look at the cleanliness of the hospital’s environment as well as practices and procedures that are in place to prevent and manage infection. For example, assessment managers will be looking at procedures for isolating patients, hand-washing and for the cleaning of equipment.

The Commission will examine whether trusts have proper organisational systems in place and whether infection control is a priority. For example, trusts are required under the Code to have infection control teams. They should also table regular reports with the board so there is ‘board to ward’ accountability for reducing risk of infection.

Where the Commission identifies breaches of the Code, it will require trusts to outline an action plan to rectify problems within a specified time.

Trusts must assure the Commission that the breach has been rectified or that systems are in place to reduce the risk of it happening again.

Failure to provide this assurance will result in the Commission publicly issuing an "improvement notice", which requires trusts to make immediate improvements. The ability to issue improvement notices is a new legal power that was given to the Commission under the Health Act 2006 to enforce the Hygiene Code. If a trust does not adequately respond to an improvement notice, the Commission can ask the Secretary of State to impose special measures and oversee a programme of improvements in the trust.

To reinforce the importance of the Hygiene Code, the Commission will for the first time make compliance an automatic part of all inspections carried out as part of the 2006/7 annual assessment of NHS trusts. Under the assessment, the Commission inspects approximately 20% of trusts each year to ensure they meet the government's core standards - three of these standards relate to the Code.

Both inspection programmes will be coordinated to ensure that Trusts are not visited unnecessarily. Where a trust fails to meet requirements relating to hygiene, either in the assessment of compliance with the Hygiene Code, or the annual assessment of performance, it may affect their annual rating.

Anna Walker, Chief Executive of the Healthcare Commission, has this week written to all chief executives of NHS trusts informing them of the programme of visits.

Ms Walker said: "Boards at all acute trusts must take notice: chances are you’re going to be assessed against the Hygiene Code, so make sure you’re ready. We don’t want to catch trusts out. We would much prefer to find that everything is in place to protect patients and the public.

"The 120 assessments will be in-depth, from interviews that assess the knowledge of staff, through to checking whether wards and bathrooms have been cleaned properly.

"Visits will be unannounced so that we can see the hospital in action. What we want to know is whether trusts are taking infection control seriously. Is it a key part of their day-to-day business and could it effectively manage an outbreak should it occur?

"Although the Commission seeks to reduce the overall number of inspections it makes, this is one area where we must be out there actively checking.

This is what the public expects of a regulator and is part of our duty to the public. The issue of healthcare-associated infection has rocketed up the agenda over the past few years.

"We are not saying that nothing has improved. Rates of MRSA are starting to drop and that of Clostridium difficile are now rising less quickly. And our recent survey of patients showed that people are reporting improvements in hand-hygiene and cleanliness of the hospital’s environment.

"This is a credit to the hard work that trusts have already done to prevent and manage healthcare-associated infection. It is not easy to control outbreaks of infection, but more can and must be done to protect patients."

Lord Hunt, Minister of State for Quality, said: "I'm very pleased to see the Healthcare Commission is taking this action. Reducing healthcare-associated infections is a top priority for the NHS and all NHS bodies have a duty to comply with the Code of Practice.

"The Commission are empowered to issue improvement notices where necessary but these rigorous checks will ensure that Trusts adhere to the Code and will help to give patients the assurance that, wherever they may be treated, everything possible is being done to keep infections to a minimum."

The Hygiene Code came into force in October 2006. In the same month, the Commission also launched its annual health check, which gives a performance rating to each NHS trust. Ratings are based on a range of indicators including core standards set by the Department of Health.

The Commission subsequently made a series of announced visits at 32 trusts that had declared they were not complying with core standard C4a. This standard relates to directly the Hygiene Code and requires trusts to have systems in place to ensure that the risk of healthcare-associated infection is reduced.

Inspection reports will be published on the Commission’s website at www.healthcarecommission.org.uk throughout the year. The Commission also plans to publish key learnings from the programme of inspections.

Notes to editors