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Home Topics Infectious Diseases Infections A-Z Antimicrobial Resistance HCAI and Antimicrobial Point Prevalence Survey – England

HCAI and Antimicrobial Point Prevalence Survey – England

Chest radiograph demonstrating bilateral pneumonia

The HPA (part of Public Health England, as of 1 April 2013) coordinated England's participation in ECDC's Fourth National Prevalence Survey on Healthcare Associated Infections & First National Prevalence Survey on Antimicrobial Use and Quality Indicators in England. Hospitals in England participated in data collection between September and November 2011.


This report provides a snapshot of the levels of healthcare-associated infections (HCAI) and levels of antimicrobial use (AMU) in hospitals in England in Autumn 2011. This is the first survey to include hospitals from the independent sector. 

There have been three previous HCAI PPS surveys and the last survey was carried out in 2006. It is difficult to compare each survey as the data was collected in a different way. However, there was an overall drop in HCAI prevalence from 8.2 %in 2006 to 6.4% in 2011.  The prevalence of AMU was 34.7%, no previous national survey has taken place.

The English PPS data collection was undertaken by hospital teams between October and November 2011; 103 organisations surveyed 52,443 eligible patients (50,778 from the NHS and 1,665 (3.2%) from the independent sector. The average age of all patients was 69 years old. A total of 4,372 (out of the 52,443, 8%) children under 16 years of age were also surveyed.

Key results from this year’s survey have shown that:

  • The prevalence of HCAI was 6.4%. A total of 3,360 patients were diagnosed with an active HCAI with 135 patients having more than one.
  • When comparing ward specialties, HCAI prevalence was highest in patients in intensive care units (ICUs) at 23.4% followed by surgical wards at eight per cent. 
  • The most common types of HCAI were respiratory (including pneumonia and infections of the lower respiratory tract) (22.8%), urinary tract infections (UTI) (17.2 %), and surgical site infections (15.7%). Since the last PPS in 2006 there has been a 18-fold reduction overall in MRSA bloodstream infections - from 1.3% to less than 0.1% in patients; and a 5-fold reduction in C. difficile infections (from 2% to 0.4%).
  • The prevalence of antimicrobial use was 34.7%. 
  • Most antibiotic use (53%) in hospitals was in patients receiving treatment for infections which commenced in the community. Thirty percent of surgical prophylaxis was prescribed for greater than one day. 

Download full publications 

English National Point Prevalence Survey on Healthcare-associated Infections and Antimicrobial Use, 2011 (PDF, 1.9 MB) 

English National Point Prevalence Survey on Healthcare-Associated Infections and Antimicrobial Use, 2011 - Appendices (PDF, 3.3 MB) 

PPS Frequently Asked Questions (PDF, 654 KB)

England PPS Steering Group

Chair: Prof. Anthony Kessel, Director Public Health Strategy, HPA
DH representative: Ms. Sally Wellsteed
HIS representative: Dr. Adam Fraise/ Dr. Barry Cookson
IPS representative: Ms. Tracey Cooper
BIA representative: Dr. Louise Teare
ARHAI Chair/ Paediatric representative: Prof. Mike Sharland
BSAC/ARHAI representative/ Pharmacist representative: Prof. Jonathan Cooke
RM – Dr. Bharat Patel
RE  – Dr. Mark Reacher
PHE Colindale – Prof. Barry Cookson, Dr. Liz Sheridan
Coordinators: Dr. Susan Hopkins, Ms. Karen Shaw


1. European Centre for Disease Prevention and Control: Annual Epidemiological Report on Communicable Diseases in Europe 2008. Stockholm, European Centre for Disease Prevention and Control, 2008
2. ECDC, Importance of Surveillance; Surveillance is essential to understanding the epidemiology of infectious diseases.  Website site 13 May 2011 [external link]
3. National Audit Office, Improving patient care by reducing the risk of hospital acquired infection: A progress report, Report by the comptroller and auditor general HC 876 sessiuon 2003-4, London Stationary Office, 2004.
4. Humphreys H, Newcombe RG, Enstone J, Smyth ET, McIlvenny G, Fitzpatrick F, et al; Hospital Infection Society Steering Group. Four country healthcare associated infection prevalence survey 2006: risk factor analysis. J Hosp Infect. 2008 Jul; 69(3):249-57. Epub 2008 Jun 11.

For further information please contact the Public Health England PPS team via email on: