Healthcare-associated infections (HCAIs) are among the most persistent and serious patient safety challenges in the NHS. The UK has made remarkable progress — MRSA bacteraemia has fallen by 76% since its peak in 2007/08. But in 2024/25, MRSA cases are rising again, C. difficile infections are increasing sharply enough to trigger a national incident response, and E. coli bacteraemia continues its long-term growth. Antimicrobial resistance (AMR) — the capacity of bacteria to defeat the antibiotics used to treat them — threatens to reverse decades of progress.
Key facts and figures
- 1,064 cases of MRSA bacteraemia reported by NHS acute trusts in England in 2024/25 — a 16.9% increase from 2023/24 (910 cases) (UKHSA, February 2026).
- 76.1% lower — despite the increase, MRSA remains 76.1% below the 2007/08 peak of 4,451 cases.
- 1.9 per 100,000 — the incidence rate has fallen from 8.6 per 100,000 population (2007/08) to 1.9 per 100,000 (2024/25).
- Zero tolerance — NHS England has a zero-tolerance policy for healthcare-associated MRSA bacteraemia.
- National incident — C. difficile infections are increasing, and UKHSA has stood up a National Incident Response due to rising CDI rates in England in 2024/25.
- 43,639 cases of E. coli bacteraemia in England in 2024/25 — up 3.3% — with 8,397 (19.2%) hospital-onset cases.
- Up 35.1% — E. coli bacteraemia has increased 35.1% since 2012/13 (from 32,309 to 43,639 cases).
- 13,438 Klebsiella species bacteraemia cases in 2024/25 — up 2.5%.
- 4,474 Pseudomonas aeruginosa bacteraemia cases in 2024/25.
- 17% reduction — the AMR National Action Plan 2024–2029 targets no increase in gram-negative bloodstream infections from the 2019/20 baseline by 2029, effectively requiring a 17% reduction in underlying rates given population ageing trends.
- Hundreds of £millions — the cost of healthcare-associated infections to the NHS runs to hundreds of millions of pounds per year in additional bed-days, treatment and remediation.
- Hand hygiene — compliance remains the single most cost-effective intervention for reducing HCAI.
MRSA: progress and resurgence
From a peak of 4,451 cases in 2007/08, sustained MRSA prevention efforts reduced the rate to just 1.2 cases per 100,000 population during the COVID years (2020–2022). The increase to 1,064 cases in 2024/25 — a 16.9% rise — is concerning. While levels remain dramatically below the pre-intervention peak, any upward movement in a zero-tolerance indicator demands serious attention. The causes are under investigation but likely reflect NHS capacity pressures, reduced infection prevention and control (IPC) resource during and after the pandemic, and antimicrobial resistance trends.
C. difficile: a national incident response
Clostridioides difficile (C. difficile, or CDI) is a bacterial gut infection typically affecting patients who have received antibiotics that disrupt normal gut flora. It causes severe diarrhoea, colitis, and in serious cases, toxic megacolon and death. Rising CDI rates in 2024/25 prompted UKHSA to stand up a National Incident Response — the first such escalation for CDI in many years. CDI infection rates at some trusts exceed NHS England trajectory thresholds.
Key risk factors include:
- Antibiotic use (particularly broad-spectrum)
- Advanced age
- Hospitalisation
- Immunosuppression
- Proton pump inhibitor use
E. coli bacteraemia: the growing challenge
With 43,639 cases in 2024/25, E. coli bacteraemia dwarfs MRSA in absolute terms — a 35% increase since surveillance began in 2012/13. The majority of cases are community-onset (arising from UTIs and bowel conditions), but 19.2% (approximately 8,400 per year) are hospital-onset. Preventing hospital-onset E. coli bacteraemia requires rigorous urinary catheter care, wound management, hand hygiene, and environmental cleaning.
| Organism (England, 2024/25) | Cases | Change on prior year |
|---|---|---|
| MRSA bacteraemia | 1,064 | ▲ 16.9% |
| E. coli bacteraemia | 43,639 | ▲ 3.3% |
| Klebsiella species bacteraemia | 13,438 | ▲ 2.5% |
| Pseudomonas aeruginosa bacteraemia | 4,474 | — |
Hand hygiene: the most important intervention
The most evidence-based, cost-effective intervention for reducing healthcare-associated infections remains consistent and correct hand hygiene. The "5 Moments for Hand Hygiene" framework (WHO) is the global standard. Alcohol hand gel alone is ineffective against C. difficile spores — soap and water are required for CDI prevention.
Antimicrobial resistance
The AMR National Action Plan 2024–2029, published by the UK Government in May 2024, sets out commitments to:
- Prevent any increase in gram-negative bloodstream infections from the 2019/20 baseline by 2029
- Reduce total antibiotic use in human populations by 5% from the 2019 baseline
- Increase UK public and healthcare professional knowledge on AMR by 10%
AMR is listed on the UK Government's National Risk Register. The WHO has declared it one of the top 10 global public health threats. For workplaces that handle biological agents or hazardous substances, robust controls and competent staff are central to prevention — the principles behind COSHH training apply directly to controlling exposure to biological hazards.
Sources & references
- UKHSA / Gov.UK – Annual Epidemiological Commentary: MRSA, MSSA, C. difficile and Gram-Negative Bacteraemia, FY 2024/25 (February 2026)
- UKHSA Data Dashboard – Healthcare-Associated Infections
- Gov.UK – Healthcare-Associated Infections (HCAI) Statistics
- Gov.UK / DHSC – Confronting Antimicrobial Resistance 2024 to 2029 (AMR National Action Plan)
From food hygiene and fire safety to first aid, mental health and more, we offer a wide range of accredited, online courses you can start today.
Browse all 22 accredited courses →
Mark writes about workplace health and safety, compliance and accredited online training for Online CPD Academy.