Confronting infection in the English National Health Service.

It is exactly 160 years since Ignác Semmelweis was removed from his post as lecturer in obstetrics in Vienna for introducing hand decontamination for medical students between the autopsy room and the delivery suite. Fortunately, he was later reinstated and then was able to continue his pioneering work as Professor of Obstetrics in Budapest. Yet even now the challenge of healthcare associated infections (HCAI) for the NHS in England is represented by over 7000 reports of meticillin-resistant Staphylococcus aureus (MRSA) bacteraemia in each of the five years since mandatory surveillance was instituted in 2001, and by mandatory surveillance of Clostridium difficile associated diarrhoea showing over 44,000 cases in 2004 and nearly 52,000 cases in 2005 in patients over 65 years old. The programme to address HCAI in the NHS in England is one of biology, politics, and performance management, which are not always comfortable partners.