Addressing healthcare inequalities in IPC

The burden of infectious diseases, and healthcare‑associated infections (HCAIs) in particular, is not evenly distributed. People living in the most deprived communities, those from some ethnic minority groups, and people in inclusion health groups (such as those experiencing homelessness, imprisonment, or insecure migration status) experience higher rates of infection, more severe outcomes, and poorer access to prevention and care. Recent UK analyses make this uncomfortably clear: emergency hospital admission rates due to infectious disease are almost twice as high in the most deprived areas compared with the least deprived, with stark differences also observed by ethnicity and geography (UKHSA, 2025). I was involved in a study some time ago that bore this out – those suffering from material and social deprivation were more likely to be infected or colonised with MRSA.

This post has been written in preparation for Kerry Holdens upcoming Insight Webinar on this topic, scheduled for Wednesday this week (register here).

Why inequalities matter for IPC

Health inequalities arise from complex, interacting structural factors: socioeconomic deprivation, housing quality, access to healthcare, occupational risk, environmental exposures, and discrimination. These determinants shape both infection risk and exposure to healthcare systems, where HCAIs may occur. There’s an awful lot of co-correlation between these variables, which makes true causation difficult to determine. But the bottom line is that inequality, deprivation, and infectious diseases go hand-in-hand.

From an IPC perspective, this means that some patients arrive sicker, later, and with fewer protective layers. It also means that staff working in high‑pressure environments serving marginalised populations may face higher operational risks and fewer resources. Ignoring these realities risks designing IPC programmes that work well “on average” but fail those who most need protection.

Inequalities within the hospital setting

Health inequalities are often framed as a community or public health issue, but they do not stop at the hospital entrance. Within healthcare organisations, inequalities can influence:

• Access to timely diagnosis and treatment, including delays in blood cultures, imaging, or specialist review.
• Risk of device‑associated infection, where higher acuity, greater comorbidity, and longer lengths of stay increase exposure.
• Communication and consent, particularly when language barriers, health literacy, or trust in healthcare systems are limited.
• Environmental exposure, including overcrowded wards, older estate, or higher bed occupancy in organisations serving deprived populations.
• Lower vaccination uptake.
• Increased rates of antimicrobial resistance.

These factors intersect directly with IPC priorities such as antimicrobial stewardship, vascular access management, environmental hygiene, and water safety.

Moving beyond “one‑size‑fits‑all” IPC

Traditional IPC guidance is necessarily standardised, but implementation does not have to be uniform. An equity‑informed IPC approach asks not just “Does this intervention work?” but “For whom does it work, and under what circumstances?”. And perhaps also “For whom does this not work, why not, and what can be done to change this”!

Practical steps might include:

• Using local data intelligently, stratifying HCAI surveillance by deprivation, ethnicity, and service line where possible to identify hidden variation.
• Targeting prevention resources, such as screening, antimicrobial stewardship, or vascular access support, to areas with the highest burden rather than distributing effort evenly.
• Designing services around patients, including flexible clinic models, outreach‑linked pathways, and improved interpretation and engagement support.
• Supporting the workforce, recognising that staff working in under‑resourced or high‑turnover settings may need additional training, time, and psychological safety.

These approaches align with wider public health thinking that sees inequalities as systemic and avoidable, rather than attributable to individual behaviour alone (POST, 2025).

Measurement, accountability, and leadership

One of the most important recent developments in England has been the creation of consistent metrics to describe inequalities in infectious disease and health protection (UKHSA, 2025). This is helpful, and informs a data-led approach to monitor progress in this important area. Leadership is crucial here. Boards and executive teams should expect IPC assurance papers and quality reports to consider equity explicitly, not as an afterthought, as part of routine governance. Addressing inequalities is not about lowering standards in challenging settings; it is about raising standards intelligently where risk is greatest.

A core IPC responsibility

IPC has always been about fairness - protecting patients, staff, and communities from avoidable infection. In a health system where disadvantage and infection risk so clearly overlap, tackling inequalities is a core IPC responsibility.

The challenge now is to translate high‑quality national analysis into local, practical action by using data, partnership, and behaviour change insights to design IPC systems that work for everyone, not just the ‘average’ patient.