Bugs Galore

Inquiry after bug implicated in 20 patient deaths

· C difficile infection more deadly than MRSA · Hospital trust calls in health inspectors

Wednesday September 27, 2006
Health inspectors announced an inquiry yesterday into an outbreak of the hospital infection Clostridium difficile which contributed to the deaths of 20 patients at an NHS trust in Kent.
The Healthcare Commission said C difficile had emerged as the most serious hospital-acquired infection, causing more deaths than the superbug MRSA. Its inspectors will look into an outbreak at Maidstone hospital, where 136 patients were diagnosed with the infection between April and June.
Maidstone and Tunbridge Wells NHS trust said the infection was the definite cause of death of six patients. Another 14 died due to a range of medical problems including C difficile, but the infection was not deemed to be the main cause of death. A further four had C difficile, but it was unlikely to have led to their deaths. The commission said the infection was the major infectious cause of diarrhoea acquired in hospitals in the UK and may cause fatal inflammation of the walls of the intestine.
In July the commission published the findings of an inquiry into three outbreaks of C difficile at Stoke Mandeville hospital near Aylesbury which may have killed at least 41 older people since 2003. Anna Walker, the commission's chief executive, said there were 'serious failings on the part of senior managers [at Stoke Mandeville] who did not follow advice on stopping the spread of infection'.
On this occasion the inquiry has been launched at the request of the Maidstone and Tunbridge Wells trust and its strategic health authority.
Nigel Ellis, the commission's head of investigations, said: 'We recognise that outbreaks of infection such as C difficile are not always easy to control, but when they do happen they pose a very serious risk to patient safety. We need to find out what happened, what systems the trust has in place to ensure this does not happen again and whether further improvements are needed to protect the safety of patients.' A report is not expected until next year.
The trust said it had 136 patients diagnosed with C difficile between April and June. They included people who came to the hospital with the infection as well as those who contracted it while they were there. It took measures to deal with the outbreak, including asking GPs not to send patients to hospital if their only symptom was diarrhoea, changing its antibiotics policy, placing patients with diarrhoea symptoms 'in the most appropriate setting' and providing extra nurses and cleaners.
The number of patients with the infection has now 'returned to the number of patients you would expect to see with C difficile', a source said.
Rose Gibb, the trust's chief executive, said: 'The trust takes the care and safety of its patients extremely seriously. It has approached the Healthcare Commission to independently and publicly scrutinise its handling of the C difficile outbreak after listening to and working closely with members of the public on its own service review.'
According to the Office for National Statistics, in 2003 there were 1,748 mentions of C difficile on death certificates, of which 934 noted the infection as the underlying cause of death.
FAQ What is Clostridium difficile?
C difficile usually causes diarrhoea, but can lead to fevers, severe inflammation, and death in around 5% of cases. Older people are particularly at risk.
How many have been affected?
More than 51,000 people over 65 were diagnosed with it in 2005-06, more than twice as many as in 2002-03.
Did they all catch it in hospital?
No. Many brought it with them when they arrived.
How can hospitals deal with it?
It can be controlled by rigorous hygiene, rapid isolation of infected patients and avoidance of antibiotics.