Friday, October 12, 2007

NHS superbug negligence kills 90

At least 90 patients died and more than 1,100 became infected as hospital managers failed to control the worst outbreaks ever recorded of the super-bug clostridium difficile, a report states today. Inadequate staffing levels, dirty wards and too much focus on cost-cutting and government targets contributed to two serious outbreaks of C difficile in as many years at Maidstone and Tunbridge Wells NHS Trust, an investigation by the Healthcare Commission found. The Health and Safety Executive and Kent Police are now considering the possibility of criminal charges being brought against the trust or its executives.

The commission found "significant failings" in infection control at three hospitals run by the trust between April 2004 and September last year, including unwashed bedpans, a lack of isolation units, beds being spaced far less than the recommended 3.6 metres apart to stop the spread of infection and nurses telling some patients with diarrhoea to "go in their beds". Pictures taken as recently as February disclosed continuing hygiene concerns. Rose Gibb, the chief executive of the trust, left her job on Friday by mutual agreement with the board.

The failure to contain and treat infections at all levels contributed to 1,176 patients being infected with the bug at Kent and Sussex Hospital, Pembury Hospital and Maidstone Hospital, Kent, the watchdog said. A total of 345 patients died while infected with the bacterium between April 2004 and September 2006, 21 died as a direct result of infection and for 69 patients it was probably the main cause of death, it added. In addition, C difficile could also be considered a "contributing factor" in as many as 241 of the deaths, although the report said that patients, many of them elderly or frail, may well have died of other causes if they had not acquired the infection. The trust had previously told the Healthcare Commission there had been "no deaths that were definitely caused by C diff" between April 2004 and March 2006.

The first big outbreak was between October and December 2005 but, despite the number of infected patients quickly doubling to 150, the trust did not identify the outbreak. The second significant outbreak was between April and September 2006, in which 258 patients were affected, and was recognised as serious by the trust. But despite these problems, the trust declared itself compliant with national government standards for hygiene and infection in May 2006.

At the time of the outbreaks the trust was carrying out a programme to save 40 million pounds over three years in the face of huge debts. At the end of 2003, the trust had an accumulated deficit of 17.6 million. Last year, it reported a deficit of 4.5 million.

The commission said that there was evidence patients had been moved between several wards, increasing the chance of spreading infection. It said this was partly due to concerns over hitting the Government's targets on waiting times for treatment in A&E.

Anna Walker, the chief executive of the commission, said that the lack of infection control at the trust had been "unacceptable" but that conditions had improved as a result of monitoring by the commission. Improvements included increasing the space between beds, appointing a new director of infection prevention and control and implementing a policy on the use of antibiotics which are known to help C difficile thrive.

"What happened to the patients at this trust was a tragedy," Ms Walker said. "This report fully exposes the reasons for that tragedy, so that the same mistakes are never made again." She called for the NHS to treat C difficile as an illness rather than just an added complication.

Health Protection Agency figures showed that rates of C difficile are now lower than the NHS average last year. A spokeswoman for the Health and Safety Executive said that it was working with Kent Police to consider the report.

Patients were treated on open wards instead of in isolation. A former children's ward was being used for adults. It contained an uncleaned shower, one wash basin for 12 beds and beds placed only 30cm (less than a foot) apart. A shortage of nurses contributed to the spread of infection "because they were too rushed to undertake hand hygiene, empty and clean commodes, clean mattresses and equipment properly" and wear aprons and gloves. High bed occupancy - over 90 per cent at Maidstone and the Kent and Sussex - led to less time for cleaning. Staff used alcohol wipes, which are ineffective against C. Diff spores, to clean commodes instead of soap and water. Old commodes were used despite the trust agreeing to replace them and setting aside 250,000 pounds to do so


Political stupidity about superbug prevention

Government plans for tackling superbugs, such as MRSA, have been condemned by a leading medical journal for not being based on scientific fact. The Lancet said there was little evidence to support hospital "deep cleans" or short-sleeves for medical staff as recently proposed. Instead of "pandering to populism" politicians should listen to the evidence, the editorial said.

The government said the plans were part of a wide range of preventive measures. On Sunday, Prime Minister Gordon Brown announced plans to "deep clean" hospitals ward-by-ward over the next year to return hospitals to the state they were in when they were built. His comments followed proposals from Health Secretary Alan Johnson for a new dress code for NHS staff which would advise against long-sleeved coats and ties for doctors as they can become contaminated.

But The Lancet said a government working group had found no conclusive evidence that uniforms or other work clothes posed a significant hazard in terms of spreading infection. And the focus should be on disinfection of high-touch surfaces rather than deep-cleaning wards to get rid of visible dirt, the journal said.

The editorial said: "Brown also plans to double the number of hospital matrons, to check on ward cleaning, and accost doctors wearing long sleeves. "They would be better employed making sure doctors, nurses and visitors wash their hands properly, the proven way to stop hospital acquired infections," the editorial stated.

Professor Richard James, director of the Centre for Healthcare Associated Infections at the University of Nottingham agreed the evidence on transmission of infection from clothing such as long sleeves was not clear but short sleeves may encourage staff to wash their hands properly. He added: "The main route of transmission of MRSA is person-to-person contact and this will be affected little by deep cleaning.

"In contrast, Clostridium difficile is transmitted by contact with faecal contamination so it may be more effective here." He said in addition to hand washing, other useful strategies would be screening patients for MRSA on admission, regular use of hydrogen peroxide vapour generators to kill bugs in the hospital environment and educating patients and visitors on ways they can reduce risk.

Chief Nursing Officer, Professor Christine Beasley said there was no single solution and the new proposals were part of a wider set of measures to reduce hospital-acquired infections. She agreed that there was no evidence that uniforms themselves pose a significant risk of transmitting infections but said long sleeves and watches "get in the way of washing and decontaminating the hands, wrists and forearms". "Clean and tidy hospitals and staff are very important to patients," she said. "We make no apology for asking hospitals to take every reasonable measure to reduce infection and increase patient confidence that this is an issue the NHS is taking seriously."

Dr Mark Enright, an expert in molecular epidemiology at Imperial College, London said deep cleaning would be a waste of resources and an inconvenience to patients and staff. "MRSA is a major problem in the UK because it is present, mostly unknowingly, in patients and staff. "Interrupting the chain of transmission from these people to new hosts should be the main focus of infection control, not attempts at the sterilisation of floors and windows."


Australia: Public hospital doctors revolt against NSW government lies

HEALTH Minister Reba Meagher's credibility is in tatters today as leading emergency doctors break their silence to condemn patient care at Royal North Shore Hospital. As the minister frantically downplayed The Daily Telegraph's revelation that a 91-year-old grandmother had been placed in a supply room, experts came forward to tell the truth about the RNS.

NSW chairman of the Australasian College for Emergency Medicine, RNS senior emergency doctor Tony Joseph, disputed the minister's claims that the rooms were used for "clinical" reasons. He confirmed it was hospital policy to shuttle patients into rooms not designed for patients when the emergency department overflowed. "They are unsafe and it is part of the over-crowding policy," Dr Joseph told The Daily Telegraph. "When emergency departments are bursting . . . they will put patients in these side rooms."

The "over-census" policy was even admitted to by one of Ms Meagher's hospital bureaucrats, who said the side rooms were used to deal with over-crowding. The 91-year-old's granddaughter yesterday said the family were unhappy with the treatment of their frail grandmother


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