Britain: Deaths linked to hospital infection Clostridium difficile double in two years

The number of deaths linked to the hospital infection Clostridium difficile has more than doubled in the last two years, official figures show. Last year in England and Wales 8,324 people died either from C. diff or were infected with it when they died from other causes - this is a rise of 28 per cent in just one year. The infection which particularly affects elderly people has increased four times over since 2001 when 1,804 deaths were linked to the superbug, data from the Office of National Statistics shows.

Deaths linked to MRSA rose steadily between 2003 and 2005 but have levelled off. In the last year there has been a slight drop of 3.6 per cent in deaths either directly from MRSA or linked to it to reach 1,593.

Andrew Lansley, the shadow health secretary, said the 'vast majority' of these deaths could have been avoided with better prescribing of antibiotics and proper isolation of infected patients. Critics say Labour's waiting list targets have encouraged hospitals to rush through patients leaving wards overcrowded with time for cleaning patient areas between cases.

The data is collected from death certificates where doctors note down one underlying cause of death and can mention any number of other factors that may have contributed. In recent years doctors have been encouraged by Sir Liam Donaldson, the Chief Medical Officer, to mention hospital infections on death certificates where patients have them even if it was not the underlying cause of death. The figures show of the 8,324 death certificates that mentioned C.diff, around half noted it as the underlying cause of death.

C.diff is mainly a disease that affects the elderly who have been in hospital for other reasons and who have received broad spectrum antibiotics. These drugs cut the natural flora in the stomach allowing C.diff to multiply and produce a toxin which causes diarrhoea. The ONS figures there was one death per million people aged under 45 but 2,000 deaths per million people aged 85 and over. The number of actual cases of reported cases of C difficile in the over-65s - the main age group affected - fell by nine per cent from 55,635 in 2006 to 50,392 in 2007.

The Clostridium difficile bacteria is a major cause of antibiotic-associated diarrhoea and the intenstinal infection colitis. In most cases the infection is mild and a full recovery is made. Although elderly and vulnerable patients may become seriously ill through dehydration caused by severe diarrhoea. The more serious symptoms include ulceration and intenstinal bleeding and it can be life-threatening.

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The tragedies that prompted `our massive wake-up call'

Bacteria will be present in hospitals as long as people are, but vital lessons in infection control have been learnt since outbreaks of Clostridium difficile caused the death of at least 90 patients at Maidstone and Tunbridge Wells NHS Trust in Kent.

Sara Mumford, formerly of the Health Protection Agency, the watchdog for infectious diseases, helped to bring attention to how much bad hygiene and poor staffing had contributed to hundreds of infections during the outbreaks of 2005 and 2006, which were later the subject of a high-profile investigation by the Healthcare Commission.

Now the director of infection control at the trust, Dr Mumford has an array of tools and procedures to keep superbugs at bay, she told The Times yesterday. "Unlike MRSA, there is no way of screening for C. difficile, so the most important thing to get right is cleanliness," she said. "Patients, staff and visitors can carry the bacteria into a hospital without knowing it, or become infected in the community. That's why handwashing is so important."

After an infection had been identified, soap and water were not enough, she said. "We use chlorine-based cleaners and have antimicrobial disposable curtains that we remove after an infected patient has been in a ward. During the `deep clean' we evacuated every ward and subjected everything to ultra-sonic baths or other cleaning. "It was so thorough that afterwards the wheels on the beds seized up - they would not run properly because they'd been cleaned of oil. "The most important thing when you suspect an infection is to isolate the patient quickly - even before you get the test results back from the lab," she said.

The isolation facility at Maidstone - introduced only after the notorious outbreaks - is a dedicated 12-bed ward. Dr Mumford said it helped recovery if patients with the same condition could talk to each other. Patients with a C. difficile infection required specialist nursing and treatment, she said, because other factors could also cause avoidable illness. "Antibiotic use in particular is really, really important," Dr Mumford said. "If you give patients broad-spectrum antibiotics designed to kill all bacteria, they get rid of even the types that help keep C. difficile at bay."

The three hospitals run by Maidstone and Tunbridge Wells Trust are now reporting rates of C. difficile that are below the national average. "Maidstone has had a tragic wake-up call and had to undertake a crash-course in infection control, but some trusts still have work to do - it's something that they ignore at their peril," Dr Mumford said.

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Australia: Surgery freeze call over public hospital beds crisis

A ban on elective surgery is being called for as a desperate solution to the chronic shortages of public hospital beds in Queensland's health system. Frustrated emergency specialists have called for a two-week statewide ban on surgery to free up beds. The situation is so critical at hospital emergency departments some patients are forced to sit in waiting rooms for more than 24 hours before being admitted.

Australasian College for Emergency Medicine Queensland chairwoman Sylvia Andrew-Starkey said: "We try really hard not to put elderly people in chairs ... but we've had a situation recently where we've had to put elderly people with pneumonia in chairs for 12 hours or so because we didn't have a bed. "It's awful. It's the worst it's been for years. We're powerless to do anything."

In the past fortnight, some of the state's largest public hospitals - including the Royal Brisbane and Women's Hospital, the Princess Alexandra and Logan - have been forced to go on bypass and redirect ambulances to other facilities because they could not cope with the numbers of patients needing a bed.

In the state's north, a backlog of trolleys and people filled the corridors at Townsville Hospital yesterday as 23 patients waited to be transferred from the emergency ward to beds. Australian Medical Association North Queensland president Dr Sam Baker said Townsville Hospital was overcrowded and in "meltdown" and backed calls for a suspension of elective surgery. "We've got no beds," Dr Baker said. "Staff are being pushed to the limits. It is a bottleneck. It is a shambles. And it is only going to get worse."

Queensland hospitals are so overcrowded that private facilities have also been redirecting patients. "We haven't been able to get a private patient into a private hospital for weeks - they're full too," said Dr Andrew-Starkey, who is based at the RBWH. Freezing elective surgery for a period would free up beds for other patients, taking pressure off emergency departments which are stretched during the traditional winter flu season. "The system needs resetting," Dr Andrew-Starkey said. "I'm not sure suspending elective surgery for a week would be enough. It might take two."

Specialists admit a freeze on elective surgery is a radical step, given lengthy public hospital waiting lists. Queensland Health Minister Stephen Robertson said an elective surgery freeze was unnecessary, but individual hospitals might need to suspend elective surgery from time to time to cope with emergency department demand. "What I do expect is hospital management to make decisions on a daily basis about what is in the best interests of providing safe patient care," Mr Robertson said. "If that means they've got to temporarily suspend elective surgery, then unfortunately, if that decision is made in the interests of patient safety, I support that. I would rather that not be the case, but that's the reality of the very busy times we are experiencing at the moment."

Townsville Hospital staff were yesterday forced to set up makeshift wards in X-ray waiting rooms and lounges. Ten operations were postponed, feeder hospitals at Ingham and Ayr were full, and every nursing home bed in the north Queensland city was occupied. It is the fourth "code yellow" - a complete lack of beds - activated by the hospital in the past two months. Townsville Hospital Acting Director of Medical Services Dr Isaac Seidl said they were working to reduce the likelihood of "ramping" where patients wait outside in ambulances.

Mr Robertson said the situation in Townsville had been exacerbated by 22 nurses calling in sick with "flu-like symptoms", with another 49 off on sick or family leave the day before.

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Update:

PATIENTS have fallen off trolleys in overcrowded hospital emergency wards which overworked doctors describe as the worst they have experienced. The Royal Brisbane and Women's Hospital's emergency department was in "gridlock" yesterday, forcing hospital administrators to redirect ambulances to other facilities for more than two hours, The Courier-Mail reports. As the bypass was declared, 22 patients were sitting in chairs in an overcrowded corridor. Some had been waiting more than 24 hours to be admitted, with no guarantee when a bed would become available.

Australasian College for Emergency Medicine Queensland chairwoman Sylvia Andrew-Starkey said hospital emergency departments were at crisis point. "People don't get fed properly, people get sleep deprived. The staff get frustrated as well. It leads to a whole snowball effect," she said. "I can give you three instances of elderly people falling out of trolleys because they were confused. They should never have been on trolleys in the emergency department." "Increasing the amount of time that patients spend in an emergency department leads to deaths," she said. "The number of long-stay patients in Queensland emergency departments has skyrocketed in the last couple of months."

Health Minister Stephen Robertson said the State Government was moving towards "quarantining" hospital emergency departments from elective surgery to alleviate problems. Opposition Leader Lawrence Springborg said the "entire health system in Queensland is in danger of collapse".

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