Hospitals failing to curb C Difficile superbug warns watchdogs

More than a third of NHS hospitals do not follow Labour Government guidelines on preventing the spread of the virulent stomach bug Clostridium Difficile, health watchdogs said yesterday. The Health Protection Agency and the Healthcare Commission urged the health service to do more to minimise the risk to patients of Clostridium difficile (C. difficile). C. difficile is a healthcare- associated infection that can cause diarrhoea, sometimes more serious conditions and occasionally death.

The call comes as interim findings of a joint survey, released today, reveal that over a third of trusts surveyed do not routinely follow government guidelines on the management of C. difficile infection in their hospitals.

The survey aimed to provide more information about C. difficile and the measures trusts have in place to deal with the infection.

The agencies are publishing interim findings now, as winter is when the prevalence of C. difficile tends to be highest. More detailed findings will be published in spring 2006.

The two organisations say trusts should:
* Ensure that their policies on antibiotic prescribing are informed by current guidelines on best practice, and that these policies are properly monitored. Current guidance states that trusts should have up-to-date guidelines for treating specific infections, policies to reduce inappropriate administration of broad-spectrum antibiotics*, and regularly monitor antibiotic usage through audit and feedback to prescribers.
* Review their procedures and capacity to isolate patients with C. difficile. The isolation of patients is an effective method of rapidly controlling the spread of infection.
* Ensure that they understand the criteria for testing and reporting samples of C. difficile, and that they comply with the scheme for mandatory surveillance introduced last year. This requires that all NHS trusts report to the HPA the number of cases of infection caused by C. difficile diagnosed in patients 65 years of age and older.

Questionnaires were sent to directors of infection prevention and control. Responses have been received from 118 of the 173 trusts (68%) in England. The survey showed:
* Thirty eight per cent of trusts surveyed said they do not have restrictions in place to prevent the inappropriate use of antibiotics, which would help to minimise the risk of C. difficile infection.
* Over a third of respondents reported that they are unable to routinely isolate patients with C.difficile infection. Only 11% of trusts said they have a ward that can be used for isolating patients with C. difficile.
* Less than half of trusts surveyed use the same recognised definition of an outbreak. Forty percent reported that, in the event of an outbreak, they do not routinely follow guidance, which recommends that they should inform the consultant in communicable disease control.
* Most of the trusts surveyed also reported that they do not routinely inform the relevant authority that is responsible for monitoring their performance i.e. the strategic health authority, or Monitor in the case of NHS foundation trusts.
* Two-thirds of respondents felt that the reported incidence of C. difficile infection has increased in their trust during the past three years.
* A quarter of trusts reported they had closed wards in the past 12 months due to cases of C. difficile.

Responses confirmed that cases of C. difficile are not confined to older people: 41% of trusts estimated that one out of ten cases affected people under the age of 65.

Respondents thought that the most practical measures to reduce the incidence of infection from C. difficile were: improved prescribing of antibiotics (55% of trusts); isolation of patients (39%); clean environments (32%); and improved hygiene (19%).

Over two thirds of trusts thought that the prescribing of antibiotics and the lack of facilities for isolation represented the greatest challenges to controlling infection.

Despite concerns that the severity of the infection has increased in the past few years, most of the trusts surveyed do not routinely collect clinical data on patients with the infection. Sixty-five per cent of trusts reported that they do not routinely record information on deaths from C. difficile.

Marcia Fry, Head of Operational Development at the Healthcare Commission, said “This survey reflects the views of the trusts of their own arrangements for managing C. .difficile. It is deeply worrying that a significant number of trusts are not managing to implement existing guidance on C. difficile. We recognise that these outbreaks are not easy to control, but trusts must do more to ensure that they have systems in place to protect patients from this potentially lethal infection. We and the HPA will be working with them on this.”

Professor Peter Borriello, Director of the Centre for Infections at the Health Protection Agency, said “Although we are concerned to see that guidance is not implemented in a uniform way among trusts, the results of this survey will help us to improve our surveillance of C. difficile and learn more about how trusts treat patients and tackle outbreaks. This will then inform the way in which we work with trusts to protect patients”

The Healthcare Commission and the Health Protection Agency will incorporate learning from these interim findings, and the final report, into their respective programmes of work.

For example, the Healthcare Commission will take into account trusts compliance with procedures for the control of infection in its annual health check on NHS trusts and its assessment against the expected hygiene code, the legislation for which is going through the House of Commons.

http://www.healthcarecommission.org.uk/NewsAndEvents/PressReleases/PressReleaseDetail/fs/en?CONTENT_ID=4022047&chk=n0pJM/