It is that no amount of central guidance, top-down imposition of an annual steam clean of wards, the creation of extra matrons or ward sisters’ right to demand better cleaning – some of the government’s headline solutions – is going to solve the problem.

The Healthcare Commission’s investigation shows that copious existing guidance – on antibiotic use, on hand-washing and disinfection, on infection surveillance, on patient isolation – was simply not followed.

Nor does the easy explanation that the pressure of government waiting time targets, on their own, somehow “caused” the outbreak hold water.

C. difficile infections are on the rise, with hospitals struggling to control them. There may indeed be other, as yet undisclosed, scandals to follow those of Maidstone and Stoke Mandeville, where 33 patients died between 2003 and 2005.

But there are several hundred acute hospitals in England and, in the four years since the first Stoke Mandeville outbreak, the overwhelming majority have balanced the competing demands of finance, waiting times and infection control without such disastrous outbreaks of hospital acquired infection.

“The government does not want to admit there could be a conflict between lots of ­targets and hospital infections,” Richard James, Professor of Microbiology at Nottingham University says. “And I understand that many other trusts cope. But with such a large number of them, it is inevitable that some will be better than others.”

The most striking part of the commission’s investigation, he says, is the “mirror image” findings with what happened at Stoke Mandeville – parallels that the commission itself highlights.

These might be characterised as the risks of reorganisation. Both trusts had undergone difficult mergers, both were preoccupied with finance and both were trying to reconfigure services and build a private finance initiative (PFI) hospital.

Both had old hospitals with many large “Nightingale” wards and few single rooms in which to isolate patients.

Both had also cut nurse staffing levels and beds, producing very high occupancy levels, and both ignored the complaints of patients and relatives that would have highlighted the risks, and the outbreaks, earlier. And both allowed the governance arrangements, at board and infection control level, to be “over-ridden by other imperatives, including targets relating to finance and access”.

Waiting times and finances are important, the commission said, but they should not be “at the price” of infection control.

The Maidstone trust closed wards at one hospital to transfer work to others but with “no evidence” that it sought the efficiencies needed to allow it to cope if demand for beds remained high.

More than 90 per cent of beds were occupied and, Prof James says, “it is well established that occupancy rates above 85 per cent make infection control difficult because staff are rushed and isolation is difficult to do”.

Newer hospitals with more single rooms make that easier, he says. But infection control, according to Prof James, is essentially about behaviour.

“The first thing that is needed is for politicians to admit the scale of the problem,” he said. “We let the genie escape the bottle in the early 1990s and it is going to take years to put it back.”

Screening patients for the superbug MRSA will help, he said “and we can model that, to show that rates of blood-borne MRSA infections would get down to the best in Europe over six years”.

But it is likely to take that long, he said, and even then other measures, notably isolation and hand washing, are needed to tackle C. difficile.

Doing so, and reducing excessively high bed occupancy, health professionals acknowledge, is likely to have a small, but measurable, effect on waiting times.

From:
http://www.ft.com/cms/s/0/f4e40090-7920-11dc-aaf2-0000779fd2ac.html

The damming verdict from the Healthcare Commission was echoed by the Lancet last month when Health Direct posted: Stalinist Brown’s superbug plans ignore scientific evidence claims Lancet on Fri 28 Sep 2007- Labour 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 mentioned by Health Direct.

Instead of “pandering to populism” politicians should listen to the evidence, the editorial said.

The Lancet said a labour government working group had found no conclusive evidence that uniforms or other work clothes posed a significant hazard in terms of spreading infection.

Instead 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 main route of transmission of MRSA is person-to-person contact and this will be affected little by deep cleaning.”