UK health groups look abroad to fight MRSA superbugs

UK companies developing products that fight MRSA hospital superbugs are complaining that there are few opportunities in their domestic markets, and focusing their sales efforts overseas.

In the UK, hospital acquired infections (HAI) such as MRSA and clostridium difficile affect 300,000 patients each year and cause about 5,000 deaths- nearly double the number of people killed in road accidents.

The problem is worse in the US, where HAIs are estimated to be one of the top 10 causes of death, claiming close to 100,000 lives every year.

And the costs are mounting. In the US, government studies estimate that the extra cost of treating a patient with HAI averages almost $9,000 (£5,600).

UK companies are among the leaders in the fight against superbugs but they say that they are encountering problems in getting their products adopted by UK hospitals. They complain that hospital managers lack accountability for deaths relating to HAIs.

In November, a report by the Department of Health criticised the NHS for not achieving “measurable reductions” in HAIs outside of MRSA and C.difficile.

“The heart of the problem is that whatever DoH says or decrees, it doesn’t necessarily impact hospitals,” says Nick Adams, chief executive of Bioquell, the decontamination technology provider. “In the US, a hospital can be sued and that’s a big deal because they’re desperate to keep it out of the press, so they’ll settle. In the UK, hospitals pass the issue very quickly on to the NHS litigation board, so it’s not the hospital’s problem.”

Synergy Health is another company that produces decontamination technology. It has concentrated its sales efforts in Asia and Europe.

One of Synergy’s decontamination products uses a disinfectant technology produced by another company, Byotrol, that has been tested by the NHS in an 11-month study. The Byotrol technology was deployed against a bleach-based product currently used by the NHS.

Despite positive results showing superior effectiveness and lower side effects, the product has not been taken up, even by the Manchester Royal Infirmary where it was tested.

Richard Steeves, Synergy’s chief executive, says that his group is making more sales to countries where hospitals are encouraged to innovate, such as in the Netherlands, where “hospitals are competing for patients”.

Although there is state-funded national insurance for health care in the Netherlands, hospitals compete with each other to provide services for a number of private insurers.

Most UK hospitals are run by the NHS, and Dr Steeves points out that many of the UK’s private hospitals are owned by private equity, and that there is financial pressure to reduce costs.

However, there are those in the sector that say that innovation by UK companies is a direct result of the “laissez faire” environment.

Paul Swinney is chief executive of Tristel, which produces a chlorine dioxide-based disinfectant that treats everything from salads in supermarkets to surgical instruments and surfaces.

Its product is used throughout the UK, which Mr Swinney says is “de facto approval”. Moreover, he says, companies here do not have to pass the expensive regulatory procedure of the US Food and Drugs Administration or the Environmental Protection Agency.

From:
http://www.ft.com/cms/s/0/f989ee86-f405-11de-ac55-00144feab49a.html?nclick_check=1

David Cameron sets out policies to boost NHS

David Cameron has pledged to protect spending on the NHS as he set out twenty policies to boost Britain’s health services if the Conservatives win the forthcoming general election.

Launching the Conservatives’ election campaign, Mr Cameron said that health care was his top priority and that he represented “the party of the NHS”.

The Conservative leader pledged to channel more health spending to poorer areas to tackle the growing gap in life expectancy between the wealthier and less well off.

A new maternity service giving mothers greater choice will also be set up if the Tories are elected.

Mr Cameron published the first chapter of a “draft manifesto” detailing twenty Conservative policies for the NHS.

These included a pledge to end mixed sex hospital wards, a plan to withhold funding from hospitals which infect patients with MRSA, and new proposals to give patients detailed information about the quality of treatment from each doctor, hospital or surgery.

Patients will also be given more opportunity to manage their own care and could receive treatment for minor ailments at their local pharmacist.

In a speech to Conservative activists, Mr Cameron said: “Today, the Conservatives are the party of the NHS. But talk is cheap. You've got to back that with action, and we have.

"We are the only party committed to protecting NHS spending. I'll cut the deficit, not the NHS. And don't for one minute buy the Labour claim that they'll do the same. They won't - and their own figures show they won't.

"Unlike us, they have not committed to protecting areas of the health budget such as public health and capital investment."

Mr Cameron accused Labour of failing to tackle the gap in health between rich and poor, describing it as "one of the most unjust, unfair and frankly shocking things about life in Britain today".

"Health inequalities in 21st century Britain are as wide as they were in Victorian times," he said.

He promised the Tories would introduce a new health premium that would divert cash to the poorest areas and "banish health inequalities to history".

"With our plans, the poorer the area, the worse the health outcomes tend to be, so the more money they can get," he said, adding that local people would decide how it was spent.

From:

http://www.telegraph.co.uk/David-Cameron-sets-out-20-policies-to-boost-NHS

Ban on hospital flowers over MRSA fears are wrong

Many hospitals have banned fresh flowers on wards amid concern that they could harbour potentially harmful bacteria or pose a health and safety risk like MRSA and superbugs.

But new research and a survey among staff and patients at the Royal Brompton Hospital and the Chelsea & Westminster Hospital, both in London, found there is little evidence to support some of the concerns around the presence of blooms on wards.

In a study by Giskin Day and Naiome Carter of Imperial College London, and published in bmj.com, it was even claimed flowers could help improve a patient's health and recovery.

One of the reasons given to support the ban was that flower water contained high levels of bacteria, but subsequent research has found no evidence to suggest that it has ever caused a hospital acquired infection.

Southend University Hospital recently imposed a ban on flowers on the grounds that they posed a health and safety risk around high tech medical equipment.

But the report argues that flower vases are no more risky than having crockery containing drinks or food around bedsides.

Interviews with staff in this study however found that nurses were generally more concerned about the practical implications of managing flowers than risks of infection.

Other studies report that flowers have immediate and long term beneficial effects on emotional reactions, mood, social behaviours, and memory for men and women alike.

One trial found that patients in hospital rooms with plants and flowers had reduced systolic blood pressure and heart rate; lower ratings of pain, anxiety, and fatigue; and had more positive feelings.

The authors of the report said given that flowers and herbs have been used as remedies in the earliest hospitals, and as a means of cheering up the hospital environment for at least 200 years, it seems remarkable that flowers still tend to be treated in an ad hoc fashion in hospitals.

Although flowers undoubtedly can be a time consuming nuisance, the giving and receiving of flowers is a culturally important transaction, the report concludes.

In an accompanying editorial, Simon Cohn, a medical anthropologist at Cambridge University argues that flowers have fallen victim to new definitions of care.

Describing the decision to ban flowers, he said: “[The decision] seems to reflect a much broader shift towards a model of care that has little time or place for more messy and nebulous elements.”

Katherine Murphy, director of the Patients Association, said: "Most patients love flowers. The job of nurses is to be the patient's advocate and carer. Surely it is not beyond management capabilities in a trust to ensure that the needs of patients and staff are accommodated.

"If flowers on wards pose such a problem, it's no wonder that critical patient safety issues appear to be insoluble."

Flowers are just one of the items to have fallen foul of strict hospital health and safety regulations.

Mobile phones have long been forbidden on many hospital wards, even though a government report in 2007 said there was no justification for a blanket ban.

Doctors were banned from wearing watches and jewellery last year because of fears that they were an infection hazard.

An NHS Trust in Sheffield also banned nurses from wearing Crocs shoes at work, as the static electricity they generated could disable hospital equipment.

Perhaps the strangest ban, though, was at the Fazakerly Hopsital in Liverpool, where the controversial ITV television programme The Jeremy Kyle Show has been banned after complaints that it was upsetting patients. Well you win some, you lose some.

From:

http://www.telegraph.co.uk/health/healthnews/6824574/Hospital-flowers-not-harmful-report-claims.html

MRSA superbugs not the only threat to NHS warns MPs

The labour government has taken its "eye off the ball" on hospital infections other than MRSA and Clostridium difficile, a cross-party group of MPs says.

The Public Accounts Committee said setting targets in England for the two infections had led to a fall in cases.

But they warned there were signs other bugs, such as E. coli, were becoming more common and they called for better surveillance to curb the problem.

In England, MRSA rates are now a quarter of what they were at their peak in 2004, while C. difficile rates have fallen by nearly a third in the past year, following the introduction of targets.
   
THE OTHER THREATS
E. coli
Pneumonia
Surgical site infections
Urinary tract infections
Gastrointestinal infections
Skin infections

But the MPs said these only accounted for about a fifth of the total number of all infections seen in hospital.

While MRSA is the most high-profile bloodstream infection, E. coli is much more common and has actually increased by a third in the past four years, the report said.

It also highlighted surgical site infections, which were twice as common as bloodstream infections, and respiratory and urinary tract infections, which were three times as common.

MPs warned there was still no robust data on the extent and risks of at least 80% of bugs linked to hospital care.

Committee chairman Edward Leigh said this report was the third time the committee had warned about the threat of other infections, adding it was "disappointing" the issue had yet to be addressed.

"The government has taken its eye off the ball regarding all other healthcare associated infections - which actually constitute most by far of all infections."

The report suggested hospitals start reporting all types of infection and that they look to curb the use of antibiotics.

Professor Mark Enright, an infections expert at Imperial College London, said: "I can understand why the government focused on the infections it has, but now we are getting to grips with those it is time to look elsewhere.

"There are some strains of infections, such as E. coli, where we are seeing increasing levels of antibiotic resistance and that is concerning."

Nigel Edwards, of the NHS Confederation, which represents trusts, agreed it was time to review other infections.

But he added: "We would want to know the balance of costs and benefits from additional surveillance."

Katherine Murphy, director of the Patients Association, said: "This target culture is just like squeezing a balloon - if you squeeze one end it will bulge out at the other.

"But the problem for patients is that the balloon stays the same size. The problem of patient safety will stay the same huge size as long as it is regarded as an optional extra by some."

From:
http://news.bbc.co.uk/1/hi/health/8351269.stm

Five die in hospital superbug outbreak

An outbreak of the Clostridium difficile (C. diff) superbug has killed two hospital patients and contributed to the deaths of three more.

The patients were among a total of eight elderly people who contracted the infection at Ninewells Hospital in Dundee over an 18 day period.

All of those affected had been in the hospital's ward 31, which generally cares for geriatric patients.

Seven of the patients had contracted the more dangerous 027 strain.

NHS Tayside said it carried out regular testing in order to detect C. diff outbreaks early.

Dr Gabby Phillips, lead infection control doctor for Ninewells Hospital, said the ward remained closed to new admissions.

The hospital has been dealing with the outbreak since September, over a 10 week period.

The deaths occurred between 19 October and 6 November.

'Appropriate measures'

Dr Phillips added: "We have comprehensive infection monitoring procedures throughout our hospitals and these are able to rapidly identify any emerging trends of infection which then trigger a rapid response from our infection control teams.

"These cases of C. diff infection were detected very early which meant we were then able to identify the 027 strain rapidly and reinforce all appropriate infection control measures.

She added that the hospital had sought external advice over its policies and procedures, and had been "reassured that our surveillance systems are robust".

From:
http://news.bbc.co.uk/1/hi/scotland/tayside_and_central/8352612.stm

Swine flu could lead to rise in MRSA

A second wave of swine flu hitting Britain could lead to a rise in MRSA infections, medics have warned.

The MRSA Working Group, together with National Concern for Healthcare Infection and the Patients Association, is calling for the early discharge of patients from hospital to try and prevent a rise in the killer superbug.

They said when hospital bed occupancy rates were high, MRSA infection rates increased.

The group has written to all NHS hospital staff, reminding them to review their policy for the early discharge of MRSA patients.

The also urge hospitals not to let increasing pressure on staff and rising bed occupancy rates during winter to reverse the good work they have done to date to reduce MRSA rates.

Department of Health research has shown that when a hospital's bed occupancy rate exceeds 90%, MRSA rates can be as much as 40% above average.

Dr Matthew Dryden, consultant microbiologist at the Royal Hampshire County Hospital and General Secretary of the British Society of Antimicrobial Chemotherapy, said: ''The NHS has been working really hard to plan for swine flu and ensure there will be enough hospital beds available for patients who need to be admitted.

''What we don't want to see is an increase in infections such as MRSA, which have been linked to high bed occupancy rates.

''A way to get around this is to support patients with infections to get out of hospital earlier with outpatient and home care and good antibiotic stewardship.''

The letter to hospitals outlines methods to help ensure sufficient critical care beds are available this winter through identifying MRSA patients and discharging them early. Studies have shown that providing IV treatment at home or switching eligible patients to oral antibiotics could free-up scarce hospital beds by enabling patients who are well enough to go home earlier.

''When faced with a difficult winter, it is vital that hospitals ensure sufficient beds are available,'' said Dr Dryden.

''Treating patients with infections such as MRSA at home can help by reducing their length of stay in hospital, freeing up much-needed beds and easing pressure on staff and resources.

''It also helps to improve a patient's quality of life.''

Katherine Murphy of The Patients Association, who co-signed the letter, said: ''There is a real risk that swine flu patients may block isolation beds resulting in patients with healthcare infections such as MRSA being treated on general wards.

''This coupled with a highly pressured and reduced workforce, could increase the risk of infections such as MRSA spreading to other vulnerable patients and throughout the hospital.''

Neil Manser, of the NCHI, added: ''Where possible and when it is clinically prudent, patients who have been infected or colonised with infections such as MRSA should be treated in the safety and comfort of their own homes.

''Only then can we be sure we are doing our best to effectively contain the spread of infectious diseases such as MRSA and prevent further infection of hospital patients during any winter bed crisis period.''

From:

http://www.telegraph.co.uk/Swine-flu-could-lead-to-rise-in-MRSA.html

MRSA infections warning for care homes

Poor communication between hospitals and care homes in England may be putting people at risk of MRSA and other superbug infections, the regulator says.

The Care Quality Commission found nearly a fifth of homes were not being told if patients discharged from hospitals are or had been infected.

Even when they were told, the data was sometimes incomplete or illegible, the survey of more than 1,000 homes showed.

Latest figures show that MRSA levels in hospitals - they are not measured in care homes - have fallen in the past year.

C difficile figures have also been falling. But the CQC report said the progress being made could be compromised by communication problems.

Hospitals are meant to include infection history on discharge summaries.

However, the survey revealed 17% of care homes said they did not receive information from hospitals, while another 28% complained of incomplete and ineligible data.

The regulator also highlighted poor practice by care homes - a quarter were not following guidelines covering issues such as isolating residents with infections and antibiotic management.

It said care homes had until next year to follow the guidelines or face being refused registration.

CQC chief executive Cynthia Bower said: "Infection prevention and control is not simply an issue for hospitals - care needs to be clean and safe wherever it is provided.

"If we are to tackle infections effectively we need to check that all providers of care are talking to each other."

Health minister Mike O'Brien said while there had been good progress on infections, he agreed closer working was needed.

"People have the right to the same standards of clean, safe care whether in health or social care."

A separate CQC report also criticised the way patient information was being used.

The regulator said it had concerns about privacy - a third of staff said they had not been given training on confidentiality - while delays in hospitals sending GPs information after discharge were also noted.

From:

http://news.bbc.co.uk/1/hi/health/8266443.stm

Death toll from MRSA hospital bugs hits new high

More than 30,000 people have died after contracting the hospital infections MRSA and Clostridium difficile in just five years, official figures show.

Between 2004 and 2007 there were more than 20,000 deaths linked to C. diff and more than 6,000 associated with MRSA.

Data from the Office for National Statistics covering 2004 to 2008 shows record numbers of deaths linked to the superbugs in England and Wales.

Opposition politicians said the labour Government had allowed "a horrifying death toll" because of its "slow and sloppy" response to spiralling levels of infection in NHS hospitals.

Official data shows a doubling in the death toll linked to MRSA during the period 2004 to 2007, compared with the previous four years, and a quadrupling in deaths linked to C. diff, when two sets of three-year figures are compared.

Norman Lamb, the Liberal Democrat health spokesman, said: "These figures describe an absolutely horrifying death toll, and many of these people have lost their lives because of infections which could have been avoided if firm action on infection had been taken a long time ago".

Annual deaths linked to MRSA quadrupled between 1997 and 2007, while those associated with C. diff quadrupled between 2004 and 2007, figures show.

Katherine Murphy, from the Patients Association, said the statistics showed the gulf between "flowery" Government rhetoric about a war on infection, and poor hygiene which had been allowed to continue unchecked.

"The NHS has been told to put other targets ahead of safety, and this is the inevitable outcome," she added.

Infection experts have repeatedly warned that assessments based on the number of death certificates which record the presence of MRSA and C. diff are likely to underestimate the scale of the problem, because doctors are reluctant to admit that basic infections have caused fatalities.

Earlier figures published by the ONS have shown that the worst hospital for C. diff deaths in England or Wales was the Royal United Hospital in Bath, which had 268 deaths from the infection between 2002 and 2006.

The George Eliot hospital in Nuneaton, Warwickshire, the Walsgrave Hospital in Coventry and the Royal Infirmary in Leicester all had more than 200 deaths caused by the infection over the same period.

The worst-ever outbreak of C. diff in this country occurred between 2004 and 2006 at Maidstone and Tunbridge Wells NHS Trust, where the bug was linked to the deaths of 331 patients.

More than 5,000 people have backed The Sunday Telegraph's Heal Our Hospitals campaign, which is calling for a review of hospital targets to make sure they work to improve quality of care.

From:
http://www.telegraph.co.uk/Death-toll-from-hospital-bugs-hits-new-high

Many hospital bugs neglected by MRSA targets

The NHS in England is neglecting the threat from many healthcare acquired infections not covered by labour government targets, a watchdog has warned. Efforts to tackle MRSA and Clostridium difficile have been a success, but they account for only about 15% of cases, the National Audit Office said.

Pneumonia and urinary tract infections are among those which deserve more attention, its report said.

The Care Quality Commission said they would "keep up the pressure" on trusts.

Two previous reports from the NAO have played a big role in highlighting the problem of healthcare-associated infections in the NHS.

It led to targets to reduce rates of MRSA and C. difficile - a pressure which has successfully cut those infections.

But they account for only a small proportion of the one in 12 patients admitted to hospital who end up with an infection they did not have before.

Urinary tract infections, largely associated with the use of catheters, are responsible for 20% of these.

Other bloodstream infections with bacteria such as E. coli are also important, the NAO said, and limited data suggests they are on the rise.

Compulsory monitoring of healthcare-associated infections should be widened to cover far more infections and checks should be done to ensure that antibiotics are being used effectively, it concluded.

Karen Taylor, report author, said MRSA and C. difficile rates started to come down only once targets were imposed, although local goals may be more appropriate for other infections.

"It's looking better for MRSA and C. difficile, which have been subject to targets, but the main focus of our report is they only account for about 15% of healthcare associated infections in hospitals and in the rest of the infections there's very poor data.

"Some of the bloodstream infections are just as significant on the impact on the patient."

The report also found that government funding for tackling infections had saved the NHS money overall.

It added that the controversial "deep clean" programme had boosted staff and patient confidence - but it was impossible to measure what effect it had had on the number of infections as other strategies were being implemented at the same time.

HOSPITAL INFECTION BREAKDOWN
Urinary tract infections - 20%
Lower respiratory tract infections - 20%
Gastrointestinal infections - 22%
Surgical site infections - 14%
Bloodstream infections - 7%
Skin and soft tissue infections - 10%

However, even with MRSA and C. difficile there was variation, with 12% of trusts reporting an MRSA infection.

Amyas Morse, head of the NAO, said that in 2004 the problem with MRSA and C. difficile had seemed to be "an intractable problem" and hitting the targets was a "significant achievement".

"Inevitably, with a focused and centrally driven initiative of this kind, the improvements are not uniform across the NHS and we still don't know in any meaningful way what impact there has been on other healthcare-associated infections."

Health minister Ann Keen said: "We remain totally committed to eliminating all preventable healthcare-associated infections.

"As a nurse myself, I am especially pleased to see that the National Audit Office has recognised the contribution that nurses and the reintroduction of matrons onto our wards have had in delivering the reductions in MRSA and C. difficile infections."

From:
http://news.bbc.co.uk/1/hi/health/8095074.stm

Act now to prevent blood clots becoming the next MRSA warns NHS Confederation

NHS trust boards must act to stop deadly blood clots becoming “the next MRSA” in the eyes of patients and the media, the NHS Confederation is warning.

In a report to trusts, the confederation says clinical issues such as healthcare acquired infections have the capacity to cause “enormous damage” to trust reputations.

With public, political and media interest in venous thromboembolism (VTE) increasing, checks for blood clot prevention could become part of future trust assessments, the report says.

The condition causes the deaths of around 40,000 hospital patients each year, as well as increasing treatment costs and hospital stay length.

The cost implications of risk assessing patients are likely to be minor when compared with the costs of treating post-surgical deep vein thrombosis and pulmonary embolism patients, the confederation says.

Policy director Nigel Edwards said: “Managers, clinicians and patients have a real chance to build on the success of reducing infections. If we work together we can save lives and reduce NHS costs by improving the assessment of all patients and using cost effective preventative measures.”

Hospital boards could include venous thromboembolism measurements in trust quality dashboards and appoint clinical champions to promote the issue to colleagues, as well as appointing lead non-executive directors for the condition.

Baseline assessments can be used to establish how trusts are performing on assessing patients and boards can ask whether venous thromboembolism prevention is included in staff training.

Primary care trusts could include risk assessments and prophylaxis targets in contracts with providers.

The report comes as a survey by thrombosis charity Lifeblood reveals the public is largely unaware of the risk of blood clots.

From HSJ:
http://www.hsj.co.uk/5001282.article

Health Direct is amazed that the public is largely unaware of the tens of thousands that deie risk of VTE, because Health Direct certainly is not.

Within only a few months of lauching the Health Direct blog we came across the terrible death toll that VTE causes in the UK.

On March 08, 2005 Health Direct posted- 25,000 die from preventable VTE
Each year over 25,000 people in England die from venous thromboembolism (VTE) contracted in hospital.

This is more than the combined total of deaths from breast cancer, AIDS and traffic accidents, and more than twenty five times the number who die from MRSA.

And again, on October 31, 2006 we posted NHS patient safety 'must improve' says Healthcare Commission

More needs to be done to improve standards of safety in the NHS and independent sector, a watchdog says. The Healthcare Commission said that while most patients received safe care, standards were inconsistent in England and Wales.

The watchdog said there was no clear indication on the number of deaths that could be avoided.

Rose Gibb the MRSA paperpusher judgement ends era of pay-offs

NHS managers could increasingly turn to employment tribunals with the rights and wrongs of their dismissals debated in public after Rose Gibb lost her claim for breach of contract, her union leader has warned.

Ms Gibb left her position as chief executive of Maidstone and Tunbridge Wells trust in October 2007 after agreeing severance terms.

But this week the High Court turned down her bid to enforce this contract, ruling the trust had shown “irrational generosity” in agreeing to pay her £175,000 above the £75,000 she was contractually entitled to in lieu of notice.

Mr Justice Treacy accepted that Ms Gibb had received assurances of the payment’s approval further up the NHS hierarchy. However, even this was not sufficient for her to be awarded any of the outstanding £175,000.

Ms Gibb left the trust days before the Healthcare Commission published a critical report on two C difficile outbreaks which contributed to at least 90 deaths.

Jon Restell, chief executive of Managers in Partnership, Ms Gibb’s union, said the outcome would make it more rigorous in checking compensation agreements were properly authorised.

“If people have been given reassurances this case is a wake-up call to double check,” he said.

He questioned whether it served MiP members’ best interests to enter discussions on severance payments, or whether it would be better to go through a disciplinary process and potentially launch unfair dismissal claims at an employment tribunal.


“Maybe we will see a lot more litigation. That could lead to interesting arguments around whether people are culpable. In the past we would have been sitting down to discuss a compensation agreement. That may not happen in the future.”

Employment tribunals could consider whether a chief executive was responsible for problems, or whether wider, systemic issues such as targets were involved, he said. And he warned that chief executive jobs could look increasingly unattractive.

One foundation trust chief executive in the North of England said the case, combined with the recent turnover of chiefs, added to the unattractiveness of the positions.

“We have got a double whammy,” he said. “There is a great propensity to fire the chief executive and there has been a tightening up on pay-offs.”

County Durham and Darlington foundation trust chief executive Stephen Eames said: “The verdict reinforces the accountability of senior public servants like ourselves.”

The judge awarded costs against Ms Gibb and refused her leave to appeal.

MiP – which gave her legal advice – said options being considered included asking the Court of Appeal directly for permission to appeal and asking an employment tribunal to hear the case, even though it is technically out of time.

In a statement issued by the union, Ms Gibb said: “The evidence showed that senior NHS people made decisions and acted in ways that they themselves agree were both unjust and unfair to me. They said they would not have defended a claim of unfair dismissal. The judge’s ruling has been made over a contentious and complex point of law. This matter has been difficult for all parties and there can be no winners.”

From:
http://www.hsj.co.uk/5000912.article

Health Direct is delighted that Rose Gibb has lost her appeal for more blood money after presiding over the deaths of 90 patients in her dirty hospital.

What were the "NHS hierarchy" thinking of when they tried to pay off Mrs Gibb with another £175,000?

Perhaps they will now be similary generous to the relatives of those who died an early death as a result?

Worst NHS trusts for hygiene threatened with fines and closure by super regulator

The worst NHS organisations for hygiene standards have been named and shamed by a new super regulator and threatened with fines and even closures if they do not improve.

In a first show of strength, the new Care Quality Commission has named 21 organisations which are failing to take sufficient action to prevent superbugs like MRSA and C. difficile.

The list contains eight trusts where there are high infection rates, persistent problems or a potential risk to patients has been identified. They will face further inspections by the regulator.

All the failing trusts have been warned they must improve within set deadlines or face further sanctions including warning notices, fines, and the possibility of wards or units being closed down.

Problems found included inadequate cleaning of ambulances, poor antibiotic prescribing practice, delays in isolating infected patients, lack of supervision of cleaning and infection control staff, dirty surgical equipment, lack of reporting of infection control measures to board level, delays in receiving laboratory test results and poor standards of cleanliness on wards.

All healthcare providers, except GP and dental surgeries, must be registered with the Care Quality Commission by 2010, in what is in effect a 'licence to practice', and the first step has been to register compliance on infection control measures.

All 388 NHS organisations that provide direct care to patients have been registered but the 21 trusts judged to be failing have been given conditional registration.

Barbara Young, chairman of the CQC, said: "Most trusts have stronger systems to protect patients from infection than a few years ago, and trusts' boards are taking the challenges seriously. We commend them for that.

"In 21 trusts we need further assurance that they are meeting the regulations. We have placed rigorous conditions on these trusts' registration and will monitor them closely.

"While infection rates at these trusts are not necessarily higher, they can do more to strengthen their approaches to infection control and help prevent outbreaks. We will monitor their performance throughout the year and will not hesitate to use our enforcement powers to protect patients' safety where needed.

"This is only the beginning of our work with NHS trusts. We aim to ensure they strive for continued improvement and that patients receive the same consistently high service wherever they receive care."

In eight cases, the trust failed to achieve required standards for infection control on repeated occasions and/or had a high infection rate and/or a potential risk to patients' safety was found on inspection.

The eight trusts are: Barnet, Enfield And Haringey Mental Health NHS Trust, Barts And The London NHS Trust, Kettering General Hospital NHS Foundation Trust, Leeds Teaching Hospitals NHS Trust, North Bristol NHS Trust, Plymouth Hospitals NHS Trust, South West London And St George's Mental Health NHS Trust, United Lincolnshire Hospitals NHS Trust.

Registration on healthcare associated infection is the first step towards full registration on all basic standards, a regime that will come into force from April 2010.

For the first time the regulator has the power to impose fines of £4,000 on the spot and up to £50,000 through the courts. The Care Quality Commission also has the power to close wards, services or a whole hospital in extreme circumstances.

From:
http://www.telegraph.co.uk/health/healthnews/5095540/Worst-NHS-trusts-for-hygiene-threatened-with-fines-and-closure-by-super-regulator.html

Patient safety at risk as urgent NHS repairs ignored

Patients are being put in danger because of a backlog of hundreds of millions of pounds of urgent repairs at hospitals.

More than half of hospital trusts have a backlog of repairs which the NHS says need to be urgently completed to ensure patient safety.

The NHS defines the work is so pressing that it “must be addressed with urgent priority in order to prevent catastrophic failure, major disruption to clinical services or deficiencies in safety liable to cause serious injury and/or prosecution”.

Yet despite the urgency of the work, the new figures show that the level of outstanding urgent repairs rose last year, by £11 million to £310 million.

Crumbling buildings and failings in the infrastructure of hospitals have been repeatedly linked to risks to patient safety.

Last year, the official investigation into Britain’s deadliest outbreak of the infection Clostridium Difficile, which killed more than 90 patients at Maidstone and Tunbridge Wells hospitals cited its high maintenance backlog as a contributing factor in the spread of the disease.

The figures obtained by the Conservatives reveal that more than 120 of England’s 210 hospital trusts admitted to a backlog of urgent repairs in the financial year which ended in April 2008.

Imperial College Healthcare trust, which runs Hammersmith and St Marys Hospitals, had an urgent repair backlog of £27 million pounds, a figure which was almost matched by the bill at Guys and St Thomas foundation trust. Hospitals in North West London, Worthing and Southlands and Nottingham also reported an urgent backlog of more than £10 million.

Eight years ago, the Government pledged to reduce the total NHS maintenance bill, which then stood at £3.1 billion, by one quarter.

The new figures show in fact the total bill has soared to more than £4 billion, including a 29 per cent increase in the last two years.

The only category of repairs where the bill fell during 2007/2008 was among those defined as carrying the lowest risk to patients and services.

Shadow health secretary Andrew Lansley described the findings as “very disturbing”. He said: “Over the last eight years the Government has done nothing to address this problem and things are going from bad to worse. The Government has no excuse for needlessly putting patients and NHS staff at risk like this.”

Mr Lansley said the Government could not pretend it was unaware of the issue, since hospitals reported their figures to the Department of Health each year.

From:
http://www.telegraph.co.uk/health/healthnews/3966201/Patient-safety-at-risk-as-NHS-repairs-ignored.html

Sir Richard Branson accuses labour of failing over hospital superbugs

Sir Richard Branson criticised horrific hospital infection rates, accusing labour politicians and health bosses of "tinkering" with the problem.

The Virgin tycoon, who was recently appointed vice president of the Patients Association, called for all hospital staff to be screened for the superbug MRSA and receive immediate treatment if infected.

He has also said managers at failing NHS trusts should be fired.

Infection rates for MRSA are falling across the UK with the most recent quarterly figures showing a 33 per cent drop year on year, but Sir Richard is calling for far more to be done.

The entrepreneur - whose daughter Holly is a doctor - told the BBC: "There have been some improvements, but the facts speak for themselves - and the facts are still horrific.

"It feels like they have tinkered with the problem rather than really got to the heart of the problem. The hospitals are there to cure people. They are not there to kill people."

He said the NHS could learn from the airline industry about how to avoid mistakes and improve.

"In the airline industry if we had that kind of track record we would have been grounded years ago," he said.

"In the airline industry if there is an adverse event that information is sent out to every airline in the world.

"And every airline makes absolutely certain that that adverse event doesn't happen twice."

Sir Richard is helping to organise an international conference on infection control and patient safety early next year.

He argued that all hospital staff including doctors, nurses and cleaners should be checked for MRSA and treated if infected - even if that causes disruption to medical services.

He said: "You don't necessarily have to ask them to leave the hospital while they are being treated.

"They can just not have any contact with patients for those two weeks while their treatment is taking place, and then they can come back and have contact with patients.

"That is far better than having people dying from unnecessary diseases, and all the misery and pain that that causes, and the cost to the NHS which is enormous."

Official data from the Health Protection Agency (HPA) showed there were 725 MRSA cases in July to September, a 33 per cent drop on the same quarter in the previous year.

The number of C difficile infections in patients aged 65 and over between April and June this year also fell 38 per cent, to 8,683 cases.

Sir Richard, who became the vice-president of the Patients Association in September, called for more patient information about infection rates and a tougher standards for trust bosses.

He said: "The patient should have the right to know the track record not only of the hospitals, but the rate on wards, on departments, on surgeons, on clinicians. That shouldn't be something which is hidden."

"And I also think if managers of hospitals are not obeying the rules that have been set by the NHS, those managers should be replaced."

From:
Sir-Richard-Branson-accuses-politicians-of-failing-over-hospital-superbugs

Hospitals fail to pass latest MRSA superbug hygiene test

Only one in 10 NHS hospitals are complying fully with a compulsory hygiene code intended to prevent MRSA hospital acquired infections, the NHS inspectorate has found in a series of spot checks.

Unannounced visits to 51 big acute hospitals - around a third of the total in England - found just five following the hygiene code completely. One in five did not comply with all the requirements for safe decontamination of instruments. One in eight had inadequate isolation facilities.

Twenty-seven of the 51 were failing to keep all of their premises clean and well maintained. And in three cases the failings were bad enough for the Healthcare Commission to issue improvement notices with which, it said, the hospitals have complied.

The figures were attacked as shocking by opposition politicians. However, the inspectorate said that 97 per cent of the lapses "did not represent an immediate risk to the safety of patients".

It added, however, that "almost all acute trusts have more work to do to get systems for infection prevention and control in place". From April next year, they will have to comply with the code or risk fines, or even removal of their licence to operate.

Anna Walker, chief executive of the Healthcare Commission, said it was clear despite the findings that trusts were making progress on infection control. With three exceptions, the breaches of the code found were not "the most serious kind" although they showed there was still work to do.

From:
http://www.ft.com/cms/s/0/da8cc266-b9c7-11dd-99dc-0000779fd18c.html?nclick_check=1

Health Direct- 4 years and 1000 posts on NHS news, advice and information

Health Direct has now posted over 1,000 news, advice and information stories about the NHS during the past four years.

During this period of labour's mismanagement of the National Health Service- Health Direct has found billions of taxpayers Pounds wasted, tens of thousands of preventable deaths and thousands of NHS staff sacked because of underfunding.

MRSA and Clostridium difficile superbugs are still killing more people than die from UK road accidents.

PFI and other off balance sheet financing that runs onto billions of Pounds- with restrictive clauses which even prevent local politicians from cutting hospital car parking charges.

The wheels are coming off the world's most expensive health IT system. Which is so blinkered and rigid that the new polyclinics will not be able to use it- if it ever works properly. Even Google have overtaken the NHS in providing an online health records system- though how secure their system will prove to be is as open to question as labour's pathetic data privacy track record.

And we have the prospect of nearly another three years of labour's dithering, stalinist, incompetent direction.

Two thirds of patients fail to get GP's appointment within 48 hours

Two thirds of NHS patients cannot get an appointment with their GP within 48 hours, a wide ranging report by the healthcare watchdog has found- and the situation is getting worse as last year 80 per cent of patients could see their GPs within 48 hours.

The most comprehensive study of its kind has shown that millions of people are being failed by their local surgeries.

Under key NHS targets, patients should be able to see their family doctor within two working days. However, the report said that just one third of people were able to see their GP within this time.

The findings come at a time when the relationship between patients and their doctors is already under strain.

There has been widespread anger over the large pay rises enjoyed by GPs under the new contract.

And ministers and GPs have been locked in bitter negotiations about forcing surgeries to open for extended hours, offering appointments into the evening, early in the morning and on Saturdays.

Gary Needle, at the Healthcare Commission, said: "Patients are not getting sufficient access to their GPs is the message from this measure."

Andrew Lansley, Shadow Health Secretary said: "Despite all their talk, Labour are still failing patients when it comes to choice and access to a GP.

"It's appalling that in seven out of ten areas, people aren't able to see their doctor within 48 hours when they wish. It shows the utter failure of Labour's top-down targets to bring about the best results for patients."

Liberal Democrat health spokesman Norman Lamb said: "For years people have known that ministers' complacent assurances about how easy it was to see a GP were wrong.

"At last a proper assessment has taken place so we can see the reality of the situation. This scandalous finding must force the Government to act now."

Last year the report found that 80 per cent of patients were able to see their GPs within 48 hours.

However, the data was gathered by using 'mystery patients' to carry out spot checks to see if they could get an appointment rather than asking patients.

This year, for the first time, the commission included information from a patient survey. The report has sparked a row with doctors who have said the figures are misleading.

Dr Hamish Meldrum, chairman of the British Medical Association said: "The report's conclusion that there has been a dramatic decline in primary care trusts meeting the GP 48-hour access target is misleading.

"There has been such significant change in the way the research has been compiled compared to last year that it is impossible to compare the data for the two years in question. The access figures are even more confusing when you consider that a recent survey showed almost 9 out of 10 patients were satisfied that they were able to get an appointment within 48 hours.

"GPs are working hard to offer as much flexibility as they can to patients, as well as providing speedy access, and delivering an expanding range of services to patients."

The latest figures show the average annual earnings of GPs, who are paid to hit the targets on appointments, are £103,530 - a drop of 2.6 per cent on last year after years of rising pay. They also showed 258 doctors earned more than £250,000 before tax last year.

The commission's healthcheck is an in-depth investigation into the NHS with each hospital trust, primary care trust, mental health trust and ambulance trust measured on waiting times, hygiene, confidentiality, management of records, reducing deaths from cancer and heart disease, cutting superbug rates and treating patients with dignity and respect.

While the report found there had been improvements in many areas, it found that infection control was a serious problem with 'lapses at almost every trust visited' and six out of ten trusts failing on at least one measure.

The Commission warned that other infections such as norovirus - the winter vomiting bug that reached record levels last winter - should be included in the measures in the future alongside Clostridium difficile and MRSA.

Of the 114 trusts that failed on at least one infection control measure, 11 said they were compliant only for this to be overturned by inspectors.

There is concern about infection control in community hospitals, district nursing, ambulances and midwifery and these areas will have extra focus in the next inspections.

From:
Two-thirds-of-patients-fail-to-get-GPs-appointment-within-48-hours.html

NHS complaints system too bureaucratic for patients, says report

Only a tiny fraction of patients unhappy with the NHS make a formal complaint because of a bureaucratic, confusing system which changes little, according to a new report.

The National Audit Office (NAO) found that while 14 per cent of patients were unhappy with their NHS service, less than one per cent made a formal complaint to their health trust.

There was also little evidence of services improving as a result of complaints made.

It also found that one in five health trusts took too long to respond to patient complaints.

While most met the target of an average of 25 working days to answer complaints, one took 55 days, more than twice as long.

Edward Leigh, Chairman of the Commons Public Accounts Committee, said that the reason so few patients make formal complaints is that they have "no confidence anything will be done as a result".

"Complainants are often confronted with a defensive and unhelpful response when sometimes all that is needed is a simple apology or a promise to improve services.

"There is also little evidence that complaints are leading to better services. This is no way to keep people's faith and trust in health and social care services."

The criticism comes after David Cameron, the Conservative leader, attacked Alan Johnson, the Health Secretary, for an allegedly cold and bureaucratic response to a complaint over the
death one of his constituents, Elizabeth Woods, after she contracted the superbug MRSA.

There were 133,600 official complaints about the NHS last year.

A spokesman for the Department of Health said that ministers agreed that the NHS had to be better at handling complaints and that was why a new, simplified system would be introduced next year.
NHS-complaints-system-too-bureaucratic-for-patients-says-report.html

NHS managers get away with murder as MRSA superbug hospital escapes criminal charges

The hospital trust at the centre of Britain's worst recorded hospital MRSA superbug outbreak which led to the death of 331 patients has escaped prosecution.

Clostridium difficile contributed to the deaths of the patients over two-and-a-half years at three Kent hospitals a health watchdog report found.

Appalling standards of care, crowded wards, financial problems, a shortage of nurses and poor hygiene all led to the outbreak the Healthcare Commission found in a highly critical report in October.

However after studying that report, Kent Police and the Health and Safety Executive said there would be no charges over the deaths at hospitals run by the Maidstone and Tunbridge Wells NHS Hospital Trust.

Assistant Chief Constable Allyn Thomas said: "Whilst the report makes for grim and at times distressing reading, our review has not identified any information that would indicate a need or duty to conduct a criminal investigation into the Trust at this time."

Relatives of those who died in the outbreak reacted angrily to the announcement.

Steve Stroud, whose 77-year-old stepmother Doreen Ford died in Maidstone Hospital said he was "disgusted" by the decision.

Mr Stroud, husband of former Bucks Fizz singer Cheryl Baker, said: "This is disgusting. Someone has got to be held to account over all these deaths and if it is not the hospital trust, then who the hell can it be?

"Someone really should have to carry the can over this... for no charges to be pressed is really disgusting. I can't believe it".

Baker, described the death of her mother-in-law as "legalised killing".

She said: "The Trust is to blame, I know that, everyone knows it and it makes my blood boil.

"Those patients didn't die by chance, they died because they contracted C diff at the Trust because of poor hygiene and care, so they are to blame, without a shadow of a doubt."

The Healthcare Commission had found the infection probably or definitely killed 90 people and was a factor in a further 241 deaths.

It also criticised the then chief executive of the trust, Rose Gibb, who left before the findings were published and is now reported to be fighting for a payout of several hundred thousand pounds.

But police said the report held no evidence that the deaths amounted to manslaughter.

For the trust or one of its employees to have committed gross negligent manslaughter, it would be necessary to identify a single act that was grossly negligent and caused a death.

Geoff Martin, of campaign group Health Emergency, said: "The decision not to bring charges over the catastrophic management failures at Maidstone and Tunbridge Wells sends out a signal that no matter how many people die, those at the top can bail out without taking the rap.

"Maidstone and Tunbridge Wells was possibly the worst single, corporate failure in the history of the NHS. It doesn't get any worse than 90 deaths and it's massive kick in the teeth to the friends and relatives of those who died that no-one will be properly called to account.

David Nicholson, NHS chief executive, said: "Whilst criminal proceedings have not been brought in this instance, the Trust's failure to protect and care for patients during the outbreaks of Clostridium difficile between 2004 and 2006 was wholly unacceptable."

From:
http://www.telegraph.co.uk/news/2474303/Superbug-hospital-escapes-criminal-charges.html

Clostridium difficile rates still rising

The number of infections caused by Clostridium difficile are continuing to rise.

Graham Tanner, chairman of National Concern for Healthcare Infections, said: “It should be remembered that over four years, more than 20,000 patients have suffered an MRSA infection, and in excess of 200,000 contracted C. difficile.”

In 2007-08 the number of MRSA cases fell to 4,438 - 588 above the target, Health Protection Agency data show. However, in the first quarter of this year a trend of falls in C. difficile bloodstream infections was reversed, with a 6 per cent rise: there were 10,586 cases of C. difficile blood infections in patients aged 65 and over.

A total of 966 cases of MRSA were reported - an 11 per cent drop on the previous quarter and an average of 322 cases a month. In 2004 John Reid, as the Health Secretary, said that infections of methicillin-resistant Staphyloccocus aureus should be cut to a monthly average of 321. At the time that was said to be unachievable. Even within the Department of Health, leaked documents last year showed there was serious concern it would not be met.

But the recent fall in cases suggests that high-profile initiatives such as the “deep clean” of all hospitals and introduction of a mandatory “hygiene code” may have had the desired effect.

MRSA and C. difficile are carried by some healthy people, but the bacteria can cause illness when they grow unchecked, elderly hospital patients being particularly at risk. Annual figures showed a decline for both infections.

Alan Johnson, the Health Secretary, described the decreases as a remarkable achievement.

“Our strategy is clearly having an impact, with our challenging target now within touching distance, but this is not an issue we can be complacent about and we will continue to focus our efforts on reducing infections further,” he said.

Andrew Lansley, the Conservative Shadow Health Secretary, said that the Government would not have met its MRSA target had it measured the yearly rates to March.

To achieve half of the 7,700 MRSA infections in 2003-04, the NHS would have had to limit rates to just 3,850 cases this financial year, he said.

“Every case of a hospital infection is one too many, but in four years Labour hasn't even been able to halve MRSA rates, he said. “They have only got round to admitting they have missed the target by moving the goalposts. This shows just how much they've dithered and delayed over tackling hospital infections.”

Murray Devine, Safety Advisor for the Healthcare Commission, the NHS regulator, added: “This is great news for patients. There's no question that there has been a very significant turn around, but the challenge isn't over. This improvement has got to be sustained and infection rates brought down further.”

From
http://www.timesonline.co.uk/tol/life_and_style/health/article4353861.ece

NHS at 60- MRSA superbug infections are patients biggest fear

NHS at 60- MRSA superbugs and fear of picking up a superbug infection is the public's main concern about NHS hospital care, a UK-wide BBC poll shows. Of the 1,040 people quizzed, 40% listed the risk of potentially deadly infections such as MRSA and Clostridium difficile as their top NHS concerns.

In a separate finding, 31% said they would consider avoiding NHS surgery for fear of getting an infection.


Despite the concerns raised by the survey, 82% of respondents said they were proud of the health service, with half claiming it was still the envy of the world.

The most widely-cited concern after infections was the wait people face for treatment.

Despite the NHS in England, Scotland, Wales and Northern Ireland making shorter waits a priority, one in four people still cited this as a concern.

In England, which is the furthest ahead in reducing waits, no-one should be waiting longer than 18 weeks by the end of the year.

One in 10 polled also said that both the lack of staff and mixed-sex accommodation was their biggest concern.

However, it is superbugs which dominate people's thoughts in the poll carried out by ICM Research for the BBC.

Just 33% of respondents said they were confident that the NHS would protect them from picking up an infection in hospital.

In contrast, 94% were confident that the NHS would provide good care in an emergency such as a car crash, and 86% were confident it would deliver a baby safely.

Ministers have made tackling bugs a priority, launching initiatives such as this year's £50m deep clean of wards.

Infection rates are even higher in Scotland, while in Wales and Northern Ireland they are slightly lower.

Dr Hamish Meldrum, chairman of the British Medical Association, said the findings on infection were of "huge concern".

He said: "We understand why people are so concerned about hospital-acquired infections and although infection rates are coming down, no-one can be happy with the levels that still exist.

"We owe it to patients to be able to prove to them that hospitals are a safe place to go to benefit from the help modern medicine can provide."

Professor John Appleby, chief economist of the independent think thank The King's Fund, said media coverage had fuelled fears about hospital infections.

A Department of Health spokeswoman said it had "come a long way in tackling infections, but any avoidable infection is one too many".

"We have introduced a raft of measures that we know will reduce infection and are already having an impact," she said.

From:
http://news.bbc.co.uk/1/hi/health/7475561.stm

Superbugs MRSA and Clostridium difficile record numbers of patients deaths

Record number of patients are dying in hospitals and nursing homes after contracting superbugs, new figures show. Deaths from C difficile in 2006 were almost double those in 2005

MRSA and Clostridium difficile were linked to more than 8,000 deaths in England and Wales in 2006, up from 5,300 the previous year.

The first ever breakdown of deaths from both infections by location released by the Office for National Statistics shows that the vast majority of patients died from the bugs in hospital.

The deadly infections also killed small numbers of patients in nursing homes and hospices.

In total there were 6,424 deaths from C difficile in all three locations in 2006, almost double the 3,719 deaths caused by the infection in 2005. MRSA was responsible for 1,625 deaths, up from 1,621 the previous year.

The worst hospital for C difficile deaths in England or Wales was the Royal United Hospital in Bath, which had 268 deaths from the infection between 2002 and 2006.

The George Eliot hospital in Nuneaton, Warwickshire, the Walsgrave Hospital in Coventry and the Royal Infirmary in Leicester all had more than 200 deaths caused by the infection over the same period.

Maidstone hospital in Kent, which was part of one of the worst outbreaks of the infection in the country when more than 90 patients died at three hospitals run by Maidstone and Tunbridge Wells NHS Trust died from the bug, had 113 cases over the same period.

With 94 deaths Derriford Hospital in Plymouth had the highest number of deaths from MRSA cases between 2002 and 2006.

Over the same period, The Queen Alexandra Hospital in Portsmouth recorded 81 deaths from MRSA, Maelor Hospital Wrexham 79 deaths and the Musgrove Park Hospital in Taunton, Somerset 77 deaths.

More than 1,100 hospitals, hospices and nursing homes had at least one death from C difficile in the last five years and more than 900 had at least one death from MRSA.

The Office for National Statistics cautioned that many of the hospitals who recorded large numbers of deaths from both infections were also more likely to have high patient numbers generally. The data, collected from death certificates, also shows only where patients died, not where they acquired the infections initially or where they received other treatment before their death.

A spokesman for Help the Aged said he was "concerned" at the wide variation between hospitals.

He added: "We know that older people are at greater risk of hospital acquired infections, so any rise will affect them more heavily."
Worst ten hospitals for deaths from superbugs

Number of deaths from MRSA 2002 - 2006
Derriford Hospital, Plymouth 94
Queen Alexandra Hospital, Portsmouth 81
Maelor Hospital, Wrexham 79
Musgrove Park Hospital, Taunton 77
Royal Sussex County Hospital, Brighton 75
General Infirmary, Leeds 70
Addenbrookes Hospital, Cambridge 68
Birmingham Heartlands Hospital 67
Norfolk and Norwich University Hospital 65
General Hospital, Southampton 64

Number of deaths from C difficile 2002 - 2006

Royal United Hospital, Bath 268
George Eliot Hospital, Nuneaton 235
Walsgrave Hospital, Coventry 233
Royal Infirmary, Leicester 203
General Hospital, Kettering 200
Birmingham Heartlands Hospital 177
General Hospital, Leicester 169
Frimley Park Hospital 164
Sunderland Royal Hospital 152
General Hospital, Southampton 149

From:
Superbugs-MRSA-and-Clostridium-difficile-killing-record-numbers-of-patients.html

Deaths from superbug Clostridium Difficile quadruple

The number of deaths in Britain linked to the potentially deadly superbug Clostridium difficile has quadrupled in just five years, a report warns.

More than 6,000 people died in 2006 after becoming infected with the gut infection in hospitals across England and Wales - a more than four-fold rise compared with 2001 figures, the Office of National Statistics says.

Meanwhile, the number of deaths linked to MRSA rose by more than one third, with the infection mentioned on almost 1,700 death certificates in 2006.

The figures follow an admission by the Department of Health's most senior experts in infection control that the main reason for a 50-fold increase in cases of Clostridium difficile in less than two decades is the failure of hospitals to follow hygiene rules drawn up 14 years ago.

Research by the Liberal Democrats found half of hospital trusts still do not put infected patients in their own rooms, while just one in five puts aside dedicated isolation wards in case of an outbreak.

Last year more than 50,000 people in England and Wales were infected with the infection, which is often triggered by a course of antibiotics. Although the elderly are most vulnerable to C. difficile, one in five cases involves those below the age of 65.

Infection experts said the labour Government had prioritised targets and finances at the expense of safety.

Dr Mark Enright, professor of microbiology at London's Imperial College, said hospitals often suffered the worst outbreaks when managers were afraid to miss targets requiring emergency patients to be admitted within four hours, even if wards were overcrowded or harbouring infection.

The worst-ever outbreak of the disease, at hospitals run by Maidstone and Tunbridge Wells trust, killed 90 people in 2005 and 2006.

An independent investigation said pressure to meet waiting targets was one of the reasons the crisis spiralled out of control.

Prof Hugh Pennington, emeritus professor of bacteriology at Aberdeen University, said patients across Britain had paid a heavy price for the collective failure of hospitals and governments to take infection seriously.

"The failure to invest in proper isolation facilities was wrong; too many people have suffered and perished as a result," he said.

Health spokesman Norman Lamb said two successive governments had failed to ensure recommendations from their own experts were followed.

He criticised the current labour prime minister for introducing "headline-grabbing gimmicks with little scientific value", such as the recent "one off" deep-clean of all hospitals, and a new short-sleeves uniform policy, instead of ensuring that hospitals were detecting and isolating infected patients.

From:
Deaths-from-hospital-superbug-Clostridium-Difficile-quadruple

NHS hospitals' care standards vary in postcode lottery

Most patients staying overnight in hospital are happy with their care, but this masks problems in key areas and variations in standards, a survey says.

Nine in 10 inpatients in England said their care was good, very good or excellent, the Health Commission poll of almost 76,000 people showed.

But problems with the quality of food, information on treatment and the use of mixed sex facilities were reported.

The government said it would look to drive up standards where necessary.

But campaigners said the results were worrying and demonstrated that the NHS was struggling to give patients the respect and dignity they deserved.

OVERALL APPROVAL RATINGS
Top five trusts:
Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust, Oswestry: 92
Queen Victoria Hospital NHS Foundation Trust, East Grinstead, West Sussex: 91
The Cardiothoracic Centre, Liverpool NHS Trust: 90
Christie Hospital NHS Trust, Manchester: 90
Royal Marsden, London: 90

Bottom five trusts:
Ealing Hospital, London: 65
Homerton University Hospital, London: 67
Mayday, Croydon: 67
Barking, Havering and Redbridge Hospitals NHS Trust, London: 68
North Middlesex University Hospital, London: 69
On a scale of 0 (poor) to 100 (very good)

Overall, one in four patients said they shared a sleeping area with patients of the opposite sex when first admitted - but in some of the 165 trusts this rose to nearly half, while others had almost no sharing.

For non-emergency care, which is where the labour government has promised to eradicate the use of mixed-sex accommodation, one in 10 said they had shared a sleeping area.

On the quality of food, just over half described it as good, while 15% said it was poor.

A fifth of those needing help with eating also said they did not get it, but again there were big variations, with more than 40% reporting a lack of help in some trusts.

Patients also reported problems with the way they were kept informed about decisions relating to their care. One in five said they were not given enough information.

Mixed sex wards

The numbers saying their wards or rooms were very clean has also fallen slightly in the last five years to 53%, despite the focus on hospital infections such as MRSA.

However, overall attitudes to the care patients received were largely positive.

The numbers saying their care was excellent rose from 41% to 42% in the last year. Overall, 92% said it was good, very good or excellent.

Healthcare Commission chief executive Anna Walker said the findings were "encouraging". But she added: "Some hospitals are struggling to deliver on some of the basics of hospital care.

"There are striking variations in performance in key areas. Those performing poorly must learn form those who perform well."

And Charlotte Potter, of Help the Aged, added: "Scores in some trusts were worryingly low when it came to being treated with dignity and respect or receiving help with eating - areas of care particularly important to older people."

From:
http://news.bbc.co.uk/1/hi/health/7397037.stm

Superbugs deaths now at 10,000 a year

Superbugs kill at least 10,000 people in Britain each year — 20 times the number who die of Aids. Why isn’t the labour government spending more on finding out why?

Warnings about the dangers of antibiotic overuse started to emerge from laboratories, but because relatively few patients were affected and nobody knew what to do about it, the situation was ignored. Antibiotics continued to be consumed in ever-growing quantities by sick humans and farm animals alike.

The problem took off in 1991, when Britain contributed its own supercharged strain to the world lexicon of multi-drug-resistant superbugs. MRSA-16 first appeared in Northamptonshire, rapidly infecting 400 patients and 27 staff in three hospitals.

Within 18 months it had been reported in 135 more hospitals. Nobody knows how it spread. Along with another British strain, MRSA-15, it went on to infect patients around the world, a pattern that continues.

A meticulous Health Protection Agency study, mapping how the new strains popped up unexpectedly in new hospitals, was published in the Journal of Clinical Microbiology in 2004. But it was too long after the event to shed any light on how the infection had carried. Now research funding is focused on firefighting – casting around for ways to damp down the effects of the pathogens.

It is not just MRSA that is sweeping across Britain like a plague.

Streptococcus, enterococcus and Escherichia coli (E coli) are among a host of bugs emerging in resistant forms and causing everything from pneumonia to tuberculosis, bone destruction and lethal damage to the heart. In addition, we are facing “hyper-virulent” new strains of the bacteria Clostridium difficile (C diff), which have colonised the sites left free by the effect of antibiotics, which kill off many harmless bacterial colonies in their path.

Although C diff is not resistant to treatment, its spores linger indefinitely and, until recently, NHS staff were largely unaware of how to kill them. Consequently, it is the biggest killer of the current superbugs.

In 2006 it was mentioned on the death certificates of 6,480 people, against 1,652 deaths officially attributed to MRSA. However, these figures are recognised to be underestimates, as many superbug deaths are never identified.

Mandatory surveillance of MRSA bloodstream infections is a recent innovation, the number of people carrying it with no symptoms is not recorded, and the formal collection of figures for death and disease associated with C diff (which causes unstoppable diarrhoea or gut perforation) only began in April 2007. The government estimates the annual cost of treatment for such cases to be over £1 billion.

Officially, the total number of MRSA infections is 7,000-8,000 a year, while C diff is running at an annual 55,600 cases. Many experts believe the real total for all superbug infections is nearer 300,000 – how many are fatal is believed to be vastly higher than the official figures suggest. There is no way of knowing the true figure, as relatively few people are tested.

Meanwhile, a variety of new resistant pathogens are waiting in the wings. In September 2006, a variation of Staphylococcus aureus that produces a toxin called Panton-Valentine leukocidin (PVL) claimed its first British victims. Since then, anxiety over this threat has escalated. The pathogen selectively attacks the young rather than the old; it gets into bones and joints, causing crippling damage.

A multi-drug-resistant version of a common food-poisoning bug, ESBL (extended-spectrum beta-lactamase) E coli, is also causing anxiety. First identified in the 1980s, it has spread steadily to cause an average of 30,000 cases of blood poisoning and urinary-tract infections a year.

Although it has officially been blamed for 57 deaths so far, the true total is believed to be many thousands. Government scientists think the source is meat and milk, colonised by superbugs as a result of overuse of agricultural antibiotics.

From:
http://www.timesonline.co.uk/tol/news/uk/health/article3582299.ece

Health Direct laments the disaster that is labour's superbug strategy. Which causes between 3 and 4 times the number of deaths compared to UK traffic accidents.

Superbugs- children hit by playground superbug PVL-MRSA

A new form of the superbug MRSA attacks its victims, usually children, with frightening speed, doctors are warning. One of those who has seen the effects is Sherean Roberts, whose son Daniel, 10, was infected after a trivial fall from a playground slide in north London.

Within two days he had suffered septic shock and total organ failure. Despite treatment with huge volumes of antibiotics, he was not expected to survive.

Daniel had been struck by Panton-Valentine leukocidin (PVL), a toxin that combines with MRSA, the methicillin-resistant staphylococcus aureus bacterium that causes thousands of infections in hospitals.

The PVL-MRSA infection can get into the skeleton, where it is particularly hard to treat with drugs. Instead, doctors have to remove infected bone.

Daniel was in a coma for a month and has had to undergo five operations to scrape out the infected bone in his leg and hip. He is now largely confined to a wheelchair. “One day he was playing happily, and the next day he couldn’t see, speak or move,” said Roberts, 33. “The doctors didn’t know what to say to me, they didn’t know what was happening.

“They tried drug after drug and nothing seemed to work. It was a terrifying experience that you would not wish on anyone. We still don’t know how much the bones will grow back or how well he will recover.”

David Hunt, a children’s orthopaedic surgeon at St Mary’s hospital, Paddington, said the infection had eaten away the bone in Daniel’s hip and leg.

“The most worrying element of Daniel’s story is that although he complained that his leg began to hurt after the fall, there was no sign of broken skin, bruising or other damage to allow the bacteria into his bloodstream,” said Hunt. “It is very alarming. We don’t know enough about these organisms. They are appearing in new forms and what happened here is going to happen more frequently.”

The phenomenon of PVL combining with MRSA was first identified in the United States several years ago. The Sunday Times established that reports of cases in Britain have occurred from the south coast to Birmingham.

They include a six-year-old girl left brain-damaged after she fell off her scooter and contracted the infection in her shin bone, from where it spread throughout her body; a boy of nine crippled after a graze playing football; a girl of 12 who fell while dancing; and a 13-year-old who banged his leg on the side of his bed, suffering similar near-fatal infections.

One 11-year-old in a boarding school did not appear to have had an accident that could have led to the bacteria taking hold.

Specialists in the condition accuse the labour government of ignoring warnings about the seriousness of PVL-MRSA, failing to mount adequate infection surveillance and blocking the use of a costly treatment to tackle it.

Professor Richard Wise, a leading microbiologist, says he warned a labour government health minister three years ago of the threat. Wise said the minister told civil servants: “This needs to be sorted, get it sorted.”

Yet the special advisory committee on antimicrobial resistance, which Wise chaired, was later disbanded, and a commitment to provide £250,000 to study the bug was not honoured. “It does seem strange to set up specialist advisory committees and then take no notice of the advice they give,” said Wise last week.

A deputation of three experts from the Intensive Care Society and specialist infectious diseases societies met officials to try to persuade them to change guidelines on the treatment of PVL. At present the use of intravenous immunoglobulin, a blood product that costs £2,500 a treatment, is not approved by the NHS. Doctors say it can save lives.

“We are bracing ourselves for much more of this,” said Nick Clarke, professor of paediatric orthopaedic surgery at Southampton University, whose team treated the case of the boarding school child and another nine-year-old victim.

“MRSA has not only mutated to get round antibiotics but it has also picked up this PVL toxin, which even seems to change once it has infected someone. There are grave fears about this in the paediatric orthopaedic community worldwide.”

A number of other cases, particularly of young adults, have involved PVL pneumonia, a “necrotising” infection that can eat away a fatal level of lung tissue within 48 hours.

One victim was Kirstie Bristow, 23, of Torpoint, Cornwall, who contracted it while pregnant two years ago. Luckily an Australian locum doctor recognised the symptoms and arranged emergency treatment. She was unconscious for three weeks and given only a 50% chance of survival. “I am so lucky to be alive,” she said recently. “It’s important people know what to look for and act quickly.”

Marina Morgan, a consultant microbiologist in Exeter, Devon, said the Health Protection Agency (HPA), had no idea of the real level of risk: “I have had eight cases of PVL pneumonia in Exeter alone and three of them have been fatal,” she said. “It is worrying and it will get worse.”

The latest HPA figures show the number of recorded PVL infections DOUBLED from 224 in 2005 to 496 in 2006. A Department of Health spokesman said research on the prevalence of PVL was now being planned.

According to other figures to be reported on Panorama on BBC1 tonight, 10 times as many elderly patients die from the superbug clostridium difficile in Britain as in any other country in the world. The health department denies the comparison.

From:
http://www.timesonline.co.uk/tol/life_and_style/health/article3822582.ece

MRSA superbug rises show deep clean did not work

MRSA superbug infections caught in hospital are still at unacceptable levels and Labour is failing to tackle the problems of fatal bugs in the correct way, the Conservatives said.

New figures released showed C.Difficile infection cases had gone down but there were still nearly 10,000 cases in those aged over 65.

And while MRSA cases have dropped over the past year they rose slightly in the last quarter of 2007.

Figures released by the Office for National Statistics (ONS) in February showed a huge rise in the number of death certificates mentioning C diff.

In England and Wales, there was a 72% rise, from 3,757 mentions in 2005 to 6,480 in 2006.

Death rates involving C diff increased by 77% among males and 66% among females between 2005 and 2006.

Rates went up from 37 to 65.5 per million males, and from 38.6 to 64.2 per million females.

Andrew Lansley, the Shadow Health Secretary, said: “From start to finish, Labour's attitude to hospital infections has been woefully misguided. For years even their own advisers have been telling them that the way to tackle the problem is to identify infected patients as early as possible and then isolate them to make sure others don't catch it.

"But Labour have ignored the experts and Gordon Brown has stubbornly chosen to put time, money and effort into a 'deep clean' which made a good headline but wasn't backed up by any evidence.

"These figures are for the period when the 'deep clean' started. If it had been effective we would be expecting to start to see a decrease in the number of infections, not another rise.”

The new data shows there were 1,087 cases of MRSA during October to December 2007.

This represents a 0.6% increase on the previous quarter, when 1,080 cases were reported to the Health Protection Agency.

In the same quarter in 2006 there were 1,543 cases.

Meanwhile, figures for the bug Clostridium difficile (C diff) showed an 8% drop, to 9,872 cases in patients aged 65 and over between October and December 2007 compared with the previous quarter.

However, the HPA warned that changes to how NHS trusts report their C diff figures could have influenced the result, as some data may be incomplete.

The HPA stressed it could not be confident that the apparent reduction was an accurate reflection of the current situation.

Dr Duckworth, who is head of the HPA's healthcare-associated infection and antimicrobial resistance department, said: “Over the last year cases of MRSA bloodstream infection have been steadily falling.

"We would obviously like to have seen the trend continued in this quarter and hope that ongoing surveillance will show that this plateau is not indicative of a levelling trend, but we need to see next quarter's figures.

"The NHS has faced a great challenge in turning around the seemingly unstoppable rise in MRSA bloodstream infections that we saw throughout the 1990s.

"The substantial decreases seen in recent quarters clearly demonstrate the huge efforts made by our NHS colleagues to combat these infections.

"Although the current figures indicate a plateau, variations in the rate of decrease over time are not unexpected and are not necessarily a cause for alarm.”

Professor Peter Borriello, director of the HPA's centre for infections, said: “The reduction of healthcare-associated infections is a big challenge throughout the world.

"The Agency continues to support the hard work of our NHS colleagues in combating these infections and the never-ending battle to fight all types of infection.”

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2008/04/24/nmrsa124.xml

Health Direct notes that once again labour's dithering is literally killing people with preventable early deaths at the same time as wasting yet more taxpayers' money.