Doctors’ tie ban resulted in scruffy health professionals

A health professional has criticised “scruffy doctors” and called for a return to ties and white coats.
Doctors' tie ban resulted in scruffy health professionalsStephanie Dancer, a microbiologist at Hairmyres Hospital in East Kilbride, said patients complained they did not know who the doctor was.

In 2008, the Scottish government dropped the white coat and banned ties in a bid to cut infection rates.

However, Ms Dancer said the role of the uniform in transmitting bacteria had been exaggerated.

There is no evidence that the white coat is a vehicle for the spread of infection, she said, whereas “hand-touch contact, airborne delivery, environmental reservoirs, and human carriage are all implicated in transmission”.

She added that informal dress could project an image of poor personal hygiene and imply declining standards of cleanliness.

Ms Dancer also claimed it eroded the image of doctors as responsible and competent.

The consultant warned that easy access to antibiotics was eroding the importance of basic hygiene over the past half century.

“Given that cleanliness is no longer a matter of life or death, it is no wonder our junior doctors dress the way they do,” she said.  “Before the antibiotics run out, we need to revisit the hygiene values of the past”.

The white coat was first introduced in the 19th Century in part to prevent cross-contamination.

However, 100 years later they fell out of favour with Labour’s nanny state. In 2007, national NHS guidance advised against wearing long-sleeves and ties during clinical work.

The Scottish government introduced a new NHS uniform in 2008, which included tunics in four shades of blue for clinical staff and tunics in green for support staff.

The uniforms were brought in to help tackle healthcare associated infections such as MRSA and C.difficile.

Norovirus winter vomiting bug claims a million people

The number of sufferers of the winter vomiting bug Norovirus in England and Wales have topped a million the latest figures from the Health Protection Agency suggest.Norovirus winter vomiting bug claims a million peopleIt said there were 3,538 lab-confirmed cases up to 16 December – but that for each another 288 go unreported.

The figure is 83% higher than at this stage last year – but has not increased greatly since last week.

Norovirus is a highly contagious short term illness and causes severe vomiting and diarrhoea.

It can be spread through contact with contaminated surfaces or objects, by contact with an infected person, or by the consumption of contaminated food or water.

The HPA’s figures show that – so far this year – there are 83% more cases than there were at the same point in 2011 when there had been 1,934 norovirus cases reported.

In addition, there were 70 hospital outbreaks in the two weeks up to December 23rd, compared with 61 in the previous fortnight.

It could be there is simply an earlier peak in cases – or that figures will be higher overall this year.

The HPA stresses norovirus is unpredictable, and no two years are the same.

The norovirus “year” – the date from which experts start to count cases – begins in July and runs to the following June.

Laboratory confirmed reports represent a small proportion of the actual number of cases because most people do not see a doctor – and therefore their case is not recorded.

A Department of Health spokeswoman said: “The NHS is well prepared for the winter. No A&Es have had to close so far this winter and we are providing additional funding to the NHS to help it cope with the added pressure that the winter brings.

“Our weekly published figures show the number of beds closed across the NHS due to norovirus symptoms is around 2.4%. This compares to 2.9% of beds that were closed during the peak of norovirus cases last winter.”

DNA code of MRSA superbug cracked by scientists

The DNA code of the superbug MRSA has been cracked by scientists so that their future spread can be halted more quickly.DNA code of MRSA superbug cracked by scientistsA new device can identify specific bacterial strains from their genetic codes so experts can target the transmission path of the infection and cut it off.

In an early test of the technology, researchers halted an outbreak of the MRSA superbug in a special care baby unit at the Rosie Hospital in Cambridge.

It is believed to be the first time DNA sequencing has been used to contain an infectious disease outbreak at a hospital.

The scientists are now developing the concept into a simple system that can be used routinely by hospital staff who are not genetics experts.

In future, it could be used to combat many kinds of infection outbreak, and also help doctors decide the best way of treating patients.

Professor Sharon Peacock, from Cambridge University, who led the research team, told a news briefing in London: ”What we’re working towards is effectively a ‘black box’. Information on the genome sequence goes into the system and is interpreted, and what comes out the other end is a report to the health care worker.

”It could, for example, determine the species of the bacterium; it could determine antibiotic susceptibility, and it could provide information about what genes are present that are often associated with poor outcomes in patients.

”It will give information about how related that organism is to other organisms within the same setting, giving an indication of the capability of transmission from one patient to another.”

A report on how the baby unit outbreak was brought under control appears in the latest issue of the journal The Lancet Infectious Diseases.

The scientists used a technique called rapid whole genome sequencing, which maps an organism’s entire genetic code, to analyse MRSA bacteria taken from 12 babies.

MRSA (methicillin resistant Staphylococcus aureus) is an antibiotic resistant form of a common skin bug that can cause potentially deadly wound infections in hospitals.

Standard procedures had not been able to show whether a genuine outbreak had occurred, or whether the babies had all coincidentally been exposed to MRSA.

The team was quickly able to confirm that 10 babies were part of an MRSA outbreak involving a previously unknown strain of the bug.

Measures were introduced to clear MRSA from carriers and deep-clean wards, but two months later a new infection case was identified in the baby unit.

DNA sequencing showed it was caused by the same strain identified earlier, carried to the ward by one of 154 screened health care workers.

Co-author Dr Julian Parkhill, head of pathogen genomics at the Wellcome Trust Sanger Institute in Hinxton, Cambridgeshire, said: ”The staff member was decolonised and went back to work, and we believe this brought the outbreak to a close.”

He said he expected the cost of whole genome sequencing of bacteria to fall from around £100 per sample to £50, and ultimately just ”a few pounds” in the near future.

”People are talking about the thousand dollar human genome,” he added. ”If you can do the human genome for a thousand dollars you can do a bacterial genome for one dollar.”

The MRSA outbreak at the Rosie Hospital, part of Cambridge University Hospitals NHS Foundation Trust, was estimated to have cost the NHS around £10,000. This was double the cost of the DNA sequencing, said the researchers.


Hand hygiene campaign cut hospital superbug infections

The campaign to improve hand hygiene in hospitals in England and Wales is contributing to a significant fall in the rates of superbug infections, according to a report.Hand hygiene campaign cut hospital superbug infectionsThe study published on the BMJ website showed the amount of soap and hand gel being used tripled during the campaign.

At the same time, levels of MRSA and C. difficile infections in hospitals fell.

The government has since dropped the campaign, but said its ambition was to “wipe out” such infections.

Hospital superbugs were once a real fear for many patients. In response the Clean Your Hands campaign, funded by the Department of Health, was introduced in all hospitals by June 2005.

Alcohol gels were put by bedsides, posters reminded staff to wash their hands and there were regular checks to ensure hands were kept clean.

By 2008, the total amount of soap and alcohol gel being purchased by hospitals trebled, going from 22ml per patient per day to 60ml per patient per day.

Rates of MRSA more than halved in the same time period and C. diff infections fell by more than 40%.

One of the report’s authors, Dr Sheldon Stone from the Royal Free University College London Medical School, estimated that around 10,000 lives were saved because of the campaign.

He told the BBC: “It’s been a real British success story, we’ve gone from being the dirty man of Europe to being world leaders.

“What we need to do is keep up the momentum and stay at the forefront of world hand hygiene.”

A spokesman from the Department of Health said: “The Clean Your Hands campaign was successful in its aim to highlight the importance of good hand hygiene practice across the NHS. We know this has been successful.

“The challenge now is to ensure the NHS embeds the good practice highlighted in the campaign to achieve our ambition to wipe out avoidable healthcare-associated infection.

“We know real progress has been made in this area as MRSA bloodstream infections have dropped by 41% and C. difficile by 30% across the NHS in England since 2009/10.”


Record number of patients catch infections in hospitals

The number of patients who contracted life threatening infections in NHS hospitals has almost doubled in two years to a record level, official figures have shown.Record number of patients catch infections in hospitalsRecorded cases of patients with a “nosocomial condition” – any infection acquired in hospital or a medical environment – also rose by more than a third last year compared with the year before.

A large proportion of the patients involved were aged over 75, the figures from the NHS Information Centre show. Illnesses related to such infections led to average stays in hospital last year of 31.1 days.

Experts blamed poor hygiene for the dramatic rise in infections, including superbugs MRSA and Clostridium difficile (C. diff) as well as norovirus and E.coli.

But the Department of Health dismissed the “misleading” figures, published online, saying that officials have “got better and better at tackling hospital infections”.

According to the new figures, supplied by NHS hospitals, the number of patients found by consultants to have hospital acquired infections rose last year reached a record 42,712.

That figure increased from the 31,447 recorded in the previous year and almost double the 22,448 documented in 2008/09.

Last year’s figures were the highest levels recorded in the 13 years in which the records have been publicly available. In 1998/99 there were just 335 such cases. The Centre did not provide a breakdown of illnesses.

It came as the Health Protection Agency said that there were 46 suspected outbreaks of norovirus in hospitals over the past two weeks, with more than half leading to ward closures or admissions restrictions.

The agency said the levels were within seasonal norms.

Commenting on the overall infection levels Joyce Robins, co-director of Patient Concern, said the figures were a “terrifying prospect for vulnerable elderly people who think they are going into hospital to get better”.

“It contrasts sharply with the happy propaganda that has been telling us that infection rates had dropped sharply,” she said.

A DoH spokesman said: “The NHS has got better and better at tackling hospital infections, demonstrated by the record lows we have seen this year.

“Because we are not complacent, we have introduced mandatory reporting of more hospital infections. That means that we have shone a light on the problems previously swept under the carpet.  But patients should be confident that the measures we have taken will continue the downward trend in hospital infections.”

Norovirus bug outbreak at 35 hospitals closes dozens of wards

Health officials have issued a warning about the serious threat posed by the norovirus bug after an outbreak has seen cases jump by 20 per cent on this time last year.Norovirus bug outbreak at 35 hospitals closes dozens of wardsThe winter diarrhoea and vomiting bug has affected 35 hospitals, with hundreds of beds unavailable after 27 wards were shut in the past two weeks to isolate infected patients and deep cleaned.

Overall confirmed individual cases across the country from July to mid-December are 19 per cent higher than during the same period last year.

Norovirus is extremely contagious and can be lethal to the elderly, very young or very sick patients.

People who have been ill are being asked not to visit friends and relatives in hospital until they are well.

Medical bosses at hospitals across the country are working to prevent the condition spreading and to reopen wards that were closed yesterday.

Nationally data from the Health Protection Agency released last week shows that norovirus rates remain below the level expected for this time of year, possibly reflecting the mild weather until now.

The HPA declares norovirus season has started when 4.8 per cent of calls to NHS Direct are about vomiting. Last week there were 4.2 per cent of calls about vomiting.

The first sign of Norovirus is usually a sudden sick feeling followed by forceful vomiting and watery diarrhoea. Other symptoms include a raised temperature, headaches, stomach cramps and aching limbs.

The data showed that last week the North East and South West were the worst affected.

Three hospitals reported that 124 beds are unavailable as a result of the ward closures. It is thought that the true number across all eight hospitals will be more than 200.

Wards were also closed to new patients at Montagu Hospital in South Yorkshire while 82 beds were closed on two wards at Northwick Park in Harrow, north London.

Croydon Health Services said it had one ward closed to new admissions.

Two wards were also closed at Warwick Hospital and the Richard Wells Ward was shut at Bedford hospital to contain a bout of gastroenteritis.

Director of nursing and patient services at Bedford hospital, Eiri Jones, warned visitors not to sit on hospital beds and not to visit at all if they had been ill in the preceding 72 hours.

Queens Hospital in Burton had one ward temporarily closed after a number of cases of diarrhoea and vomiting while the Countess of Chester Hospital had visiting restrictions in place at four wards to contain the outbreak.

A 14-bed ward at the University Hospital Southampton Trust was closed and County Durham and Darlington said it had seen isolated cases but had not had to close any wards.

Visitors to Northern Devon hospitals were warned only close relatives should visit patients and Mid Essex Hospital Trust said it had closed wards last weekend because of a similar outbreak.

The Royal College of GPs say the virus has not been a major problem so far this year – although outbreaks can occur very quickly, as the complaint is extremely infectious.

A statement from the Health Protection Agency said: “Norovirus is highly contagious and can be transmitted by contact with an infected person; by consuming contaminated food or water or by contact with contaminated surfaces or objects. The virus spreads rapidly in closed environments such as hospitals, schools, nursing and residential homes.

“Anyone who thinks they may have norovirus should not to go to their doctor’s surgery or A&E as this could spread the illness to vulnerable people and health care workers.”

Europe losing superbugs battle

The emergence of antibiotic resistant infections has reached unprecedented levels and now outstrips our ability to fight it with existing drugs, European health experts are warning.
Europe losing superbugs battleEach year in the EU over 25,000 people die of bacterial infections that are able to outsmart even the newest antibiotics.

The World Health Organization says the situation has reached a critical point.

A united push to make new drugs is urgently needed, it says.

Without a concerted effort, people could be dealing with the “nightmare scenario” of worldwide spread of untreatable infections, says the WHO.

One example is the New Delhi or NDM-1 superbug recently found in UK patients. They have brought the infection back with them from countries like India and Pakistan, where they had visited for medical treatment and cosmetic surgery.

The Cardiff University researchers, who made the discovery last August, now say bacteria with this new genetic resistance to antibiotics have contaminated New Delhi’s drinking water supply, meaning millions of people there could be carriers.

Dr Timothy Walsh and his team collected 171 swabs of seepage water and 50 public tap water samples from sites within a 12km radius of central New Delhi between September and October 2010.

The NDM-1 gene was found in two of the 50 drinking-water samples and 51 of 171 seepage samples.

Worryingly, the gene had spread to bacteria that cause dysentery and cholera, which can be easily passed from person to person via sewage-contaminated drinking water.

“Oral-faecal transmission of bacteria is a problem worldwide, but its potential risk varies with the standards of sanitation.

“In India, this transmission represents a serious problem… 650 million citizens do not have access to a flush toilet and even more probably do not have access to clean water,” the researchers warn in the journal Lancet Infectious Diseases.

The scientists are calling for urgent action by health authorities worldwide to tackle the new strains and prevent their global spread.

Zsuzsanna Jakab, WHO regional director for Europe, said: “Antibiotics are a precious discovery, but we take them for granted, overuse and misuse them: there are now superbugs that do not respond to any drugs.

“Given the growth of travel and trade in Europe and across the world, people should be aware that until all countries tackle this, no country alone can be safe.”

The UK’s Health Protection Agency said it was monitoring the spread of NDM-1 closely.

“The first case of a bacterial infection with this resistance was identified in January 2008. Monitoring of this resistance began in 2009 as more cases were identified.”

So far, there have been around 70 cases of the infection recorded in the UK.

The HPA insists that the risk of infection to travellers to the Indian subcontinent who are not treated in hospital is minimal.

“If members of the public are travelling for surgery overseas they should satisfy themselves that appropriate infection control measures are in place,” says the HPA.


New superbug NDM-1 spreads to UK hospitals by health tourists

International travel and medical tourism helped the spread of drug resistant bacteria that could lead to the end of antibiotics, scientists have warned.
New superbug NDM-1 spreads to UK hospitals by health touristsA new gene, NDM-1 (New Delhi metallo—lactamase), emerged which allows bacteria to be highly resistant to almost all antibiotics, the scientists said.

NDM-1 spread in India, Pakistan, and Bangladesh.  But it was also found in 37 patients from the UK, who travelled to India or Pakistan for medical procedures including cosmetic surgery, according to an article published in The Lancet.

“The potential of NDM-1 to be a worldwide public health problem is great, and co-ordinated international surveillance is needed,” Timothy Walsh of Cardiff University and his international colleagues wrote.

The gene was mostly found in E Coli, a common cause of urinary tract infections and pneumonia, which is highly resistant to antibiotics.

The authors said it could be easily copied and transferred between different bacteria, suggesting “an alarming potential to spread and diversify among bacterial populations”.

The paper said several of the UK patients had travelled to India or Pakistan for surgical procedures within the past year.

They wrote: “India also provides cosmetic surgery for other Europeans and Americans, and it is likely NDM-1 will spread worldwide.”

Study co-author Dr David Livermore, director of antibiotic resistance monitoring at the Health Protection Agency, said: “The findings of this paper show that resistance to one of the major groups of antibiotics, the carbapenems, is widespread in India.

“This is important because carbapenems were often the last ‘good’ antibiotics active against bacteria that already were resistant to more standard drugs.

“We have now also identified bacteria with this type of resistance – NDM – in around 50 patients in the UK.  Most, not all, had previously travelled to the Indian subcontinent, and many had received hospital treatment there.”

“International travel gives a great potential for spread of resistant bacteria between countries.  Few antibiotics remain active against these bacteria. Their spread underscores the need for good infection control in hospitals both in the UK And overseas, and the need for new antibiotic development.”

A Department of Health spokesman said: “We are working with the Health Protection Agency on this issue. The HPA alerted the NHS in January and July last year to be vigilant about these bacteria and take appropriate action where necessary.

“Hospitals need to ensure they continue to provide good infection control to prevent any spread, consider whether patients have recently been treated abroad and send samples to HPA for testing.

“So far there has only been a small number of cases in UK hospital patients. The HPA is continuing to monitor the situation and we are investigating ways of encouraging the development of new antibiotics with our European colleagues.”


Payout for hospital chief after 90 superbug deaths after DoH bungle

A senior judge has delivered a stinging rebuke to the Department of Health over its treatment of a former head of an NHS trust that experienced the worst superbug outbreak in memory.
Payout for hospital chief after 90 superbug deaths after DoH bungleLord Justice Sedley gave his ruling as the Court of Appeal awarded more than £190,000 in damages to Rose Gibb, former chief executive of the Maidstone and Tunbridge Wells NHS Trust in Kent, where outbreaks of clostridium difficile from 2004 to 2006 infected more than 1,100 patients and led directly to 90 deaths.

Ms Gibb went to court after the Department of Health withheld a six-figure severance payment she had agreed in return for her resignation days before a report into the outbreak was published by the Healthcare Commission.

The judge said the trust had offered to compensate Ms Gibb, who was paid £150,000 a year, so it could “sacrifice on the altar of public relations a senior official who had done nothing wrong”. Its decision was one that “the Department [of Health] does not appear to have cavilled at,” he added.

But when the department later disallowed most of the payment, worth £250,000, it triggered the court action by Ms Gibb.

Lord Sedley said: “The effect of unwarranted departmental interference has been to trap the trust between a rock and a hard place and to expose it, in its attempt to escape, to heavy legal costs.” He added: “It seems that the making of a public sacrifice to deflect press and public obloquy, which is what happened to the appellant, remains an accepted expedient of public administration.”

The Healthcare Commission inquiry into the outbreak, published in October 2007, was highly critical of the trust’s leadership but pinned much of the blame on the Trust’s board – all of whom resigned following its publication.

The Commission’s report said the trust should review its leadership and the trust ordered its legal advisers to report on allegations against Ms Gibb. But no adverse findings were discovered and a decision was made not to remove her by the trust’s Remuneration Committee.

That decision was reversed at a meeting of the committee in September 2007, when it was decided to pay off Ms Gibb before publication of the Healthcare Commission report in October. It was agreed that she would receive £75,000 in lieu of notice and £175,000 compensation.

But the trust rescinded the agreement after being ordered by the director-general of NHS Finance, Performance and Operations to withhold the £175,000 compensation payment, which has since increased to £190,000 with interest.

The Court of Appeal yesterday ordered the trust to pay Ms Gibb the full amount of the compensation plus the costs of the court hearings.

Lord Sedley concluded: “Perhaps those responsible will now reflect that, since such blame as the report allocated was subsequently accepted by the trust’s board – all of whom resigned following publication of the report – there had been no good reason to dismiss the CEO; and that all this money, both compensation and costs, could have been spent on improving hygiene and patient care in the trust’s hospitals.”

Patients and relatives affected by the superbug reacted angrily. Former Bucks Fizz singer Cheryl Baker, whose mother-in-law Doreen Ford died at Maidstone Hospital in 2008 aged 77 after contracting clostridium difficile, called on Ms Gibb to give the money to the families whose loved ones died.


Quarter of NHS trusts failing hygiene tests

A quarter of health trusts failed to meet standards over hospital infections while five were warned over blood-spattered walls and mouldy instruments under a toughened regulatory regime.

Of particular concern was the state of ambulances, which were inspected for the first time. Investigators found dirty forceps stored in some vehicles as well as bloodstains.

The Care Quality Commission (CQC) used its sweeping powers last year to assess how well NHS trusts were coping with hospital infections – which affect 300,000 patients a year.

Of the 167 trusts inspected, 42 were found by the commission to be in “breach” of NHS registration requirements by not meeting standards.

All 11 ambulance trusts in England were assessed – and four found to have violated the terms of their NHS contracts.

Things were so bad that ambulance services in the north-west, east of England and east Midlands received formal warnings for the state of vehicles and stations.

The CQC, derided by critics as a toothless watchdog for “naming and shaming but not paining”, revealled that it has been granted the power to impose tough sanctions that could see failing hospitals warned, prosecuted, fined up to £50,000 and ultimately closed down if they fail to comply with the regulator’s edicts.

As a test-run of this regime the commission was authorised to examine the risks in the NHS of healthcare- associated infections and the results revealed that a minority appeared to take a cavalier approach to safety.

The reasons for failure were worrying: 36 trusts were not providing areas to decontaminate instruments; in three trusts there was a failure to regularly flush unused water outlets – crucial for the control of legionella infections; and 13 trusts were criticised for not keeping clinical areas clean.

Nigel Ellis, the CQC’s head of national inspection, said: “Good infection control takes constant vigilance – and meeting that every day, for every patient, is an ongoing challenge for the NHS.

“We have found evidence of a direct risk to patients and have intervened using our new enforcement powers to ensure swift improvements were made.”

Of these failing trusts, five had to be issued with a warning notice – the first step towards losing the right to operate in the NHS. Investigators pinpointed several serious transgressions, especially in ambulances.

In the north-west vans were stocked with dirty neck braces that were continually reused despite health guidelines urging disposal after one patient’s use.

At Stockport ambulance station, vehicle interiors were “seen to have stains (which appeared to be bloodstains) on the walls as well as visible dirt on the floor and walls”.

In Essex “hand wipes were not available” and “poor levels of cleanliness” were found in 22 out of 23 vehicles inspected. Ambulance equipment in the East Midlands was singled out for being “visibly dirty, including suction units, defibrillators and the tips of forceps”.

The hospitals highlighted for poor practice were both foundation trusts: Basildon and Thurrock university hospitals, and the world-famous Alder Hey children’s foundation trust in Liverpool.

In Basildon, where the commission’s old ratings system had come under fire last year for labelling the hospital “good” weeks before it emerged that dozens of patients might have died after receiving substandard care, investigators found a dismal scene: “Procedure trays used by staff to carry equipment when they take blood samples or give injections had blood spattered on them … a commode soiled under the seat.” Out of date equipment was also found in the emergency stores.

In Alder Hey, one of Europe’s largest children’s hospitals, the inspection revealed dirty toys, hair stuck to medical equipment and “nappy changing mats stored on the floor next to a toilet … and a dirty baby bath was inside the full-size bath”. The water “ran brown” from taps in rooms ready for patients to be admitted.

The commission said the threat of further measures had pushed the offenders into cleaning up their act. Hospitals and ambulance trusts were forced to set up better procedures, buy new equipment and “deep clean” wards and vehicles – or face a rolling wave of inspections. The last of the conditions imposed for infection control was removed only last December.

Under the new regime CQC can send teams of investigators, accompanied by groups of patients, to hospitals to see whether they match “client” expectations. The bolstered regime is capable of 2,000 unannounced visits a year – three times the current level. “We want to put the patient at the heart of what we do,” said Dame Jo Williams, acting chair of the commission. “Doesn’t matter if it’s the health service, the banking system or Tesco, there is something about the way you are treated as a patient or a client or a customer.”