Monday, April 28, 2008

Superbugs and Bed Numbers

Panorama ran a terrifying story yesterday about the problem for hospitals posed by the c-diff superbug which is now killing about 6,000 patients a year in British hospitals - worse than MRSA.

The story included an in-depth examination of one particular NHS hospital trust in Southern England where 90 patients had died from c-diff and there had obviously been some serious management failings. But although Health Secretary Alan Johnson claimed that the management of this trust was uniquely bad, the sheer number of deaths over the whole country indicates that c-diff is clearly not an isolated problem - only about 1% of deaths over the UK from this bug were in that trust.

And it would appear that we as a country are doing something wrong - if you look specifically at the age range and circumstances of the type of patients most affected in the UK, one of the experts who appeared on Panorama that UK death rates from c-diff are ten times worse than in other comparable countries.

The most frightening aspect of this is that once you get an major infection of the most virulent strains of c-diff it is almost impossible to eradicate the bug. Proposals to recruit more matrons and the fact that a "deep clean" of hospitals are a welcome indication that the problem is at least beginning to be addressed, although I note that some clinicians have been quite scathing about the effectiveness with which the "Deep Clean" policy is being implemented. But according to the Panorama programme, some strains of c-diff can go into a dormant state in which they can survive heat, broad-spectrum antibiotics, and disinfectant, then go active again and infect somebody years later.

The most effective defence appears to be to operate very high standards of hygenie so that the bud doesn't get well established in the first place.

The North Cumbria Acute Services NHS Trust which runs the West Cumberland hospital has one of the better records for controlling Hospital Acquired Infections but it would appear that no hospital or trust can afford to be complacent when confronted with the new superbugs.

In particular, the danger of a c-diff outbreak appear to be higher if

1) Bed occupancy rates are very high, making limited time to clean beds between patients and making it likely that patients will be moved between wards

2) Nurses are overworked

3) Management is fixated on central government targets and consequently paying less attention to the basics of cleanliness and good patient care.

Which means that the number of beds available at the West Cumberland, at Millom Community Hospital and Keswick Cottage Hospital will need very careful attention with the planned changes to make sure that bed occupancy rates do not get too high.


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