Pressure to meet government targets may have undermined attempts to combat an outbreak of a virulent bug that kills more patients than MRSA, a health protection expert said yesterday.
The hospital-acquired infection Clostridium difficile struck nearly 44,500 patients, mostly over 65, in England last year. But it first hit the headlines in June when it was disclosed that more than 300 patients had been infected at Stoke Mandeville hospital in Buckinghamshire.
Twelve died. Some have been hit by a more virulent strain of the bug.
But Dr Elizabeth Haworth, of the Health Protection Agency's (HPA) south-east division, said there had been pressure to meet targets on treatment and waiting lists. This meant a large isolation ward had possibly been reopened for general medical patients too soon.
"Unfortunately that was the time when the spread to other parts of the hospital was recognised. It was acting too soon and that is an example of tensions between targets and good infection control. The ward should probably have been kept as an isolation ward for several weeks until things were under control," she said.
The fact younger patients in the hospital were being infected - the youngest was 20 - should have been a warning.
A shortage of small and single rooms meant many patients had to be treated on large wards which can take up to 26 patients. But this meant infection control was more difficult, said Dr Haworth, a speaker at the agency's national conference at Warwick University.
C difficile is associated with severe diarrhoea and colitis. It is found in around 5% of healthy adults but kept in check by good intestinal bacteria. However, antibiotics given to patients can knock out the good bacteria, leaving them vulnerable to the toxins produced by C difficile. The infection used to be considered life-threatening only to older, vulnerable people. Last month the Department of Health revealed it was the cause of death in 934 people, compared with 321 where MRSA was said to be the underlying cause.
But Georgia Duckworth, of the HPA's centre for infections, said it was asking hospital laboratories around the country to provide samples from infected patients under 65, because of concerns about the 027 strain of C difficile.
"Historically we have always had surveillance of over-65s, and there was almost no point in testing younger age groups. But outbreaks in the States and Canada would suggest it was going for extra groups such as the 50-64s," she said.
Dr Duckworth also revealed that there may soon be national systems to monitor whether patients develop a range of hospital-acquired infections after they have been sent home. One trust in London, which she declined to name, already employed medical students to telephone patients to ensure wounds and sutures were still healthy and had already saved money on clinical negligence claims.
