Published Date: 2007-02-09 17:00:02
Subject: PRO/EDR> Clostridium difficile - UK (Scotland)
Archive Number: 20070209.0508
CLOSTRIDIUM DIFFICILE - UK (SCOTLAND)
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
Date: Fri 9 Feb 2007
From: ProMED-mail <email@example.com>
Source: Inverness Courier [edited]
A serious bacterium -- that is killing 3 times more people than MRSA
-- is spreading rapidly throughout Raigmore Hospital's medical and
surgical wards, it was revealed this week. There were 84 cases of
_Clostridium difficile_ associated disease (CDAD) in the Inverness
hospital in 2006, compared to 13 in 2003, and 41 in 2005.
CDAD hit the national headlines in 2006 after 49 people died in 8
months in Leicester after catching the bug. The spread of the
disease, which causes diarrhea, high temperatures, and severe
inflammation, was described as "rapid" and "challenging" to control
by a Raigmore consultant.
A distinguished professor of bacteriology said a possible reason for
the increase could be that overstretched staff did not have enough
time to practice basic hygiene. Hugh Pennington, who spent 40 years
as professor of bacteriology at Aberdeen University and was chairman
of the inquiry into the 1996 _E. coli_ outbreak in central Scotland,
also said that many CDAD cases followed antibiotic treatment.
"There's no doubt it kills more people than MRSA, about 3 times more
people," he said. "It produces a poison; a toxic illness that's
really quite serious. It often affects people who are already ill
with something else and it is very often the last straw. "People have
rather underestimated these bugs and are now paying the price. When
CDAD gets itself established in a hospital, it takes quite a long
time to get rid of it."
The internationally respected expert said there were a few possible
reasons for the increase in cases. "It may be due to everything that
hospitals have got to do -- more and more patients is a reason why
staff just don't have the time to do things like basic hygiene," he
explained. "There may be strains of the bug about that are better at
causing mischief and also we are getting better at counting the
number of cases."
He emphasised its spread could be controlled by treatment procedures,
such as using antibiotics more wisely, as well as ensuring high
levels of hygiene among staff, patients and visitors. "It is vitally
important for hospitals to have good old fashioned hygiene in place," he added.
Raigmore Hospital's cleanliness was called into question in 2006
after inspectors, who watched cleaners at work, gave it a compliance
rating of only 83.1 percent, the worst in the country. However it
redeemed itself during the following quarter between July and
September 2006, achieving a 92.1 percent pass mark.
Cases of CDAD rose nationally in 2005 by 17 per cent, with 51 000
infections reported to the Health Protection Agency with a death rate
of around 5 percent.
A spokeswoman for Raigmore Hospital said yesterday it was "not aware"
of anyone dying from CDAD in Inverness and highlighted a 40 percent
drop in MRSA levels between 2005 and 2006.
Andrew Hay, NHS Highland consultant microbiologist, outlined measures
to bring the CDAD figures down after his report on the disease was
presented to NHS Highland's board meeting on Tuesday [6 Feb 2007] in Inverness.
"These include the recent appointment of 2 hand hygiene coordinators
as part of the National Hand Hygiene campaign as well as proposals to
increase the proportion of beds as single cubicles," he said. "There
are also plans to recruit an antimicrobial pharmacist to improve
antibiotic prescribing, which will be influential in controlling the
spread of CDAD."
Dave Petrie, Highlands and Islands Conservative MSP, called for the
return of ward sisters. "We've advocated going back to ward sisters,
someone to monitor people coming in and out."
[Byline: Calum Ross]
[It is not clear if any of the cases are due to the hypertoxin
producer, _C. difficile_ ribotype 027. _C. difficile_, however, is a
potentially life-threatening issue even without the hypertoxin
_C. difficile_, along with a number of other often hospital-acquired
(nosocomial) infections such as methicillin-resistant _Staphylococcus
aureus_ and a variety of multidrug-resistant Gram negative bacilli
including _Acinetobacter_ and _Klebsiella_, is difficult to manage in
today's health care environment. The factors responsible for this
are alluded to in the posting.
Modern medicine allows people with potentially rapidly fatal
illnesses to survive longer. These medical interventions include
respiratory support, cancer chemotherapy, multiple indwelling
intravenous and other devices, and aggressive surgery, and leads
individuals at high risk to develop intercurrent infections. The use
and potential abuse of broad spectrum antimicrobials select for
microbes such as those above. With _C. difficile_, previously called
antibiotic-associated colitis, antimicrobial use is a major player in
predisposition to disease but the spores of _C. difficile_ may spread
by inadequate hygiene.
The linchpin in preventing transmission of these agents in the
hospital milieu is aggressive and effective hand-washing before and
after each patient contact. It is the "critical control point" in a
HACCP (Hazard Analysis and Critical Control Point) analysis for
diminishing transmission of the bacteria. Having said that, the
development of a hospital-acquired infection is not, per se, an
indication of a misdeed by the healthcare system. In modern medicine,
infections still occur in the best of circumstances and emergent
situations can arise where there is no time even for hand-washing.
A map of Inverness in the Scottish Highlands can be found at:
<http://www.cameronandpaterson.co.uk/scotland_map.gif>. - Mod.LL]