London

Mark Gould

The number of infections of Clostridium difficile in hospitals in England has risen sharply, new figures from the Health Protection Agency show. In particular, the number of reported cases in patients aged over 65 years rose by 17% last year—from 44 107 in 2004 to 51 690.

The agency said the increase was partly due to better reporting―all 169 NHS trusts submitted returns last year. But Georgia Duckworth, head of the agency’s department for healthcare associated infections, was “encouraged” by a slight downturn in the number of cases of methicillin resistant Staphylococcus aureus (MRSA) bacteraemia: from 7250 cases in 2004-5 to 7087 in 2005-6. Six trusts reported no cases, and major decreases were reported at large acute trusts in London and Yorkshire.

Some two thirds of cases of MRSA and three quarters of cases of C difficile were in people aged over 65. Length of stay in hospital increased the risk of infection, but around a quarter of patients were already infected when they were admitted.

Peter Borriello, director of the agency’s Centre for Infections, reiterated the need for good infection control and agreed that mandatory surveillance and reporting of infections could be extended to nursing homes.

"The public has a right to expect hospitals to be squeaky clean and smelling of disinfectant and carbolic," he said. "The exhortation ‘do no harm’ in the Hippocratic oath could be extended to all areas in which health care is given. You wouldn’t be reassured if you were in a restaurant where the tablecloths were mucky but the waiter told you the kitchen was spotless."

He stressed that even the most rigorous regime would not eradicate all infections and intimated that the Department of Health’s target of halving the number of MRSA infections by 2008 might not be met.

The figures were released on the same day as the Healthcare Commission issued a highly critical report concerning what the health minister Andy Burnham called "inexcusable" failings by senior managers at Stoke Mandeville Hospital, where two outbreaks of C difficile affected 334 patients, killing at least 33.

Anna Walker, the commission’s chief executive, said that senior managers at Buckinghamshire Hospitals NHS Trust, which runs Stoke Mandeville, were too preoccupied with targets on reducing waiting time for emergency care. They had ignored advice from infection control staff, clinicians, nurses, and the local health protection agency on the need to isolate infected patients and on cutting down on the transfer of patients between wards.

Only national publicity and the involvement of the health department, which dispatched a senior microbiologist to advise on the outbreak, changed the trust’s approach.

Under the terms of a new code of practice to curb healthcare associated infections, issued by the health department, the hospital has 60 days to implement a series of recommendations or face sanctions that include the removal of its board or the downgrading of its star rating.

Mandatory Surveillance of Healthcare Associated Infections: Report 2006 is available at www.hpa.org.uk. Investigation into Outbreaks of Clostridium difficile at Stoke Mandeville Hospital, Buckinghamshire Hospitals NHS Trust is at www.healthcarecommission.org.uk.