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HAI Diary

6th March 2007

Healthcare Acquired Infections are increasingly hitting the headlines as UK hospitals fight a continuing battle against MRSA and C difficile outbreaks. Here we catalogue the incidences of HAIs as they occur:

MRSA1

 


Hospital hand washing 'spreads disease'

29th December 2009

One of Britain’s leading bacteriologists Professor Hugh Pennington has suggested that washing your hands in hospitals can actually make you more likely to pick up infections because hospital taps were often crawling with dangerous germs.

The emeritus professor of bacteriology at Aberdeen University said money needed to be spent urgently to replace hand taps with automatic infra-red systems to stop staff, patients and visitors picking up viruses. He said it was “crazy” that such technology was available in slaughterhouses and airports but not in hospitals.

 

'Confusion' over C difficile guidance

30th June 2009

NHS Quality Improvement Scotland has said in a report that there is widespread confusion about guidance over the hospital bug C. difficile.

The report looked closely at three health boards: NHS Grampian, NHS Orkney and NHS Highland. The report said: "We found widespread lack of clarity at all levels within the organisation, from ward to board, around the status, uses and application for the large number of documents, tools and guidance produced at national level."

Dog and cat bites MRSA risk

22nd June 2009

US researchers warn doctors treating dog and cat bites to be aware of the risks of MRSA.

MRSA cases on the rise

12th June 2009

A National Audit Office (NAO) report has shown that cases of MRSA and C difficile are on the increase in some hospital trusts.

Although the total number of cases of MRSA has been cut by 50% following the government's establishment of a national target in 2004, 3,000 cases are confirmed annually in hospitals across the country.

Cases of C difficile, which have fallen by one third since the target was introduced, are currently approximately 3,000 per month.

The superbugs were recorded as "contributing to" the deaths of 9,000 people in hospital in 2007.

The report showed that although 25% of trusts made a reduction of 80% in the number of MRSA cases, 12% saw an increase.

While 29% of trusts saw C difficile rates decrease by more than half, cases at 19% of trusts increased.

The report said cases of a MRSA variant known as MSSA were also increasing.

Edward Leigh, chairman of the Public Accounts Committee, said: "The report shows that other, just as deadly bloodstream infections (as MRSA) are on the rise and threatening all those who use our healthcare system. "

Health minister Ann Keen said: "I welcome this report which acknowledges the achievement of the NHS in reducing MRSA and C.diff and financial savings that have been made as a result of the increased priority that the Government and the NHS have placed on reducing healthcare associated infections over the past few years."

Hospital bugs 'neglected'

12th June 2009

The NHS across England is neglecting the threat posed by a number of healthcare-acquired infections.

While the NHS has had success in tackling superbugs such as MRSA and Clostridium difficile, the National Audit Office says it has not given enough attention to other infections not covered by government targets such as pneumonia and urinary tract infections.

The watchdog has highlighted the problem of MRSA and C diff in previous reports, leading to a cut in rates but warns they only account for 15% of cases of healthcare-acquired infections.

Of the rest, urinary tract infections largely associated with the use of catheters are responsible for 20% of these. Other bloodstream infections, bacteria such as E coli; lower respiratory tract infections, gastrointestinal, surgical site and skin and soft tissue infections are also an issue.

The NAO wants to see compulsory monitoring of healthcare-associated infections widened to cover more infections with checks conducted to ensure that antibiotics are being used effectively.

Report author Karen Taylor said: "It's looking better for MRSA and C difficile, which have been subject to targets, but the main focus of our report is they only account for about 15% of healthcare-associated infections in hospitals and in the rest of the infections there's very poor data.

"Some of the bloodstream infections are just as significant on the impact on the patient."

Health minister Ann Keen said the government remained "totally committed" to eliminating all preventable healthcare-associated infections, while the Care Quality Commission said they would "keep up the pressure" on trusts.

 

Fertilizers contain superbugs

4th June 2009

Scientists discover superbugs that are resistant to antibiotics are being used in farm fertilizers.

New MRSA threat

21st May 2009

Fears are growing that a new strain of MRSA seems to be triggering a deadly form of pneumonia in people who catch flu.

The potential of the threat from the new strain of the antibiotic-resistant bacterium, which is becoming more widespread, is outlined in a study in the journal Lancet Infectious Diseases.

Known as community acquired MRSA (CA-MRSA), it poses a significant risk outside hospitals.

While cases of pneumonia caused by CA-MRSA in the UK are very rare, researchers from Emory University School of Medicine in Atlanta say death rates following infection may be higher than 50%.

Experts warn that swine flu may intensify the problem because CA-MRSA appears to strike people who are already ill with flu.

The researchers said: "Community-acquired MRSA infections are no longer restricted to certain risk groups or to the geographic areas where outbreaks first occurred.

"They now occur widely both in the community as well as health care facilities and have been reported on every continent."

MRSA expert Professor Mark Enright from Imperial College London said that CA-MRSA pneumonia was particularly dangerous “due to the rapid, aggressive nature of the infection.”

"The emergence of pandemic influenza and increased prevalence of CA-MRSA in many countries may cause increased morbidity and mortality in infected individuals," he added.

Professor Richard James of the University of Nottingham said the threat from CA-MRSA in the USA was a very serious concern.

However, the Health Protection Agency stressed that while several other countries had encountered problems, it said these infections remain uncommon in the UK.

 

Babies MRSA tests were 'wrong'

7th May 2009

An investigation is under way at a Manchester hospital after families were told that their babies had MRSA only to discover none of them had the disease.

Central Manchester University Hospitals NHS Foundation Trust has apologised for the error and said that the first tests provided "false positive results". The health trust found the superbug on seven babies during routine screening at St Mary's Hospital but further tests carried out on the babies on the neo-natal unit provided negative results.

 

Software to help fight against superbugs

6th May 2009

Researchers hope powerful software that mimics evolution of superbugs may help scientists tackle them more effectively.

Viruses could kill superbugs

23rd April 2009

A virus could become the next weapon against antibiotic-resistant bacteria.

New paint 'can kill superbugs'

21st April 2009

A research team from the United States has come up with a super-paint that can eliminate the superbugs that kill thousands each year.

It is meant for use in healthcare settings, offices, and homes, and does away with disease-causing bacteria, viruses, mould, and fungi.

Researchers Yuyu Sun and Zhengbing Cao of the University of South Dakota say that the paint shows promise when defending against microbes that already resist the action of antibiotics.

They say that the paint is the most powerful tool to date for fighting the infectons that cause up to 88,000 infections per year in the US alone.

The paint eliminates dangerous microbes such as the methicillin-resistant Staphylococcus aureus, also known as MRSA.

But resisting the hard-to-kill bacteria commonly harboured in modern hospitals is only one function of the new paint.

The researchers said that when any building or furnishing is damp for more than 48 hours, mould may grow.

Mould due to water damage from a roof or plumbing leakage can cause allergic responses or serious fungal infections in some people, as well as damaging the materials from which buildings are made.

The researchers said that another increasingly important application of antimicrobial paints is to help control the spread of healthcare-associated infections, which are increasingly associated with multi-drug resistant pathogens, including MRSA and vancomycin-resistant enterococcus.

They said that such infections cause an estimated US$4.5 billion in healthcare costs in the United States alone.

The new paint, which has the potential to significantly reduce the viability of such microbes in hospital settings, outdoes the range of antimicrobial paints currently available in stores.

But in addition to its increased potency, which can be recharged by adding a coat of chlorine, the new paint keeps its resistance for longer periods than existing brands.


Scottish hospitals to screen for MRSA

9th April 2009

Patients who undergo treatment or surgery at hospitals across Scotland are to be screened for superbugs.

The screening programme is set to be rolled out nationally over the next 12 months following a £3.7m pilot programme at three Scottish health boards.

The screening will focus on groups considered most at risk, including the elderly and people admitted for kidney disease, skin problems and vascular surgery.

However, patients not to be screened will be psychiatric, obstetric and paediatric patients.

Health Secretary Nicola Sturgeon said: “Screening allows us to reduce the number of people admitted to hospital with MRSA, minimising the risk of infections spreading.”

The announcement comes as figures show falls in superbug cases in Scottish hospitals.

In the last quarter of 2008 there were 1,299 cases of Clostridium difficile, down 9% on the previous quarter and down 19% on the same period in 2007.

There were 157 MRSA cases, up 7% on the previous quarter but down 24% on the same quarter in 2007.

However, there remain concerns over the screening with an interim report from Health Protection Scotland (HPS) saying it was not yet known if universal MRSA screening was clinically or cost effective.

Since last June, patients have been routinely tested for MRSA in the pilot areas of Ayrshire and Arran, Western Isles and Grampian health board areas.

Ms Sturgeon said efforts to reduce the incidence of hospital superbugs were working.

However, Liberal Democrat health spokesman Ross Finnie criticised Ms Sturgeon for announcing the screening programme, despite HPS concerns.

 

Superbug test available in Europe

2nd April 2009

Roche's LightCycler test for detecting the superbug MRSA is now available in the European Union.

MRSA breakthrough

26th March 2009

Scientists have developed what is believed to be a new way of tackling MRSA and other hospital superbugs.

Researchers from Queen’s University’s ionic liquids team have been developing salts which can be used to prevent the growth of colonies of dangerous germs. Publishing the findings in the journal Green Chemistry, the team believes the salts could soon be used in the battle to keep wards free from MRSA by breaking down the biofilm coatings that protect the superbugs from antiseptics, disinfectants, and antibiotics.

 

C diff outbreak kills three

24th March 2009

Eastbourne District General Hospital has confirmed that three patients have died following a superbug outbreak.

The hospital, in East Sussex, said ten more deaths may have been caused by Clostridium difficile infections and 17 more patients were undergoing treatment for the bug. Chief nurse Jane Hentley said: "We are doing a cycle programme of deep cleaning in all of our ward areas, also using specialised equipment, using hydrogen peroxide, and we believe that's been instrumental in helping us to manage this infection."

 

MRSA rates in NHS drop again

19th March 2009

The Healthcare Commission has praised progress in infection control as the number of patients with MRSA dropped again.

MRSA carried on mobile phones

6th March 2009

Researchers said mobile phones carried by nursing staff tested positive for MRSA.

C diff studies incorrect

2nd March 2009

It has been claimed that scientists fighting C diff have spent decades aiming at the wrong target.

Steam cleaning in superbug battle

2nd March 2009

The fight to rid hospitals in Scotland of infections such as MRSA and Clostridium difficile is to be stepped up.

Hospitals are to get 250 more regular steam cleaning machines under a £400,000 investment from the Scottish Government. Twenty machines are already available, but the investment will mean every health board has its own equipment. NHS Greater Glasgow and Clyde will get 61 of the cleaning machines, which cost £1,600 each. NHS Lothian will receive 32 machines while NHS Grampian will have 22.

 

GPs urged to review PPI scripts

27th February 2009

Doctors have been urged to review PPI prescriptions in all patients after a new study found the drugs could raise the risk of Clostridium difficile infection by as much as three-fold.

After a study of 254 patients admitted to a London gastroenterology department, researchers warned there was growing concern over the complications from PPI use, which could also include community-acquired pneumonia, hip fractures and osteoporosis. It comes as figures show that the number of PPIs dispensed in primary care rose by 12.9% in the year to September 2007.

 

War hero picks up MRSA, C diff and E coli

24th February 2009

A stay in an NHS hospital sees this war hero wheelchair bound.

MSRA decreases in ICU

18th February 2009

A study shows MRSA in intensive care units in the US has been decreasing.

Jackson has MRSA-type bug

12th February 2009

Michael Jackson has contracted an MRSA-type skin infection during plastic surgery.

GPs can reduce C diff danger

9th February 2009

A study has found that GPs can do more to lessen the risk of Clostridium difficile infections by reducing their prescription of cephalosporin antibiotics.

Dr Saran Braybrook, Herefordshire PCT pharmaceutical advisor, gave a talk to present her study at the UK Drug Utilisation Research group conference in London. She said: "This review highlighted issues such as inappropriate use of cephalosporins...this is a simple type of review that can be used across practices and PCTs. A multifaceted intervention, of which practice prescribing reviews is just part, is a key to implementing prescribing change in primary care."

 

MRSA killed by blue light

5th February 2009

Blue light - not including dangerous UV frequencies - kills MRSA.

C diff cases fall by a third

15th January 2009

Health Secretary Alan Johnson has praised the relentless focus on tackling superbugs as figures emerged showing that cases of Clostridium difficile are continuing to fall in England.

Between July and September, there was a 19% drop in cases in the over 65s compared with the previous quarter - from 8,696 to 7,061 cases.

Mr Johnson said while the NHS was on track to meet the target, a reduction of at least 30% against the average quarter in 2007/08 would have to be sustained for four consecutive quarters.

He said: "This is very good news, and shows that the relentless focus on tackling infections has been working effectively.

"It isn't just about extra investment and tighter regulation - it's also about ensuring that everyone follows the hand-washing routine, the bare below the elbows dress code, the proper hygiene measures and responsible prescribing of antibiotics."

The Health Protection Agency said hard work by NHS staff in the fight against superbugs was paying off.

But Professor Mike Catchpole, director of the Health Protection Agency's Centre for Infections, said: "Winning against these infections will only happen if this hard work continues. Healthcare-associated infections are a global problem and remain a challenge for all of us."

NHS trusts have a target to cut C difficile infections by 30% by 2010/11.

C difficile is a bacterium found in the gut, and over 65s can be more susceptible to the infection that has symptoms ranging from mild diarrhoea to severe inflammation of the bowel. It can occasionally be fatal.

 

Clostridium difficile infection: how to deal with the problem

15th January 2009

Based on a report by a working group established by the Health Protection Agency's Steering Group.

C diff probe, nurses questioned

14th January 2009

Police are to question nurses over deaths from Clostridium difficile at the Vale of Leven Hospital in Dunbartonshire.

A C diff outbreak was linked to 18 deaths and a report, which identified failures in hygiene and infection control, was passed to prosecutors last year. Police are working alongside the Health and Safety Executive, which has been reviewing the hospital's paperwork in relation to infection control procedures. The Royal College of Nursing said its members would meet with legal advisers before being interviewed by police.

 

Improvement for superbug deaths trust

9th January 2009

An NHS trust at the centre of a Clostridium difficile scandal has made progress on infection control and superbug rates.

Ninety people died as a result of two outbreaks of Clostridium difficile in 2006 and 2007 at Maidstone and Tunbridge Wells NHS Trust in Kent.

An investigation by the Healthcare Commission found that dirty wards had contributed to the outbreaks and a subsequent report also blamed low staffing levels and uncovered evidence that staff had left patients to lie in their own excrement.

The Healthcare Commission has found that since then the trust has made substantial improvements and it has commended staff for their progress, although it stressed further work was still needed at the trust.

The Healthcare Commission's head of investigations Nigel Ellis said: "This is a very different trust to the one we investigated in 2007. It was never going to be easy to turn things around in just 12 months and indeed, there is still some way to go."

Kent Police and the Health and Safety Executive investigated the possibility of prosecuting staff and though no charges were brought, the trust's chief executive, Rose Gibb, resigned by mutual agreement following the scandal.

Mr Ellis added: "Staff at every level have put in considerable effort to make these improvements and should be recognised for their hard work.

"However now is not the time for the trust to relax. The trust's infection control systems still need further improvement."

NHS South East Coast has welcomed the  Healthcare Commission’s latest findings.

 

Branson issues infection call

23rd December 2008

Sir Richard Branson has accused politicians of "tinkering" with infection control in hospitals.

In his capacity as vice-president of the Patients Association, Sir Richard wants all hospital staff to be screened for MRSA and treated immediately if infected.

He says any disruption caused would be better than the pain, misery and deaths caused by avoidable infections.

MRSA rates are falling in this country but Sir Richard still wants to see more action taken.

"There have been some improvements, but the facts speak for themselves - and the facts are still horrific.

"It feels like they have tinkered with the problem rather than really got to the heart of the problem. The hospitals are there to cure people. They are not there to kill people," he said.

He also suggested that the NHS could learn from transport industries, such as airlines, on how to avoid mistakes.

The Patients’ Association will hold a conference in the New Year to examine what works most effectively in infection control.

MRSA Action UK agreed on the need for a tougher stance.

However, MRSA expert Professor Mark Enright said Sir Richard’s suggestion made sense but would be difficult to implement.

He said: "It could be successful, but it would be very costly because you would have to employ extra staff. There is no slack in the NHS."

Meanwhile, the British Medical Association warned that running an airline was not the same as running a health service and the Department of Health pointed to tough government actions in the fight against infections.

 

MRSA targets boosts other bugs

15th December 2008

A UK expert has said government efforts to stamp out MRSA could have caused increases in other strains of superbug infections.

Dr Michael Millar said "It's not clear that overall things have got better. Rates of E. coli are going up and it almost compensates for MRSA. All you've done is replaced one problem with another one."  

 

Oregano could fight MRSA

25th November 2008

Researchers in the UK have found out that oregano, a herb usually added in food, could be useful in the fight against MRSA.

Scientists working at the University of the West of England in Bristol discovered that small amounts of carvacrol, which is found within oregano, performed more efficiently as an "antimicrobial agent than 18 pharmaceutical drugs it was compared against".

The compound contains strong antibacterial ingredients which could be used in water sterilisation, as an anti-fungal agent and to kill microbes, including bacteria such as MRSA.

Oregano's properties still functioned in boiling water, which means it could potentially be employed in the disinfection of hospital bed sheets. It could also be used in antibacterial sprays.

Biolaya Organics, an organisation which promotes sustainable farming methods in the Himalayas, has been at the forefront of oregano research. It was set up by Ben Heron last year.

The company is keen to publish its findings in a scientific journal and work with other companies to produce oregano-based products.

Mr Heron said: "Himalayan oregano oil kills MRSA at dilution's of less than 1 to 1000 and the antimicrobial properties, unlike most conventional antibacterial agents, are not affected by heat treatment."

Project leader and professor of microbiology at the University of the West of England, Vyv Salisbury said: "If you wanted to put something through the wash an oregano oil-based product would continue to be effective against MRSA. This is exciting as it also means that we could consider using the oil to develop disinfectant washing powders."

 

Hospital bug fine unfair say experts

21st November 2008

A team from Oxford University and the Medical Research Council has said that the government's plan to fine hospitals for not hitting Clostridium difficile targets is unfair.

The team looked at the new system of fines that are due to start next year but in the British Medical Journal the researchers said most NHS trusts in England would end up paying out because of the random nature of the hospital bug. Researchers said there should be more leeway, but the government said NHS bosses could use discretion.

 

C diff factors in more deaths

19th November 2008

A leading expert says Clostridium difficile infection is a greater contributory factor to deaths in Scottish hospitals than currently recorded.

Professor of bacteriology Hugh Pennington said that C diff should appear on a death certificate more often than it does at present.

Latest figures from the General Register Office for Scotland show that C diff was a factor in 597 deaths last year, compared with 313 deaths in 2005.

In an outbreak at the Vale of Leven Hospital between December and June, 55 people were affected with C diff. It was recorded as the primary cause of death in nine patients and a contributory factor in another nine.

Following the deaths, the Scottish government commissioned an independent investigation which found that there was no clear surveillance system in place, infection control procedures had failed and there were failings in leadership and accountability.

However, Prof Pennington said that it was "very reasonable" to suppose that more than 18 people died at the Vale.

He said that often when it was "abundantly clear" that a hospital acquired infection was material in causing death, it does not appear on the death certificate.

Health Secretary Nicola Sturgeon said: "The key failure at the Vale of Leven is that the surveillance systems weren't robust enough to pick up what was happening there and I think that is a matter of enormous regret and something that I never, ever want to see happen again."

She dismissed suggestions that the report into the Vale of Leven outbreak was not comprehensive enough.

 

Teach pupils about superbugs

18th November 2008

School children in the UK are to be taught about "superbug" infections and encouraged to use antibiotics carefully, as part of a new campaign.

The e-Bug teaching campaign by the Health Protection Agency is designed, according to Dr Cliodna McNulty, the team lead: "to educate our future generation of adults and parents about the benefits of antibiotics and the problems that can arise through their misuse."

"Children are our future generation of antibiotic users and they will also take these important messages home to their parents."  

 

C diff testing 'inaccurate'

31st October 2008

Research carried out by Professor Sanjeev Krishna and his team from St George's NHS Trust has found that hospital testing for Clostridium difficile are not precise enough.

The research will be published in December's Lancet Infectious Diseases. Hospital tests usually look for the presence of a Clostridium difficile toxin from patients' stool samples, but the research showed significant false and missed positive results. The authors wrote: "No assay reliably fulfilled the criteria we preset for an acceptable single test to detect CDT."

 

C diff will get worse before it gets better

31st October 2008

The nation's epidemic C diff will likely get worse before it gets better, says a panel of experts.

Peroxide bombs help fight infection

29th October 2008

Hydrogen peroxide, ozone removal machines and a portable decontamination chamber used to fight HAIs.

Copper door handles and taps kill 95% of superbugs

29th October 2008

Making door handles, taps and light switches from copper could help the country beat superbugs.

Zyvox-resistant MRSA small outbreak

28th October 2008

There's been a small cluster of MRSA that failed to respond to the antibiotic of last resort, Zyvox.

Safety kit that kills superbugs

14th October 2008

A DIY safety kit has gone on sale that protects patients from hospital superbugs.

HAIs boosted Tristel

7th October 2008

Growing concern over HAIs boosted Tristel, the maker of sterilisation and disinfection products.

Health bosses may be charged with MRSA deaths

6th October 2008

The government has said that hospital directors in charge of institutions where patient deaths have been caused by superbugs and negligence could face prosecution under new legislation.

The new manslaughter laws came into effect in April 2008 and allow corporations to be fined an unrestricted amount.

The Sentencing Guidelines Council is due to publish regulations which will clarify if a person can be put in prison if they have not paid the fine. Hospital directors who are convicted of "gross negligence" can also be put in prison.

Maria Eagle, the Justice minister, spoke to a group of NHS directors and warned that they should expect prosecution if they ignored health dangers.

She said: "Putting the offence into context, imagine that a patient has died in a hospital infected by MRSA and the issue of corporate manslaughter has been raised. Could the organisation be prosecuted and convicted? The answer is 'possibly'."

Relatives of affected patients have angrily reacted to the failure to respond to problems by the Maidstone and Tunbridge Wells NHS Trust in Kent. A critical report was published by the Healthcare Commission in October 2007 after 90 deaths from the Clostridium difficile bug and more than 1,000 infections.

There were further outbreaks in 2005/06 and the chief executive of the trust resigned. She was given a £75,000 payout, but has this year lodged an action to receive more.

 

New superbugs fears

16th September 2008

Professor Hugh Pennington, a microbiologist, has spoken to the BBC to voice his worries about new types of superbugs infecting the public.

Professor Pennington said that the Health Protection Agency did not have sufficient resources in order to tackle the problem. He said: "If we do neglect these bugs, we neglect them at our peril. It would be quite wrong if we allow these things to develop." 

 

Paint that could kill superbugs

10th September 2008

Hospitals could tackle hospital superbugs by painting walls and ceiling with a 'killer paint'.

Superbug alert system delay

30th July 2008

A system to alert doctors in Scotland to superbug outbreaks will not be launched until next year.

The Electronic Communication of Surveillance in Scotland (ECOSS) system, which is a web-based early warning system, was scheduled to be deployed later this year. However, Health Protection Scotland says linking Scottish diagnostic labs to the system will take longer than planned.

At present, real time local surveillance and monitoring is already in place in NHS boards but once implemented, ECOSS will collect all data and participating laboratories will routinely report superbug outbreaks.

 

Record fall in HAIs

18th July 2008

Health Protection Agency statistics have revealed that MRSA infections in hospitals in England have dropped by 11%.

The number of cases dropped from January to March to 966. Health Secretary Alan Johnson said: "We are tackling infections on every front with a relentless focus on cleanliness, best practice guidance on antibiotic prescribing, isolating patients and more infection control staff with more powers to help drive down infection rates".

 

Superbug vaccines in a decade

14th July 2008

The government's chief medical officer for England, Sir Liam Donaldson, has said "vaccines against the two major hospital superbugs" should be produced within ten years.

Sir Liam's report will indicate that patients should be offered immunisations against MRSA and Clostridium difficile.

The two superbugs caused 8,000 deaths in England and Wales in 2005 and 2006.

Sir Liam spoke to the Observer and said that vaccines for C difficile should be offered within five years, and for MRSA within five to 10 years.

Sir Liam said the vaccines could be used to offer protection to a patient who was entering hospital to be operated on.

"The other way of looking at it would be to try to interrupt the chain of transmission - to study the pattern of infection in the community, in hospitals and nursing homes, and try to eradicate the pools of infection."

Sir Liam added that hospital staff would need to remain vigilant in case a new strain of infection emerged.

In 2008, the government has introduced a £50 million deep clean of hospitals.

The rates of MRSA infections have decreased steadily since 2006 and the government believes it will reach its target to cut rates by 50%. However the rates have recently stalled at "just under 4,000 cases per quarter in England".

Scotland has higher rates of hospital superbugs, while Wales and Northern Ireland have lower rates.

 

Britain back to pre-antibiotic age

11th July 2008

Superbugs are threatening to return Britain to a 'pre-antibiotic' era.

Stop superbugs with laser treatment

1st July 2008

Researchers at University College London have said that a dye activated by lasers could be used to kill superbug infections such as MRSA.

The team found that the dye generated chemicals which eradicated bacteria. "The growing resistance to conventional antibiotics among organisms that infect wounds and burns makes such infections difficult to treat," the team wrote. 

 

Biggest fear in NHS is infections

30th June 2008

A survey by the BBC has found that people are most worried about contracting an infection while in hospital.

1,040 people were interviewed and 40% said they were most concerned about catching a superbug infection such as MRSA and Clostridium difficile.

31% reported they would think about "avoiding" surgery carried out by the NHS because they were worried about catching something.

Only 33% of respondents said they felt "confident" that the health service would provide adequate protection against hospital infections.

One in four respondents said they were worried about waiting times. The government has targeted this area recently and in England patients should not have to wait more than 18 weeks to receive treatment by the end of 2008.

However, 82% of people reported that they "were proud" of the NHS and 50% said it was "the envy of the world".

94% said they thought the NHS would provide good emergency care and 86% said they thought it provided safe maternity care.

The government has ordered a £50m "deep clean" of hospitals in 2008 and MRSA cases have been decreasing since 2006.

Dr Hamish Meldrum, chairman of the British Medical Association, said: "We understand why people are so concerned about hospital-acquired infections and although infection rates are coming down, no-one can be happy with the levels that still exist."

"We owe it to patients to be able to prove to them that hospitals are a safe place to go to benefit from the help modern medicine can provide."

 

Ward overcrowding fuels infection

24th June 2008

Researchers have said that overcrowded wards and a lack of staff contribute to the risk of hospital infections.

The team from the University of Queensland, said 71% of NHS trusts went over Labour's target bed occupation rate of 82%. Andrew Lansley, the Conservative health spokesman, said: "Labour ... has failed to take even the most basic action to improve hospital accommodation and patients are living with the consequences."

Minister takes the rap for C diff deaths

19th June 2008

Alan Cochrane writes in The Telegraph about the Scottish government's health minister Nicola Sturgeon and the latest outbreak of superbug hospital deaths.

The worst post in government must surely be the one which has to take responsibility for the operation of the health service.

Nicola Sturgeon must face one of the largest outbreaks of clostridium difficile in Britain where 17 people have died, in what may be "the most serious outbreak of its kind".

The Scottish government has responded badly to the outbreak. When "patients at one of Scotland's major hospitals have been dropping like flies for six months, with the cause of their deaths being linked directly to one of the most deadly of the so-called superbugs", what has been their answer?

They have come back with an "eight-minute ministerial statement, delivered weeks after it should have been". In addition they only allocated 20 minutes of questions to the issue, in front of a "half full" chamber.

How are the people of Scotland able to respect a government that treats such crucial issues with disregard? Surely discussing why patients have died in health service hospitals must be the most "serious" of issues?

Ms Sturgeon delivered a "truly shocking" speech regarding the state of the Vale of Leven Hospital, in West Dunbartonshire.

She was honest enough to admit that she was taken aback at the conditions of the hospital - although the key issue is how much she knew and when she found about the problem.

Ms Sturgeon said she was told about the three cases of clostridium difficile - of which one patient had died - at the hospital on 22 May. She said she was first aware that there were many deaths when a newspaper got in touch with her on 6 June.

It was only on 10 June that health service sources informed her that eight people had died from the outbreak and eight more deaths were "indirectly" attributed to clostridium difficile.

However, Labour complained that she did not "ask enough questions about the outbreak".

Ms Sturgeon may have attempted to make amends for a "dreadful situation" but the stigma caused by the department's lack of awareness about the outbreak will surely be "hard to remove".

 

Minister 'knew about C diff deaths'

18th June 2008

The BBC has learned Scotland's health minister knew of C diff deaths four days before action taken.

New superbug worries overhyped

13th June 2008

Infection control experts say that warnings about the emergence of a new superbug infection are overhyped.

Health Protection Agency experts say in an article in the British Medical Journal that concerns about Stenotrophomonas maltophilia, which infects about 1,000 people every year in the UK, are unfounded.

Stenotrophomonas maltophilia gained prominence in May when researchers from the University of Bristol published its genetic code. But the HPA say that Stenotrophomonas maltophilia infections are rare in comparison to the numbers caused by other viruses such as MRSA and Clostridium difficile.

 

C diff kills eight patients

12th June 2008

Eight patients have died as a result of a superbug outbreak in Scotland.

An investigation into cases of Clostridium difficile at the Vale of Leven Hospital has shown that between December and June, eight out of the 54 patients who contracted C diff died as a direct result.

It has also emerged that C diff was also a contributory factor in a further eight deaths.

Overall 22 patients who had contracted C diff during that period died, although the infection was not found to have played a part in the further six deaths.

The NHS Greater Glasgow and Clyde launched an inquiry in May amid concerns that the infection had been passed between the Vale of Leven Hospital and the Royal Alexandra Hospital in Paisley and a review of hygiene procedures and antibiotic use is now under way.

Dr Syed Ahmed, chair of the Outbreak Control Team, said: “The overall number of C diff cases within the six-month period is higher on average than we would expect, but we are particularly concerned about the number of deaths due to this infection.

"This may not be due to any specific strain of C diff but more to do with the type of patients treated at the Vale of Leven which has a high proportion of elderly patients who are more likely to develop symptoms of the infection"

Reducing healthcare associated infections is a key priority for the Scottish Government which has said it expects all health boards to have robust policies in place to help manage C diff.

 

How many lives will MRSA claim?

11th June 2008

According to a Panorama report MRSA is claiming 10 times more lives of elderly patients in Britain than anywhere else in Europe.

Hospital bugs claim more than 10,000 lives each year in Britain alone - that's 20 times more than the number of people who die of AIDS. At least 42% of MRSA bacteria in British hospitals fall into the virulent 'superstrain' category, compared with 20% or lower elsewhere.

The estimated annual spend on treatment for superbugs is more than £1bn according the government.

The question then is, what can be done about it?

Hospitals in Denmark, Finland and the Netherlands have managed to bring their rates of superbug infections down to zero.  They have achieved this with rigorous rules on hand washing, meticulous cleaning of equipment and hospital rooms and use of gowns and disposable aprons to prevent doctors and nurses from spreading germs on clothing.

Not only could the NHS improve their basic hygiene but could also cut down on bed occupancy which is currently 85% in most NHS hospitals. This makes it difficult to control infection, says Professor Richard James of Nottingham University.

This isn't just a UK problem. Superbugs in the US claim 900,000 lives a year. Many American hospitals spend up to $1m per year just testing patients as they enter the hospital.  This is a good thing as 25% of the population carry colonies of the MRSA bacteria on their skin.

The answer for Britian therefore, appears to be to turn to infection control groups for help - the kind of companies that specialise in decontamination, tracking patients and assessing risk of infection.

 

Could our MRSA worries soon be over?

21st May 2008

A new drug, XF-73 could be in our hospitals in three years.

Wipes 'spreading' MRSA

4th June 2008

Researchers claim hospital antibacterial wipes may be helping to spread MRSA.

C diff death inquiry

4th June 2008

Calls have been made for an inquiry into the deaths of seven people from a superbug infection at a Welsh hospital.

They were among at least 33 affected with Clostridium difficile died during an outbreak at the Prince Charles Hospital, Merthyr Tydfil earlier this year.

There have also been four recent C diff deaths at the Princess of Wales hospital at Bridgend and two at the Royal Glamorgan.

Cwm Taf NHS Trust confirmed there was an outbreak at the Prince Charles Hospital and says a "deep clean" has been carried out.

The trust said a number of actions were put in place as a result of the outbreak which included: daily monitoring of all cases of diarrhoea and vomiting; all new C diff positive results to be communicated to the wards and the infection control team immediately; patients moved to side rooms and barrier nursed; and C diff information leaflets were given to patients.

However, after relatives of those who died raised concerns, there have been calls for an independent inquiry.

Jonathan Morgan AM, chair of the Welsh assembly’s health committee, said the investigation should be independent and he wants Auditor General for Wales, Jeremy Colman, to conduct it.

He added: "I think that if the public of Wales is to have confidence in their hospitals and the ability of nurses and the cleaning services to keep hospitals clean to prevent the spread of infection then we need an enquiry in to what happened at Prince Charles and to ensure that we have the best procedures throughout Wales."

 

MRSA food chain fear

3rd June 2008

Three British people, who are being treated in Scottish hospitals, have been reported to be carrying an infection which is an "animal variant of MRSA".

The patients have a type of MRSA known as ST398. This has been identified previously in pigs which are raised in factories in Holland.

Strains of MRSA have been discovered in pigs and other livestock across Europe. The ST398 type is thought to have originated in pigs who were given growth-enhancing medicine. 

A 2006 study carried out in Holland revealed MRSA was present in 20% of pork products, 21% of chickens and 3% of beef.

All the British patients did not have a "close association with farm animals, raising the possibility that the superbug has entered the food chain".

Previous cases of ST398 have shown that it is spread by people working closely with infected animals. However, chefs can get the infection if they have open cuts which attract the bacteria.

The Soil Association said the UK should test its meat supply as two-thirds of pork products consumed in the country come from Holland.

Professor Richard James, of the Centre for Healthcare Associated Infections at Nottingham University, said: "It is a concern. We need people testing pork to see if it's there."

The Soil Association said the Department for Environment, Food and Rural Affairs should make public test results carried out on pigs.

Policy adviser, Richard Young said they suspected MRSA had been found in pigs in Britain.

"ST398 is no more serious than existing strains of MRSA, but it is resistant to different antibiotics, and where it is present it will make it harder for doctors to select an effective drug quickly. In some cases, that could be the difference between life and death," he said.

 

MRSA figures revealed

23rd May 2008

The Office for National Statistics has named the hospitals with the highest numbers of deaths linked to the superbugs MRSA and Clostridium difficile.

Figures for the Royal United hospital in Bath, 268 people who died had C diff recorded on their death certificates – more than 3% of all deaths at the hospital over the four years between 2002 and 2006. Some 235 people with C diff died at the George Eliot hospital in Nuneaton, Warwickshire, similarly equating to more than 3% of deaths there.

 

Could our MRSA worries soon be over?

21st May 2008

The new drug, codenamed XF-73, could be in use in our hospitals in three years’ time.

Drug that can kill MRSA?

19th May 2008

A team of scientists in Britain have said they are carrying out tests on a compound which can eradicate the superbug MRSA.

The research is being performed at Destiny Pharma, a pharmaceutical firm based in Brighton, with the aim of employing the drug to treat MRSA by 2011.

The company showed its research at the European Congress on Clinical Microbiology and Infectious Diseases in Barcelona in April.

The compound, called XF-73, is able to kill bacteria. Conventional antibiotic treatment for hospital infections are "bacteriostatic" (it prevents bacteria multiplying).

Studies of the drug revealed that when MRSA was exposed to XF-73 55 times, it was not able to develop a resistance to it. The drug was also able to kill the "five most common strains" of the superbug during testing.

The latest statistics showed that there were over one thousand cases of the superbug from October to December 2007.

Destiny Pharma's chief executive, Dr Bill Love, spoke to the Independent on Sunday.

"The potential is really quite amazing," he said.

He stated that he hoped the health service would support the compound if it was approved by the National Institute for Clinical Excellence.

A Department of Health spokesman stated that they would keep "a close watch" on all new research related to MRSA.


Test case against NHS board

15th May 2008

A test case against an NHS board is given the go ahead after pensioner contracted superbug.

Baby catches MRSA

14th May 2008

Liam King was diagnosed with a blocked heart whilst still in the womb.  His parents were told he wouldn't survive more than 15 minutes after birth.

However, he became the youngest in Britain to have a pacemaker fitted. The operation was deemed a success.

Now, at just nine weeks old, he is fighting a hospital superbug.  Liam is back in isolation after contracting MRSA.

His parents had been impressed by hygiene and cleanliness in the ward where the pacemaker was fitted and believe it was picked up during one of his many follow-up appointments at other hospitals.  They are now speaking to their MP to complain about the standards of cleaniness at the hospital where they believe Liam caught the bug.

 

Stopping injections cuts MRSA

9th May 2008

The Winchester and Eastleigh Healthcare NHS Trust claims it has eliminated MRSA bloodstream infections by stopping the routine practice of administering intravenous injections.

The trust has instead started to prescribe the insertion of cannulae to give intravenous fluids and this has meant that doctors are able to monitor the tubes more closely for signs of infection. The trust said since the introduction last November there have been no new cases of MRSA infections, compared to 2007/08 when there was 11 reported bloodstream infections.

 

C diff deaths rising sharply

28th April 2008

Research carried out by the BBC programme Panorama has shown that there is one death every hour in UK hospitals because of Clostridium difficile.

The superbug kills more people aged over 65 in the UK than anywhere else in the world, according to the new figures, and is associated with the deaths of quadruple the number of people as MRSA.

The research will be shown as part of a Panorama Special called 'How Safe is Your Hospital?' which will be broadcast on May 4.

Panorama also performed a Freedom of Information survey, which was sent out to all acute trusts and health boards in the UK. 83% of the trusts responded.

Although the government said this week that Clostridium difficile cases decreased by 8% from October to December in 2007, Panorama said this was because the method use to count the number of cases had been altered.

It calculated that the true number of cases was actually between 16-35% more than this amount - meaning cases had increased during the time, rather than decreased.

The number of cases in Scotland went up by 10%, and they increased substantially in Northern Ireland, by 36%. Welsh figures have not been published so far.

The results put the UK last in a table of global cases of the superbug.

Professor Richard James, who investigates hospital infection at in Nottingham University said: "The figures for C difficile show that more than 50% of hospital trusts in the UK have a rate of infection that's more than 10 times that of any other country."

 

MRSA drop stalls

25th April 2008

Latest figures from the Health Protection Agency show that MRSA rates have stopped falling in England and have begun to plateau.

Final quarterly figures for 2007 reveal that there were 1,087 MRSA bloodstream infections reported in England during October to December, which is a 0.6% increase on the previous quarter when there were 1,080 cases. The HPA said that it hoped the plateau was not “indicative of a levelling trend.? Meanwhile, Clostridium difficile infections fell by 8% in patients aged over 65.

 

Hospital infection progress

16th April 2008

Ipswich Hospital has now made the necessary improvements required by the Healthcare Commission over infection control.

The Commission said the trust is now compliant with the requirements of an improvement notice, issued on 21 February 2008, which required immediate changes to infection control practices. In an earlier unannounced visit the Commission had found four breaches of duty in the hygiene code. The code, which all NHS trusts must comply to, outlines how trusts can prevent and manage infections such as MRSA and Clostridium difficile.

 

MRSA medics still working

8th April 2008

According to a survey of NHS trusts by the Independent on Sunday, medical staff are being allowed to treat patients after they test positive for bugs, including MRSA.

Many trusts do not screen their staff and do not stop staff working as a matter of course if they carry MRSA. Derek Butler, the chairman of MRSA Action UK, said: "We are talking about people who come in from the outside every day and could well be bringing this infection in with them."

Alligator blood could fight superbugs

7th April 2008

Proteins found in alligator blood may lead to new antibiotics to treat superbugs, such as MRSA.

Early bug detection hope

7th April 2008

Researchers from the University of Sunderland have developed a way to quickly detect a superbug which infects weakened immune systems.

Under the new diagnostic method, a non-coloured compound reacts with an enzyme in pseudomonas aeruginosa, which then produces a distinctive purple colour. Researchers say it could identify the pseudomonas aeruginosa bug within 24 to 48 hours of infection and greatly increase a patient’s chances of survival. Cystic fibrosis, cancer and AIDS sufferers, burns and transplant patients are particularly at risk from the potentially-fatal bacterium.

 

Hospital deep clean under attack

1st April 2008

Critics have attacked the government's £57.5 million plan to ensure all hospitals in the country were deep-cleaned by 31 March.

Labour confirmed that 93% of NHS trusts would have completed the cleaning process by the deadline. Professor Hugh Pennington of Aberdeen University said: "Politicians get hung up on cleaning but the major issue isn't environmental, it is the people bringing the bugs into hospital. That is what they should be attacking."

Risk of MRSA despite deep clean

31st March 2008

Patients still at risk from MRSA because vital screening will not be put in place for another year.

MRSA knowledge poor

20th March 2008

One fifth of GPs have admitted they have "poor" knowledge of infections such as MRSA in a survey for the GP newspaper.

169 doctors were polled by the paper, which also showed two thirds of GPs reported they had not been given any data about how to act if they believed a patient had an infection. 21% said their understanding of MRSA was "good", 2% said "excellent", 59% said "fair" and 17% said it was "poor".


MRSA screening doubts raised

12th March 2008

The effectiveness of MRSA screening – currently being phased in across hospitals in England by the government as part of plans to control superbug infections - has been thrown into question.

A study at Geneva University and published in the Journal of the American Medical Association suggests screening has little effect. Researchers compared rates for 22,000 surgical patients, some screened and some not, and found little difference between the numbers getting the superbug. Lead researcher Stephan Harbarth said the trial did not show any added benefit for widespread rapid screening on admission.

 

E coli could enter community

28th February 2008

A review published in The Lancet says it is possible hospital types of E coli could enter community.

MRSA target row

30th January 2008

A row has erupted over MRSA figures as it emerged that the government is close to meeting its target on combating the superbug.

Opposition politicians have accused the government of manipulating data after it was revealed that in England from July to September 2007 there were 1,072 cases of MRSA, close to half the 1,925 average quarterly figure of 2003/04.

This comes a year after a leaked memo from the Department of Health indicated the target of halving the rates of MRSA by 2008, set in 2004 by former health secretary John Reid, was likely to be missed. The latest figures show an 18% fall.

However, the Conservatives and Liberal Democrats have accused the government of moving the target back so it comes after the £50m deep clean of hospitals.

Shadow health secretary Andrew Lansley said the government was “selectively choosing? data to try and fix an outcome.

He added: “It’s no coincidence that the time frame they selected is after hospitals finish their deep clean programme.?

Lib Dem health spokesman Norman Lamb said: “This is disturbing evidence of the government manipulating figures to hit a target. By shifting the numbers around in this way, they are far more likely to hit a target which had previously seemed out of reach.?

The government has denied manipulating the figures, saying it was it always planned to use the April to June period to assess the MRSA target.

Figures also show Clostridium difficile figures are falling, though the Healthcare Commission says too many people are still suffering superbug infections.

 

Ash gets £5m payout

17th January 2008

The actress Leslie Ash has won a record £5m compensation payout after contracting the hospital-acquired infection MSSA (Methicillin-Sensitive Staphylococcus Aureus).

The 47-year-old contracted the infection at Chelsea and Westminster Hospital in London in 2004 and the payment includes compensation for the amount Ms Ash, who now has to walk with a stick, would have earned if she had carried on working. The hospital has apologised to Ms Ash. The NHS Litigation Authority said the compensation was the highest yet paid following a hospital-acquired infection.

 

MRSA test case to be heard

15th January 2008

A 71-year old woman from North Lanarkshire has take unprecedented legal action against the hospital where she caught MRSA.

Elizabeth Miller, caught the bug in 2001 after she had heart surgery in Glasgow's Royal Infirmary. Her legal team want to prove that poor hygiene levels at the hospital led to Mrs Miller catching MRSA.

The test case is thought to be "the first of its kind in the UK" and is against Greater Glasgow NHS Board.

New deadly form of MRSA

15th January 2008

A new, deadly strain of MRSA that can lead to a flesh-eating form of pneumonia has emerged.

Mute swans have bird flu

10th January 2008

Tests have revealed that three mute swans found dead in Dorset had the virulent H5N1 strain of bird flu.

Now other birds at Abbotsbury Swannery, near Weymouth, are being tested but so far culling has been ruled out. However, Acting Chief Veterinary Officer Fred Landeg said the message to bird keepers, particularly those in the affected area, was that they must be vigilant. Prime Minister Gordon Brown said the government would do everything it could to stop the spread of infection.

 

MRSA treatable at home

7th January 2008

Experts have claimed that up to one third of people with MRSA could be discharged from hospital and treated at home.

The suggestion is discussed in a report about managing MRSA where a panel of experts say a move away from treating patients in hospital with antibiotics administered into their veins could save the NHS significant sums of money.

The researchers say that often people being treated for MRSA in hospital were otherwise medically fit and could be given antibiotics at home once the infection had left their bloodstream.

Professor Mark Wilcox, who is an expert in microbiology at the University of Leeds, said: “Treating people with MRSA at home offers multiple benefits in terms of infection control, and reducing NHS costs and resource use.

“Many patients would also prefer to be discharged from hospital to be with their families while they finish their treatment, and they should be given that option, where possible.?

But other experts have cast doubt on whether home treatment was suitable for many patients.

Patients with MRSA spend an average of an extra 11 days in hospital but sending them home could save the NHS £1bn a year in treatment costs, says the report which is funded by drug company Pfizer.

The plan comes after Prime Minister Gordon Brown indicated all patients entering NHS hospitals in England would in future be screened for MRSA and Clostridium difficile.

The Department of Health said while treatment at home may not always be appropriate, it was an option for trusts to examine.

 

MRSA infections reduced by 40%

19th December 2007

A major London hospital has cut its infection rates by 40% within the space of a year, thanks to a test for the drug-resistant bacterium MRSA.

Over a 12-month trial, MRSA bloodstream infections fell 38.6% compared with the previous year at University College Hospital. Over the same period, wound infections fell by 27.9%. Writing in the British Journal of Surgery, the team stressed that while a link between the testing and the fall in infections cannot be proved, the rapid availability of the test results is a possible explanation.

 

New way to fight superbugs

11th December 2007

Scientists pave the way for development of antibiotics capable of fighting superbugs.

Superbug protection from ozone

4th December 2007

Foxearth Nursing Home in Suffolk is attempting to combat superbug infections by using ozone in their laundry processes.

Ozone acts to naturally disinfect bedding and linen when it is put into the water used by the hospital's washing machines. It can kill both the C diff and MRSA infections.

James Cantrell, home manager, said they were confident in the new system: "The result is that everything being laundered becomes sterile so residents are more protected from infections."

Anti-superbug pyjamas on sale

29th November 2007

Special silver-lined pyjamas designed to protect against the hospital superbug MRSA have gone on sale in the UK.

Silver is known for its infection-fighting properties and silver-laced nightwear has already been tested in a handful of hospitals. Experts say that the pyjamas would reduce the risk of a patient getting a skin infection that enters a wound. However, campaigners have called the pyjamas a gimmick and say the only way to tackle MRSA was by making hospitals cleaner. The Sleep Safe pyjamas cost £45 and are being trialled by M&S at 100 stores.

 

Are hospitals winning MRSA fight?

1st November 2007

Latest figures suggest that hospitals in England may be beginning to win the battle against infections.

Quarterly figures revealed by the Health Protection Agency (HPA) shows that cases of MRSA fell by 10% from April to June to 1,303, compared to the 1,447 reported between January and March. There are also indications that Clostridium difficile infections may also be falling with the number of new cases was down 7% to 13,660. That is a reduction of 1,022 cases for the same period last year.

However, the MRSA fall is still not enough to halve the rate of infections by the 2008 target date.

The HPA said the MRSA figures were impressive given hospitals were treating increasing numbers of elderly and seriously ill patients.

HPA infection expert Dr Georgia Duckworth said the increases in MRSA throughout the 1990s had been truly awful.

But she added: “It’s started to come down and that’s brilliant news - two to three years ago professionals would have told you we couldn’t have done that. When MRSA has become endemic or even hyper-endemic in a hospital it's not easy to turn that around.?

Professor Peter Boriello, director of the HPA Centre for Infections, said MRSA had fallen because hospital trusts had been forced to introduce best practice such as hand washing and isolation of patients.

Health secretary Alan Johnson said he was encouraged by the reductions.

“Healthcare-associated infections pose a significant challenge for health services around the world, including the NHS, and we are determined to tackle them,? he said.

 

Baby unit reopens

1st November 2007

A hospital neonatal unit has reopened to new admissions following cases of six babies testing positive for a strain of MRSA.

The East Lancashire Hospitals NHS Trust closed the unit at the Royal Blackburn Hospital to reduce the risk of spread of infection, which was first identified in mid-September. The infants being treated for the strain of the bug - Panton-Valentine Leukocidin – were kept in separate areas during the outbreak. The hospital said all proper procedures were being followed, as verified by the Health Protection Agency.

 

Targeted cleaning to tackle MRSA

31st October 2007

An expert has said that "targeted cleaning" of particular objects will help to win the health service's fight against MRSA.

Microbiologist Dr Stephanie Dancer, from South General Hospital in Glasgow, said the Government's plan to perform a deep clean of hospitals in England would not have lasting effects.

"It is like using a sledgehammer to crack a nut. And anyway it will only have an impact in the first week and then hospitals will be dirty again," she said.

Dr Dancer said that hospital cleaners should clean those objects which patients, staff and visitors come into contact with most frequently.

In the study, published in Lancet Infectious Diseases, bed sheets and tables were discovered to be a more likely source of MRSA than floors.

Bed linen, patient gowns and overbed tables had the highest rates of contamination (all over 40%), while floors had rates of contamination of 34.5% and furniture of 27%.

Recent figures show there were over 6,000 new MRSA cases in the past year - a reduction on previous years. However this reduction will not be enough to reach the government's target of halving the MRSA rates recorded in 2004.

Dr Dancer commented that cleaners in hospitals usually targeted floors and dirty areas they could see. She argued that cleaning would work better if it focussed on areas which were touched by hands.

"Governments across the UK need to reconsider their approaches." she said.



Newborns test positive for MRSA

31st October 2007

Six newborn babies have tested positive for MRSA at Leeds General.

MRSA patients isolation delayed

3rd October 2007

Delays in isolating potentially infectious patients with MRSA occurred after problems with the Care Records System installed at Buckingham Hospitals NHS Trust.

The trust has revealed that between March and July of this year the MRSA patients were not isolated for between two and 17 days, because of problems with the Cerner-supplied system that was recently installed at the trust by Fujitsu under the NHS IT programme.

Board papers show that the problem arose because the historic infection control alerts had to be manually entered onto the system in the six weeks following go-live.

 

MRSA plans criticised

28th September 2007

The government’s plans for tackling superbugs such as MRSA have been criticised.

The leading medical journal The Lancet condemned the plans for not being based on scientific fact and said there was little evidence to support hospital “deep cleans? or short-sleeves for medical staff.

In an editorial, the journal said that instead of “pandering to populism? politicians should listen to the evidence.

The criticism follows Prime Minister Gordon Brown’s announcement that hospital wards would be deep cleaned in a bid to improve cleanliness and tackle superbugs and proposals from Health Secretary Alan Johnson for a new dress code for NHS staff which would advise against long-sleeved coats and ties for doctors to avoid contamination and the spread of infection.

However, The Lancet said there was no conclusive evidence to back the effectiveness of this move and that the focus of the fight against MRSA and other infections should be on disinfection of high-touch surfaces rather than deep cleaning wards to get rid of visible dirt.

The editorial said: “Brown also plans to double the number of hospital matrons, to check on ward cleaning, and accost doctors wearing long sleeves.

“They would be better employed making sure doctors, nurses and visitors wash their hands properly, the proven way to stop hospital acquired infections.?

Chief Nursing Officer Professor Christine Beasley said there was no single solution and the new proposals were part of a wider set of measures to reduce hospital-acquired infections but she agreed there was no evidence that uniforms pose a significant risk of transmitting infections.

 

'Deep clean' hospital bug battle

24th September 2007

Prime Minister Gordon Brown is to order NHS hospitals to conduct a “deep clean? to tackle the spread of infections such as MRSA.

Mr Brown wants the cleaning process to be pre-emptive, rather than reactive, to outbreaks, though critics have questioned the effectiveness of such a move pointing out that it is staff, patients and visitors who carry infections such as MRSA into hospitals.

The Prime Minister has also indicated that he wants to make the future of the NHS a key issue at the next general election, fuelling speculation that he will go to the country for an autumn poll.

Mr Brown has vowed to restore the cleanliness of hospitals over the next year to get rid of infections such as MRSA and Clostridium difficile. The plan will involve wards closed for a week at a time to be cleaned.

He said: “A ward at a time, walls, ceilings, fittings and ventilation shafts will be disinfected and scrubbed clean.?

However critics have labelled the clean-up plan as “irritatingly populist.?

Former NHS trust chairman Roy Lilley said it may earn Mr Brown a round of applause at the Labour Party conference but added: “At the end of the day, the infection control systems are about hand washing; it’s about clinical discipline and it’s about screening people before they come in.?

In an interview with the Sunday Times, Mr Brown also promised a reduction in waiting times for cervical screening from six weeks to two and to extend the age range for routine screening from 47 to 73.

 

All patients screened for MRSA

19th September 2007

A health standard watchdog for Scotland has called for all patients to be screened for the MRSA superbug.

NHS Quality Improvement Scotland wants to see £2m spent on a one-year pilot to see how the screening could be implemented. The idea would be for swabs for MRSA to be taken as soon as a patient was admitted to hospital for treatment.

With the MRSA bug now resistant to a growing number of antibiotics, the move follows research which suggests that screening could prevent infection, saving lives and leading to shorter stays in hospital.

Scotland’s Health Secretary Nicola Sturgeon has expressed a commitment to introducing an MRSA screening programme.

MRSA is carried harmlessly on the skin by millions of people but becomes a problem if it enters the body through a wound.

A study by NHS QIS into MRSA screening found that routine testing of patients on admission to hospital could significantly reduce infection rates, isolating those found to be carrying the bacterium so that they can be treated.

NHS QIS Chairman, Sir Graham Teasdale said: “The source of MRSA is not hospitals, it is the human body. The main reservoir for infection is on our own skin. By identifying those people carrying MRSA and separating them, it is less likely that the bacterium will spread in the hospital and therefore we can reduce infection rates and save lives."

The total cost for Scotland would be £55m over five years but health chiefs says this will be saved by cutting the number of hospital infections.

 

Crackdown on NHS infections

4th June 2007

A national health watchdog body is planning a massive clampdown on infections in hospitals with a blitz on hygiene standards.

The Healthcare Commission is planning a series of unannounced spot checks on 120 NHS trusts over the coming year.

The visits will check on cleanliness and also examine infection control procedures in individual trusts and hospitals.

Critics say the unannounced visits are long overdue but come with new powers bestowed on the Healthcare Commission under the Health Act 2006, which orders health trusts to improve their standards.

The government is hoping to cut hospital infections such as MRSA by half for the period 2004-2008. But while cases of MRSA are falling another so-called superbug Clostridium difficile is becoming more common. In 2006 there were 55,681 cases of Clostridium difficile among the over-65s, a rise of 8% on 2005.

The Healthcare Commission visits will focus on hospitals but they will also include some mental health establishments.

Checks will look at whether the right management structures and infection control teams are in place, whether patients with infections are isolated properly and if hand-washing is common practice in accordance with the government’s hygiene code.

Health Minister Lord Hunt said: “These rigorous checks will ensure that trusts adhere to the code and will help give patients the assurance that everything possible is being done to keep infections to a minimum.?

Shadow health secretary Andrew Lansley accused the government of taking 10 years to introduce unannounced checks, adding that during that period deaths from MRSA had quadrupled.

 

Many C diff cases ignored

31st May 2007

NHS trust data has shown thousands of cases of superbug Clostridium difficile (C diff) have not been recorded since 2004.

Hospitals have submitted information - compiled by the Health Protection Agency - regarding C diff since that date. However, until April 2007, cases were only reported for patients aged over 65.

The new data comes after a Freedom of Information application which asked all trusts to show C diff rates for all ages. Conservative MP Grant Shapps, who compiled the figures, said the information showed that hospital C diff rates were "dramatically worse than previously thought."

Figures show there were an additional 26,000 cases to add to the 176,450 already logged. There were 55,000 C diff infections in 2006, representing a rise of 8% from 2005.

Mr Shapps called for the government to publish all figures in future and commented that the government has been "simply ignoring anyone who contracts the infection, but happens to be under the age of 65."

He has compiled a report called "The Complete Germ Map of Britain" which maps all cases of C diff. It includes 32,707 unrecorded cases in Scotland and Wales.

Katherine Murphy, of the Patients' Association, said: "It is vital for the public to see what is really happening in our hospitals and we should not need special attempts made to get the information."

A Department of Health spokesperson said: "We have recognised that C difficile is a growing problem...we have improved the surveillance system to provide better local data, and local trusts have agreed local targets to significantly reduce C difficile infections."

Universal tests for MRSA

13th March 2007

A team from Nottingham University has developed a test which can identify MRSA, in all its forms, within hours.

The scientists say their test would enable all patients to be screened for superbugs before being admitted to hospital thus cutting MRSA rates in the UK.  The new test scans for 84 MRSA genes and can show if a patient has MRSA (methicillin-resistant staphylococcus aureus), MSSA (methicillin sensitive staphylococcus aureus) and the community-acquired strain of the bug which has been spreading among healthy people.  The test can also identify the Panton-Valentine Leukocidin (PVL) form of MRSA, which (as we reported earlier in the year) recently killed two people and infected six others at a West Midlands hospital.

Current research suggests that up to 8% of hospital patients are carriers of MRSA but only 1% are infected while they are in hospital.  Identifying carriers before they are admitted means they could be isolated and the superbug stopped in its tracks. The test currently used by NHS trusts to check if someone has basic MRSA takes up to three days and tests for PVL MRSA can take up to four weeks. The Department of Health supports universal screening but has left it up to individual trusts to decide upon their own course of action.  Professor Richard James, from the Nottingham University team said, “The Department of Health says everyone should be screened, but leaves it up to individual trusts to decide what to do. The evidence is that if you decide who is most at risk, and just screen them, you're going to miss some who might be carriers who could then transmit MRSA to patients around them."

'Overused' beds an MRSA threat

6th March 2007

Patients are being put at risk of catching MRSA because hospitals are overusing their beds, according to research.

Studies show that those hospitals where fewer beds are left empty have a higher risk. Longer gaps between patients allow cleaners time to disinfect more thoroughly. Consequently, experts advise a bed occupancy rate of no higher than 85% at any one time.

The government’s own figures show that those exceeding that rate had 16% higher MRSA rates. Those trusts with rates higher than 90% had almost double the average rate.

But figures from 2005/6, compiled by the Liberal Democrats, reveal hospital trusts exceeded the recommended level due to the pressure to cut costs and reach government waiting time targets. More than one in five trusts had occupancy rates of more than 90%, while more than half were higher than 85%.

Figures from the previous year showed deaths linked to MRSA rose by 39%.

Superbug deaths on the rise

22nd February 2007

Clostridium difficile is now being linked to more deaths than MRSA. Figures from the Office of National Statistics show one in 500 death certificates between 2001 and 2005 mentioned MRSA. For C. difficile it was one in 250.

A total of 3,800 deaths involved C. difficile in 2004/5. Figures for MRSA for the same period show an increase of 39 per cent to 1,629.

The rise includes all deaths where the infections were mentioned as a contributory factor, but not necessarily the cause of death. Most occurred among older patients.

The government say the rises are caused by more accurate reporting, rather than actual increasing rates of infection. The ONS agreed greater public awareness of C. difficile could have contributed to the increase.

Healthworkers’ union Unison has called for safe minimum cleaning staffing levels to be set, while patients’ groups added their fears that infection control is being forgotten amid growing pressure to cut waiting times.

Health minister Lord Hunt said healthcare associated infections (HAIs) were a government priority, with hygiene targets helping to reduce MRSA rates within hospitals. And he promised similar action to reduce C. difficile, although a range of measures that have reduced MRSA contamination, such as alcohol hand rubs, have had no effect on C. difficile.

C. difficile naturally occurs in around three per cent of the healthy population but can cause problems if it grows unchecked. It can live outside the body for long periods and spread in the air. Only thorough cleaning with warm water and detergent will remove these spores.


Deadly hospital bug fears

30th January 2007

08012007_testtubeblood1.jpgThe government is failing to win the battle against the superbugs according to new figures which show MRSA infections are not dropping fast enough and Clostridium difficile rates are rising.

Figures from the Health Protection Agency show the MRSA rate fell by 5% to 3,391 during the first three quarters of 2006. The government wants to see the number of cases halved by next year compared to 2004 rates.

Already a leaked memo to ministers has predicted the NHS will miss the target, instead cutting rates by a third.

Experts in healthcare acquired infections (HAIs) have ruled out universal screening of all new hospital admissions, despite government recommendations, due to staff shortages.

The HPA said while the drop was encouraging, it showed there was still much to be done to reach the government target of halving rates by 2008. The figures are being seen as more of a plateau than a significant drop.

At the same time figures for Clostridium difficile (C difficile) show it rose by 5.5% in England during the same time to 42,625. Experts say the rate of increase may be slowing.

There has been no nationally set target to cut rates of C difficile, but NHS trusts have been asked to set their own reduction targets.

Some 90% of the £50m government fund has now been handed out to NHS trusts to invest in new facilities to tackle infections.

The Healthcare Commission described the latest figures as ‘disappointing’.

MRSA attacks youngsters

19th January 2007

02082006_MRSA1.jpgBritish youngsters could be susceptible to a new deadly strain of MRSA.

PVL-MRSA is particularly dangerous because it attacks the young and healthy, killing them quickly by causing a lung-destroying pneumonia.  Healthcare Today first reported on this new strain of MRSA in December when two young hospital workers succumbed to the superbug.  Since then experts have called for urgent fast-track NHS tests in order to trace the spread of the disease. Existing detection methods can take up to 14 days but the bug can kill within 24 hours.

New forms of the superbug, called community associated MRSA (CA-MRSA), spread rapidly and easily, especially amongst school children.  CA-MRSA produces a toxin called PVL (Panton-Valentine Leukocidin) which destroys the body’s white blood cells resulting in skin infections, a serious flesh-eating disease or life-threatening pneumonia.  As a skin-disease, CA-MRSA is relatively harmless but the superbug can be deadly if it gets into the bloodstream.  Experts are worried that young children will succumb to the more serious side-effects of the bug before it has been detected. "We have no surveillance. At the moment we have no screening for CA-MRSA in the community, and no rapid detection of PVL,? said Professor Richard James, director of the Centre for Healthcare Associated Infections at the University of Nottingham.  He has called for a national screening system to identify all MRSA strains.

There has long been concern about a variant of the bacterium Staphylococcus aureus, which no longer responds to the usual antibiotics and results in hospital strains of MRSA which mainly affect the elderly and infirm.  However, these new aggressive forms of CA-MRSA are now also affecting hospital wards giving rise to increasing fears for the safety of patients.  Professor James has said that more sophisticated ways of dealing with the superbugs are needed to prevent a national epidemic.

MRSA target could be missed

11th January 2007

02082006_MRSA1.jpgThe NHS looks set to miss its target to halve MRSA rates by 2008, says a leaked government memo.

The document sent out to ministers in October also warned of the rising problems of Clostridium difficile, which is now ‘endemic’ throughout the NHS, linked to twice as many deaths as MRSA.

In 2004, then Health Secretary, John Reid pledged the number of MRSA cases would be halved by April next year.

The memo, written by the Department of Health's Director of Health Protection Liz Woodeson, predicted rates would be cut by a third by the deadline.

The government has ignored recommendations that the MRSA target be dropped or delayed to offset a media or public backlash. Instead ministers say they will continue to aim for the original target.

DoH infection experts said achieving the target was not just a matter of extending the deadline, but said the NHS was ‘light years ahead’ of where it had been.

The memo offers six options, five of which concentrate on dropping or changing the target and its timescale.

Experts reported measures to combat MRSA, such as alcohol hand rubs, have had no impact on Clostridium difficile, which can survive for longer periods on surfaces and spread in the air.

Contaminated environments, including staff hands, need to be rigorously cleaned with warm water and detergent to remove spores.

Strain of MRSA kills two

18th December 2006

02082006_MRSA1.jpgTwo young mothers are believed to have died from a fresh outbreak of MRSA.

According to the Health Protection Agency (HPA), Panton-Valentine Leukocidin (PVL) MRSA has never previously caused deaths in hospitals. However, a healthcare worker died in September and a patient later succumbed to the deadly virus. Nine others also contracted the strain in the outbreak at University Hospital of North Staffordshire, Stoke-on-Trent but have not died.

PVL MRSA attacks white blood cells meaning victims cannot fight infection. It is unusual because it can affect young and otherwise healthy people whereas hospital-associated strains of MRSA normally affect more elderly or previously unwell patients.

In the Staffordshire hospital outbreak, the first person to die from PVL MRSA was a healthcare worker at the hospital who was receiving inpatient treatment. The other fatality was a patient who was being treated on the ward where the first victim had worked.

The HPA said there have been other cases of this particular strain of PVL MRSA in England and Wales but these have been in the community, not in hospitals. Thirteen cases of PVL MRSA were recorded in the community in 2005, all of which were skin and soft-tissue infections. This outbreak is the first time transmission and deaths due to this particular strain of the super-bug have occurred in a healthcare setting in England and Wales. The hospital is taking advice from the HPA on how to manage the outbreak.

Stop blaming NHS for MRSA

8th December 2006

08122006_emptybedQ.jpgAmid the clamour for the NHS to ‘do something about MRSA’ Telegraph columnist and junior doctor Max Pemberton argues for the public to take its share of the blame.

In the public mind the bug has been indelibly linked to hospitals and hygiene, but the reality is MRSA lives on around a third of the general population. The problem comes when it gets into a wound, causing infections that can be difficult to treat.

Now as lawyers hunt for legal ways to sue the NHS and patient groups redouble their call on the NHS to ‘take responsibility’, he asks, ‘is the NHS responsible?’

‘Politicians would have us believe that it is simply a matter of cleaner hospitals, but it is not that simple,’ he writes. ‘It takes only three hours for a new colony of MRSA to establish itself on a ward, so guaranteed eradication would require near-constant cleaning of every surface. The chain of responsibility is complex and the sad fact is that we're all implicated.’

This includes those patients who demand antibiotics for viruses –giving bacteria like MRSA a chance to build up resistance, and demand for cheap, factory-farmed meat where antibiotics are used to keep out infections in livestock.

Nurses and doctors have responded to the hand washing campaigns and cut cross-contamination, but estimates suggest less than a third of visitors wash their hands. Simply doubling that number would break the chain of infection, he writes.

Condemnation over superbug

25th July 2006

25072006_emptybed1.jpgA highly critical report from the Healthcare Commission concluded that more than 60 people died at a single hospital, Stoke Mandeville, from complications linked to the superbug Clostridium difficile as a result of serious failings of senior management.

More than 300 patients contracted the C. difficile stomach bug at the hospital in the outbreaks between October 2003 and June 2005. The health inspectorate said that two outbreaks killed more than 33 people, while a culture of poor hygiene and hospital managers’ failure to act contributed to several dozen additional deaths since 2003.

The report detailed a catalogue of serious hygiene offences including faeces on bed rails and patients’ clothes kept on the floor. The commission blamed the spread of the bug on the failure to isolate infected patients, with hospital managers reducing the number of single rooms.

Chief executive of the Healthcare Commission, Anna Walker, said that government targets, the control of finances and the reconfiguration of services had been put above basic patient care. She added that the leadership of the trust had failed to learn lessons from the first outbreak, which killed 16 people.

Nurses at the hospital complained to the trust's chief executive and to the Royal College of Nursing that they were worried about the standard of care; a shortage of nurses meant that staff were too rushed to answer call bells or change soiled sheets and failed to take basic precautions eg hand washing or wearing aprons and gloves.

Limited action was taken after the first outbreak but senior managers failed to bring the second outbreak under control in 2005 because they prioritised other objectives, for example Government's targets on accident and emergency waiting times.

An inspection at the hospital between December 2005 and January this year showed there were still problems with hygiene at the hospital.

Three senior managers at the trust have left or have announced their plans to leave this month and the hospital is to create a new post with sole responsibility for infections control. Buckinghamshire Hospitals NHS Trust acting Chief Executive, Alan Bedford, said the hospital had since tightened its procedures.

A second report, by the Health Protection Agency (HPA), showed that the number of cases of C. difficile rose in two-thirds of health trusts, despite government efforts to improve hospital hygiene. Annual figures revealed that rates of C. difficile in patients over the age of 65 have risen across England by 17.2 per cent in the last year. The HPA said the increase was likely to be down to both an increased number of cases and improved reporting.

Our Health, our care, our say

27th March 2006

30032006_large-crowd.jpgThe 'Our health, Our care, our say: a new direction for community services' White Paper was published in January 2006. It sets out the Government's vision of more effective health and social care services outside hospitals.

In brief it calls for more emphasis on primary and preventive care; new clinical pathways that will reduce the role of hospitals; a new drive to correct the "inverse care law" under which the most deprived areas receive the poorest health services despite their greater needs, and more support for family carers. Health checks will be offered at 50 as well as three earlier dates. Pilot programmes under which 1,200 health trainers provide advice on diets, exercise and lifestyles, promised in an earlier white paper, will begin in 2007.

It calls for a shift in the way services are delivered towards more personalised and community-based approaches; it also seeks to tackle health inequalities through funding changes and to give people a stronger voice so that they become the major drivers of service improvement.

The Context

The government says that the NHS is now halfway through its 10 year plan to provide a more modern and effective health care service, and that Our health, our care our say White paper is the next step in that process.

The emphasis has been on increasing the capacity of the NHS, shorter waiting lists and cutting deaths from cancer and coronary heart disease. This paper puts the focus on treating people more efficiently and responding to their needs and expectations.

This fits with the present emphasis on a patient-led health service. Tony Blair said that it heralded "a new era where the service is designed around the patient rather than the needs of the patient being forced to fit around the service already provided."

The government staged a number of consultation and listening exercises in preparation for the White Paper; the first consultation was about adult social care - the 'Independence, Well-being and Choice' Green Paper. This was followed by a listening exercise 'Your Health, Your Care, Your Say'.

Meetings were held in Gateshead, Leicester, London and Plymouth, followed by a national citizens' summit in Birmingham.

The messages from these consultations were that there was a need for a more personalised service, with more care closer to people's homes to support independence.

The Paper

'Our Health, our care, our say' identifies five clear areas for change: more personalised care, services closer to people's homes, better co-ordination with local councils, increased patient choice and a focus on prevention rather than cure.

It contains several key initiatives and issues for further consideration which can broadly be divided into; partnership working across health and social care; working with local General Practices to move care out of hospital; improving access to primary care and community services, infrastructure to support these changes; and new services and developments for existing services.

New measures include:

  • shifting expenditure from spending on hospitals to spending on care closer to home and on preventative services
  • new responsibilities on local councils and the NHS to work together to provide joined up care plans for those who need them
  • bringing some specialties out of the hospital nearer to people including dermatology, ENT, orthopaedics and gynaecology
  • introducing a new generation of community hospitals for diagnostics, minor surgery, outpatient facilities and access to social services in one location.
  • a new NHS "Life Check" pilot to assess people's lifestyle risks and the right steps to take and provide referrals to specialists if needed
  • a guarantee of registration onto a GP practice list in the patient’s locality
  • incentives to GP practices to offer opening times that respond to the needs of patients in their area
  • increased quantity and quality of primary care in under-served, deprived areas through nationally supported procurement of new capacity with contracts awarded by PCTs
  • supporting self care by trebling the investment in the Expert Patient Programme
  • an "information prescription" for people with long term health and social care needs and for their carers
  • professional education and skills development
  • a personal health and social care plan as part of an integrated health and social care record
  • more support for carers including improved emergency respite arrangements and a national helpline for carers
  • extension of direct payments and piloting of individual budgets for social care.

The Comments

Many sources broadly welcomed the White Paper's initiatives, whilst holding reservations on the financial, practical and structural implications;

The Royal College of Physicians (RCP) and Royal College of General Practitioners (RCGP) welcomed the proposals and looked forward to working with the Department of Health 'developing new patterns of care that will enable people to have more control over their health and well-being.'

However, they felt that 'the implications of the changes for the future of acute hospitals is not clear, particularly the workforce implications' and that the proposals to bring some of the services currently provided by hospitals into the community is sensible provided that 'this is done in a supported and structured way' making the best use of doctors, both specialists and generalists.

Dr Mayur Lakhani, Chairman of the Royal College of General Practitioners said that they welcomed the White Paper as a major step forward in improving patient care, but that delivering the White Paper presented a 'formidable' challenge to PCTs, says the Health Service Journal (HSJ).

The British Medical Association (BMA) said that an increased focus on prevention and making services more responsive to patients and closer to them are welcome, but that 'there must be the capacity and resources to make this happen'.

The Royal College of Nursing (RCN) welcomes the proposals for giving people more choice over the community care they receive, and ensuring closer working between health and social care, but warns that caution is needed.

Beverley Malone, the General Secretary of the RCN, when commenting about the competitive tendering process suggested to tackle health inequalities says 'this is an experiment with the health needs of the most deprived communities.' In fact, after consistent failure to address those needs over many years 'experiments are exactly what is needed' suggests the HSJ.

The King's Fund Chief Executive Niall Dickson said that "The White Paper offers an unprecedented opportunity to redesign community health and social care services." But he also said that "we must not underestimate the challenges ahead - we've been trying to do this for more than 30 years with limited results." The announcement, he said, has to be seen in the context of a health service that is struggling financially and finding it difficult to meet all the demands being placed on it.

The reservations around finance were echoed by Nigel Edwards, the NHS Confederation policy director, who said the shift in finance from acute to primary care would mean a 'pretty big dent' in the finances of acute hospitals, reports the HSJ.

Chris Ham, former head of strategy at the Department of Health, said that it would likely prompt the closure or severe scaling-back of larger hospitals. He added that those hospitals tied into long-term repayment contracts with the private sector could face serious problems, says the Times.

Other newspapers also had a mixed appraisal of the White Paper; the Guardian emphasised that moving health care from hospital to the community or even to patients' homes is an old dream which new technology can help deliver. But the timing of reconfiguring hospital care was a challenge, it said as 'We are now halfway through the biggest hospital building programme in the history of the NHS.'

The timing of these reforms in the context of the present state of the NHS was also picked up by Andrew Lansley, the Conservative Health spokesman. He welcomed the Governments "u-turn" on community hospitals, says the Daily Mail. But Andrew Lansley also said “Many primary care trusts are cutting back precisely the community-based services on which her care plan depends" and that the White Paper “fails to face up to the reality of the NHS today" reports the Times.

Royal College of GPs chair Dr Mayure Lakhani said that, with all the good intentions of Our health, our care, our say, "Winning the hearts and minds of doctors and nurses is the key to making this white paper happen" report the HSJ.

Anna Walker, Chief Executive of the Healthcare Commission, also cautioned that, whilst choice, and the movement of care to the community, is no doubt to be commended, none the less "patients and the public must be sure that they have the same assurances on quality and the same information to support choice, wherever care is provided."

MRSA hit squad urgency

16th March 2006

17032006_corridor.jpgThe BBC said it had learned that health officials have not decided which trusts are to be visited by MRSA "hit squads" a month after the move was announced.

In February Ministers said the superbug teams would be sent into the 20 trusts with the biggest MRSA challenges, however only three have begun work. These were in Sandwell, Northumbria and Aintree, which had volunteered for help.

The Department of Health said it always planned to allocate the teams over the coming months and denied undue delays. They have been accused of lethargy by opposition politicians.

The Health Minister Jane Kennedy announced the deployment of specialist teams in early February, after new figures revealed a rise in the number of MRSA infections. Half of trusts were not meeting their MRSA targets.

The Department of Health says it is in the process of setting up five specialist teams, but they will not be able to go in to all 20 trusts simultaneously; The list of trusts to be targeted was not yet finalised, the next wave would only be decided once the teams were ready.

The department said it was also legislating to put a hygiene code and a tougher inspection regime into law with sanctions for trusts that failed to deliver.

Opposition spokesmen have emphasised that urgent action is required.

The nurse adviser for acute and emergency care at the Royal College of Nursing, Mike Hayward, expressed concern that there had been reports of infection control nursing posts being frozen in some trusts. He also said that other measures such as providing nurses with laundry facilities in hospital so they could wash their uniforms at the very high temperatures required to kill infections should be put into action.

Patient Choice

6th March 2006

06032006_JellyBeans1.JPGWhat is the background to patient choice?

The idea of patient choice first emerged as a strategy for shortening waiting times, and to this end has been tried in a number of other European countries. It also aims to bring the NHS up to date with responding to a new type of consumer.  Today's consumer no longer wants a one-size-fits-all, paternalistic service; modern patients want choice and convenience. 

The power of the consumer is also a central element of the market model that lies at the heart of the Payment by Results funding system introduced on a trial basis by the Government in 2002, to which patient choice is intrinsically linked. In theory this provides a financial incentive for hospitals to attract patients through improved quality.

Patient choice is seen as one of several levers in the government's programme to modernise the NHS to create a more personalised, responsive and efficient health service. Consumers, it is argued, will choose hospitals that offer shorter waiting times or which they believe to offer a higher standard of care. Those hospitals losing business will have to improve or face closure.

Patient choice initiatives were initially piloted in 2001/2002 and have since been taken forward through a number of public consultation exercises and white papers, through the implementation of Choose and Book, the Connecting for Health initiative, and most recently taking patient choice into the community with 'Our Health, our Care, Our Say'. 

What have been the main initiatives in patient choice?

Pilot programmes began in 2001/2002 for heart and cardiac surgery with the National Coronary Heart Disease Choice scheme. In 2002 the London Patient Choice Project offered patients the chance of quicker treatment in areas such as orthopaedics, and  ear, nose and throat surgery.

In 2003 the Department of Health began a consultation exercise 'Choice, responsiveness and equity', culminating in December 2003 with ‘Building on the Best’ which looked to extend the concept of choice into primary care and pharmacy services as well. From summer 2004, all patients waiting six months for any form of elective surgery were to be able to choose at least one alternative hospital for treatment.

The policy drive to encompass patient choice was taken forward in the 'NHS Improvement Plan' of 2004 with the inception of  Connecting for Health, the move to a system of ‘Choose and Book’, and setting out further priorities for the NHS to be achieved by 2008.  The ‘Choosing Health’ white paper, also in 2004, expanded this to public health, emphasising the role of personal choices in the prevention of illness and promotion of well being. The information strategy to facilitate patient choice was set out in 'Better Information, Better Choices, Better Health' published in December 2004.

Two papers in 2005, 'Choosing a patient led NHS' and 'Commissioning a Patient Led NHS' spelt out in greater detail the reality of the implementation to keep patient choice central. The Department of Health set out how it intended to deliver the patient choice and public involvement in healthcare, promised in the NHS Improvement Plan.

From 1 January 2006, patients requiring a first outpatient appointment are required to be offered a choice of at least four hospitals for their treatment. These hospitals can be NHS trusts, NHS foundation trusts, treatment centres, private hospitals or practitioners with a special interest, operating in primary care; implementation has been dogged by delays in the NHS National Programme Connecting for Health and the implementation of e-booking systems, as well as inertia on the part of some  GPs.

The recent consultation exercise and publication of Our Health, Our Care, Our Say (February 2005) is set to take this into the community, including increased choice to be underpinned by a direct payment or care budget for people to pay for their own home help or residential care.

What are the potential benefits of the patient choice initiatives?

If successful, patient choice could deliver improved services and a rapid change in public perceptions of a service that has offered few choices in the past, with information empowering patients to make choices about their method and place of care. 

It has the potential to mean that healthcare will reflect patient’s priorities, that treatment is faster and that there will be less variation in standards of care.

It is hoped that for the NHS in general, allowing people to vote with their feet if they are unhappy with a service will galvanise the NHS into becoming more responsive to patients needs, reducing waiting times and raising standards of care.

Choice, and perception of choice, can be a means to establishing a sense of autonomy and trust in patients, crucial elements both for the public and for health professionals.

What are the risks involved in patient choice?

Aside from the delays experienced from the practical implementation of e-booking the biggest risk of patient choice may be its impact on the under-reported problem of healthcare inequalities.

There have been concerns that not every patient is able to make a choice in terms of location of care. Both the London Choice Pilot, and a recent report published by the Kings Fund 'Where the patient was king', examining the experiences of HIV patients, indicate that certain patients were more likely to exercise their right to choose their place of treatment than others. These included those who were better-educated, more vocal and more mobile.

In contrast to this however, a British Social Attitudes survey revealed that it found that older people and those on lower income were more pro-choice than those on higher incomes.  There was more enthusiasm for choice among those with lower or no educational attainment than those with higher qualifications.

If patients do begin to exercise choice, then those hospitals losing business may be forced to close the departments affected. Fewer hospitals mean less choice for patients - and it is the most vulnerable members of society, such as the elderly, who will suffer the most if they cannot access hospital services on their doorstep, leaving them with no real choice at all.

What of the future?

Further initiatives are anticipated to take forward patient choice in long term conditions, in maternity services and end of life care. A recent review of patients with long term conditions revealed strong preferences for involvement in choices about  diagnosis and treatment. 

From 2008, the Government promises to offer all patients the choice of any hospital, public or private, anywhere in the country which meet NHS standards at NHS costs.

If patient choice is to be a success then it is acknowledged that all patients, especially the vulnerable, must be enabled to exercise and take advantage of the extra benefits choice can bring. A key task is therefore to ensure that all patients have enough, and appropriately accessible, information with which to capitalize on the increased choice in healthcare offered.

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Article Information

Title: Patient Choice
Author: Chris May
Article Id: 67
Date Added: 6th Mar 2006

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