Bug killed patients after officials ignored advice, watchdog says

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A senior official at the Government's public health watchdog has blamed managers at Stoke Mandeville Hospital for failing to control a lethal bug that has killed a dozen patients.

The official at the Health Protection Agency, who spoke on condition of anonymity, said the hospital authorities had rejected the advice of their own infection control team on eradicating a virulent strain of Clostridium difficile.

When a number of patients at the hospital in Aylesbury, Buckinghamshire, contracted the infection at the same time, and there were too many to have been placed in individual isolation rooms, they should have been isolated as a group in one ward, the official said. But managers at the hospital were reluctant to act because it would have slowed the rate at which patients were admitted, lengthening waiting lists.

"That was how they got into problems. When they declined to do that, things got difficult.

"It's a hard call for managers. They have to take these tough decisions. But if they don't take action [against hospital infections] they may have worse things happen, as we have seen at Stoke Mandeville."

C.difficile 027 has caused the deaths of 12 elderly patients and infected 300 others at Stoke Mandeville since 2003.

The Health Secretary, Patricia Hewitt, came under pressure on Thursday to make a statement on the outbreak. The Leader of the Commons, Geoff Hoon, responding to calls from MPs, said that the matter must be addressed urgently.

Nigel Ellis, head of investigations at the Healthcare Commission, said: "We are standing ready to do whatever is necessary to ensure this bug is handled in the most effective way possible across the NHS and not just at Stoke Mandeville."

The outbreak has focused attention on the increase in infections with ordinary strains of C.difficile which have soared from just over 1,000 cases in 1990 to more than 43,000 in 2004. Part of the increase is due to better reporting but public health experts say the problem is getting worse. Responding to the call by the shadow Health Secretary Andrew Lansley for an inquiry into the outbreak, the Health Protection Agency official said: "An inquiry would have its value. It would make NHS trust chief executives think more about listening to their infection control teams.

"The outbreak [at Stoke Mandeville] was poorly managed. My understanding is that the hospital did not follow the advice of their infection control team."

Figures show C.difficile caused almost 1,000 deaths in 2003, about the same number as MRSA (methicillin-resistant Staphylococcus aureus), yet it has had only a fraction of the attention. "It has got a bit submerged by MRSA," the official said.

MRSA is officially classed as a "superbug" because it is resistant to antibiotics but C.difficile can also be difficult to treat. Though most cases respond well, 20 per cent of patients develop recurrent disease, according to a review published in the Journal of Medical Microbiology last month.

The review by Lynne McFarland of the University of Washington says that existing treatments using the antibiotics metronidazole and vancomycin work well initially but leave patients more vulnerable to future infections. "Severe complications in patients, an increasing frequency of nosocomial outbreaks [originating in hospital] and cases of recurrent C.difficile- associated disease have fuelled the search for treatments that may be more effective," she writes.

Antibiotics - overused or misused - are also, paradoxically, the cause of C.difficile infections by disrupting the normal gut bacteria that hold the bug, which is found naturally in the intestine, in check. Infection control experts say failings in hospital antibiotic policies are a key factor behind the rise in cases.

Andrew Berrington, consultant microbiologist at Sunderland City Hospital and a member of the C.difficile standards group set up by the Department of Health, said: "I feel strongly that patients are given antibiotics when it would be right to watch and wait and they are given broad-spectrum antibiotics when they should have specific ones. The drug companies push the view that unless you give broad-spectrum antibiotics the patient will die. But it is wrong. Few patients come into hospital when you don't know what is wrong with them."

'I saw the complacency of doctors'

Annie Davies died, aged 81, in May 2004, six weeks after being diagnosed with Clostridium difficile. She had severe diarrhoea, her body swelled to twice its normal size and she developed pseudo-membranous colitis, a recognised complication of the infection in which the bowel becomes intensely inflamed.

Yet her death certificate, issued by the Ipswich Hospital NHS Trust where she spent her final weeks, made no mention of the lethal bug that her family are convinced killed her.

Now her daughter, Hazel Pettifor, is campaigning to have her mother's death certificate changed as part of a wider complaint to the Healthcare Commission about the care her mother received.

"From her diagnosis with C.difficile to her death, I witnessed the complacency of doctors and nurses to my elderly mother, almost as if her contraction of this hospital bug was inevitable. Nothing I saw convinced me that the prevention of cross-infection of other patients was being given high priority," she said.

Mrs Davies was admitted to the hospital in February after a heart attack and received excellent care at first. She made good progress but her condition deteriorated as she was moved from ward to ward. Despite being diagnosed with C.difficile at the end of March, no special infection control measures were taken, her daughter said.

"We were appalled to watch nurses wiping her bottom and then touching fixtures on the ward such as curtains, lids of cream and, on one occasion, my mother's intravenous line, with the same plastic gloves on. You didn't have to look far to see how the infection was spread," she said.

A spokeswoman for Ipswich Hospitals NHS Trust said she was unable to comment on an individual case while the complaint to the Healthcare Commission was being investigated.

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