Infection expert resigned over hospital's failure to control new superbug

Protests mount after 12 die and 300 infected at Stoke Mandeville
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An expert in infection control at a hospital that was stricken by a lethal new bug resigned last month in protest at managers' failure to control the outbreak.

An expert in infection control at a hospital that was stricken by a lethal new bug resigned last month in protest at managers' failure to control the outbreak.

Paul Gillett, a consultant microbiologist at Stoke Mandeville Hospital, where 12 patients have died and 300 have been infected, took early retirement after what colleagues said was a long struggle to get the problem of hospital infections taken seriously.

Protests were growing last night that the hospital in Buckinghamshire did not take necessary measures to tackle the infection. The bug, a virulent new strain of Clostridium difficile, which causes severe diarrhoea and can be life-threatening, has resisted all attempts to control it since the outbreak began 18 months ago.

As revealed in The Independent yesterday, specialists from the Health Protection Agency and the Department of Health's Recovery and Support Unit have been called in to assist at Stoke Mandeville but the bug is still spreading. The most recent case of infection was last week.

Two years ago, Dr Gillett is understood to have established an isolation ward at the hospital to treat patients with hospital- acquired infections, but it was closed by managers because of a shortage of nurses.

"He complained that managers were prepared to make a fuss but not to spend the money. He resigned in protest at the way things were going ," a colleague said.

It also emerged yesterday that the hospital ended its cleaning contract with a private company last week and has taken cleaning of the hospital back in house.

C. difficile is endemic throughout the NHS and cases have soared from fewer than 1,000 in 1990 to 43,672 in 2004. Latest figures show there were 934 deaths in 2003, a 38 per cent rise in two years.

The new strain of the infection, first identified at Stoke Mande-ville in 2003, is more virulent and harder to destroy than existing strains. It is closely related to a type found in the US and Canada and may have been brought in by a patient admitted from abroad to the hospital's world-famous spinal injuries unit, which is supported by Sir Jimmy Savile.

The bug poses a particular threat to hospitals because it produces hardy spores that are resistant to normal methods of cleaning and can persist on hands, clothes, bedding and furniture, transmitting the infection to new patients. Alcohol gels used throughout the NHS to clean hands are ineffective against the spores which can only be removed with soap and water.

The cleaning contract at Stoke Mandeville was held jointly by two private companies but, next year, the hospital plans to second staff under a new type of contract to a different company, Sodexho, retaining responsibility for the staff and standards.

David Lidington, Conservative MP for Aylesbury, the area served by the hospital, said yesterday: "This is shocking news. Thousands of patients will be wanting an explanation and a promise everything necessary is being done to eliminate this."

Mr Lidington said he would press local health managers and health ministers to explain why Stoke Mandeville was the only hospital affected and why the outbreak had persisted for almost two years.

"If it is true a consultant microbiologist at the hospital has resigned, I would call for a clear explanation from the trust as to what has happened."

Bed occupancy at the hospital had routinely been above 90 per cent, which was too high, he said. "Hospitals have got to treat patients in the minimum time so they can never leave a bed unoccupied or allow a ward to be disinfected. Will the Government now give local managers power to put hygiene first, even if it means breaching national targets for waiting times?"

Managers were accused of failing to inform staff about the outbreak of the new bug. An in-house publication called The Bug Buster, circulated to hospital staff at Stoke Mandeville, failed to highlight the new strain of C. difficile.

In a statement to The Independent last night, Buckinghamshire Hospitals NHS Trust declined to comment on the resignation of Paul Gillett. It said it had set up a dedicated ward for affected patients and had established protocols "for the movement of patients around the hospital, decontamination and deep cleaning of affected areas, hand-washing and surveillance." It added: "The change in our arrangements for our cleaning staff, from contractor to NHS employ, has been planned for more than a year and is part of our PFI scheme, which is due to open later this year."

Stoke Mandeville has set up a phone line for patients and relatives on 01296 315539.

'I am not sure, even now, how she got it'

Sandra's elderly mother went into hospital with a cough, but was dead within four months after contracting Clostridium difficile.

She had experienced severe diarrhoea but it was only when Sandra picked up her mother Maria's prescription that she realised that she had caught the lethal bug that is infecting patients across the NHS.

Sandra looked up the antibiotics on the internet and found that they were used to treat C. difficile, which she had not heard of before. "I was not told what the illness was and I had never heard of the antibiotics" she recalled.

"So I looked them up and the first word that came up was C. difficile. I did not know what it was - but the more I saw, the less I liked it.

"I found a support group in America set up by a husband and wife and it had taken the wife a year to get better."

Maria Klumpers, 90, had been admitted to St George's Hospital, south London, in January 2004 with a violent cough and was given antibiotics before being discharged. Shortly after returning home, she experienced an aggressive form of diarrhoea.

"Her diarrhoea got worse over time. I was putting two or three pads on her every single change because she would have been upset if she had soiled herself.

"The diarrhoea was so bad that it felt like her insides were coming out. Then she lost her appetite - she was always a picky eater and did not like meat or fish - but, in the end, I was thinking this was not right," she said. Sandra, 55, who works in marketing in London and was her mother's carer, accompanied Ms Klumpers to the next hospital check-up and began asking questions about the C. difficile infection.

"No one told me what she had. I am not sure even now how she got it. She was on a lot of antibiotics on feed drips. When I saw the doctor at the check-up, I had the print-outs from the internet and I said: 'Is it true?' It was only because I asked the question that it was confirmed to me that she had C. difficile. I don't know how long I might have waited to be told."

When she went to collect one dose of antibiotics, the chemist had said: "You should not be giving your mother these. She should be in hospital".

Despite her worry that her mother could not cope with another dose of antibiotics, she was reassured her new dose would not be as harsh. She said: "Towards the end of the course of antibiotics, I thought she was going to die. She was very weak, but at the same time, I thought if she goes back to hospital, she might pick up MRSA. The diarrhoea stopped for one day, but then it came back.

"Then one day, one of the carer's came in to change her (incontinence pads) and found blood on her pads. An ambulance was called and she was taken to hospital where she was kept in isolation, so someone they must have known she had C. difficile," she said.

Ms Klumpers recovered a little but after two relapses, she died on 4 May last year, four weeks after being re-admitted to hospital.

Sandra said she bore no grudge against the medical teams or hospital as her mother had received good care, but felt she would have acted differently if C. difficile had been confirmed at an early stage.

"With what I know now, I would have done things differently. I would have got my mum into hospital much quicker. She need not have died from this. She got it needlessly," she said, adding: "I remember sitting at the hospital wondering if anyone else in Britain knows there's a lethal bug other than MRSA."

She was aggrieved that "old age" was written as the main cause of death on her mother's death certificate, while C. difficile had been a "contributing factor".

"I remember thinking it was C. difficile and not old age that killed her. I am not blaming anyone - neither the hospital nor the GPs, who very compassionate and kind - they were fantastic," she said.

Arifa Akbar

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