How C. difficile caused a seismic shift in health policy

  • @jeremylaurance

The arrival of a virulent new strain of Clostridium difficile in Britain in the early 2000s caused a medical and political firestorm, led to hundreds of deaths and claimed the scalps of several NHS trust chief executives.

The first serious outbreak, reported exclusively in The Independent, occurred in 2005 at Stoke Mandeville Hospital in Buckinghamshire, where 334 patients were infected with the new 027 strain, which produced 10 times more toxin than the familiar strain, and 33 died.

Hospital infections were already causing alarm thanks to the rise of MRSA, but no one had heard of C. diff before the Stoke Mandeville outbreak, and it catapulted the issue of hospital infections up the political agenda.

Eight days after The Independent’s report, Patricia Hewitt, the then Health Secretary, ordered an inquiry as surveys showed the public was more worried about contracting an infection in hospital than by the long waits to get there. Days before the inquiry report was published in July 2006, the chairman and chief executive of the trust in question resigned.

Outbreaks were subsequently reported at 15 other hospitals around the country. The worst affected trust was Maidstone  and Tunbridge Wells in Kent, where in 2007 the Healthcare Commission concluded that the superbug caused 90 deaths and was a contributory factor in a further 255 in two-and-a-half years. The chief executive resigned.

Then, in 2008, the then Prime Minister Gordon Brown declared that reducing hospital infections was an “absolute priority” and ordered a programme of deep cleaning for hospitals and screening for all patients on admission.

Infections with C. diff and MRSA have since fallen, as the political focus on the superbugs increased awareness of the risks among hospital staff and patients. Alcohol hand rub dispensers are now ubiquitous on wards and hospital visitors are encouraged to use them. But they are still not used enough.

Hand-washing is the best defence we have against transmitting these bugs – those who fail to do it reliably and thoroughly carry death on their hands.