Superbugs call for serious measures, not panic

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The Independent Online

The outbreak of a new hospital superbug, a strain of Clostridium difficile, which has already claimed 12 lives and infected 300 other people at Stoke Mandeville, is bound to add to mounting feelings of gloom about the state of Britain's hospital wards and of the health service in general.

The outbreak of a new hospital superbug, a strain of Clostridium difficile, which has already claimed 12 lives and infected 300 other people at Stoke Mandeville, is bound to add to mounting feelings of gloom about the state of Britain's hospital wards and of the health service in general.

Barely a day goes by without the media breaking the news of a fresh outbreak, a particularly filthy ward, a dire hospital lavatory, or an unwelcome discovery under someone's hospital bed, such as used needles, or worse.

It is not surprising that one result of these hospital horror stories is that people become increasingly queasy about the prospect of going into one at all. This situation is becoming reminiscent of the fearful sentiments ordinary people entertained about hospitals before Florence Nightingale came in with her mop and broom.

The climate of fear can be ascribed in part to some sensational reporting in sections of the media. This is certainly a widespread view within the health service. Part of the panic is also down, paradoxically, to better and more accurate reporting of the problem, this time on the part of the health service. The mandatory reporting of infections caused by Clostridium difficile has only been in place since 2004. Until then, we had no means of knowing whether cases of infection were increasing, or were simply being reported more diligently.

Finally, it needs to be spelled out - however callous it may sound - that hospitals suffer from more cases of bacterial infections as the patients in them get older and sicker. This is demography at work, not declining standards of health care. As the nation ages,improvements in medicine are keeping us alive for longer.

Many of these factors are reflected in the outbreak at Stoke Mandeville, the only hospital to be affected by this virulent new strain of Clostridium difficile. Many patients there remain on the wards for months at a stretch and the average age of those who died was 85.

However, even if the scale of the problem has been exaggerated, that does not mean the problem does not exist. There is no doubt that the spread of Clostridium difficile is directly linked to cleanliness. One problem here is that the routine practice of staff washing their hands with alcohol gel works against MRSA but not against Clostridium difficile. More washing of hands in soap and water, as well as better cleaning of the wards, will help to stop an infection of this type from spreading.

An additional, quite separate, factor behind the spread of these infections is the abuse and misuse of antibiotics, which is a growing medical problem worldwide.

As this newspaper reports today, cases of Clostridium difficile have soared in Britain from less than 1,000 a year in 1990 to 43,672 in 2004 indicating that something is seriously amiss.

We should not exaggerate the extent to which Britain's hospitals are becoming prone to lethal bacterial infections and so fuel patients' worries about even setting foot in a ward. We need to recognise the unpleasant fact that as hospital wards become increasingly full of long-stay patients in their eighties and nineties, they will also become more vulnerable to certain types of infection.

But recognising that some outbreaks are going to happen does not mean we should meekly accept that they are all inevitable. It is a cause for deep concern that countries with similar demographic profiles to our own, such as the Netherlands, have far lower rates of MRSA then we do. Outbreaks that can be directly traced to the maintenance of basic standards of hygiene can and should be prevented. Britain's hospital patients may be becoming older and sicker on average, but they still have a right to expect that they will not come out of hospital sicker than when they went in.

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