We must make cleaner hospitals a health priority

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The Independent Online

It is a paradox that a microbe which acquired its name because it was so difficult to grow in the laboratory has become one of the fastest growing hospital infections in Britain. But the emergence of a "superbug" strain of Clostridium difficile is causing major problems for the National Health Service in general and for Stoke Mandeville Hospital in particular. Twelve people have died and a further 300 have been infected since an outbreak there began in 2003.

It is a paradox that a microbe which acquired its name because it was so difficult to grow in the laboratory has become one of the fastest growing hospital infections in Britain. But the emergence of a "superbug" strain of Clostridium difficile is causing major problems for the National Health Service in general and for Stoke Mandeville Hospital in particular. Twelve people have died and a further 300 have been infected since an outbreak there began in 2003.

As this newspaper reported on Monday, the bug is posing a grave threat to the NHS because it is yet another potentially deadly infection that can quickly sweep through a ward full of sick people. For the past 18 months, Stoke Mandeville has battled against the bug with little success. Disturbingly, the extent of the infection received little or no wider publicity.

Strictly speaking, the strain of C. difficile in question is not a superbug because it is not resistant to antibiotics. This means it is readily treated if diagnosed early. Yet the bug has proved highly resistant to total eradication from a hospital owing to the bacterium's ability to produce hardy spores. These can linger for days on the floors and walls of a ward that has not been cleaned thoroughly with soap, water and disinfectant. The spread of the bug can therefore be linked directly with hospital cleanliness as well as the personal hygiene of staff and patients.

It is now mandatory for hospitals in Britain to report the infection when it is detected. This is a sensible and long-overdue measure, especially as reports from Canada and the United States have described the emergence of an even deadlier strain of the microbe that releases highly unpleasant toxins into the gut. Indeed, the outbreak at Stoke Mandeville may eventually be linked directly with this American strain.

The explosive growth of C. difficile in Britain can be matched by the rise in incidence of a true superbug, methicillin resistant Staphylococcus aureus (MRSA). While C. difficile has soared from fewer than 1,000 cases in 1990 to 43,672 cases in 2004, MRSA has grown from virtually nothing to more than 5,000 cases over the same period of time. The latest figures show that the two bugs each killed more than 900 people in 2003.

Unfortunately, these sorts of statistics will only confirm many people's fears about staying in hospital. These risks will increase as the population gets older because elderly patients are more vulnerable to hospital-acquired infections. The average age of the patients who died at Stoke Mandeville was 85.

So what needs to be done? Cleaner hospitals should be a priority, even though some microbiologists say that dirty floors and walls are not necessarily the real problem. They argue that infections are spread more by dirty hands than by dirty wards. This seems to be the case with MRSA bacteria which are known to be passed more easily during physical contact between staff and patients than by contact with inanimate objects.

But the issue of C. difficile, whose spores can linger on dirty walls, floors and toilets for longer than other bugs, shows that meeting the target for cleaner hospitals must be more than a public relations exercise. It must be an absolute imperative. There is no point in the NHS curing people of one malady, only to have them fall ill or die from a hospital infection. If managers believe this can only be done by taking privatised hospital cleaning back in-house, as Stoke Mandeville has done (but only after their problems became public), they must be free to take that decision. The system - public or private - is secondary; the priority must be cleanliness, rigorously observed and monitored. Anything else is a false economy.

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