Super-virulent strain of C.difficile could be behind sudden increase in cases across hospitals in England
A NEW super virulent strain of the hospital infection, C.difficile, is being blamed for a sudden increase in cases.
The superbug, which was first reported in Canada, produces more spores, therefore spreading faster and having a more serious effect on patients.
Its emergence is being seen as a key reason why 45 hospital trusts in England reported higher levels of C.difficile this year than last year, as revealed in the latest Quarterly Monitoring Report on NHS Performance published by The King's Fund. It shows that, while across the board hospital acquired infections have reached a new low, with MRSA cases falling to record levels, C.difficile reports are beginning to creep up.
In August 2008 there were nearly 1,550 cases a month, while in August 2011 the figure was 666. Current annual rates are running at around 9,500 cases, down from nearly 20,000 three years ago.
However, the report reveals that variations in counts are evident between hospitals and 21 foundation trusts in England reported higher numbers of C.difficile infection for the first quarter of 2011/12 compared to the same period in 2010/11. Subsequent investigations found 25 foundation trusts and 20 non-foundation trusts had higher counts this year than last. In contrast, MRSA has fallen from 130 cases a month in 2008 to 34 in 2011 – the lowest level ever recorded. Annual rates are around 660 cases a year.
Professor John Appleby, chief economist at The King's Fund, said of the figures: “While the NHS continues to perform well, a minority of trusts are struggling to reduce hospital-acquired infections. Looking ahead, the challenge will be to maintain performance and deliver productivity improvements as finances tighten further. Six months into an unprecedented four-year period of financial restraint, the pressures already emerging in a small number of trusts highlight the scale of the challenge facing the NHS.”
The report goes on to warn that future cash cuts could have a knock-on effect on infection levels, stating: “Hospital-acquired infections including C difficile and MRSA can be seen as a specific measure of the quality of patient care, which could be affected by tight budgets.”
If the new strain of C.difficile is to blame, then hospitals will have to find a new line of defence to avoid thousands of deaths every year.
Bradford Teaching Hospitals NHS Foundation Trust is one of those seemingly affected by the superbug. In the first quarter of 2011/12 there were 21 cases at the trust, with eight in July and four in August. However, in September this figure rose to 14.
The trust, which manages Bradford Royal Infirmary and St Luke's Hospital, fears the new more-infectious strain could be to blame. Dr Philip Stanley, director of infection prevention and control and a consultant in infectious diseases at the trust, said of the increase: “It has been a big blip, but if you look at the three months before there was an increase in cases in the community and we understand other trusts in the region have also seen an increase.”
He said staff had received orders to be more stringent in hand hygiene. And it is these measures by medical staff that will provide the best defense against the new superbug becoming more prevalent, according to researchers.
Experts from the University of Northampton are urging NHS trusts to improve training, particularly for new staff.
Dr Terry Tudor, a researcher within the university's centre of sustainable waste management, said: “The management of various factors in the physical environment, including clinical waste, has been demonstrated to impact upon levels of pathogens. However, there are social and economic factors to consider if further improvements are to be made. Staff perceptions have to be addressed through training at all levels in order to sustain improvements that have been made and to avoid complacency creeping in. Importantly, there have to be efforts to consider the associated environmental impact and cost of managing hazardous medical waste.
“Infection is not only about hygiene - it is about attitude from management through to ward staff. Differences in practices by different job categories suggest that any initiatives should be targeted towards specific job categories and have the support of senior managers if they are to be successful. In addition, there should be particular attention paid to younger staff who have been employed for less than 10 years at the site.”
