Clostridium difficile

By Jeremy Laurance, Health Editor
06 June 2005


An outbreak of a lethal new bug at a leading specialist hospital has claimed 12 lives and is posing a grave new threat to the NHS, doctors have warned.

More than 300 patients have been infected with the bug, a virulent new strain of Clostridium difficile, at Stoke Mandeville hospital in Oxfordshire, known for its world-famous spinal injuries unit supported by the former disc jockey Sir Jimmy Savile. But all attempts to control the infection, which causes severe diarrhoea that can be life-threatening, have failed.

The disclosure raises new concerns about NHS hygiene following a series of scares over the superbug MRSA and the pressure on hospitals to hit waiting list targets.

Cases of C. difficile have soared from fewer than 1,000 in 1990 to 43,672 in 2004 but it has not received the same attention as MRSA. Latest figures show there were 934 deaths in 2003, a 38 per cent rise in two years. A similar number of people died from MRSA in the same year, with 955 people dying from the infection, a 30 per cent increase in two years.

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 by medical staff to clean their hands between patients, in an attempt to combat MRSA, are ineffective against the spores of C. difficile. The Health Protection Agency (HPA) said washing in soap and water was necessary to eliminate the bug and powerful disinfectants were needed instead of ordinary detergents to clean the wards.

Fears about the growing threat posed by the bug led the Department of Health to introduce mandatory reporting of infections caused by the bacterium last year. The cost of treating each case was estimated at £4,000 in 1996, implying a cost to the NHS today of more than £200m.

A report by the National C. difficile Standards Group set up by the health department in 2003 said the rise in cases was "dramatic" and it had happened "at a time when there is a general perception that standards of hospital cleaning have been declining".

Andrew Berrington, consultant microbiologist at Sunderland City hospital and a member of the standards group said: "It is a serious problem and in some ways more serious than MRSA. A new strain would be an important and concerning thing. "

The outbreak at Stoke Mandeville, which started in 2003, is caused by a more virulent strain of the bacterium closely related to a type found in the US and Canada, which is more infectious and harder to destroy. Stoke Mandeville is the only hospital in Britain where large numbers of cases of the new strain have been recorded. The hospital treats patients with severe spinal problems who may remain there for months, putting them at high risk from hospital infections.

Doctors at the hospital blamed managers' "obsession" with hitting government waiting list targets for the failure to eradicate the bug, and claimed HPA advice had been ignored. In a statement, Buckinghamshire Hospitals NHS Trust said 225,000 people had been seen at the hospital in the last 18 months and everything possible was being done to contain the outbreak. The average age of the patients who died was 85, although it is understood some younger patients have been affected. The number of infections peaked, then fell and then peaked a second time.

Dr Andrew Kirk, director of Infection Prevention and Control, said: "Infection control is one of the top priorities for this trust. We are adopting the most up-to-date technology to ensure that we minimise any risk of patients acquiring infection while in hospital. We do however need to be realistic about the prevalence of these bacteria in our community and ensure that patients who acquire it are treated effectively and quickly to prevent any further spread."

A spokeswoman for the HPA said the pressures on the hospital had hindered its capacity to deal with the outbreak. "We have met with them quite a lot of times and we have gone into a lot of detail about the measures they should take," she said. "We wanted them to keep all the infected patients in one ward but that meant they could be left with empty beds. They didn't want to turn patients away and they have had difficulty obtaining sufficient staff to implement all the measures immediately."

She added: "It is taking a long time [to get it under control]. I believe the hospital is doing better now and moving to our preferred arrangement of keeping all infected patients in one ward. It is a virulent strain and it is hard to crack once you have got it."

A spokesman for the health department said: "The large majority of cases of C. difficile diarrhoea make a full recovery, however some patients may have a more severe course that in a small percentage of cases can be life-threatening."

"The HPA has received some reports of this new strain and is keeping a watching brief on this but the available information indicates that this new strain is rare in the UK. New toxin-producing strains of C. difficile have occurred before and are not a new phenomenon. Our guidance says nurses should wash their hands in soap and water."