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BMJ. 2007 May 5; 334(7600): 924.
PMCID: PMC1865397

C difficile infections rise—but MRSA rates drop

The number of infections of Clostridium difficile in the NHS in England rose again last year. Hospitals saw 55 681 cases among patients aged over 65 years—up 8% on the 2005 figure, says the Health Protection Agency.

The latest figures come two months after it was revealed that C difficile and methicillin resistant Staphylococcus aureus (MRSA) had killed record numbers of patients in 2005. In that year C difficile was mentioned on 3807 death certificates—up 69% on the 2004 figure, the Office for National Statistics said. MRSA was a factor in 1629 deaths, a rise of 39%.

The Health Protection Agency noted that the latest increase in the number of C difficile cases was smaller than the 17% jump seen in 2005. And there was also evidence of the tide turning against MRSA bacteraemia. A total of 1542 MRSA bloodstream infections from October to December 2006 represented a 7% fall from the figure for the previous quarter.

However, Katherine Murphy, director of communications at the Patients Association, said: “This is no reason for celebration. The number of deaths from C difficile is equivalent to a packed jumbo jet crashing every month.

“When is a [NHS] chief executive actually going to lose his or her job over this?”

The Healthcare Commission's chief executive, Anna Walker, said the apparent decline in the rate of MRSA infection was encouraging.

“However, the figures for C difficile are less encouraging,” she said. “Although the increase is slower, it is still on the rise. This will cause concern to patients.

“We fully recognise that outbreaks of C difficile are not easy to control. But we also know that trusts can minimise the spread of infection by following rigorously established guidance on infection control.”

A government memo leaked earlier this year predicted that ministers would miss the deadline set in November 2004 for halving the rate of MRSA infection by April 2008.

The memo said that C difficile was now “endemic throughout the health service, with virtually all trusts reporting cases.”

The government's chief nursing officer, Chris Beasley, said: “Many trusts that have received help from MRSA improvement teams have seen significant reduction in infection. We are determined to see these national reductions replicated for C difficile.”

The Conservative party blamed the continuing rise in the number of C difficile infections on the thousands of job losses in the NHS in the past 12 months, particularly among nursing staff.

The Liberal Democrats' health spokesman, Norman Lamb, said that tougher action was needed “to deal with the many hospitals that are not meeting acceptable hygiene standards.”

From May the Healthcare Commission will start sending “hygiene hit squads” into NHS trusts. Trusts found to be in breach of good practice “will be issued with improvement notices to ensure that they take the appropriate remedial action.”

Trusts' compliance with standards for infection control will also be reflected in the 2006-7 “annual health check”—the rating of their performance—which will be published later this year.

In a BMJ editorial last month, however, John Starr, reader in geriatric medicine at the University of Edinburgh, questioned whether Cdifficile should be thought of as purely a hospital acquired infection and suggested that other infection control measures might be needed, such as screening people in the community before they were admitted (BMJ 2007;334:708, doi:10.1136/bmj.39169.601285.80)

Notes

Quarterly MRSA and C difficile figures are available at www.hpa.org.uk.


Articles from The BMJ are provided here courtesy of BMJ Publishing Group