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Ulster Med J. 2010 January; 79(1): 31.
PMCID: PMC2938999


John E. Moore, Clinical Microbiologist, B. Cherie Millar, Clinical Scientist in Molecular Microbiology, Paul J. Rooney, Consultant Medical Microbiologist, Colin E. Goldsmith, Consultant Medical Microbiologist, and Anne Loughrey, Consultant Medical Microbiologist
Northern Ireland Public Health Laboratory, Department of Bacteriology, Belfast City Hospital, Lisburn Road, Belfast, Northern Ireland, BT9 7AD
John McCormick
Soltex Global Ltd., Clinical Translational Research and Innovation Centre (C-TRIC), Altnagelvin Hospital, Glenshane Road, Londonderry, Northern Ireland, BT48 6BS, UK
John Mallett
School of Psychology, University of Ulster, Magee College, Northland Road, Londonderry, Northern Ireland, BT48 7JL, UK


Between June 2007 and August 2008, an outbreak of the spore-forming anaerobic bacterium, Clostridium difficile, occurred within the Northern Health Trust, particularly associated with Antrim Area Hospital. During this period, there was sustained local media attention in its reporting via radio, newspaper and television. Following the outbreak, it was the aim of this study to compare public perceptions to and fear of healthcare-associated infections (HCAIs) of responders in Northern Ireland with responders elsewhere in the UK and worldwide.

An on-line e-survey was performed over the four month period, June through September 2009, hosted at the Infection Free by Design (IFBD) network site (, where IFBD was supported through an Invest NI facilitation grant. Twelve questions were asked to assess the public's perception of HCAIs and how these are being challenged. In total, 201 responses were analysed, originating from 53% males and 47% females, including 104 from persons with a Northern Ireland postcode, 75 with a postcode from Great Britain and 22 responders from other countries, including Australia (n=4), Germany (n=1), India (n=2), Malaysia (n=3), New Zealand (n=1), Republic of Ireland (n=3), South Africa (n=1) and the USA (n=7). Overall, the greatest fear of going into hospital in descending order was (i) fear of catching a HCAI (120/201 (59.7%) respondents ranked this their greatest fear, (ii) waiting lists (82/201 (41.0%) respondents ranked this as their second greatest fear, (iii) being away from home , (iv) hospital food and finally, getting to/from hospital . Within the Northern Ireland context, fear of catching a HCAI was also the greatest concern regarding going into hospital (62%), which was markedly higher than GB (56%) and where waiting lists ranked the second most significant anxiety/fear (49% in NI versus 33% in GB). Most responders described themselves as having a medium level fear of HCAIs (51.3%), whilst approximately one fifth of interviewees (18.1%) expressed having a high level of fear of HCAIs, whilst approximately one third of responders (30.7%) declared having a low level of HCAI anxiety. When questioned as to where this anxiety towards HCAIs originated, media reports were responsible for the majority (62.1%), followed by what one had seen when visiting a hospital (27.7%), stories from other patients (24.6%), practical/personal experience (22.1%) and finally what one had seen as a patient (8.2%). Approximately three-quarters of responders (75.5%) did not feel that hospitals were doing enough to prevent HCAI-related infection. Three patients in Northern Ireland (2.9%) failed to keep a hospital appointment due to the fear of acquiring a HCAI during their visit to hospital. For two of these patients, the failure to attend a hospital appointment was on more than one occasion. Overall, in 2008/2009, there were 1,565,497 outpatient attendances recorded within DHSSPSNI ( In 10.8% of these scheduled attendances, the patient did not attend (7.4% of new referrals and 12.3% of review attendances). Therefore, if we attempt to estimate the total number of outpatient appointments missed in NI in the 2008/2009 period, potentially attributed to a fear of acquiring a HCAI, this crudely is 3,374 missed new referral appointments, which represents a significant cost to the HSC Trusts locally.

Unfortunately, we do not have any baseline data prior to the Clostridium difficile outbreak to make comparisons, although local rates appear to be higher, when compared to GB rankings . What is clear from these preliminary findings is that the fear of acquiring a HCAI from interacting with a HSC Trust is the dominant factor, ranking even higher than HSC waiting lists and that such anxiety is being driven by media reports. Statistically robust data is urgently required, particularly within the in-patient and out-patient setting, to inform policy, so that clear patient communication interventions are put in place to (i) communicate such risk to the patient in an informed and balanced manner, (ii) optimize patient management and (iii) avoid “missed” appointments by patients who fear attending a HSC Trust will result in a HCAI, thus saving the Trust valuable resources.


The authors have no conflict of interest.

Articles from The Ulster Medical Journal are provided here courtesy of Ulster Medical Society