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NHS Greater Glasgow and Clyde Takes Steps to Reduce C-diff Deaths

June 11, 2008 12:07 PM

NHS Greater Glasgow and Clyde (NHSGGC) recently announced an investigation into a cluster of three cases of the 027 strain of Clostridium difficile (C-diff) in the Clyde area.

As part of this investigation, NHSGGC has carried out a full review of all cases of C-diff at the Vale of Leven Hospital.

The hospital’s infection control team looked back over all incidents of C-diff infection within the hospital from December 1, 2007 to June 1, 2008.
That investigation has shown higher than expected levels of C-diff cases in January, February and May of this year.

The investigation has also established that a high number of elderly patients died during that period.

54 patients have been treated in hospital for the infection (13 of these patients had the infection on admission). Twenty-two of them have died … in eight of these cases C-diff was thought to be the main cause of death and in a further eight cases it was a contributory factor.

The investigation, however, shows that there are currently only three patients in the hospital with C-diff and that all are being treated in isolation.

Following the full review of records completed yesterday (Tuesday, 10 June), NHSGGC Public Health Protection Unit immediately called an Outbreak Control meeting attended by Health Protection Scotland and NHSGGC infection control leads to discuss all actions taken to date and recommend next steps.

This meeting agreed a series of further actions to help control the spread of C-diff, including:

• Urgent review of use of antibiotics which are known to reduce the body’s natural defences against C-diff
• Improved hand washing facilities throughout the hospital
• A reinforced drive to improve compliance with the Board’s strict hand hygiene protocols. The Board’s hand hygiene co-ordinator is being drafted in to the Vale to support this measure along with top-level medical and nursing leadership
• Introduction throughout NHSGGC of latest techniques in treatment and management of C-diff.

Professor John Coia, Consultant Microbiologist and Director of the National C-diff Reference Service, said: “One of the most significant measures we may be able to take to curb the increased incidence of C-diff is to change the way we use antibiotics. Recent reports from elsewhere in the UK and North America show that significant reductions in C-diff rates can be achieved when this measure is used to supplement existing infection control techniques as part of a package of interventions.

“A side-effect of treating patients with antibiotics is the destruction of ‘good bacteria’ in the gut. These good bacteria are part of the body’s natural defence system against C-diff.”

Dr Linda Bagrade, Consultant Microbiologist and Infection Control Lead for the Vale of Leven, who led the infection control review, agreed that this measure could be significant as there was an extensive use of antibiotics amongst those C-diff patients who subsequently died.

Dr Syed Ahmed, chair of the Outbreak Control Team, emphasised that this outbreak was in relation to a look-back over the past six months: “The one thing that we know for certain is that the numbers of confirmed C-diff cases are rising in Scotland due to better methods of surveillance, testing and reporting but I want to assure all patients and the public in general that we are taking every measure we can to tackle this problem.

“The overall number of C-diff cases within the six month period is higher on average than we would expect but we are particularly concerned about the number of deaths due to this infection.

“This may not be due to any specific strain of C-diff but more to do with the type of patients treated at the Vale of Leven which has a high proportion of elderly patients who are more likely to develop symptoms of the infection. Older people have a far greater natural occurrence of C-diff. One in five older people carry the bug in their gut compared to only one in fifty young adults.”

Dr Anne Eastaway, Consultant Microbiologist and Head of C-diff Surveillance at Health Protection Scotland, said: “We have worked closely with the Board and agree with the measures they are putting in place. We know that due to improved surveillance and detection by doctors, there are higher notifications of C-diff throughout the country. This enables us to understand and monitor the changing epidemiology of this infection and work with boards to improve infection control measures most appropriately.”

ENDS

For further information contact the Press Office on 0141 201 4429.

Notes to Editor

The Outbreak Control Team will meet again tomorrow afternoon after which a further media update will be issued.

Clostridium difficile (C diff) is a bacterium that causes diarrhoea and more serious intestinal conditions such as colitis. It is found in around one in fifty healthy adults, who carry the bug without showing any symptoms. People who have other illnesses or conditions requiring prolonged use of antibiotics and the elderly are more likely to develop symptoms of the infection.

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