Scotland: 'C.diff now a regular occurrence'

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Source: http://news.bbc.co.uk/2/hi/uk_news/scotland/glasgow_and_west/7464294.stm


'C.diff now a regular occurrence'

By Eleanor Bradford
BBC Scotland's health correspondent

All hospitals in Scotland have been told to review their death rates from Clostridium difficile following the outbreak at the Vale of Leven hospital.

An independent review is to be carried out into why it took so long for the outbreak to be identified, and whether standards at the hospital in Dunbartonshire were up to scratch.

The outbreak first came to light on 22 May when Greater Glasgow and Clyde Health Board revealed there were three cases of the virulent "027" strain at the Vale of Leven.

But it was only in June when the public learned the true scale of the outbreak. On 11 June the health board announced it had looked back over the previous six months and found 54 cases of C.diff.

Eight elderly people had died from the infection and it was a contributory factor in the deaths of a further eight people.

So how could this have gone unreported for so long?

That is now the subject of an independent review, to be carried out by an Aberdeen expert, Professor Cairns Smith. But in the meantime clues may lie in the national statistics already collected.

Alarm bells

According to the Information and Statistics Division of the NHS, in the last three months of 2007 alone there were 1,608 cases of C.diff in Scotland, all of them among over-65's.

Figures collected by the General Register Office for Scotland suggest it was a factor in the deaths of 417 people in 2006, the most recent year for which figures are available.

Clostridium difficile is not uncommon. Its rise has been brought about by the over-prescription of antibiotics, which knock out the body's natural ability to deal with bacteria living in the gut.

The deaths at the Vale of Leven may not have rung alarm bells because Clostridium difficile has now become a regular occurrence in wards caring for the elderly.

Professor Smith's review will establish what lessons can be learned, but will probably echo the conclusions of similar inquiries into other outbreaks.

[/B]In particular, an inquiry into an outbreak in Kent which killed 90 people between 2004-2006 concluded that nurses were too busy to wash their hands.[/B]

The Vale of Leven is not the only hospital dealing with regular outbreaks of C.diff.

It may have dealt with those outbreaks poorly, but only dramatic changes across the whole of the NHS in Scotland will really have an impact on what is clearly a national problem.

 

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Re: Scotland: 'C.diff now a regular occurrence'

Source: http://www.dailyrecord.co.uk/news/s...erbug-outbreak-report-reveals-86908-20614069/


Lives could have been saved in superbug outbreak, report reveals

Jun 20 2008 By Magnus Gardham

LIVES may have been saved if guidelines on killer bug C diff had been updated in Scotland.

The scale of a deadly outbreak at Vale of Leven Hospital, Dunbartonshire, only came to light after a health board "lookback" exercise last week.

New reporting guidelines were issued in England in January to ensure cases of clostridium difficile were spotted early and tackled.

But NHS Scotland have so far failed to follow suit - despite a call from Scottish government officials after a meet ing with English colleagues in February.

Yesterday, ministers were under pressure to explain the delay in drawing up new surveillance guidelines.

Labour MSP for Dumbarton Jackie Baillie said: "Why is it that some five months after that meeting on February 14 new guidance covering this infection has not been issued?

"It is highly likely that the advice issued to hospitals in England would be virtually identical and a delay of this magnitude is completely unnecessary.

"It is reasonable to ask whether lives could have been saved if there had not been a delay in issuing clear guidance on C difficile.

"People in Dumbarton and across Scotland need to be assured that the Scottish government are on top of the problem."

The bug has been linked to 17 deaths at Vale of Leven Hospital.

Fifty-four patients have caught it since December and 23 have died. C diff caused eight deaths and played a part in nine others.

A Scottish government spokesman said new guidelines would be put in place following inquiries into the outbreak.

He said reporting guidelines were laid down in 2006 and updated last year.

New advice will be in place by September.

Internal health service documents seen by the Record show an advisory group set up to look at new guidelines met for the first time on June 11.

Health secretary Nicola Sturgeon yesterday rejected grieving relatives' calls for a public inquiry into the Vale of Leven deaths.

She insisted that the investigation she announced on Wednesday would be "no holds barred".

 

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Re: Scotland: 'C.diff now a regular occurrence'

Source: http://ukpress.google.com/article/ALeqM5gwK3BEDG064i4oRVELIgv45dpiGw

Hospital bug death roll rises

42 minutes ago

The death toll in an outbreak of the C. difficile bug at a hospital has risen to nine, officials said.

A rechecking of records has revealed that a patient already known to have the bug has died, said the officials.

The Clostridium difficile hospital bug was the main cause of death, taking to nine the total number of deaths linked to the outbreak at the Vale of Leven Hospital in Alexandria, West Dunbartonshire.

 

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Re: Scotland: 'C.diff now a regular occurrence'

Source: http://www.eveningtimes.co.uk/news/display.var.2359897.0.death_toll_hits_18_at_c_diff_hospital.php

Death toll hits 18 at C.diff hospital

ANOTHER patient has died at a hospital hit by Clostridium difficile, taking the toll to 18.

The latest victim died in the Vale of Leven Hospital in Alexandria. NHS Greater Glasgow and Clyde today said the patient was seriously ill from an unrelated condition, and while C.diff was a contributory factor, it was not the main cause of death.

Nine people have now died at the hospital with C.diff cited as a contributory factor. The superbug has been listed as the main cause of death in another nine cases.

Dr Syed Ahmed, chairman of the outbreak control team, said: "I would like to express my deepest sympathies to the family of this patient."

In a separate outbreak, a ward at Glasgow's Victoria Infirmary remains closed to new admissions after four patients tested positive for C.diff.

Publication date 24/06/08

 

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Re: Scotland: 'C.diff now a regular occurrence'

Source: http://news.scotsman.com/environment/Deadly-new-strains-of-C.4536283.jp

Deadly new strains of C difficile superbug on the way, warn doctors

Published Date: 29 September 2008
By LYNDSAY MOSS
HEALTH CORRESPONDENT

SCOTLAND must brace itself for an increase in new and severe strains of the Clostridium difficile superbug ? and the infection could also become more resistant to the drugs used to treat it, experts have told The Scotsman.
Rising deaths from the bug, which can cause life-threatening illness and spreads easily in hospitals, have prompted concerns about virulent forms of the disease becoming more common in Scotland.

Now experts have predicted that cases involving severe strains could increase further in our hospitals, while new types of the disease are already starting to emerge.

Fears were also raised that C difficile could become less sensitive to the antibiotics currently used to treat it.

Earlier this month, it emerged that the infection was linked to almost 600 fatalities in Scotland in 2007 ? up more than 40 per cent on the previous year.

The rise in cases has been linked to the growing prevalence of the 027 strain ? or ribotype ? of the disease, which first emerged in Scotland in 2006 but which has only become more common in the last year. It has been linked to more severe disease and deaths in patients, and is also thought to be better at spreading around hospitals than other strains.

Professor John Coia, director of Scottish Clostridium difficile Reference Service, said 027 was a concern for the NHS, but it was not the only strain causing death and disease.

He said: "For obvious reasons, people are concerned about 027. But to put it in perspective, I think 106 is something we have to be very aware of as well because it is the commonest type we see."

But while 027 has been the focus of much attention, other new strains are also starting to trouble microbiologists. One type ? known as 078 ? has recently emerged in Scotland.

In one study, scientists found that 078 was more likely to infect younger patients, but it has not yet been found to be any more severe than other strains.

Prof Coia, a consultant microbiologist at NHS Greater Glasgow and Clyde, said there was concern about 078 picking up resistance to antibiotics which could allow it to spread more easily, like other types.

Dr Anne Eastaway, a consultant microbiologist at Health Protection Scotland, said it was quite possible that new strains of C difficile could start to emerge ? and some could be severe in nature.

Professor Ian Poxton, professor of microbial infection and immunity at Edinburgh University, said focusing on any one specific strain of C difficile would not help solve the problem.

"I think the biggest worry at the moment is everyone latches on to 027 and they think that is the only strain that is important," he said. "But certainly from the Edinburgh side, we have a lot of disease and none of it is caused by 027."

Strain is heading for Scotland, and we ignore it at our peril

PREDICTING what will happen next with Clostridium difficile in Scotland is a challenge for scientists and the NHS.

Our main source of information is from other countries. It is fair to say what happens in England and further afield will eventually happen in Scotland, as C difficile is very efficient at travelling around.

So, as they have seen rising rates of the virulent strain 027, we will probably see this continue to rise as well.

But it is not just 027 that we have to worry about. The other more common strains also cause severe and life-threatening disease and we ignore those at our peril.

It is likely that new strains will also appear and that is why it is so crucial that we have a referencing service to detect these strains when they do emerge.

At the moment there appears to be a consensus that the biggest concern is about the 027 strain of C difficile.

I would be surprised if the rise in cases of C difficile we have seen recently was linked to inappropriate use of antibiotics.

But another factor which could play a role in rising C difficile is the ageing population. More and more older people are going into hospital to have their hips done and knees replaced just because they are living longer.

Elderly people are more at risk of getting C difficile than young people. It is also likely that these patients will have had antibiotics at some point because they are more likely to get pneumonia.

To some extent we have to accept that more people are at risk these days.

PROFILE

? Clostridium difficile causes diarrhoea, and in the worst cases can lead to perforation of the intestine ? and death.

? The infection is most common in elderly patients with other serious illnesses. Antibiotics can affect the balance of bacteria in the gut, allowing the infection to take hold.

? Although C difficile was first described in the 1930s, it was not identified as the cause of diarrhoea and colitis following antibiotic treatment until the late 1970s

? Between 3 and 5 per cent of the population are thought to carry C difficile in their gut at any one time without becoming ill.

 

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Re: Scotland: 'C.diff now a regular occurrence'

#5:
"Our main source of information is from other countries. It is fair to say what happens in England and further afield will eventually happen in Scotland, as C difficile is very efficient at travelling around. ...
I would be surprised if the rise in cases of C difficile we have seen recently was linked to inappropriate use of antibiotics.
#2: ...
New reporting guidelines were issued in England in January to ensure cases of clostridium difficile were spotted early and tackled.
But NHS Scotland have so far failed to follow suit - despite a call from Scottish government officials after a meet ing with English colleagues in February. ...
#1: ...
According to the Information and Statistics Division of the NHS, in the last three months of 2007 alone there were 1,608 cases of C.diff in Scotland, all of them among over-65's.
Figures collected by the General Register Office for Scotland suggest it was a factor in the deaths of 417 people in 2006, the most recent year for which figures are available.
Clostridium difficile is not uncommon. Its rise has been brought about by the over-prescription of antibiotics, which knock out the body's natural ability to deal with bacteria living in the gut. ...
In particular, an inquiry into an outbreak in Kent which killed 90 people between 2004-2006 concluded that nurses were too busy to wash their hands."

Another deadly illness.
Shamefully for these nurses to became an deadly illness vector (as an alternative to washing they can put on new gloves for every diferent patient), their managers who didn't employ more nurses (even part-time) to slow down the working rush, and instaurate new guideliness.

 

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Re: Scotland: 'C.diff now a regular occurrence'

Source: http://www.theherald.co.uk/news/new..._as_superbug_kills_28_at_Glasgow_hospital.php

Fears as superbug kills 28 at Glasgow hospital
Exclusive by BRIAN DONNELLY July 29 2009

Twenty-eight patients have been killed by the superbug clostridium difficile at a Glasgow hospital, leading to fears the full scale of fatal cases may be being hidden from the public.

The total deaths at Gartnavel directly attributed to the bug has nearly doubled over two years, and is only being revealed today even though the rate is approaching that of the high-profile outbreak at the Vale of Leven Hospital.

An MSP has raised questions over the reporting of superbug cases at the Glasgow hospital where figures show 18 people died of C diff last year alone.

The Scottish Government ordered a major inquiry into the deaths at Vale of Leven after nine people died directly from C diff in six months with the superbug contributing to a further nine fatalities between December 2007 and June last year.

Figures due out next week are expected to confirm Gartnavel, which is larger than the West Dunbartonshire hospital, had 18 deaths directly attributable to C diff and six as a contributory factor over 12 months. The previous year it had 10 deaths directly attributed to C diff and 10 as a contributory factor.

Families have also quizzed NHS Greater Glasgow and Clyde (NHSGGC) over its policy of inclusion of C diff on death certificates. One only got the bug included on their mother's death certificate as contributory after months of wrangling with the health board, despite her testing positive for C diff and it being a "major factor" in her health during her final days.

Patricia Ferguson, Labour MSP for Maryhill, said: "I have asked the government how many death certificates were amended and they said none. That seems strange when I know of one. I just don't think we are getting the full story. I will be looking at the new figures when they come out."

Professor Hugh Pennington, of Aberdeen University and one of the country's leading experts on infectious disease, said: "The death certificates issue was supposed to have been resolved by NHSGGC after Vale of Leven."

He said it was "wrong that a family should be in the position to have the death certificate changed" and added: "I've seen this many times. It spoils the statistics. These people get the impression it's a cover up."

A spokesman for the health board said it did not dispute the figures but added infection rates were improving and said: "Gartnavel includes the Brownlee Centre for Infectious Diseases and the Beatson West of Scotland Cancer Centre, which both treat patients from across Scotland with serious medical conditions."

Questions over hygiene were also raised after the Gilmour family of Clydebank were sent home with their 89-year-old mother Edith's soiled clothing in plastic bags 15 minutes after she died, despite her testing positive for the bug. In another case a doctor treating a patient with C diff was seen to leave the bedside and return without having changed clothes.

Professor Pennington said if a patient is in isolation doctors should always remove protective clothing after each procedure, and sending patients home with soiled clothing was "bad practice".

A health board spokesman said regarding the doctor: "Strict infection control policies are in place and our staff have been made aware of their responsibility to adhere to this policy. We are therefore concerned to hear of this case and will reinforce the infection control policy to staff.

"When a family member has died our staff return personal belongings. If any items have been soiled clear instructions are given on appropriate laundering."

A Scottish Government spokesman said any C diff death was regrettable but pointed out Gartnavel was much bigger than Vale of Leven, with a large proportion of elderly patients.

 

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Re: Scotland: 'C.diff now a regular occurrence'

Source: http://www.theherald.co.uk/news/new...cord_number_of_Scots_killed_by_C_Diff_bug.php

Record number of Scots killed by C Diff bug
BRIAN DONNELLY August 08 2009


Pressure is mounting on the Health Secretary for a Scotland-wide public inquiry into deaths caused by the hospital bug clostridium difficile after the latest figures put fatalities at a record high.

The bug either directly killed or played a part in the deaths of 765 people in 2008 in Scotland, compared to 597 in 2007.

In 2008 the bug was the main cause in 248 deaths and a "contributory factor" in a further 517, according to the General Register Office for Scotland.

Further questions were raised over the recording of C Diff as Health Secretary Nicola Sturgeon was forced to apologise over an incorrect set of figures she had issued previously for Gartnavel Hospital in Glasgow.
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Ms Sturgeon also came in for criticism for highlighting an "encouraging" downward trend with figures that showed a drop from 75 at the start of the year to 42 in the past three months.

But there were concerning rises in deaths in almost all health boards in Scotland.

There were 40 more deaths related to C Diff in the health board areas for Grampian in 2008 than in 2007, 25 more in Ayrshire and Arran, 23 more in Tayside, 22 more in Forth Valley, 20 more in Fife, 14 more in the Borders and 11 more in Lanarkshire.

NHS Greater Glasgow and Clyde had 58 patients die in its hospitals as a direct result of C Diff, down one on last year, and 124 C Diff-related deaths, up six on the previous year.

Only Lothian on the mainland experienced a decrease, of five C diff-related deaths, with Orkney having a drop of one.

The statistics prompted further cross-party calls for widening the public inquiry which is to be set up into the Vale of Leven deaths after nine people were killed by the bug at the West Dunbartonshire hospital in the first six months of last year.

Glasgow MSP Patricia Ferguson is convinced the "full story" is still not being told and she will help co-ordinate a fresh campaign with patients from Gartnavel who contacted her and the existing C Diff Justice Group, which includes Vale of Leven families, for the nationwide inquiry.

Criticising the Health Secretary's positive take on the statistics, Ms Ferguson said: "These figures are not very encouraging, nor do they instill confidence."

The LibDems and Tories joined Labour in pressing for a wider public inquiry.

Michelle Stewart, who lost her mother-in-law in the Vale of Leven outbreak, said recording of the illness was still "a shambles", and added that a wider probe was now essential.

Professor Hugh Pennington of Aberdeen University, one of the country's leading experts on infectious diseases, said failing to broaden the inquiry would be a mistake. He said: "It is a very serious problem. It is killing more people than swine flu."

 

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Re: Scotland: 'C.diff now a regular occurrence'

Source: http://www.northern-scot.co.uk/news...2/Hospital_superbug_linked_to_six_deaths.html

NEWS ? Local News
Hospital superbug linked to six deaths
Published: 18 September, 2009

SIX elderly patients died during the C-diff superbug outbreak at Dr Gray's Hospital, it has been revealed.


However, only two of them were as a direct result of contracting the infection in hospital. The other four had C-diff recorded as a contributory factor on the death certificate but not the main reason.

Important lessons have been learned from the C-diff outbreak at Dr Gray's Hospital, health chiefs have said.

A total of 18 patients were affected by C-diff, ranging from 47 to 94-years-old. Fourteen were female and four male.

The formal report by the NHS Grampian outbreak control team was presented to members of the Moray Community Health and Social Care Partnership (MCHSCP) last week.

It revealed that the two patients who died from C-diff were aged 82 and 86. In one case acute renal failure was also listed as a cause of death, while in the other the patient also had septicaemia and MRSA.

Those patients died between June 8 and 19, after the main outbreak was declared over by the control team on June 5.

During the formal period of the outbreak from April 1 to June 5, four other patients ? aged 87, 94, 84 and 92 also died. However, in these cases C-diff was listed only as a contributory factor and not the main cause of death.

Two medical wards were closed to new admissions during the outbreak and affected patients isolated within the wards. New admissions to these wards were re-directed to Raigmore Hospital, Inverness, and Aberdeen Royal Infirmary during the outbreak.

Deep cleaning of both wards was implemented and visiting restricted during the outbreak.

Charles Muir, MCHSCP chairman, said it was a "very comprehensive and honest report". And he added: "This is an extremely important report and lessons have been learned."

Andrew Fowlie, NHS Grampian general manager in Moray, said a number of recommendations in the report had already been implemented.

He said clearer trigger points had been established which would now give a better picture of the number of patients with C-diff at any given time and over the preceding four-week period. This would give staff and senior managers a better indication of when to initiate a formal outbreak procedure, he told the committee.

Although the outbreak was subsequently declared to have started on April 1, it was only on April 29 that a higher number of patients testing positive for C-diff was flagged up and the following day an outbreak process was put in place.

The report said there was no delay in the response of the local management team once the increased incidence of C-diff became apparent.

That included setting up an incident room and ensuring that the appropriate staff were brought on board.

However, it added: "There was a delay in escalation of the incident within the infection prevention and control team leading to failure to declare an outbreak at the appropriate time."

Mr Fowlie said a procedure for providing written reports giving frontline nurses and doctors better information with which to handle an outbreak had now been implemented, and charts showing the C-diff trend within hospitals and whether this is within acceptable limits will be placed in each ward in Dr Gray's and community hospitals.

Wards 7 and 9 at Dr Gray's, the two affected wards, have undergone a major refurbishment which has seen carpets replaced with new flooring, new sink and washing facilities and enhanced space between beds to improve infection control.

Ward 7 has already re-opened and ward 9 was due to open again this week. One patient was also identified in ward 8 but transmission from patients in wards 7 and 9 was ruled out.

The use of antibiotics has also been reviewed in the wake of the outbreak and a new prescribing agenda is being put in place, including an education programme for junior doctors and daily prescription monitoring by pharmacists in high risk areas, such as the two wards affected at Dr Gray's.

Mr Fowlie said more careful prescribing was now in place. "Prescribing is the most critical part of managing infection," he told members.

"Bugs become infectious to others and come out when we are unwell and some of the drugs we use to promote wellness also bring out the symptoms of infectious disease," he added.

All but one of the 18 patients had antibiotic treatment during their stay in hospital and nine of them had been in hospital in the three months prior to their latest stay.

"Antibiotic prescribing must be considered an important factor in causes of this outbreak," said the report.