Senior hospital managers were condemned today for failing to tackle repeat outbreaks of a deadly stomach bug, that killed at least 65 people and infected several hundred.
The bosses of Stoke Mandeville Hospital in Aylesbury, Buckinghamshire, were censured by NHS inspectorate, the Healthcare Commission, for prioritising political targets, such as reducing waiting times over patient safety.
There were 174 cases of the potentially fatal bug Clostridium difficile in the first outbreak at the hospital between October 2003 and June 2004, and another 160 cases in the second between October 2004 and June 2005. Of the 38 patients who died in the outbreaks, 33 definitely contracted the infection after being admitted to the hospital.
But the Healthcare Commission found that over three years a total of 65 deaths at the hospital were linked to the C-bug. In a damning report the infection definitely or probably killed 41 patients and contributed to the deaths of another 24.
The report came as it emerged there was a 17.2% increase in cases of Clostridium difficile in hospitals throughout England last year. The Health Protection Agency, the national body responsible for tackling infectious diseases, found there were 51,690 cases in 2005, up from 44,107 in 2004.
All those infected were 65 or older. The number of hospital trusts reporting outbreaks of the potentially fatal stomach bug rose by 60% over the same period.
During the first outbreak at Stoke Mandeville senior managers ignored calls by doctors and nurses to isolate infected patients in order to meet the government's target for a maximum waiting time in A&E of four hours. This led to patients with diarrhoea being kept in or put on open ward.
During the second outbreak managers decided to close an isolation ward against the advice of both the hospital infection control team and the HPA.
Shortages of nurses and a lack of cleaning facilities also contributed to the poor standards of hygiene in the hospital. Utility rooms on the wards were cluttered with dirty linen and sluices containing urine and excrement, which meant nurses could not reach washbasins.
The watchdog found nurses were "too rushed to take basic precautions such as washing their hands, wearing aprons and gloves consistently, emptying commodes promptly and cleaning mattresses and equipment properly." The inspectors said some of the cleaning practices they observed were of "a completely unacceptable standard".
Senior doctors and nurses contacted the hospital's chief executive with their concerns but they were not acted on. The watchdog found "staff were required to work in situations that compromised their professional standards." Doctors said senior managers told them "that nothing would be changed 'unless a disaster occurred'."
The healthcare watchdog found the executive team of Buckinghamshire Hospitals NHS Trust, which runs Stoke Mandeville, so deficient in their response to the outbreaks that it recommended they be replaced.
The inspectors noted that it was "only when the outbreak reached the attention of the Department of Health and then received national publicity, that the trust's leaders gave urgent priority to its containment."
The inspectorate's chairman, Professor Sir Ian Kennedy, said: "Senior managers concentrated too much on one responsibility [meeting waiting times] and neglected others. Safety cannot ever be allowed to play second fiddle to other objectives that may emerge from time to time."
The trust's chief executive, chairman and director of nursing have already left and the medical direction, responsible for infection control, is due to leave in the next few months. But acting chief executive Alan Bedford denied they had been sacked or that their departures were related to the damning report.
The Healthcare Commission chief executive, Anna Walker, said the report showed serious management failure. But she added that patients could be reassured that improvements had now been made.
She added: "This is a sad and distressing story. It is a tragedy for the families, for the hospital and for the NHS as a whole. Our first thoughts must be with those who have lost relatives."
The Conservative shadow health secretary, Andrew Lansley, said the national increase in Clostridium difficile cases belied "the government's complacency in tackling hospital acquired infections".
He said: "Urgency on the part of the government to implement best practice has been sadly lacking, as demonstrated by the Stoke Mandeville report, which was published over a year after the last spate of outbreaks in Buckinghamshire."
The government today said NHS trusts that fail to follow good practice in infection control would by issued with an improvement notice by the Healthcare Commission, setting them a deadline to raise their standards. Those that fail to do so face being reported to the health secretary and could face further penalties.
Health minister Andy Burnham added that many trusts had reduced levels of hospital acquired infections. The number of cases of superbug MRSA fell by 2% between 2004-05 and 2005-06, from 7,233 to 7,087.
