The latest outbreak of a "superbug" in three hospitals in Leicester shows that, despite NHS efforts to eradicate them, hospital-acquired infections are not going to go away. At least 49 - possibly as many as 78 - patients were killed by the bacterium Clostridium difficile (C difficile) in Leicester and it is thought that it killed at least 20 patients at hospitals in Kent earlier this year.
"Clostridium difficile is a bacterium that lives in the bowel of a small percentage of adults and is more likely to be found in elderly people. This means that some patients are admitted to hospital with it," says Judy Potter, who chairs the Infection Control Nurses Association (Icna). "In balance with the other friendly bacteria in the bowel it causes no harm. However, if something happens to reduce the friendly bacteria, the C difficile bacteria flourish and damage the lining of the bowel, resulting in a range of symptoms from diarrhoea through to more serious, and much rarer, consequences such as bowel perforation.
"In the last year or so we have seen a more virulent strain of C difficile that seems to cause the more severe symptoms. Antibiotics often cause the balance of friendly bacteria in the bowel to be reduced, predisposing patients to Clostridium difficile infection."
Until now, MRSA (methicillin resistant Staphylococcus aureus) was considered the biggest superbug danger in hospitals - instances have risen by 600% in the past decade and it was cited on 1,623 death certificates in 2004 as the contributing or underlying cause of death. However, C difficile is now thought to be a greater danger. In 1999, it was mentioned on 975 death certificates; in 2004, that had risen to 2,247, though not all these infections would have been picked up in hospital.
It has genetically mutated to be resistant to the treatments that kill other hospital-acquired infections such as MRSA - from the detergents used to clean hospital floors, to the alcohol hand-wipes used by doctors and nurses, to antibiotics prescribed to patients. "Patients with C difficile diarrhoea contaminate the environment with the bacteria and the hardy spores that it produces," says Potter. "The spores are extremely resilient and can survive indefinitely in the environment. If picked up on hands and then transferred into the mouth it gains entry to another person's bowel. If those who ingest it also have a reduced balance of friendly bacteria in their bowel, they too develop symptoms of infection and so the cycle goes on."
Experts say that hands should be thoroughly washed with soap and water, surfaces should be washed with bleach and wards steam-cleaned. Hospitals should also find space to set up isolation wards for those affected. "There are some general measures that are recommended to protect patients against infection generally when coming into hospital," says Potter. "They are mainly about common sense and good hygiene."
Judy Potter
Chair of the Infection Control Nurses Association
Keeping your hands and body clean are important when you are in hospital. Take personal toiletries including soap and a clean flannel. Men should use their own razor. Taking a container of moist hand-wipes, such as baby wipes, with you will ensure you always have some available. [Chemists also sell antiseptic wipes, or, if you're really worried, you can buy medical wipes called Clinell, at orderhealth.com].
Always wash your hands after using the toilet. If you use a commode, ask for a bowl of water to wash your hands, or use a moist hand-wipe afterwards. Many hospitals now routinely offer one, but do not be afraid to ask.
Always wash your hands or clean them with a hand-wipe immediately before you eat a meal. Many hospitals provide a moist hand-wipe on the meal tray, but often people use it after they have eaten. Use it at the start of the meal to ensure your hands are clean before you eat.
If someone needs to examine you or perform a procedure, do not be afraid to ask if they have first washed their hands or used an alcohol rub or gel.
Try to keep the top of your locker and bedside table free from clutter so that it can be cleaned properly.
The area around your bed should be cleaned regularly. If you or your visitors see something that has been missed, report it to the nurse in charge.
If you are concerned that the toilet or bathroom looks dirty, report this immediately to the nurse in charge of the ward, and use an alternative, if available,until it has been cleaned.
Always wear something on your feet when walking around in hospital.
Dr Vas Novelli
Consultant in paediatric infectious diseases, Great Ormond Street Hospital
We screen every patient and all the information goes on to a computer so we know which patient is carrying which bugs. That means if a child has an infection, we can isolate them. We limit the use of antibiotics unless they are absolutely essential. Their use causes some infections to mutate and become resistant to them.
It is difficult for parents to tell their children what to do, especially if they are young, but we encourage them to wash their hands regularly. Our nurses will watch out for children who fiddle with their wounds or a central line [catheter].
Visitors should wash their hands before and after touching their children. We have had infections being spread by parents who go to get a cup of tea without washing their hands.
Due Macqueen
Clinical nurse and director of infection prevention and control, Great Ormond Street
C difficile really isn't the same in small children as it is in elderly patients. We see the organism but not the outbreaks. Parents need to ask what hospitals do to prevent infections - don't be afraid to ask.
Make sure doctors and nurses wash their hands before touching your child, and that they wear gloves and aprons if they are seeing to a wound. Look around and make sure things are clean and report dirty wards or facilities.
Gail Johnson
Midwife and educational professional development adviser at the Royal College of Midwives
The important thing to realise is that most women who are pregnant are healthy and going into hospital to give birth is a normal event. You probably won't have to stay long and you are unlikely to be at risk from one of these infections. However, if you do start feeling unwell, especially if you have diarrhoea, report it quickly.
Be aware of general hygiene (see Icna advice above). It is perfectly acceptable to ask staff to wash their hands so don't feel embarrassed or awkward about it - they won't be offended.
If you get a lot of visitors, make sure they wash their hands before seeing you and your baby.
Breastfeeding will offer your baby greater protection against infections.
Take showers and change sanitary pads regularly. Wash your hands regularly. When you have a new baby, you quickly get into the habit of washing your hands much more anyway.
