More Clostridium difficile deaths and infections in Northern Ireland but outbreak over (?)

There has been a major outbreak of Clostridium difficile in Northern Ireland in the last year. After taking a rigorous and robust 3 pronged approach The Northern Health and Social Care Trust (fascinating Management Structure chart pdf) are widely trumpeting that the outbreak is now crushed and only 2 more unecessary deaths and 11 infections occurred last month - although they failed to reveal at which hospitals these infections were located.

Since last summer over 61 deaths have been linked to C. difficile of which 40 (now 42) have died this calendar year. When we last covered this topic 2 months ago the respective figures were 53 and 32. see Saturday, July 05, 2008 Northern Ireland Clostridium difficile deaths and infection continue despite throwing money at it £6 Mn "investment" by McJimpsey

So the NHSCT have declared the outbreak over "as at August 31st" because " there had been a sustained reduction in the number of new cases and there was no evidence of recent transmission."

Meanwhile they will continue with their multi million £ three-pronged policy against this faecal contaminant ;

1. Infection control procedures - including restrictions on visiting ***
2. Rigorous antibiotic management
3. Enhanced environmental cleaning

Not to mention carryong on spending the £9m the NI Health Minister Michael McGimpsey has thrown (he calls it an "investment") at Northern Health and Social Care Trust, with the very modest aim of reducing MRSA by 10% and C. difficile by 20% by March 2009. Ulster Unionist and property developer 60 year old McJimpsey spends nearly half the NI total Budget.

The Northern Health and Social Care Trust emply 13,000 staff providing services to a population of around 440,000 in rural and suburban communities with an annual budge of £500 million.

*** Visiting Policies in NI Hospitals

Western Health and Social Trust have issued a "Hospital Visiting Policy" a 12 page document dateed August 2008 which has the fascinating restriction :

Visitors should be advised that in the interest of promoting patient privacy that camera phones, cameras and camcorders should not be used within the ward area except in Maternity Department where special guidance in available.

The Southern Health and Social Care Trust have a 13 page "Acute Hospital Visiting Policy" which is undated and different to the above which has the injunction :

For confidentiality reasons cameras on mobile phones, cameras and camcorders arenot to be used by visitors within the ward area without seeking permission from wardstaff

The Belfast Health and Social Care Trust (the biggest with 22,000 employees and possibly he biggest employer in NI) revealed a "Knock out plan for C difficile " just one month ago - The Trust’s Medical Director, Dr Tony said on August 7th - “It is our intention to deliver a knock out blow to C difficile in Belfast hospitals”. This included strict adherence to the rules on visiting.

They do not appear to have any published policy on visiting but have a web page that identifies 4 simple rules dated April 4th 2008 ..

• to clean their hands before and after visiting a hospital ward
• not to visit if they feel unwell, have a cold, diarrhoea or vomiting
• not to bring perishable foods in to hospitals
• stick to the visiting times and the numbers of visitors allowed at one time.

The recently introduced restrictions on cameras refelect public hysteria about phtography but also prevent foer example (as has happened) the awkward squad taking pics of

... filthy unwashed floors, faecal smears on toilets, filthy sheets , discarded wound dressings etc.,

There were on census day 29th April 2001 ,1,685,267 people in N. Ireland (curiously females 863,818 significantly outnumbered males 821,449 ) - slightly more than the population of Merseyside..

Why do they need three bodies to organise their healthcare ?

Why can't those three bodies have a single simple staightforward standardised policy with rules and guidelines on visiting ? (Indeed why don't we have national one ?)

Rose Gibb resigns - Kent & Sussex Clostridium epidemic kills patients - all targets met.

A report from health watchdog, the Healthcare Commission, concluded that infection by Clostridium difficile probably or definitely killed at least 90 patients and was a factor in the deaths of a further 241 in 3 Hospitals (Maidstone Hospital, Kent and Sussex Hospital, Pembury Hospital) run by the Maidstone and Tunbridge Wells NHS Hospital Trust . Kent Police and the Health and Safety Executive are examining the report. BBC Full report 128 pages

CEO Ms Rose Gibb ( a qualified nurse) who took up the job in late 2003, resigned ahead of the reports publication on Friday 4th October. Chairman of the Trust Mr James Lee Mr said the appointment of a new chief executive may take a few months.

As CEO Rose Gibb was responsible for the hugely unpopular "reconfiguration "plans for the two hospitals which would see a down grading of Maidstone Hospital A&E services. Her plans had also included the loss of children’s and maternity services.

There were two major outbreaks - 150 patients were affected between October and December 2005.

258 patients were affected in a second outbreak from April to September 2006 .

This search of the BBC website alone produces a detailed history of how this nationwide Clostridium epidemic has grown remorselessly as an obsession with centrally devised targets for hospital performance has gripped hsopital managers.

http://search.bbc.co.uk/cgi-bin/search/results.pl?scope=all&edition=d&q=clostridium

See also here

The screen pic above is from a BBC undercover investigation when BBC reporter Danielle Glevin went undercover in May 2004 in the Kent and Sussex Hospital Go here first and follow links. The interview with Rose Gibbs is here. This was before the 2 major outbreaks.

A sample of the Conclusions of the healthcare Commission report ...

"The trust told us that there had been no deaths that were definitely caused by C. difficile between April 2004 and March 2006. In the Healthcare Commission’s sample of 50 patients who died and had contracted C. difficile between April 2004 and September 2006, our experts found that in 26% of the cases (13) it was definitely or probably the main cause of death and in 78% (39), C. difficile had definitely or probably contributed to the patients’ deaths. "

"Due to poor documentation and record keeping by the trust, a lack of agreed methods and staff being unable to recollect events, the Healthcare Commission has been unable to clarify the precise nature, timing and findings of the various case note reviews undertaken by the trust. "

"The chief executive was widely viewed as being difficult to challenge. "

"Communication between the trust and the PCTs focused on numbers of patients treated and associated costs. There was very little focus on the quality of care. "

UPDATE 12th Oct. Apparently Ms Gibb received a payment of £250,000 severance pay (salary was reportedly £150K pa plus 12.5 K pension contribution) and Health Minister Johnson has asked for any payment to be delayed, pending clarification. It is not unusual for such payoffs to be made tax free as pension contributions.