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Hospitals: Clostridium

Volume 475: debated on Wednesday 14 May 2008

To ask the Secretary of State for Health what the incidence of clostridium difficile was in hospitals before the deep clean; and what it has been since the completion of the deep clean. (203161)

The national deep clean programme was announced in September 2007 and the deadline for completion was 31 March 2008. The benefits of deep cleaning will only be measurable after completion. The most recent published data on Clostridium difficile (C. difficile) infection covers the period October to December 2007, which was while the national deep clean programme was under way.

We introduced the deep clean programme to improve patient care and experience. As set out in the written ministerial statement given by my right hon. Friend the Secretary of State on 17 January 2008, Official Report, columns 38-39WS, strategic health authorities will take the lead on evaluation locally as the impact of each trust’s programme will be different. No single measurement method will pick up all the benefits, particularly as trusts may be implementing a range of measures to improve cleanliness and tackle healthcare associated infections.

Improvements to patient experience and environment may be measurable through:

Patient Environment Action Team scores;

scores on National Specifications for Cleanliness;

compliance with the Code of Practice for the Prevention and Control of Healthcare Associated Infections;

compliance with the Department’s national core standards;

Healthcare Commission inpatient survey scores; and

infection rates.

The mandatory surveillance system operated for the Department of Health by the Health Protection Agency (HPA) provides data at trust level on the number of reports of C. difficile infection. Mandatory surveillance of C. difficile was introduced in 2004 for patients aged 65 and over and has been extended to all patients aged two and over from April 2007.

The HPA publishes these data on their website so information on the number of C. difficile infections for national health service acute trusts is available at:

Tables of the HPA data have also been placed in the Library. The latest data was published on 24 April 2008.

To ask the Secretary of State for Health what guidance his Department issues on the hygiene of new patients before they are allocated a bed in a hospital in order to reduce rates of clostridium difficile. (203162)

The Department does not issue any guidance on cleaning patients before they enter into hospital in order to reduce rates of Clostridium difficile (C. difficile). As explained in our “Clean, safe care” strategy, colonisation with C. difficile without symptoms is not considered to increase risk of transmission. Copies of the strategy are available in the Library.

C. difficile is a bacterium that lives in the gut of about 3 per cent. of healthy adults in England (ie about 3 per cent. of healthy adults are colonised). It is kept at bay by normal gut bacteria; but if those bacteria are killed by antibiotics, C. difficile can take over. Patients with C. difficile excrete large numbers of spores in their faeces which contaminate the environment. C. difficile is spread by a person swallowing the bacteria or the spores it produces. Spores transferred to other people can subsequently develop into bacteria that grow in the colon. People are normally only susceptible to C. difficile infections if they are on broad spectrum antibiotics, which kill normal gut bacteria. This is why good antibiotic prescribing practice is particularly important and effective for reducing C. difficile infection.