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NHS: Clostridium Difficile

Volume 686: debated on Tuesday 7 November 2006

asked Her Majesty’s Government:

What action they are taking to prevent the spread of Clostridium difficile in hospitals and in the community.

My Lords, we have an extensive programme of measures to counter healthcare-associated infections. We recently published a new code of practice on the prevention and control of healthcare-associated infections. The Healthcare Commission will assess compliance with the code and use its powers to issue an improvement notice to those not observing the code properly. These arrangements cover Clostridium difficile, for whichwe will also be introducing quarterly publication of mandatory surveillance data.

My Lords, I thank the Minister for that helpful reply. Is he aware that several trusts are not adhering to the guidelines? Is he further aware that a hyper-virulent strain came from Canada in 2004 and that more than 30 people died at Stoke Mandeville hospital? Does he agree that infection control is so important that its budgets should be ring-fenced?

My Lords, we are aware that this is a serious condition in a number of hospitals. We have made very clear what the NHS needs to do in this area. We know, in particular, that isolation of patients with C. difficile diarrhoea and good infection-control nursing procedures—such as hand-washing and wearing gloves and aprons—are absolutely critical. We now need the whole of the NHS to get behind the guidance issued by the Chief Medical Officer and the Chief Nursing Officer to try to control infection within its hospitals.

My Lords, the Minister will be aware that the present strain of Clostridium difficile is very susceptible to antibiotic resistance and can transmit this resistance to other pathogens such as salmonella and staphylococci, which, of course, are different organisms from Clostridium. What is the extent of Clostridium difficile antibiotic resistance in the country and what research is being done to control it?

My Lords, I cannot give the noble Lord, who has a great deal of knowledge in this area, an exact figure. There are two antibiotics, one of which is Vancomycin, that are effective and alternative antibiotics are being investigated. I can write to him with more details.

My Lords, following on from the previous question, is not one of the problems the increasing resistance of the new strain of Clostridium difficile bacteria, which is often caused by wanton antibiotic usage? Our current methods of recording antibiotic prescribing are not very good in hospitals. The CDC in America has pointed out that we need more research in this area. Should we not consider the lack of support for academic microbiology in the United Kingdom?

My Lords, my noble friend is right. One of the key elements in the advice that has been given to the NHS by the Chief Medical Officer and the Chief Nursing Officer is about prudent antibiotic prescribing to reduce the use of broad spectrum antibiotics. Again, it is down to people at the local level—doctors, nurses and everyone—working together to adhere to that guidance and to make sure that this infection is controlled in the hospitals where it exists.

My Lords, we know that hand-washing and other hygiene measures are probably the most effective intervention we can make at the moment for Clostridium difficile. What are the Government doing, particularly NHS Estates, about guidance for ward and hospital design, given that doctors and nurses are saying that getting to basins to wash properly is proving remarkably difficult?

My Lords, this does not apply only in relation to this particular infection. The issue of good design in hospitals is taken seriously by NHS Estates and a great deal of information and guidance has been given to the NHS in this area. The same concerns apply to other cross-infection issues. It is down to people when they redevelop their hospitals to follow the guidance that has been issued.

My Lords, we rely very heavily on the Health Protection Agency to trace and record cases of Clostridium difficile infection. Can my noble friend give us any idea whether the HPA has invested sufficient resources in its regional laboratories and regional detection centres to do all this vital work?

My Lords, this gives me the opportunity to pay tribute to the sterling work of the HPA in this area. My understanding is that it has the budgetary requirements it needs, but these things are kept under review as the agency takes on new duties.

My Lords, what is the policy on disinfecting beds and lockers between occupation by different patients?

My Lords, all hospitals are expected to clean their wards thoroughly and take account of the need to avoid cross-infection when there is a change of patient in a bed.

My Lords, how is cross-infection among patients in nursing homes being monitored? What are the levers against nursing homes with a poor record on cross-infection?

My Lords, the clinical advice I have received is that Clostridium difficile is largely and overwhelmingly a hospital-based infection; it is part of the mandatory surveillance introduced by the Government in 2004. If I have any more information in this area, I will write to the noble Baroness.