At a hospital near you

If you have ever seen a patient with Clostridium difficile diarrhoea lying in their own excrement it is not something you will ever forget, or ever wish on your worst enemy.

This startling comment from the Healthcare Commission's report into events in kent makes it clear that this could easily be happening all over the place. Bedford Hospital (where I must say the cleaning staff are very hard working) is certainly not immune to the problem.

“The investigation into the outbreaks at Maidstone and Tunbridge Wells NHS Trust has thrown up a number of similarities with the findings of our previous investigation into outbreaks of C. difficile at Stoke Mandeville Hospital, part of Buckinghamshire Hospitals NHS Trust. Both trusts had undergone difficult mergers, were preoccupied with finances, and had a demanding agenda for reconfiguration and private finance initiative (PFI), all of which consumed much management time and effort. They also had poor environments, with many dormitory style wards and few single rooms which could be used for isolating patients with infections. In both we observed unacceptable examples of contamination and unhygienic practice. Additionally, the impact of financial pressures was to reduce further already low numbers of nurses and to put a cap on the use of nurses from agencies and nursing banks. There was unrelenting pressure to reduce the number of beds. Thus, both trusts had very high occupancy levels, could not manage with fewer beds, and so had to open ‘escalation’ beds, often at short notice and in unsuitable environments, without proper support services and equipment in place and, by definition, without permanent staff. The effect of all this was to compromise seriously the control of infection and the quality of clinical care. While it should be noted that improvements have subsequently been made at Stoke Mandeville, it seems unlikely that these similarities are coincidental. We are concerned that where trusts are struggling with a number of problems that consume senior managers’ time, and are under severe pressure to meet targets relating to finance and access, concern for infection control may be undermined.”