THE identification of a new, more virulent strain of the hospital infection Clostridium difficile (C.diff) for the first time in Scotland is a reminder that there can be no let-up in the battle against bacteria.
Fortunately, the only patient infected with the new strain in Scotland, one of the first cases in Europe, has now recovered. However, because it is from the same bacterial family as the type responsible for the deadly outbreak of C.diff at the Vale of Leven Hospital, it is an aggressive strain, which has caused a surge on infections in Australia.
Between December 2007 and June 2008, 55 patients at the Vale of Leven developed C.diff. Nine died from the infection and it was a confirmed factor in another nine deaths. However, relatives of other patients who died believe they were also infected with the bacterium without this being recorded.
It is now five years after the start of the outbreak and three years since the inquiry into it began. Naturally, the families of those who died or became seriously ill are eager for it to reach a conclusion, particularly so because it was their persistence in pursuing Freedom of Information requests that brought it about. However, because the chairman Lord MacLean has been unwell, it will not now report until May next year.
That is regrettable but cannot be helped. Given the length of time that has already elapsed, however, it is essential that it fully takes into account all the evidence and its recommendations provide a comprehensive basis for avoiding similar outbreaks in the future.
There have been significant improvements to hospital hygiene in the intervening years, particularly since the former Health Secretary Nicola Sturgeon launched a zero-tolerance approach to non-compliance with hand hygiene in January 2009. The latest bi-monthly report into hand hygiene (for June and July), for example, shows a 96% average compliance rate. While this would seem reassuring, the fact that in four health boards there was a decrease in the compliance rate from the previous audit demonstrates just how quickly progress can be reversed.
Although the number of infections has fallen considerably since the 2007 peak, with a further 34% drop last year in those over 65, the appearance of this new, aggressive strain of C.diff must highlight the danger of lapsing into complacency. Hospitals have a particular problem in controlling C.diff because many patients will be on antibiotics, which allow it to thrive and sometimes cause life-threatening inflammation of the bowel. Isolating patients with symptoms such as diarrhoea is now carried out where possible.
In an age when we expect infections to be controlled, it is difficult to accept that some will be fatal. The devastating potential of C.diff has been a particularly nasty shock for both health professionals and the public. It has provided a salutary reminder that we cannot overstate the importance of basic hygiene. The inquiry is likely to identify other important lessons. It should certainly lead to lasting change in the way infections are controlled in our hospitals.
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