Outbreak of lethal superbug kills 23

BRITAIN - A lethal new strain of the hospital bug Clostridium difficile has infected a second hospital in Britain raising fears that it is spreading round the National Health System (NHS).

The outbreak of C. difficile at the Royal Devon and Exeter Foundation NHS Trust infected 265 patients in the first five months of this year and has caused 23 deaths since January.

The number of patients stricken with the virulent infection, which causes severe diarrhoea, is running at twice the level in 2004 when 254 patients at the 850-bed hospital were infected over 12 months.

The new strain of the bug, which produces 20 times more toxin than the ordinary strain, was also the cause of an outbreak at Stoke Mandeville hospital in Buckinghamshire, revealed by The Independent.

More than 300 patients have been infected and 12 have died at the hospital since the end of 2003.

The latest outbreak will raise new concerns about standards of cleanliness and pressure on hospitals to meet Government waiting time targets.

Doctors and health service managers have complained that bed occupancy levels are too high to allow proper hygiene precautions to be taken.

Cases of C. difficile rose sharply at the Royal Devon and Exeter and peaked in January.

Staff suspected something unusual was behind the rise and sent specimens for analysis that revealed infection with the lethal new 027 strain.

Public health specialists have identified 15 patients out of 18 tested at the Royal Devon and Exeter hospital infected with the new strain.

C. difficile 027 is more infectious and harder to destroy than existing strains and will raise new concerns about standards of cleaning in NHS hospitals.

Only isolated cases had previously been identified in Britain.

Brian Duerden, the chief inspector of microbiology and hospital infection at the Department of Health, said: "I am concerned we have got a new strain that is more virulent. There have been some isolated cases but we don't know of other clusters. We need to do more work on how it is spread."

Professor Duerden said the new strain was similar to one causing problems in Quebec and the US, where there have been hundreds of cases and associated deaths.

"But we have no idea how they are related or how the infection has been transmitted [to Britain]. We will be looking at all aspects of this and will re-emphasise existing guidance."

In a statement yesterday, the trust said it had set up an isolation ward and strengthened hygiene controls.

The hospital has also curtailed the routine use of antibiotics, which can trigger the infection.

Alaric Colville, the joint director of infection prevention and a consultant microbiologist, said: "Unfortunately the measures we have taken so far have not reduced C. difficile as quickly as we would have liked. As C. difficile infection is potentially very serious we have now introduced enhanced measures."

Visitors to patients in the hospital taking antibiotics have been warned that they may be more susceptible to infection and should stay away.

The bug poses a particular threat to hospitals because it produces hardy spores that are resistant to normal methods of cleaning but can persist on hands, clothes, bedding and furniture, transmitting the infection to new patients.

Alcohol gels used by medical staff to clean their hands between patients are ineffective and staff on the isolation ward at the Royal Devon and Exeter have been told to wash their hands using soap and water.

Powerful detergents are being used to clean the ward. Cases of C. difficile have soared from 1,000 in 1990 to more than 43,000 last year.

Some of the rise is due to better reporting but a report by the National C. difficile Standards Group said the rise was "dramatic".

Fears about the growing threat posed by the bug led the Department of Health to introduce mandatory reporting of infections caused by the bacterium last year.

Last week, Patricia Hewitt, the Secretary of State for Health, announced an inquiry into the Stoke Mandeville outbreak.

- INDEPENDENT