Much media attention has recently been focused on a Healthcare Commission report detailing significant failings in infection control at Maidstone and Tunbridge Wells NHS Trust.
The first of the two outbreaks occurred between October and December 2005, affecting 150 patients. Despite the fact that the monthly number of new patients with C. diff doubled, the Trust failed to identify the outbreak at the time. A further 258 patients contracted C. diff in a second outbreak from April to September 2006. In total 345 people died with the infection. The Commission’s investigation found that the Trust had not put in place appropriate measures to manage and prevent infection, despite having high rates of C. diff over several years. Evidence from patients, staff and the Trust’s own records show that patients, including those with C. diff, were often moved between several different wards, increasing the risk of spreading infection. In some instances this was due to concerns about meeting the Government’s target for waiting times for treatment in A&E wards.
Other factors contributing to the outbreaks included old buildings, with few single rooms or side rooms to isolate patients. In the second outbreak, an isolation ward was not established until August, four months after it began. Furthermore, the director of infection prevention and control had insufficient understanding of the role. Many of policies adopted for preventing and managing infection were out-of-date or not easily available to staff on the wards.
Only half the clinical staff attended mandatory updates on infection control and it was often difficult for people to attend training due to shortages of staff. The shortage of nurses contributed to the spread of infection because nurses were often too rushed to clean their hands properly, empty and clean commodes, clean mattresses and equipment properly and wear aprons and gloves appropriately and consistently. The Commission’s report recommends that the board must review the leadership of the Trust in light of these significant failings, to ensure that it can discharge its responsibilities to an acceptable standard.
Anna Walker, the Commission’s chief executive, said: “One thing this report really highlights again is the importance of leadership. Our inspections suggest infection control is not always prominent enough on the radar of some boards. Everybody, from managers to clinicians and cleaners, must understand their role. This will not happen effectively without commitment from the top.”
The Health Secretary, Alan Johnson, described the failures as a “scandal” and said that he would be sending a copy of the damning report to all hospital bosses in Britain so that the lessons would be learnt. However, he did not believe that the outbreaks were the result of hospital staff becoming preoccupied with Government targets.
