Clostridium difficile superbug

I welcome the opportunity to make this statement to Plenary. On the 11th October, the National Public Health Service published data on the number of Clostridium difficile cases identified in Wales between 01.01.2005 and 31.12.2005. This was the first time that data on a Trust by Trust basis has been presented in Wales for C. difficile infections.  The data shows that on average in 2005, for every 1,000 patients aged 65 and over admitted to hospitals across Wales, just under 15 developed the infection.  

The results varied between hospitals showing that the risk of infection depends on many local factors, something that we have emphasised for all healthcare associated infections. Similar levels of infection were recorded amongst male and female patients, but the rate of infection was generally higher amongst the more elderly patients and those undergoing treatment for kidney diseases.

Clostridium difficile can be a serious infection and one that I am committed to tackling as part of our wider campaign against all Healthcare Associated Infections (HCAI); a policy that is paying dividends.

The publication of the NPHS data is the result of a surveillance programme which has been running since January 2005 and is aimed at monitoring the level of C. difficile in our hospitals. This surveillance scheme is a significant aspect of the “Healthcare Associated Infections - A Strategy for Hospitals in Wales” launched in 2004 and aimed at helping NHS Trusts to reduce the burden of all Healthcare Associated Infections in Wales.

By undertaking this surveillance, NHS Trusts and the NPHS are able to monitor the effectiveness of infection management strategies and highlight potential areas for further investigation and action. I made a commitment to the publication of this data, alongside other surveillance schemes in October last year, which led to the inclusion of healthcare associated infection as one of our annual SaFF targets.

Members may be aware of the recent media interest in a relatively new strain of C. difficile, Type 027. This strain was associated with the outbreaks of C. difficile at Aylesbury’s Stoke Mandeville Hospital between October 2003 and June 2005. Data from the anaerobe reference lab in Cardiff shows that in England this Type has spread to over 80 hospitals in recent years. Surveillance from the NPHS has shown that Type 027 has been detected in Wales at very low levels and to date has not been associated with any outbreaks. This will continue to be closely monitored by the NPHS who host the UK’s anaerobe reference unit.  

As I have said, reducing Healthcare Associated Infections is a priority. We are working closely with the NPHS to increase awareness of all Healthcare Associated Infections, including C. difficile, and infection control procedures among staff in the NHS.

The recently launched e-learning package provides training in infection control for all NHS staff that have direct contact with patients. The data published by the NPHS does not allow direct comparison with other UK countries. However, last week saw the release of interim results of the 2006 UK prevalence of infection survey by the Hospital Infection Society at its International Conference in Amsterdam.

During the early part of 2006, the Society led a significant survey into the prevalence of Healthcare Associated Infections in the UK and the Republic of Ireland, with the NPHS leading the management of the programme within every Trust in Wales. This was such an important survey, that we made it mandatory for every trust in Wales to take part. This will allow us to gain a comprehensive picture.  Whilst as I say the recent Clostridium difficile data does not allow comparisons with other countries, the prevalence survey does.

It shows that in Wales for the over 65’s the rate of C. difficile infection is the lowest in the UK, albeit with Scotland still to publish their results.  For the under 65’s, a much smaller group of patients, Wales has the second lowest rate behind Northern Ireland. Other results from the survey are equally positive for Wales.

The prevalence rate for the UK has fallen from the previous survey’s rate of 9%, conducted in 1993/94 to 7.6%. For Wales for all Healthcare Associated Infections the rate is 6.3%. This is lower than the 8.2% recorded in England and less than the 7.6% average prevalence rate for the UK and Republic of Ireland.

This is very good news for Wales and shows that the infection reduction strategies that we have put in place are having a positive effect.

The same story can be painted for MRSA from this recent prevalence survey.  Of the 6.3% of infections in Wales, the data suggests about 13% of these infections were associated with MRSA.  This equates to a prevalence rate for newly acquired MRSA in our hospitals of less that 1%.  Further support for our continued attack on all aspects of healthcare associated infections.  

It is clear that we are seeing a real reduction in Healthcare Associated Infections but it is equally clear that we could still do more. The key will be to continue down the same path, encouraging others to confront their local infection problems and, working with partners, identify and deliver solutions.

Education is the key to realising all our expectations: education of the public as well as professionals. Through increasing awareness we will continue to deliver solutions that will improve the care of patients through reduction of infection.

In conclusion, we must avoid the knee-jerk, hunt the headline, latest super-bug media scare story. It is important that we do not unduly alarm patients to the extent that they deprive themselves of benefits of modern health care. HCAI is a serious issue which we are committed to reducing further through building on the good practice we already have here in Wales.