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Errors caused infection outbreak - by the BBC

A report has found a "litany" of errors in an NHS Trust's poor handling of the infection clostridium difficile, which resulted in 90 deaths.

The deaths, over a two and a half year period, at Kent's Maidstone and Tunbridge Wells Trust was called "a tragedy" by the Healthcare Commission. Failings included a "targets obsession" and staff shortages so dire that nurses told patients to "go in their beds".

Kent Police and the Health and Safety Executive are examining the report. They could decide to press criminal charges. The trust's chief executive, Rose Gibb, resigned last week. But the Healthcare Commission said despite her departure, nothing short of a full review of the trust's leadership would be appropriate in the circumstances.

'Improbable' claims

C.difficile is a bacterial infection of the gut which mainly affects the elderly. NURSES DID NOT ALWAYS Wash hands Empty/clean commodes Help patients go to toilet Clean mattresses Wear aprons/gloves 'My mother died' The commission began investigating amid a string of complaints, and was particularly alarmed after the trust claimed no-one had died of the condition despite admitting there had been hundreds of cases.

This seemed highly improbable given that the average death rate is between 6% and 7%. It examined in detail a sample of 50 patients of a total of 345 to whom various causes of death had been attributed, but who were also known to have had C.difficile, between April 2004 and September 2006.

The commission looked at how these patients had been treated in the course of their stay, and tried to assess whether C.difficile contributed or was the main cause of their death. Extrapolating its findings from the sample, it concluded that C.difficile was definitely or probably the main cause of death for 90 patients. It was definitely a contributing factor in the deaths of a further 124, and a probable factor in another 55.

How?

The commission described the trust as one which had been facing some "serious challenges", not least those brought on by a recent merger. Commodes were not properly cleaned after use But it suggested that the board's fixation with meeting financial targets got in the way of making sure safety was a priority, and it accused members of not addressing problems consistently raised by patients and staff.

These included the shortage of nurses, which in turn led to poor care for patients. For instance, nurses did not have time to wash their hands properly, and left patients to lie in their own excrement because they had not been able to assist them to a commode. Patients with C.difficile were moved between wards, increasing the risk of infection.

In some instances this was due to concerns about meeting the government's targets for waiting times for treatment in A&E wards, the report said. Isolation wards were few and far between, and sometimes the infected were simply kept in the middle of the ward. This was in part the problem of managing a large, old hospital with "dormitory-style" wards where beds were very close together, making them very hard to clean between.

Saying sorry

The commission noted there were "worrying similarities" with the last serious C.difficile outbreak it had investigated at Stoke Mandeville, in which 30 patients died. MAIDSTONE AND TUNBRIDGE WELLS TRUST Maidstone Hospital Kent and Sussex Hospital Pembury Hospital Both involved old hospitals, both had recently undergone mergers, and at both the boards were "preoccupied with finance".

The commission said NHS trusts across the country could learn lessons from both these examples. Chief among its recommendations is a policy of treating C.difficile as a condition in its own right, rather than a complicating factor. In addition, antibiotics should be used with utmost care in treating the condition, as they can easily make it worse by killing the so-called "friendly" bacteria in the gut which help the body fight it.

Maidstone and Tunbridge Wells Trust said it welcomed the recommendations and said it was already beginning to implement them. "We are sorry about what happened and we are determined to continue to reduce levels of infection," said its medical director, Dr Malcolm Stewart. The government has pledged £140m to tackle C.difficile as part of the Comprehensive Spending Review.

 
 
 
 
   
 
 
 
 
 
   
 
 
 
 
 
   
 
 
 
 
 
   

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