All NHS Trusts in England are required to report all Clostridium difficile toxin positive cases in patients over the age of two years to the Department of Health’s mandatory surveillance programme.
Clostridium difficile is an anaerobic, Gram positive spore forming bacillus. Various studies show that 3% of healthy adults and 16% to 36% of hospitalised patients harbour Clostridium difficile in their faecal flora.
Clostridium difficile rarely causes problems in children or healthy adults as the normal bacterial population of the intestine keeps it in check.
Clostridium difficile infection (CDI) is an unpleasant and potentially severe or fatal infection that occurs mainly in elderly and other vulnerable patient groups, especially those who have been exposed to antibiotic treatment.
Symptoms range from mild to severe diarrhoea, pseudomembranous colitis to toxic megacolon and potentially fatal colonic perforation.
Over the last decade, the number of hospital acquired CDI cases has reduced dramatically, at both GHFT and nationally as a result of extensive work and a concerted effort by the Infection Prevention Team and all staff.
However, in order to comply with the Health and Social Care Act 2008 code of practice on the prevention and control of infections and related guidance (2015) Gateshead Health NHS Foundation Trust (GHFT) is required to have in place effective management systems for the prevention of HCAI and to demonstrate year on year reductions of CDI. The trust has an effective policy in place to achieve this.
The rate of improvement has slowed over recent years and some infections are a consequence of factors outside the control of the NHS organisation that detected the infection.
Further improvement on the current position is likely to require greater understanding of individual causes across the healthcare system to ensure all learning is identified and to avoid a culture of apportioning blame through lapses in the care process.
Staphylococcus aureus is a bacterium known to colonise the nose, throat and skin of almost a third of the population. It has the potential to cause disease, particularly in the vulnerable hospitalised patient where it can cause serious infections such as endocarditis, pneumonia and septicaemia.
MRSA is a particular strain of Staphylococcus aureus that has become resistant to penicillins (including Co-amoxiclav, Flucloxacillin and Augmentin) and cephalosporin.
It is often resistant to other antibiotics, making infections caused by MRSA difficult to treat.
MRSA and Meticillin sensitive Staphylococcus aureus (MSSA) cause the same range of infections, but, due to antibiotic resistance, infections caused by MRSA are more difficult to treat.
The main route of MRSA transmission in healthcare settings is via contaminated hands of healthcare workers.
Inadequately decontaminated shared and reused equipment is also a significant mode of transmission.
MRSA may also be transmitted via the airborne route on shed skin squames but this only presents a significant risk if the patient has an excessive exfoliating skin condition (e.g. eczema or psoriasis).
MRSA remains endemic in many UK hospitals.
Specific guidelines for control and prevention are justified because MRSA causes serious illness and results in significant additional healthcare costs.
In 2008 it became mandatory for all admissions to hospital (with some exclusions) to be screened for MRSA.
During 2014, Department of Health Guidance relaxed this guidance with recommendations for patients in high-risk areas to be screened.
The Trust considered both approaches and developed a policy describing the screening of all admissions as previously, but widening the exclusion zone, depending on the risk posed to the individual and to others.
Failure to comply with this policy could result in disciplinary action for GHFT employees and it applies to all employees of GHFT, all students, visiting health professionals, locum and agency staff as well as patients and visitors across primary and secondary care environments.