Hospitals Trust Questions Representation of Data

The number of MRSA bacteraemia reports for Ashford and St. Peter’s Hospitals for the latest quarter published by the Health Protection Agency shows a reduction of seven (7) cases compared to the same quarter last year.   The total count for 2006/07 was 31 and the first quarter of 2007/08 shows that there were only four (4) cases.

Quarterly Counts of MRSA bacteraemia for Ashford and St. Peter’s Hospitals – Apr 2006 – Jun 2007

Director of Infection Prevention and Control, Consultant Microbiologist Dr Angela Shaw says: “In 2001 our estimated MRSA bacteraemia rate per 10,000 bed days was 3.38 and we had 34 bacteraemia reports between April and September 2001.  Between October 2006 and March 2007 we had 16 bacteraemia cases and our rate per 10,000 bed days was 1.93.   This represents significant progress in our fight to control MRSA and our figures for July to September 2007 are even better with only two (2) MRSA cases reported.   However, because these and the C. difficile figures include cases from the community – tests requested by GPs and patients who are tested in A&E or other admissions areas – they mask the true picture which is much better for our hospitals.   It should not therefore be assumed that these figures represent just hospital acquired infections.”

The Health Protection Agency has reported the following C. difficile figures for Ashford and St. Peter’s:

Quarterly Counts of C. difficile for Ashford and St. Peter’s Hospitals – Jan 2006 – Jun 2007

Commenting on C. difficile Dr Shaw says: “The numbers of C. difficile cases has fallen significantly, from a monthly peak of 47 inpatients in May to 16 in August.  There was a marked increase in the total number of C. difficile cases diagnosed and reported in April to June 2007 but there are a number of reasons for this.   We have undertaken a complete review of the Healthcare Commission’s recent investigation at Maidstone and Tunbridge Wells Hospitals NHS Trust and the actions taken at Ashford and St. Peter’s to prevent and control infection.   We are confident that we have actions in place, including a new 12 point C. difficileaction plan implemented in June 2007, which meet and go beyond the recommendations from that report.”

The reasons identified for the C. difficile increase include:

·          Only 123 cases (115 patients of 65 year or over) were found in patients already in hospital when they developed symptoms. The remainder (65 patients) were taken by GPs, in community hospitals or in A/E or other admission wards.

·          The figures were for patients of all ages over 2 for the first time – previously the requirement was for cases in patients of 65 and over.  Nineteen (19) patients were under 65 in this quarter, who would not have been counted before.

·          The totals are not the same as the number of patients affected, as cases have to be included more than once if positive samples are taken more than 28 days apart.   Twenty-one (21) extra cases were included as a result of this.    The increasing number of patients with persistent symptoms means that this happens more frequently nowadays.

“The 115 in-patient cases of over 65 year olds is still an increase on the 83 in-patients in the previous quarter.   But this increase coincided with a large outbreak of norovirus (‘winter vomiting disease’) that occurred in the Trust in April and May 2007, when over 100 patients were affected.   There is a known association between norovirus and C. difficile, probably as the symptoms ofnorovirus (diarrhoea and projectile vomiting) allow all gastric infections to spread more readily.”

Commenting on how the figures are reported Dr Shaw says: “We do have concerns that these figures are easily misrepresented as just infections acquired in hospital.    The number of cases found in the community has increased dramatically in the last year.   It is difficult for the Trust to control these, especially as about 30 per cent of GP cases are from outside the Surrey Primary Care Trust area where I and the Infection Control Team are involved in training staff in Community Hospitals on infection control issues and GPs on antibiotic use.”