Bed Occupancy and Superbugs

Hospital acquired infections such as MRSA and C.Diff. are on the rise. There is much evidence to suggest this is mostly down to two main factors, poor hygiene standards and bed occupancy.

Bed occupancy rates within Lincolnshire are high, very high. 99.2% !!! (Apr 05-Apr 06) The govt. target is 85%.

Several times a year the whole United Lincolnshire Hospitals Trust is on red alert. This refers to the trust having no available beds whatsoever. On 25th November 2006 Lincoln hospital had to close wards as 10 patients had the c.diff bug. One patient died.

Before any more beds and services are cut at our hospital we should ask the Trust board how they can justify further cuts to bed numbers at a time when we have already had one major outbreak at Lincoln and the bed occupancy numbers are massively over government requirements of 85% occupancy.

Quotes from around the press :

  • "People with MRSA should be treated in isolation, but that does not happen because bed occupancy is running at almost 100 per cent. We have heard of hospitals pulling the curtains around a bed and pinning a note on it to say "isolation".
    Katharine Murphy, of the Patients' Association
    http://www.telegraph.co.uk/health/main.jhtml?xml=/health/2006/11/21/nhs19.xml
  • "Good infection control is being thwarted by high bed occupancy levels, a lack of isolation facilities and too many patients with different conditions being placed together in wards."
    Edward Leigh. Public Account Committee
    http://society.guardian.co.uk/nhsperformance/story/0,,1260861,00.html
  • Experts praise the Netherlands as a country that has maintained very low MRSA levels with a "search and destroy" approach to infection control. Dutch patients are screened for MRSA when they enter hospital and those who test positive are treated in isolation.

    But the Kings's Fund says overcrowded hospitals do not have enough spare beds or enough staff to pursue a Dutch-style policy of isolating everyone with MRSA. The Netherlands has a bed occupancy rate of 60 per cent, compared with more than 87 per cent in the NHS.
    http://www.ft.com/cms/s/9f6eb506-a894-11d9-87a9-00000e2511c8.html
  • “experience in Europe shows that where levels are above 85%, patient infections rise”
    Barry Cookson, director of healthcare associated infections at the Health Protection Agency
    http://www2.netdoctor.co.uk/news/index.asp?y=2004&m=7&d=2&id=112962
  • “The reason the MRSA superbug is so prevalent is because hospitals in England are so overcrowded, says a new study published in the British Journal of Nursing.”
    http://www.medindia.net/news/view_news_main.asp?x=11644

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A recent radio programme broadcast on 1st December 2006 added to the debate…

File on 4 : Hospital Superbugs

MRSA has caused concern over the past few years; however, a newer bug is on the rise. C Dif.

C.Dif. – a type of stomach infection

The equivalent death rate up and down the country is the same as a jumbo jet a month crashing.

Why are trusts struggling to cope with superbugs?

The Govt. and trusts should be concentrating on superbugs.

No one even knows how many are dieing from the latest superbug.

MG, An active, fit man who regularly did endurance canoeing died at the age of 55. A routine operation for cancer of the prostate (non urgent). Five weeks after he entered hospital he was dead.

Bloating of the body, bed soars, diarrhoea, pressure on heart, lungs etc. He had caught C.Diff.

C.Diff. has been around for thousands of years. Strain Type 027 has now appeared and is deadly.

Due to lack of side rooms etc. a group of patients (5 or 6) were put in a bay, from which up to 13 people died in the end.

MG – family not told the hospital had C.Diff. at the time. His operation carried a risk of catching infections. Had they been told CD existed at the time in the hospital they would probably not have had the operation.

MG’s wife witnessed poor hygiene standards. Doctors would examine up to 6 patients at a time without any washing/hygiene control whatsoever.

According to the health protection agency there were 51,000 c.diff. cases (up 17% yoy). This only relates to lab tested samples. Trusts up and down the country are supposed to report their statistics each year, the majority do not. Only 27% of trusts are collecting data on c.diff. Health professionals surveyed anonymously would seem to be sending out a signal crying for help in order to get these statistics collected properly and hygiene standards to be monitored.

Many trusts are not even reporting outbreaks and no one knows how many are dying from c.diff. The Health Protection Agency states this is not well collected. They believe this is a current weakness in the system. Trusts are not reporting outbreaks, many weren’t notifying experts quickly. Many cases may not be serious and believe they are under control. Others may not be reporting out of ignorance.

The govt. maintains they are moving in the right direction. They state there is no complacency in the system. ‘I do not have evidence they are not reporting’. Why are trusts not reporting?

It is possible to treat C.Diff. in an open ward, however, poor standards lead to spreading the bug.

Targets and Waiting Lists

Snr Managers concentrate on A&E targets at the expense of infection control.

The movement of patients was a contributing factor to infection rates.

Dr Mark Enwright – specialises in study of hospital infections
Govt targets drive up bed occupancy leaving little scope for isolation facilities.

More beds need to be made available during outbreak times. Targets etc. must be ignored during times of outbreaks. The number of free beds is linked to infection rates.

The government do not accept this link.
 
With the current policies the figures for MRSA cases in the UK will rise. Unless more investment in nurses and available beds takes place there is nothing to suggest these figures will fall.