A higher than normal incidence of the Clostridium difficile bug at Ennis General Hospital in the first half of last year was “not initially appreciated by either management or clinical staff”, a report published today has found.
Many of the staff considered MRSA or norovirus a bigger threat at that time and the main focus was on best management of individual patients, the Health Service Executive (HSE) said.
The HSE said immediate steps were taken to address the issue once a routine annual audit of clinical trends in the region showed up the problem.
A review by Dr Mary Hynes and Dr Kevin Kelleher of the HSE found that between January and June 2007, 46 mainly elderly patients had Clostridium difficile Associated Diarrhoea (CDAD).
Of the 46 patients affected, 39 were women and seven were men.
“Of these, 15 patients died within 30 days of being diagnosed with CDAD. CDAD was not however the primary cause of the death of these patients,” the HSE said.
“The death notifications for eight patients referred to CDAD as an antecedent cause or significant condition. Of the 46 patients identified, six additional patients died by December 2007; one of these six patients had CDAD mentioned on their death notification.”
The number of cases peaked at 18 in April 2007 and fell steeply to four cases in May and two in June, the HSE said.
“Levels remained normal for the remainder of the year and continue to do so. At the time an individual patient’s consultant would have discussed the presence of CDAD with them or their families.”
The HSE said the doctors had noted in their report that the higher than normal presence of Clostridium difficile was “not initially appreciated by either management or clinical staff, many of whom considered at that time, MRSA or norovirus a bigger threat”.
“The main focus was on best management of individual patients,” the HSE said.
Detailed recommendations for improvements at Ennis Hospital have been made in the report, covering identification of infections, staff training, improved hand washing, education, more detailed death certification and more effective isolation for patients who pose a potential or actual high risk of infection to others.
The HSE said a detailed plan has been underway to implement these recommendations, which include the re-establishment of an infection prevention and control committee.
The body said it had contacted patients and their families by phone and letter over the last 24 hours and had provided them with a copy of the review prior to its publication.
“The hospital and HSE management have expressed their apologies to the patients and families concerned and any supports that are required or requested will be provided,” the HSE said.
Dr Kelleher said: “Clostridium difficile is being increasingly recognised as a serious health risk. A number of the bacteria identified at Ennis Hospital were of a particularly virulent and highly transmissible strain.
“Most Clostridium difficile-related infections occur in hospitals and nursing homes but it can also occur in the community.
“In most cases it causes relatively mild illness. Occasionally it may result in serious illness and even death in elderly patients or people with underlying serious illnesses.”
Fine Gael Health Spokesman, Dr James Reilly said "Sadly, the problems encountered in Ennis are reflected in other places around the country. Government under-funding and broken promises on public acute beds have left our hospital wards overcrowded, allowing cross-infection, making hygiene control difficult and isolation
impossible."
Former Co Clare TD James Breen, who contracted the MRSA bug in a doctor's surgery over three years ago, today expressed shock that Clostridium Difficile has not yet been classified as a notifiable disease.
"I raised the issue in the Dáil when I was a TD after a young woman came to me to tell me that her husband had died from MRSA. I was expelled from the Dáil twice when I tried to raise the issue but it raised awareness and within days eight TD's from across the country had table questions on the issue."
The disease is not on the HSE's list of "notifiable diseases" but will according to the HSE's Health Protection Surveillance Centre, from May 4th next. This means that at the moment, hospitals do not have to report outbreaks of C difficile and so the extent of it remains unclear.
Ennis General Hospital Development Committee Noel Hogan said: "We have all heard of outbreaks of superbugs in hospitals but we never thought that it could be this bad and it is shocking.
"Action is required and the only people who can provide that, is the HSE and there shouldn't have to be debate or discussion about it, it should be done immediately."
Labour Party's Health spokesperson, Limerick Deputy Jan O' Sullivan said: "The report by the HSE which found that 15 people who had died in the hospital had all been infected by C Difficile, is of huge concern. This report must prompt the HSE and the Minister for Health into immediate and effective action.
"The question must arise that if this is the situation in one hospital, what is the picture like nationally? Ennis is but one small part of a national network of hospitals, and it would be very useful if we knew how other hospitals, of all sizes, were performing in this regard," Ms O' Sullivan said.
Clostridium Difficile is the major cause of diarrhoea following antibiotic therapy. The bug also causes abdominal pain, inflammation of the colon, fever, vomiting and dehydration. In severe cases, the inner lining of the colon becomes severely inflamed and sometimes the walls of the colon wear away causing perforation. This can lead to a life-threatening infection of the abdomen.