Leeds hospitals battle back against superbugs

CLEANING REGIME: Tracy Glendon and Gill Lowry from the intense clean team get to work.
CLEANING REGIME: Tracy Glendon and Gill Lowry from the intense clean team get to work.
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They’re the places entrusted with making patients better – but the rise of hospital superbugs over the past 20 years led to people getting ill there instead. Katie Baldwin reports on how the problem was tackled in Leeds.

Only a few years ago, Leeds hospitals topped the ‘table of shame’.

Now the fight against hospital superbugs may finally be being won.

The number of cases is down massively and focus on the problem is greater than ever before.

But despite this progress, incidences are still exceeding tough national targets.

And fears of catching a bug whilst in hospital still worry patients – as was spelled out by one young woman who quizzed directors at this year’s Leeds Teaching Hospitals NHS Trust annual meeting.

“The main thing is that the vast majority of patients are discharged home without an infection,” said Ruth Holt, an expert in the field and former director of infection prevention and control at the hospitals trust.

Out of more than a million patients seen during the last financial year in Leeds hospitals, 14 developed an MRSA infection there.

Another 125 developed C.diff.

These both represent massive drops of 42 per cent and 25 per cent, respectively, from the previous year.

Those figures are available because of the compulsory monitoring of MRSA and C.diff which has been introduced in UK hospitals over the past decade.

Over that time these ‘superbugs’ have become household names, often inextricably linked with complaints about dirty hospitals and a nostalgia about old-style matrons who ensured wards were spotless.

However, MRSA is not a modern phenomenon.

Gillian Hodgson, nurse consultant in infection prevention and control, said: “MRSA was certainly around in the 1960s.”

The difference was that rates of the infection weren’t monitored or measured.

Only in the past 20 years has the rise of MRSA, and latterly C.diff, become a major national issue.

Figures on the number of cases started to be collected by the Department of Health.

New Government targets were introduced compelling hospitals to cut the number of incidences, with financial penalties imposed if they were missed.

Money was pumped in and experts drafted in to those struggling to cut the rates of healthcare-associated infections (HCAIs).

In Leeds, all these measures were necessary.

By the early 2000s, the city’s hospitals trust was among the worst in the country for infection rates.

Running five hospitals, including Leeds General Infirmary and St James’s, the trust is one of the biggest in the country.

But the numbers of patients picking up infections there was higher than at other similarly-sized trusts elsewhere in the country.

Ruth Holt said the size of the trust was an issue – but admits the work to tackle HCAIs started later there.

“We started our focus work a lot later than other organisations,” she said.

“It’s something that needs the whole organisation on board – it’s not just an issue for infection control, doctors, nurses and cleaning staff.”

Hospital bosses struggled to get a handle on the problem for several years.

Though managers would admit there have been a few blips on the way, the situation is much better now.

C.diff has dropped dramatically, with a 75 per cent cut in cases.

Between April 2011 and March this year there were 185 incidences among patients – compared to 734 four years earlier.

MRSA was down too, with a 40 per cent fall in the last financial year and since 2009/10, there has been a drop of nearly 60 per cent.

Managers put the improving picture down to a range of measures, but mainly a massive focus on the problem.

Ms Hodgson said that they now understood how crucial it was for every member of staff to do everything right.

“It’s a collaboration of them all,” she said.

“It’s about the care pathway where every element is important.”

As well as improved training of staff , Ms Holt said publicising infection rates was also important.

“I think some of it has been making it very visible at ward level. Every ward knows what their infection rate is for MRSA and C.diff,” she said.

“Also we work out what has happened and why a patient has got an infection, we do a root cause analysis to help us to understand what has happened and why the patient has contracted it.”

That means lessons can be learned and practices changed if necessary.

Levels of cleanliness, often blamed for the spread of bugs, have been reviewed and improved.

Hand hygiene is promoted everywhere, including for doctors and nurses, and hand gel dispensers are a fixture on every corridor and ward.

Cleaning regimes have been changed and new technology, such as the use of hydrogen peroxide “fog” to treat affected wards, has helped tackle the spread of bugs.

“While cleaning is one way of helping to reduce the spread, alone that will not stop it,” said Ms Holt.

She said education, especially of patients and visitors, was also a major weapon.

Basic measures like using hand gel, washing hands after going to the toilet and not coming into hospitals as a visitor while ill can make a big difference.

“We don’t want to discourage visitors but it’s about taking the right precautions,” she said.

“The vast majority of patients don’t get an infection in any site throughout their stay, however they can really help us by making sure they do following the hand hygiene and basic infection control precautions.

“If they are concerned, then speak to staff, either on the ward or before they come in.

Patients are now screened for MRSA before coming into hospital and Ms Holt said anyone who was positive should not be worried, but should use the products provided to kill off the bug before going in for their procedure.

Latest figures show the numbers of MRSA and C.diff infections, as well as bug MSSA, continue to fall.

“We have seen a 38 per cent reduction in MSSA, and a 33 per cent reduction in C.diff this year compared to this time last year,” Ms Holt said.

“With MRSA we had a difficult start to the year but it’s more than 75 days since our last case.”

However even with a small number of cases, already Leeds hospitals is missing the year’s targets.

Ms Holt added: “We still do have a lot of work to do.

“I am really pleased with what we have achieved but I don’t want us to stop working. It’s improving, but we want to continue that improvement.”

“We want to be the best in the country.”

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