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C. diff cases 'under-reported' to meet targets


Cases of a potentially fatal hospital infection may be under-reported in the UK because of government targets and financial penalties, according to a large proportion of specialist clinicians.

Half a group of 100 experts taking part in a nationwide survey thought financial sanctions may motivate staff to hide the truth about Clostridium difficile infection in England.

The vast majority, 72%, of the same microbiologists believed government spending cuts within the NHS increased the rate of hospital acquired infections.

According to official figures, rates of C. difficile infection in England and the rest of the UK have fallen dramatically.

In England, the incidence fell by 19% from 18,022 cases reported in 2011-2012 to 14,687 in 2012-2013. Over the same period, the number of cases dropped in Scotland by 11% to 1,832, and in Wales by 10% to 1,934. Northern Ireland saw a 4% reduction from 626 to 599 cases.

But many experts doubt these figures tell the whole story, according the the results of the UK-wide poll conducted by Opinion Matters for a new report, “Think C-Differently”.

Financial penalties are imposed on NHS trusts in England that exceed a target number of C. difficile cases.

Half the clinicians surveyed thought the sanctions may motivate hospital staff to under-report, suggesting that the true scope of the problem is hidden.

All but 5% of the experts felt that C. difficile still posed a threat despite declining infection rates.

With new strains of the bug emerging, 65% of the clinicians feared a very real threat of a future C. difficile epidemic.

In addition, 77% believed patients could be leaving hospital infected with C. difficile and 87% thought this posed a risk of transmission.

Professor Mark Wilcox, from the University of Leeds, who co-authored the report, said: “Rigorous infection control protocols, changes in antibiotic prescribing and heightened awareness have resulted in marked shifts in behaviours.

“However, transmission of C. difficile, particularly in the hospital setting, is an ever present risk,” he said. “Complacency and financial constraints are threats to the improvements that have been made in C. difficile control.”

Graziella Kontkowski, founder of the C-diff Support patient charity that commissioned the report, said: “Data shows that after steady declines in the number of C. difficile cases, this has now stopped in some areas, prompting concern that complacency is setting in.

“We are also seeing a shift in C. difficile infection being acquired in a hospital setting to a community setting, so we must take our key learning’s from the healthcare environment and apply them here, ensuring clear and open communication to support swift diagnosis and treatment of patients.”

C. difficile infects the lining of the bowel, leading to fever and diarrhoea, and can be fatal. A recent review of study data from across the EU showed that 30% of infected patients are dead within a month in the UK, compared with just 3% in France.


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Readers' comments (3)

  • Absolutely: the next big scandal to hit the NHS.

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  • Is there no integrity at all in NHS? Changing notes, falsifying results? It's unbelievable. What happened to "an Englishman's/wms word is his/her bond?

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  • In my Trust profuse diarrhoea used to lead to a routine stool specimen being sent. With a rise in number of C Diff cases this was stopped and a Registrar now has to order a specimenn [and they are told not to send unless extremely worried]. When we have an epidemic I suppose this will be the new Stafford....
    Standards are crumbling due to managers being more interested in money than in quality.

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