The health service is making significant progress to curb the spread of superbugs but, as Health Reporter Adam Morris finds, fears persist

Published on Friday 17 July 2009 10:31

IN THE early 1990s, the length of hospital waiting lists was enough to keep the sick and frail awake at night, wondering how many months it would be before they might be seen by a specialist. And once they were admitted to hospital, concerns about short staffing and poor quality meals were likely to prey on their minds.

So it is very much a sign of the times that these fears, which dominated newspaper headlines 15 years ago, now seem to have faded.

What they have been replaced by is a growing anxiety about hospital infections.

Patients are now so worried about catching so-called superbugs that the prospect of dirty wards and doctors and nurses failing to wash their hands are their two biggest fears.

Concerns about the standard of clinical care pale into insignificance in comparison, as do other regular bugbears.

The presence of enough nurses to provide care was rated only 34th priority out of 60 areas of potential concern, and a short journey time to get to hospital ranked 49th, in a patient survey commissioned on behalf of the Scottish Government.

The apprehensions about superbugs among patients in the Lothians reflect wider concerns across the rest of the country.

With 87 cases of C.diff and six of MRSA reported in April, there is clearly genuine cause for concern. But, when the facts show that there are more falls in hospitals locally every year (6,000 in 2008) than there are cases of superbugs, is it a concern that has grown beyond reasonable bounds?

Patient safety expert Dr Simon Maxwell, a senior lecturer in Edinburgh University's school of clinical sciences and community health, certainly thinks so. "You can compare it to air travel. There have been two or three high profile air disasters in recent weeks, and that will have led to an increase in fear of flying, even though statistically it is far safer than getting into a car," he says.

"The vast majority of people go into hospital and are made better without contracting an infection and have a lot to be grateful for.

"And if you consider that around 10 per cent of people suffer some kind of adverse affect from medication in hospital in this country, it puts things into perspective.

"There is a lot of publicity surrounding infections, and there are other explanations (apart from hygiene) for why superbugs are a factor now when they weren't before. A far higher number of people are passing through hospitals now, and the type of treatment is becoming more complex. Antibiotic drugs are used to a greater extent which some bugs have become resistant to.

"But it is a real fear for people, and is an issue in our hospitals."

In 2006, the situation facing patients in the Lothians did appear dire, with 40 deaths recorded from C.diff. Since then there has been a turnaround, with the number of cases falling by a third, in the wake of a series of cleanliness initiatives. There has also been a fall in MRSA cases.

By 2008, the number of deaths from C.diff had fallen to just six, although medics have raised concerns that management warnings to record C.diff on a death certificate only when they are absolutely certain may have led to a degree of under-reporting.

Professor Scott Murray, chairman of palliative care at St Columba's Hospice in Edinburgh, believes the NHS has in one sense become a victim of its own success. The standard of clinical care has reached such excellent levels, he suggests, that patients naturally turn their focus to other concerns.

"I think most people recognise that the quality of treatment on the NHS is actually fantastic," he says. "Yes, there is a lot of publicity about it, but then most people know someone who's been in and caught something or other, so the fear can be justified in that sense.

"The risk has grown a lot over the past few years, and the infections have become more severe."

However, Dr Jean Turner, director of the Scotland Patients Association, warns the concerns must not be taken lightly.

"A lot of people might look at this and think is this really what people think going into hospital, but it really is.

"Hygiene in hospitals, and the subsequent effects it can have on people's health, is an extremely serious point, and that is reflected in the survey.

"If a patient is in hospital they should feel comfortable asking a doctor to make sure they have washed their hands, and that doctor should thank them for reminding them."

New deep-cleaning equipment has been introduced to Lothians wards. At 90 per cent-plus, hand-washing compliance rates in NHS Lothian are among the best in the country. But the health board's vice-chairman Eddie Egan was still moved to warn recently that handwashing simply didn't feature as a priority in some nurses' working day because they were so busy treating patients.

Progress is clearly being made in this important battle, but superbug anxieties are likely to be around for some time to come.

Weblinks:

www.scotland.gov.uk

www.bettertogetherscotland.com

www.scotlandpatients.com

www.ed.ac.uk

www.stcolumbashospice.org.uk