Superbug Risk From High Occupancy Rates In One Third Of NHS Trusts - Randerson, Wales

Main Category: Public Health
Also Included In: Infectious Diseases / Bacteria / Viruses
Article Date: 11 Nov 2007 - 11:00 PDT

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Almost a third of Welsh NHS Trusts have dangerously high occupancy rates that put patients at risk of contracting superbugs, according to analysis by the Welsh Liberal Democrats, as the UK party publishes its Florence Nightingale Charter for cleaner hospitals.

High bed occupancy rates are known to be a significant contributor to the spread of superbugs in hospitals and were mentioned in the report into the outbreak of Clostridium difficile at Maidstone and Tunbridge Wells NHS Trust.

The figures show:

- over a third of NHS Trusts for whom data is available have occupancy rates above 84% which experts warn could contribute to the spread of hospital based infections

- Cardiff and Vale NHS Trust is at almost 90% occupancy

This follows on the back of increasing problems with delayed transfers of care as mentioned in the recent Welsh Auditor's Report

Commenting, Welsh Liberal Democrat Health Spokesperson Jenny Randerson AM said:

"As long as this situation continues, it will undermine efforts to successfully combat hospital acquired infections. It puts staff under undue pressure and risks corners being cut in order to get new arrivals admitted on time.

"One key step is to effectively tackle delayed transfers from hospitals. It is ridiculous that so many people are occupying beds when they are ready to leave. Those who work in the NHS and Social Services repeatedly tell me of the need to take pooling of budgets more seriously. This would mean that NHS and Social Services would have to work together, sharing responsibility for patients, and tackling the problem together.

"The Liberal Democrats have launched a six-point Florence Nightingale Charter, bringing into the 21st century her beliefs that healthcare must start with good hygiene, sanitation and a well ordered hospital."

The Liberal Democrat Florence Nightingale Charter is attached, the six main points are:

- Urgent review of the extent of ward overcrowding
- Zero tolerance of failures of infection control
- Quicker and wider implementation for screening
- Hospital matrons in charge: promoting a culture of strict hygiene standards and infection prevention
- Strict compliance and improved dissemination of guidance on anti-biotic prescribing
- Giving the patient power to report failure in standards

1. The Welsh Liberal Democrats collated figures from the most recently available bed occupancy rates: click here.

2. The UK Government's Emergency Services Action Team (ESAT) 1997 report found that in acute hospitals, average bed occupancy rates over 85% are associated with rapidly growing problems in handling emergency admissions.

3. In England a Department of Health report leaked to The Independent newspaper last year said: The most crowded hospitals, with occupancy rates over 90 per cent, have MRSA rates that are over 42 per cent higher than average, according to the report. Those with occupancy rates above 85 per cent have MRSA rates 16 per cent above average. Please click here.

4. In July 2004, Professor Barry Cookson, of the Health Protection Agency has said that high bed occupancy is related to the rise in hospital acquired infections: "We have got to get down to 85%. The Government have clearly got their waiting list targets and have signed up to them. I think we should be entering into a national debate. Patients should realise that there is a certain safety level above which we start having problems."

5. Alison Holmes, a specialist in infectious disease at the Imperial College and Hammersmith Hospitals NHS Trust, said: "This issue about bed capacity and throughput really does undermine best infection control practice." (The Guardian, July 2nd 2004, see here.)

6. Delayed transfer of care

The total number of patients in Wales experiencing a delayed transfer of care on the census date of 19 September 2007 was 679. Of these, 182 were delayed in mental health facilities and 497 were in other acute and community hospitals. Click here.

Timely transfer and discharge arrangements are important in ensuring that the NHS effectively manages emergency pressures. Around 42,000 in-patient discharges are arranged each month. The arrangements for transfer of patients to a more appropriate care setting (either within the NHS or in discharge from NHS care) will vary according to the needs of each patient but can be complex and sometimes lead to delays. These are known as delayed transfers of care.

7. The Liberal Democrat Florence Nightingale Charter, bringing into the 21st century her beliefs that healthcare must start with good hygiene, sanitation and a well ordered hospital:

Florence Nightingale Charter

i) Urgent review of extent of ward overcrowding
High bed occupancy rates make it difficult to isolate infected patients and spread disease at a fast rate. There should be an urgent review of the impact of high occupancy rates and the relationship with the incidence of hospital acquired infections. Occupancy rates and levels of delayed discharge need to be carefully monitored - with hospitals consistently showing high levels of one or both facing penalties.

ii) Zero tolerance of failures of infection control
(a) Good leadership is essential to ensure prevention and effective response to infection outbreaks. Responsibility for serious failures must be at Chief Executive and board level - and be treated as gross misconduct justifying dismissal without substantial payoffs.
(b) Compensation must be offered to patients who have suffered at the hands of super bugs - or to their families if they've died where there has been negligence on the part of the hospital trust.

(c) Dutch style approach when an outbreak occurs: isolation, sending staff home, closing down ward etc. Improved use of new technologies would also limit the spread of disease.
(d) Changing facilities provided for staff so that uniforms are not worn outside work.
iii) Quicker and wider implementation for screening
Screening should be immediately introduced into all hospitals. We would also roll out screening to the wider community including GP practises and care homes.

iv) Hospital matrons in charge: promoting a culture of strict hygiene standards and infection prevention
Staff at every level would be trained in infection awareness and prevention techniques. Hospital matrons would have full line management control over all staff - including cleaning staff. Measures would include:

(a) Monitoring: ensuring that all death certificates recorded incidences of super bugs.
(b) Strict compliance and improved dissemination of guidance on anti-biotic prescribing.
(c) Better promotion of hospital hygiene code to staff, visitors and patients, stressing the responsibility of everyone including visitors to maintain the highest possible standards.

v) Giving the patient power to report failure in standards
The patient is often the first to notice any drop in hygiene standards. All patients would be equipped with a copy of the hospital hygiene code on admittance and given the option to anonymously contact the matron with any concerns they may have.

http://www.wales.gov.uk