Clostridium Difficile is a serious nosocomial infection (contracted in a health care setting). It is not a notifiable disease.
The Minister for Health, Mary Harney thinks it should be a notifiable disease, as she informed the media recently.
Her comment implies that she has nothing to do with the matter.
The making of a statutory instrument would be required to make it notifiable. It would be signed by her.
She did not inform the media that she intended to ensure it became a notifiable disease. In her conversation with the media she furnished statistics (records actually) of the incidence of Clostridium Difficile infection in Irish hospitals. These figures cannot be reliable to the degree that they would be if the disease was notifiable. She then went on to favourably contrast the rate of Clostridium Difficile infection in Irish hospitals with the rate in British hospitals.
Surely, in the absence of accurate figures, the comparisons are misplaced?
They are particularly misplaced by the Minister’s attribution of the cause of the spread of Clostridium Difficile to the “overprescribing of antibiotics�.
On 9th October 2007 the results of an audit of Irish hospitals showed that the decontamination units in Irish hospitals suffered from poor practices and inadequate facilities for the units.
The units decontaminate, clean, disinfect and sterilize reusable medical devices. Without proper cleaning the device will transmit an infection from one patient to another.
That’s the kind of situation that would explain the incidence of Clostridium Difficile in Irish hospitals. The Dublin County coroner, Dr. Kieran Geraghty, recently criticised infection cocontrol policies in St Columcille’s Hospital in Loughlinstown when he found that three patients contracted nosocomial infections there, including Clostridium Difficile.
Unlike the Minister, he avoided musings about “overprescribing of antibiotics�, presumably being more interested in proximate causes and practical steps to avoid the deaths of patients.
Your casual dismissal of the overprescribing of antibiotics betrays a superficial level knowledge of this topic. While not the only cause and decontamination, patient isolation and handwashing certainly have a role to play, the overprescribing of antibiotics (especially those with a broad spectrum) destroys much of the normal bowel bacteria allowing C difficile to fill the ecological gap. Unnecessary antibiotics are a major cause of C difficile. I suggest you read the IDSA antimicrobial stewardship guidelines for a good review of the topic and what Irish hospitals should be doing.
Dear JF,
My fundamental objection to your claim, and that of the Minister is that it transfers the responsibility for what is wrong to anonymous unidentifiable persons (“doctors”) from whom we will not receive an explanation or a defence.
This is more than a claim, the link with overprescribing is scientifically validated and has been shown by numerous publications for decades. The prescribers are not anonymous as they have to sign each prescription (admittedly not always legibly). The antibiotics cause the problem but I agree that lack of cleaning, handwashing and overcrowding help the spores spread. As this is a multifactorial process there are many in the chain to blame. Unfortunately our aging population and a new more virulent strain mean that this will be an increasing problem in the future. My fear is that it will take a Maidstone scale outbreak to prompt the HSE to provide the necessary resources i.e. more staff, more isolation rooms and proper cleaning and decontamination facilities.
Dear JF,
I hold to my view. My subject is proximate cause, not every cause. Prescription of antibiotics is not per se wrong; “overprescription” is a judgment relevant to a social context, not a patient context. In the social context the doctors are anonymous, (and possibly defensible, even generally). The Minister’s prognostications are made with a view to evasion of political responsibility and not otherwise.
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