BMJ  2007;334:709 (7 April), doi:10.1136/bmj.39169.900475.1F

Letters

Clostridium difficile

Improvement targets for C difficile must be valid

The first 150 words of the full text of this article appear below.

We have identified a potentially distorting factor in the delivery of reductions in Clostridium difficile rates.¹ A letter sent to chief executives of trusts, primary care trusts, and strategic health authorities in England in December 2006 stated that the forthcoming NHS operating framework for 2007-8 and the NHS contract require primary care trusts to agree a local target with their acute hospital providers for a significant reduction in C difficile infections.² The target is expected to be "locally appropriate" and based on "current performance." A reduction of at least 25% was suggested for trusts with a rate greater than 4 cases per 1000 bed days (in people over 65), while maintenance of the current rate would be an appropriate target for trusts with a rate of 1 per 1000 bed days or lower.

The West Midlands Strategic Health Authority initially imposed indicative targets for all acute trusts to negotiate with . . . [Full text of this article]

¹ Royal Wolverhampton Hospitals NHS Trust, Department of Microbiology, New Cross Hospital, Wolverhampton WV10 0QP, ² West Midlands Public Health Laboratory, Birmingham Heart of England NHS Trust, Birmingham B9 5SS

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