Management of Clostridium difficile in NHS trusts

BMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7535.238 (Published 26 January 2006) Cite this as: BMJ 2006;332:238
  1. David Green, lead nurse infection control (david.green{at}bradfordhospitals.nhs.uk)
  1. Bradford Royal Infirmary, Bradford BD9 6RJ

    Editor—A recent report and press statement by the Healthcare Commission and Health Protection Agency (HPA) say that a third of NHS trusts are not adhering to government guidance on the prevention and control of Clostridium difficile infection. 1 2 In parallel, the chief medical and the chief nursing officers have written a joint letter to trusts' chief executives. 3 The letter says that guidance published in 1994 by the Department of Health and the then Public Health Laboratory Service (now the HPA) is “current.”4 I telephoned the publication department of the Department of Health for a copy, only to be told it does not have anything that goes back “that far.” A similar request to the HPA also drew a blank.

    The report advises trusts have antibiotic prescribing guidelines to reduce the risk of C difficile infection. 1 However, the supporting reference given was a report made to, rather than guidance from, the Department of Health, which included the findings of the national standards group for C difficile, 5 an expert group established at the request of the Department of Health to review evidence pertaining to the diagnosis and control of C difficile associated diarrhoea and to make recommendations for developing the surveillance system. This group made several recommendations to the department, but despite their report being nearly three years old and surveillance now in place, no updated guidance on prevention and control has been issued. What guidance is it that trusts are not adhering to and whose advice should be followed in the future?

    The press release from the Healthcare Commission and HPA focuses exclusively on the negative findings of the report, 1 2 and findings that 89% of trusts have a written policy that covers the management of infection from C difficile have therefore gone unreported in the media. If trusts are to reduce the incidence of infection from C difficile a useful starting point is guidance contained in a single document that is both current and accessible.


    • Competing interests None declared.


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