C.diff superbug: 'If this were the motive it would be a scandal'

IT should be of great concern to all that pressure appears to be being put on hospital junior doctors in Lothian to avoid citing the deadly bug C.diff as a contributory factor in the death of a patient.

There was alarm after the tragic events at the Vale of Leven Hospital in Dumbartonshire earlier this year, where 18 out of 55 infected patients died, and NHS Lothian is anxious that it is only recorded on death certificates when there could be no other cause of death.

A memo from Edinburgh Royal Infirmary clinical director Casey Stewart to junior doctors, which has been passed to the Evening News, is carefully worded. Although it does not forbid doctors citing C.diff as the cause of death, it appears to caution them against doing so where it is not solely responsible for the fatality.

Now one junior doctor has contacted the Evening News to say he was now "afraid" to put C.diff on a death certificate for fear it might harm his career. It was further claimed that the caution from the Directorate of Medicine might lead to under-reporting, allowing hospitals to record a drop in the number of serious cases without addressing the issues. If this were to be the motive behind the memo it would be a scandal.

NHS Lothian has been heavily criticised in the past for being one of the health authorities with the worst record on hospital-acquired infections. Since then improved hygiene measures have been introduced and there is wider testing than in some health authorities of patients under the age of 65. As a result, within the last month it was claimed that the ERI and Western General now have one of the lowest death rates from C.diff and other superbugs in the country. If so, it is excellent news.

But if public confidence is to be maintained there can be no suggestion that cases are not being properly recorded Hospitals are now obliged to keep a mandatory tally of infections, whether they are the primary cause of death or not, but there is a danger that a dramatic reduction in recorded fatalities where C.diff is a factor could lead to the importance placed on tackling it being down-played.

A wide gap between the number of recorded cases and the number of deaths should be the aim, but death certificates should not be manipulated to mask the true extent of an infection and if doctors have to provide more extensive explanations as to how a patient died, citing a combination of factors including C.diff, then so be it. Doctors should not be afraid to tell the whole truth where they believe a bug is a contributory factor. C.diff is too dangerous for doctors to be afraid of recording its effects. Much is being done in the war against hospital bugs and public confidence should not be undermined for the sake of statistics.