Published: Thursday, 28th August, 2008 11:25
Dunfermline hospital in new infection concern
By Laura Cummings
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SPACING between beds at Dunfermline’s Queen Margaret Hospital does not meet new standards by as much as a metre.
Just days after seven patients were struck down by the potentially fatal superbug Clostridium difficile, concern has been raised that the space between beds at the hospital is 2.4 metres – the standard applied at the time the hospital was built.
However, that standard has changed for new buildings by a metre, increasing to 3.4m.
While this standard has been applied to the new wing at Kirkcaldy’s Victoria Hospital, in addition to an increase in the number of single rooms with en-suites and with en-suites to each of the four-bed bays, there are no plans to follow suit at the Queen Margaret.
But a leading expert has highlighted inadequate space between beds as a potential method of spreading killer infections like C.diff.
A C.diff outbreak lead to the closure of Ward 6 at the Queen Margaret earlier this month. It re-opened after a week’s closure on Friday.
However, three days after the ward was closed to admissions – with NHS Fife advising family and friends not to visit the ward unless “absolutely necessary” – David Hingston (66), of Arthur Street, Dunfermline, visited a friend there and was shocked to find other visitors entering and leaving, while carers were not permitted.
He was also alarmed when he saw a “non-working” dog wandering down a the hospital corridors with a visitor.
NHS Fife did not provide a response regarding the dog when the Press asked them to this week.
An independent review of the recent deaths linked to C.diff at the Vale of Leven Hospital in Dunbartonshire was reported to Fife Health Board on Tuesday.
It showed that facilities were inadequate at the hospital in terms of appropriate spacing between beds and hand washing, among other areas.
It was also discovered that uniforms were worn outside the hospital as staff went to and from their workplace.
The Press reported earlier this year that this was also a problem at the Queen Margaret.
From December 2007 to May 2008, NHS Fife reported 220 cases of C.diff – higher than the national average. There were eight deaths where C.diff was an underlying cause. All the victims were over 65 years old. The number where C.diff was a contributory factor was 13.
Following the outbreak at the Queen Margaret, Emeritus Professor of Bacteriology at Aberdeen University, Hugh Pennington, said, “If hand hygiene isn’t absolutely perfect and if the beds are too close together the bug can jump about.
“It raises the question of hygiene standards at the hospital. In this kind of situation experience tells us that you do find that things weren’t as good as they should be.
“I’m not pointing the finger but if I was called in to look at it those would be the things I would be looking for right away.”
However, Professor Pennington said he was “moderately relaxed” about the space (2.4m) between beds at the Queen Margaret.
He explained, “Obviously, it would have been better for all concerned if it was the new standard (3.4m) but that’s a very high standard and the old one (2.4m) is not bad.
"An outbreak is more to do with aspects like hand washing and how patients are isolated from wards.”
But Professorr Pennington was critical of the fact that a dog was allowed to enter the premises.
“I don’t think they should have dogs in the hospital, period,” he said. “The only exception I would make would be if it was a guide dog.”
As far back as 2003, a report by the Watt Group stated that provision in high-risk areas at the Queen Margaret was not adequate.
Wards 13, 14 and 21 did not meet the minimum space requirement between beds, which the report stated was 2.7 metres.
It recommended removing eight beds per ward with a reduction in beds also required at the Victoria Hospital where spacing between beds at the time was 2.4 metres.
In a December 2004 letter to John Winton, of pressure group Local Health Concern, Dave Stewart, then chairman of Fife Hospitals Acute Division, said NHS Fife could not achieve a minimum of 2.7 metres between beds without a significant reduction in bed numbers.
Mr Winton slammed this week, “They have lived with a standard that’s not good enough right the way through from 2003 to 2008 and they will be living with it in the Queen Margaret for another few years, and dare I say in parts of the existing Victoria as well – and they wonder why they get outbreaks.”
He added, “Bed distances obviously is a factor in stopping infections spreading but how much of a factor is open to interpretation.”
None of the seven patients who tested positive for C.diff has had diarrhoeal symptoms since last Thursday and a full ‘deep clean’ has been undertaken on the ward.
The medical director of NHS Fife’s operational division, Dr Gordon Birnie, underlined that the outbreak had been contained within one ward and had not spread to the rest of the hospital.
An NHS Fife spokeswoman added, “While the ward was closed to new admissions, visitors were asked not to visit the ward during this time. However, it is not NHS Fife’s policy to stop visitors from entering wards.
“The achievement in containing the spread and maintaining enhanced precautions over a week to allow a rapid resolution is a great credit to the professionalism and dedication of the clinical, facilities and infection control staff involved.”
The space between beds is calculated by measuring the space from the mid point of the bed to the mid point of the neighbouring bed.
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