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The virulent strain of mutant bacteria known as Clostridium difficile, or C.diff for short, has hit Scotland again.  This time, at hospitals in Glascow and Aberdeen, a total of nine patients have been hit with the pathogen, and two are dead.

According to ProMED, the toxic 027 strain is the culprit.  Until recently very rare, apparently 027 is becoming not quite commonplace, but not rare anymore, either.  Again, according to ProMED, C.diff 027 killed some 65 Scottish patients at Stoke Mandeville Hospital in Aylesbury, Buckinghamshire, England, between 2003 and 2005.  Stubborn little pest, that C.diff.

Hospitals are pretty dangerous places these days.  In my opinion, that is because there is little functional difference between a hospital and a bus terminal.  We let a virtual stampede of people through our corridors, wings and even rooms.  I have personally visited patients with twelve visitors in a room at one time.  the lax "enforcement" of visitor maximums has to be part of the problem.

So is the laziness of modern healthcare practitioners.  How many surveys have we seen recently that show not even doctors bother to wash their hands between patients?  Here's a 2004 story from WebMD.com:

July 6, 2004 -- Upwards of one-half of doctors don't wash their hands between visits with hospital patients, a new study shows. It's a big infection control concern in hospitals because dirty hands transmit germs to other patients.

Why don't doctors wash their hands -- a seemingly simple procedure? Hospitals routinely promote good hygiene to doctors and other health-care workers, alerting them of the risks of dirty hands after examining different patients or after examining various infected and uninfected sites on a single patient. Yet doctors are frequently observed breaking the rules.

In this study, researchers sought to better understand doctors' attitudes. They secretly tracked 163 doctors to monitor their hand washing during the day. Each doctor also completed a survey about their attitudes on hand hygiene.

They observed just 57% of doctors washing their hands between patients, writes lead researcher Didier Pittet, MD, MS, an infection control expert with the University of Geneva Hospitals. Pittet's report appears in the latest Annals of Internal Medicine.

http://women.webmd.com/news/20040706/study-doctors-dont-wash-hands-enough   

The problem does not rest exclusively with physicians and nurses.  We have become slobs ourselves. 

Restroom Study Finds Hand Washing on the Decline

FRIDAY, Sept. 21 (HealthDay News) -- Americans aren't washing their hands like they used to.

That's the conclusion of a new observational study that found fewer users of public restrooms stopping by the sink on their way out, compared to years past.

The study was released to coincide with National Clean Hands Week by the American Society for Microbiology and The Soap and Detergent Association.

For the study, researchers observed the behavior of almost 6,100 adults at six locations in four cities -- Atlanta, Chicago. New York and San Francisco.

They found that 77 percent of people washed their hands in public restrooms, a 6 percent decline from the 83 percent noted in 2005.

This latest study found that women were still more likely (88 percent) to wash their hands than men (66 percent). In 2005, 90 percent of women and 75 percent of men washed their hands.

In both the 2005 and 2007 studies, researchers observed the hand washing behavior of people at: Turner Field in Atlanta; the Museum of Science and Industry and the Shedd Aquarium in Chicago; Grand Central Station and Penn Station in New York City; and the Ferry Terminal Farmers Market in San Francisco.

In 2007, Chicago had the most conscientious hand washers (81 percent), followed by New York City (79 percent), Atlanta (75 percent) and San Francisco (73 percent).

"According to the Centers for Disease Control and Prevention, the single most important thing we can all do to keep from getting infectious diseases and spreading them to others is to clean our hands," ASM spokesperson Dr. Judy Daly, director of the microbiology laboratories at the Primary Children's Medical Center in Salt Lake City, said in a prepared statement.

"Many cases of colds, flu and foodborne illness are spread by unclean hands, and these diseases are responsible for billions of dollars each year in health-care expenditures and productivity losses in the United States," Daly noted. "Worldwide, infectious diseases remain the leading cause of illness and death."

-- Robert Preidt

SOURCE: American Society for Microbiology, news release, Sept. 17. 2007

http://www.medicinenet.com/script/main/art.asp?articlekey=84055

Two weeks ago, a brother of a very close family friend died.  His autopsy reads, Cause of Death: MRSA.  He had been in hospital for a minor surgical procedure a few weeks prior. Did he contract MRSA from the hospital?  That remains to be seen.  One thing is for sure:  Hospitals are losing the battle against superbugs.  Their own policies regarding visitation, coupled with their inability to enforce common sanitary protocols, may be counteracting any feel-good, window-dressing initiatives their PR departments and legal counsel can conjure up to lull patients into a false sense of security.

Let me close with the last three paragraphs of the ProMED report:

_C. difficile_ is a potentially fatal bug, which mainly affects the elderly, and usually grows in the large intestine. Spores can survive for a long time in the environment, with areas around hospital beds and toilet areas common. Health officials have been concerned that the "hypervirulent" 027 strain could become more common in Scotland as it spreads from England, and a _C. difficile_ "reference laboratory" has been established in Scotland to help identify more virulent strains including 027, which might not be picked up otherwise, and help understand the bug's characteristics.

The 027 strain produces more toxins than other types, has caused large outbreaks of severe disease in hospitals in Canada and the US since the beginning of the decade, and has now been detected in more than 80 hospitals in England and Wales. The 1st Scottish case of 027 was diagnosed in October 2006. Then, in November last year [2007], an unnamed female patient died in the West of Scotland due to a "combination of factors" after being infected with the 027 strain.

Figures show all strains of _C. difficile_ caused 100 deaths in Scotland in 2005 against 57 in 2001. Cases increased by 10 per cent in 3 months.(bold mine)