By Baroness Masham of Ilton - 17th November 2010
The need to "improve patient experience" is to be addressed in a question by Baroness Masham of Ilton in the House of Lords.
Clostridium difficile is a serious problem in the UK that claims many lives and costs the NHS over £1bn a year. There was a large increase in C. difficile infections and deaths between 2000 and 2007. In 2007, 55,498 cases were reported in England alone, and C. difficile was mentioned on well over 8,000 death certificates. Certain hospital trusts such as Maidstone and Tunbridge Wells hospitals were heavily criticised for their handling of outbreaks that claimed tens of lives.
Despite a decrease in infections of 35 per cent in 2008 – due to improvements in reporting, best-practice workshops, and the introduction of targets – the number of infections plateaued in 2009 and remains high. Primary care organisations reported 6,342 infections in just the first quarter of 2010, and the most recent data from the Office for National Statistics show that the number of death certificates mentioning C. difficile has increased sixfold over the last decade, reaching 6,000 in 2008.
C. difficile is a drain on valuable NHS resources, costing over £1bn a year. This is spent on diagnostic lab work, treatment such as rehydration therapy, courses of antibiotics such as Metronidazole and Vancomycin, intestine surgery, labour time, and rigorous hygiene measures to prevent the spread of the infection. This is to say nothing of wider externalities. Of course, at a time of fiscal rectitude when securing value for money is a priority, the cost of C. difficile is particularly regrettable.
C. difficile is a bacterium that three per cent of healthy adults have in their gut. C. difficile bacteria proliferate and cause a dangerous infection when beneficial bacteria in the gut are depleted. Because antibiotics reduce the number of beneficial bacteria in the gut, C. difficile infections are prevalent in hospitals, nursing homes and outpatient clinics.
The symptoms of C. difficile include diarrhoea, colitis, dehydration and serious damage to the intestine. For vulnerable elderly patients, a serious case of the infection can be fatal. The older the patient and the longer their stay in hospital, the more likely they are to contract C. difficile.
It is particularly difficult to stop the spread of C. difficile, because the bacterium forms spores that can survive in hostile outside environments for months and even years. The spores protect the bacterium from detergents and disinfectants, and infect other patients with depleted beneficial bacteria when ingested.
Patients have a better chance of not contracting C. difficile if they maintain healthy levels of beneficial bacteria in the gut. Beneficial bacteria can be ingested in a live culture (probiotics), but this has proven ineffective because beneficial bacteria have a limited shelf life and are largely destroyed in the stomach before reaching the gut.
Prebiotics offer an innovative solution to this problem. Prebiotics are non-digestible food ingredients that are insoluble in stomach acid. They reach the gut where they act as food for beneficial bacteria, stimulating their development at the expense of harmful bacteria.
The prebiotic effect is well supported by clinical studies, unlike the probiotic effect. Unfortunately the difference between prebiotics and probiotics is not widely appreciated and the government has not commented on the use of the former in tackling C. difficile. (Despite Nigel Evans MP raising the issue in a debate on 19 November 2009).
Rather than trying to contain c. difficile outbreaks, we could save lives and valuable NHS resources by preventing infection from arising in the first place. If patients receiving a course of antibiotics were also given a prebiotic supplernent in their food, they would be less susceptible to a proliferation of c. difficile bacteria. Prevention is the most effective method with c. difficile.
In 20-30 per cent of cases, infection returns, and containment measures have already done all they can with an especially resilient and contagious disease. Even with perfect containment, c. difficile will still arise in patients on antibiotics with the bacterium in their gut.
Clasado manufacfures a prebiotic supplement called Bimuno, which is the result of nine years of intensive research in collaboration with the University of Reading's Food Microbial Sciences unit. Bimuno is a second-generation galacto-oligosaccharide that feeds beneficial bacteria while reducing the levels of harmful bacteria in the gut. Unique among prebiotics, Bimuno also has clinically proven immune defence properties and anti-pathogenic properties.
-Ascertain what consideration the government and NHS have given to using second-generation prebiotics as a preventive measure in a clinical setting.
-Secure local trials of Bimuno in hospitals with high C. difficile rates, to prove its efficacy in reducing the incidence of infection and calculate its potential for saving valuable NHS resources.
-Raise the profile of prebiotics and Bimuno with health commissioning decision-makers, health stakeholders and parliamentarians, improving awareness of how prebiotics differ from probiotics and offer far greater potential for preferring c. difficile.
The gel used for cleaning hands does not work on c. difficile; washing with hot water and soap seems to be safer but many people do not always wash their hands, thinking that the gel works. I think it is important to find new ways of trying to combat this most debilitating and dangerous infection which puts many elderly and frail people at risk.
Baroness Masham of Ilton is to ask the government 'What consideration they will give to using prebiotics to prevent Clostridium difficile in a clinical setting, with a view to improving patient experience and saving NHS resources.'
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