Huge government fines mean cases of a notorious hospital bug may be going unreported, it has been claimed.
More than half of specialist clinicians questioned for a survey believe the true number of deaths associated with Clostridium difficile is higher than official figures suggest.
A fifth claim this is because doctors under-report cases to avoid financial penalties on NHS trusts.
Tough fines are imposed on trusts that fail to meet targets for reducing C.diff infections.
In December last year, the Birmingham Post revealed hospitals in the West Midlands were facing fines of up to £45 million after a surge in cases.
C.diff is spread on the hands and contaminated surfaces. It causes diarrhoea and, in some cases, severe inflammation of the bowel. Its hardy spores can survive on the body and clothes for long periods of time.
Around three per cent of healthy adults and 66 per cent of infants harbour C.diff without suffering any ill effects. But in vulnerable individuals, such as hospital patients, the bacteria can produce serious and recurrent infections.
According to the latest Health Protection Agency figures, C.diff infection rates in English hospitals have fallen five-fold since 2006 from two per cent to 0.4 per cent of patients.
Since 2007/08, the total number of reported cases of C.diff in patients aged two and over in England has dropped from almost 55,500 to 21,695. In the whole of the UK, there were 24,751 reported cases in 2010/11 which cost the NHS an estimated £250 million.
But many of the 101 clinicians polled say the real picture is less rosy. Nearly a third thought incidence of C.diff infection had “flatlined” or even increased over the past few years.
In total, 41 per cent felt there was pressure within NHS trusts to under-report cases of C.diff to avoid fines.
More than a third of this group thought samples were sometimes not sent for laboratory tests when C.diff infection was suspected. And 63 per cent suggested that recurrent cases were going untested.
The nationwide survey was conducted by the Open Plan market research agency on behalf of two patient groups, C-Diffsupport and the National Concern for Healthcare Infections (NCHI).
A panel of experts contributed to the report, Think C-Differently, which was funded by the pharmaceutical company Astellas Pharma Ltd.
Microbiologist and panel member Professor Mark Wilcox, from the University of Leeds, said: “We have come a long way since the very high rates of CDI (C.diff infection) in 2007/08, but there is still room for continued improvement.
“We must avoid complacency and ensure CDI is appropriately contained by optimising diagnosis, improving treatment and ensuring that systems for reporting CDI are as accurate as possible.”
Five hospital trusts in the West Midlands were said to be at risk of failing to meet C.diff targets in December last year.
Each hospital faced a fine of £450,000 for every additional case over its target, up to a maximum of £9 million, according to our exclusive report.
Health minister Simon Burns said: “We have made real progress on MRSA and C.difficile.
“Annually, the numbers of MRSA and C.difficile infections are now at their lowest ever level since mandatory reporting was introduced.
“This survey is not representative – it only questioned 101 people out of the entire NHS workforce.
“However, it remains absolutely unacceptable for cases of C.difficile not to be reported. We have issued strong and clear guidelines on how C.difficile cases should be reported and expect these to be followed.
“There is also a code of practice under which hospitals have a clear legal responsibility to accurately report cases of C.difficile infection.
“We are committed to complete transparency and publication of avoidable healthcare-associated infections data to drive further reductions, deliver better patient outcomes, and allow patients to hold healthcare providers to account.”
