At least 90 patients died and more than 1,100 became infected as hospital managers failed to control the worst outbreaks ever recorded of the super-bug clostridium difficile, a report states today.

Inadequate staffing levels, dirty wards and too much focus on cost-cutting and government targets contributed to two serious outbreaks of C difficile in as many years at Maidstone and Tunbridge Wells NHS Trust, an investigation by the Healthcare Commission found.

The Health and Safety Executive and Kent Police are now considering the possibility of criminal charges being brought against the trust or its executives.

The commission found “significant failings” in infection control at three hospitals run by the trust between April 2004 and September last year, including unwashed bedpans, a lack of isolation units, beds being spaced far less than the recommended 3.6 metres apart to stop the spread of infection and nurses telling some patients with diarrhoea to “go in their beds”. Pictures taken as recently as February disclosed continuing hygiene concerns.

Rose Gibb, the chief executive of the trust, left her job on Friday by mutual agreement with the board.

The failure to contain and treat infections at all levels contributed to 1,176 patients being infected with the bug at Kent and Sussex Hospital, Pembury Hospital and Maidstone Hospital, Kent, the watchdog said.

A total of 345 patients died while infected with the bacterium between April 2004 and September 2006, 21 died as a direct result of infection and for 69 patients it was probably the main cause of death, it added.

In addition, C difficile could also be considered a “contributing factor” in as many as 241 of the deaths, although the report said that patients, many of them elderly or frail, may well have died of other causes if they had not acquired the infection.

The trust had previously told the Healthcare Commission there had been “no deaths that were definitely caused by C diff" between April 2004 and March 2006.

The first big outbreak was between October and December 2005 but, despite the number of infected patients quickly doubling to 150, the trust did not identify the outbreak.

The second significant outbreak was between April and September 2006, in which 258 patients were affected, and was recognised as serious by the trust.

But despite these problems, the trust declared itself compliant with national government standards for hygiene and infection in May 2006.

At the time of the outbreaks the trust was carrying out a programme to save £40 million over three years in the face of huge debts. At the end of 2003, the trust had an accumulated deficit of £17.6 million. Last year, it reported a deficit of £4.5 million.

The commission said that there was evidence patients had been moved between several wards, increasing the chance of spreading infection. It said this was partly due to concerns over hitting the Government’s targets on waiting times for treatment in A&E.

Anna Walker, the chief executive of the commission, said that the lack of infection control at the trust had been “unacceptable” but that conditions had improved as a result of monitoring by the commission.

Improvements included increasing the space between beds, appointing a new director of infection prevention and control and implementing a policy on the use of antibiotics which are known to help C difficile thrive.

“What happened to the patients at this trust was a tragedy,” Ms Walker said. “This report fully exposes the reasons for that tragedy, so that the same mistakes are never made again.”

She called for the NHS to treat C difficile as an illness rather than just an added complication.

Health Protection Agency figures showed that rates of C difficile are now lower than the NHS average last year.

A spokeswoman for the Health and Safety Executive said that it was working with Kent Police to consider the report.

Among the mistakes

Patients were treated on open wards instead of in isolation

A former children’s ward was being used for adults. It contained an uncleaned shower, one wash basin for 12 beds and beds placed only 30cm (less than a foot) apart

A shortage of nurses contributed to the spread of infection “because they were too rushed to undertake hand hygiene, empty and clean commodes, clean mattresses and equipment properly” and wear aprons and gloves

High bed occupancy – over 90 per cent at Maidstone and the Kent and Sussex – led to less time for cleaning

Staff used alcohol wipes, which are ineffective against C. Diff spores, to clean commodes instead of soap and water

Old commodes were used despite the trust agreeing to replace them and setting aside £250,000 to do so

Source: Investigation in to Maidstone and Tunbridge Wells NHS Trust by the Healthcare Commission

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