Hospital managers could face criminal prosecution for the worst ever recorded outbreaks of the superbug Clostridium difficile which killed at least 90 patients.

Police have launched an investigation into the infection of more than 1,100 Kent hospital patients, after a report published today blamed the spread of the disease on appalling hygiene standards.

The Health and Safety Executive and police officers are reviewing mismanagement by bosses at Kent and Sussex, Pembury and Maidstone hospitals to consider if it constituted a criminal act.

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.

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

Alan Johnson, the Health Secretary, said: “It’s a scandal. It’s awful.” But he rejected the notion that Whitehall targets were responsible for the outbreaks.

“To suggest that in this particular incident, this reflects what’s happening in the NHS across the country is absolutely wrong,” he told the BBC. “There are nurses and clinicians across the country who have dealt with the targets... but kept the highest safety standards.”

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.

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.

(Published by Times Online, October 11, 2007)

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