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‘A desperate disease requires a desperate remedy' Guy Fawkes is reputed to have said after being caught trying to blow up Parliament.

No one doubts Clostridium difficile infection (CDI) is a ‘desperate disease’. Now we have the remedy: C. difficile wards. This is, as confirmed by numerous media reports, undoubtedly a Great Idea. Remove the patients with CDI from the wards and stop the disease spreading. No matter that most people with CDI are also at high risk of delirium which moving wards is designed to bring on or worsen. No matter that people with CDI are generally frail with multiple health problems and benefit from a multi-disciplinary team approach and continuity of care. No matter that people with CDI tend to be those who would have prolonged hospital stays even if they did not develop the illness and are likely to turn into that most unwelcome of NHS guests, the ‘bed blocker’. No wonder so many people in the NHS see C. difficile wards as a Great Idea of our time.

But hold on a moment. Suppose you had CDI and were recovering on one of these wonderful ‘isolation facilities’. Would you think it was such a Great Idea to have someone with active CDI brought onto your ward, especially since most CDI so-called recurrences are actually re-infections. It’s like just having put out the fire in your oil refinery and bringing in someone with a lighted torch. Technically, this aspect of CDI control is known as herd immunity, the idea that disease spread depends on the susceptibility of the herd. But this reasoning naturally leads to what the media would almost certainly brand ‘One of the Most Stupid Ideas of our time’: instead of putting people with CDI amongst a whole ‘herd’ of people who are highly susceptible, if they need to move, find them side rooms in wards with patients who are likely to be most resistant to CDI. But then such resistant patients won’t be old or frail – and they certainly won’t be in need of anyone to speak up for them being put at such risk by a ‘Killer Bug’, least of all geriatricians.

At the beginning of Madness & Civilization, Michel Foucault describes how leprosy disappeared at the end of the Middle Ages to be replaced by ‘a new incarnation of disease, another grimace of terror, renewed rites of purification and exclusion.’ He was referring to the social stigmatisation of mental illness, but the description sounds eerily familiar; all that is needed is a change of acronym… HIV/AIDS… MRSA… CDI. Yet perhaps, if history is any guide, C. difficile wards will prove to be only an ephemeral phenomenon, just another Great Idea of our time.

John M Starr
University of Edinburgh

BGS Newsletter, Aug 2008
Issue 17 ISSN 1748-6343 17