NHSE cracks down on ‘variable’ testing after C difficile rise

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NHSE proposes development of new infection control and diagnosis standards
National bosses highlight “variation” in testing of blood and stool for infections across trusts
Experts warn of “real concern” nationally about variation in and levels of infection diagnosis

NHS England is introducing new infection diagnosis standards, which experts told HSJ reflected a “real concern” about variation between providers.

A draft document on proposed changes to the NHS Standard Contract 2026-27 says adherence to national guidance on diarrhoea sampling and testing for C difficile was currently “variable” across providers, while NHSE has also warned about variation in service delivery and outcomes for blood culture pathways.

It comes amid national concern over the rising numbers of infections caused by C difficile, a type of bacteria which can cause diarrhoea, with cases reaching a 13-year high in 2024 and experts warning they could rise again.

A number of trusts have also flagged concerns about breaching national targets for C difficile in their board papers (see box).

The NHSE contract proposes that, alongside mandatory data trusts already provide for C difficile, they must also submit their rates of stool specimens examined and tested for C difficile.

These will be used to compare the ascertainment of C difficile levels nationally and produce national targets for use by the end of March 2027.

Meanwhile, the draft contract says trusts should also set service development improvement plans to ensure they comply with UK standards for microbiology investigations, andtake steps to ensure they meet targets for collecting blood culture samples.

NHSE surveillance ‘crucial’ amid service pressure

There was a 5 per cent decrease in C difficile infections between the last quarter of 2024-25 and the first quarter of this year, according to the latest available data, with 1,885 hospital-onset cases reported between April and June.

However, the Infection Prevention Society’s vice president Kerry Holden told HSJ that concerns remain about further increases, and the society strongly supported NHSE’s move to reduce variation and improve the reliability of testing.

Ms Holden, who is also deputy director of infection prevention and control at Gloucestershire Hospitals Foundation Trust, said: “The inclusion of C difficile testing and the blood culture pathway in the draft NHS contract reflects real concern about variation in infection diagnosis across the NHS.

“Cases of C difficile continue to rise nationally, and inconsistent sampling and testing for diarrhoea increase the risk of delayed diagnosis and management, missed isolation and avoidable spread of infection.

“National surveillance will also be able to provide crucial context for benchmarking by helping to distinguish genuine changes in infection incidence from differences in testing practice.”

She added: “If implemented well, these metrics have the potential to drive meaningful improvement and support trusts to build safer, more resilient systems for patients and staff alike.”

Trusts across country flag infection control concerns

Many trusts have raised concerns about breaching national targets for C difficile in recent board papers. University Hospitals Bristol and Weston FT said it had trialled screening of patients with diarrhoea and improving cleaning of clinical equipment.

A report for Wye Valley Trust’s board in October stated that it was considered an outlier nationally, and it was therefore reviewing all of its practices relating to patients with diarrhoea.

Meanwhile, University Hospitals of Derby and Burton FT wrote in its December board papers that “poor compliance” had been observed for the taking of blood cultures, particularly when patients were put on intravenous antibiotics.

East Sussex Healthcare Trust’s quality report for 2024/25 admitted hundreds of blood samples had been rejected due to incorrect labelling and missing details.

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