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MRSA - The Vampire Superbug Superbugs - bacteria that have become resistant to antibiotics - have been the subject of much media attention. Every newspaper in the land has carried stories about MRSA, and its equally deadly cousins VRSA and GISA. The evidence shows that these Hospital Acquired Infections can be combated through basic cleanliness and hygiene, so why is the infection rate is still rising? This article examines the effect of the Superbugs and some simple steps that could help to control it. Hospitals And Superbugs
Hospitals make ideal environments in which for resistant MRSA (Methicillin Resistant Staphlococcal Aureus) to flourish because so many different strains are thrown together with so many doses of antibiotics, vastly accelerating the natural selection process. NHS patients are at a higher than normal risk of picking up a Staphlococcal infection on hospital wards for two reasons; hospital populations tend to be older, sicker and weaker than ordinary people, making them more vulnerable to the infection, and conditions in hospitals are the perfect environment for the transmission of all manner of infections. This is especially dangerous in the cases of weakened patients e.g. those with blood disorders or cancer.
Once a patient becomes infected with MRSA, they quarantined within an isolation ward where rigorous procedures are followed. Doctors and nurses wear gloves and aprons while caring for the patient, and the place is usually in a state of high alert. The Microbiology team descends upon the ward, swabbing staff and treating with antibiotics anyone who is found to be infected. An excellent leaflet for patients to download is available here. Back To Basics
Staphylococcus bacteria are particularly common - at least 25% of people carry them around in their nasal passages all the time. They can cause many different kinds of illness, including skin infections, bone infections, pneumonia, severe life-threatening bloodstream infections, and others.
These days, scare stories about antibiotic-resistant 'Superbugs' are becoming common, with the infamous Methicillin-Resistant Staphylococcus Aureus, or MRSA as it is often called, being the most well known. Since MRSA is a strain of the common Staphlococcal bacterium, it can cause the same kinds of infection as Staphylococcus Aureus. However, MRSA occurs more commonly among persons in hospitals and healthcare facilities. A classification of Staphylococcus Aureus can be found here.
No Bed For The Sick
The Money Bank This case alone clearly demonstrates how easily the infection is spread within a hospital environment. Yet MRSA is not airborne and can only be transferred by physical contact. Under these circumstances, sterility and cleanliness become vital if the march of the Superbug is ever to be checked.
While this approach has no doubt worked well for many a commercial office block, where the flick of a duster and a cameo appearance from an aging vacuum cleaner constitutes cleanliness, it is sheer folly to expect these techniques to meet the hygiene requirements of a sterile clinical environment. An army of mop-wielding contract cleaners, sloshing their way at high speed along the wards and corridors of the nation's hospitals, with one eye on the clock and the knowledge that they have several more wards to do before knocking off time at the forefront of their thoughts, cannot reasonably be expected to know or care too much about the fine details of MRSA containment.
Figures from the National Audit Office suggest that, at any given time, 9% of patients are suffering from an infection acquired on the wards or in surgery. This amounts to some 100,000 patients, costs the NHS around £1 billion and results in around 5,000 deaths per year. Such Hospital Acquired Infections are thought to be a major contributing factor in another 15,000 deaths per year, indicating that the true financial cost to the NHS could easily be as high as £10 billion per year. Some victims of MRSA infection are now suing the hospitals involved, though it is too late for the likes of Troy Eames, a 23-year old who died of MRSA after a simple operation, for an in growing toenail. The additional cost of litigation resulting from these needless deaths is almost certain to push the final cost of HAIs even higher. Prevention Is Part Of The Cure Recent research by the European Antimicrobial Resistance Surveillance System (EARSS) shows that the UK has the highest rates of resistance in Europe. Put simply, this means that in tests 41% of the Staphylococcus Aureus bacteria examined in the UK were resistant to standard treatments. Yet a growing catalogue of evidence indicates that basic hygiene procedures for hospital staff can have a dramatic impact on the spread of MRSA. If the excellent standards of hygiene that were so common in the early days of the NHS were still applied today, it seems certain that this problem - and its financial impact upon an already cash-strapped health service - would be vastly reduced. Perhaps the money saved could be poured into extra research for a drug that will truly provide an answer. In stinting on such basic necessities in order to save money, the bean counters that call the shots in the modern day NHS are, clearly, being hoist with their own petard. It is very sad that patient care sometimes has to suffer because of financial constraints. Hospitals concentrate on areas such as waiting times for day surgery, spending vast sums in order to cut waiting lists, while neglecting other, and perhaps more vitally important areas. 60% of doctors, polled several weeks ago by the British Medical Association News Review, said that they had first-hand experience of politically motivated goals distorting clinical priorities. During a recent interview with the BBC, Natasha Crowcroft, a consultant public health doctor, commented: "In 1998 there were a 114 deaths where MRSA was given as the underlying cause. It's not a huge number in terms of how many people die in the country every year. But it's a lot of people to die from something that could be prevented by hand washing." It could, quite literally, be that simple in many cases. Scrupulous hygiene measures by hospital staff, before and after contact with patients, and before any procedure, could be the single most important infection control measure in preventing the spread of MRSA. Hand washing, in between visiting patients, should be mandatory for both doctors and nurses, when on their rounds of the wards. Usually, substances such as Hibiscrub or other antibacterial hand washes are on hand for this purpose. It may even be helpful to reintroduce the post of 'ward matron', with overall responsibility for cleanliness, to improve hygiene standards. Patients with MRSA should be physically isolated in a single room with the door remaining closed and the room regularly damp dusted, or they should be nursed in a special ward away from other non-infected patients. The patient's notes should be clearly labeled 'MRSA', so that this type of accommodation is provided, if and when they are admitted to hospital at any time in the future. It is important that the clinician looking after the patient in hospital notifies the general practitioner. If this has not already been done, then the patient or their family should mention to their general practitioner that they are carrying MRSA. The use of antibiotics such as those applied inside the nose, and bathing procedures previously described, will also help to reduce the risk of spread. Finally, when such a patient is discharged from hospital, their room should be comprehensively cleaned and all linen and other clinical waste disposed of in special bags. But it is not just hospital staff that need to take precautions - patients, too, have a role to play in the fight against MRSA. You should religiously finish any course of antibiotics that the doctor might prescribe. This should ensure that no bacteria survive, because any survivors can contribute to the development of resistance. Most Staphylococcal strains now carry resistance genes, and those with two or three such genes will be extraordinarily difficult to treat. If you have cuts, or any open wounds, keep them covered and change the dressings regularly. Wash your hands thoroughly first, and the same applies if you are treating the wounds of another person. For healthy people, MRSA is rarely a problem, but it doesn't hurt to take proper precautions, and consult your GP, if you have any doubts. Future Fears Doctors are becoming very worried about what the future holds. Reported numbers of MRSA infections rise year-by-year, and the latest evidence suggests that deaths due to MRSA are increasing at a similar rate. In 1991, 1.5% of Staph strains were resistant, but, by 1997, this had risen to 31%. In March 2003, it was reported that 11,000 hospital patients had been infected with MRSA in the previous 18 months, and that the figure was rising all the time. It isn't difficult to imagine what these figures might be today, or why the medical establishment is growing nervous. At the end of last year, a 52-year-old woman died from a hospital Superbug at Monklands hospital in Airdrie, Scotland. Martha Devlin contracted MRSA after surgery last September, but the Superbug mutated further to become GISA (Glycopeptide Intermediate Staphylococcus Aureus), which the medical staff found themselves unable to treat. Like its cousin, VRSA (Vancomycin Resistant Staphylococcus Aureus), GISA has developed a resistance to antibiotics of the Vancomycin family - once considered the "last line of defense" when all other antibiotics had failed against these Superbugs. Even more worryingly, University College Hospital in London last December recoded the first known case of a patient in whom MRSA was resistant to the drug Linezolid. Linezolid is the current "last line of defense", and is rarely used lest the Staphylococcus population starts to build resistance to it. Doctors have now been told to cut back on the amount of antibiotics they prescribe, amid perhaps-justifiable fears that bacteria resistant to all antibiotics will make an appearance in the future. Of course, a massive research programme is constantly seeking new treatments, and one came into being recently with the introduction of Synercid. This new drug contains two ingredients that work together to kill bacteria. Researchers believe that bacteria will take much longer to develop resistance to it, and overseas trials found that of 432 patients, half of whom had life-threatening bacterial blood infections, almost three-quarters were successfully treated. Many experts, however, believe that it may take a breakthrough, perhaps as important as the discovery of penicillin, before medicine regains the upper hand in the ongoing battle against the Superbug. If you have any questions regarding this article, please email us at superbug@nhs-exposed.com Resources Breathing easier with better hospital design Private treatment bill paid by NHS I was gob smacked by the filth Super bugs Possible from Genetically Modified Foods Patients Fight Back Against Super bug Crackdown on Hospital Super bugs Scottish Microbes May take on Super bugs Reid Under Fire over Super bugs Cleaners Hold the Key to Beating Superbugs Garlic Frightens Hospital Superbug Government Launches Super bug Crackdown
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Hospital
Acquired Infection (HAI) is something you would hardly expect in an
average hospital ward, yet NHS hospitals are indeed a hotbed for
bacteria. Cleanliness and health go hand in hand but standards seem to
have deteriorated within NHS hospitals. A shift in resources from the
clinical environment to management seems to be the cause of this
silent, exponential, multiplication of the "superbug". To
add to this, doctors and nurses are not educated enough to ensure
hygiene is maintained. Often, busy staff are forced to take "short
cuts" and unknowingly transfer the super bug from patient to
patient. 
Without
rigorous hygiene standards, which it seems are lacking within the NHS,
the stage is set for an epidemic of infectious diseases, particularly
among the most vulnerable who have lowered resistance. Recent
estimates suggest that one in ten patients acquire an infection during
their stay in hospital, leading to at least one hundred thousand
hospital-acquired infections occurring each year.
We
have to go back a long way if we really want to understand what we are
discussing here. Bacteria are the oldest life form on the planet, far
more ancient than mankind, and, because they evolve so fast, it can be
very difficult to keep track of them. Like any other life form, they
learn to develop resistance to things that threaten their existence,
and therein lies the problem.
In
the past, most serious cases of staphylococcal infection were treated
with a certain type of antibiotic related to penicillin. Over the past
50 years, treatment of these infections has become more difficult,
because staph have become resistant to various antibiotics, including
the commonly used penicillin-related antibiotics. These bacteria
mutate constantly, so that those you pick up are more likely to have
already survived antibiotic attacks.
In
the UK, around 5,000 patients each year die of hospital-acquired
infections. An unknown number of these deaths are due to MRSA, which
infects the wounds of patients who have been weakened by surgery or
illness and spreads rapidly through the body, often leading to
multiple organ failure. More than 7,000 cases of MRSA were recorded in
England and Wales last year, compared with 4,767 in 2001 but it is not
known how many patients died from the bug. An interesting view of the
escalation of MRSA is featured in
Speaking
in an interview with the
Unfortunately,
in today's bureaucracy-ridden NHS that is, apparently, run by business
oriented managers with little, if any, understanding of clinical
matters, cost cutting has become the all-pervasive overriding
objective. All too often, ancillary services - such as cleaning - are
farmed out to private companies, with the contract going to the lowest
bidder.
Consider
also, the waste of NHS resources on administration costs. With some
administrators on £60,00 a year, and the startling revelation
that that there are now 211,650 managers in the NHS, as opposed to
199,670 beds for patients, is it any wonder that hospitals are finding
it hard to afford proper cleaning staff?