MRSA – A silent stigma

A diagnosis of MRSA (methicillin-resistant Staphylococcus aureus) infection is not something to be taken lightly. It has the potential to become a life-threatening condition and intensive treatment with antibiotics will be required. However, there is another side to the diagnosis which is rarely talked about. There is the stigma attached to having an infectious condition and it forms a significant part of the MRSA journey. Hospital staff are best trained to deal with medical emergencies but their management of patients with an infectious status sometimes leaves a lot to be desired.

When I was first diagnosed with MRSA I was treated with the utmost urgency and received excellent care. I was barrier nursed in isolation whilst undergoing intensive intravenous antibiotic therapy. This involuntary withdrawal from the world took some getting used to but I quickly developed my own coping mechanisms to get through that lonely time. However the ‘fun’ really starts when a patient has to come out of isolation for investigation or treatment. When an MRSA infection is confirmed by laboratory tests, a patient’s hospital chart is labelled with a luminous sticker proclaiming their infectious status. This is a method of alerting staff to take the necessary precautions to minimise the spread of infection. Hospital staff however should be aware of the sensitivities involved for MRSA infected patients.

I had to be taken to theatre for some minor surgery while still being treated in isolation. Patients with a positive MRSA status have to wait until last in the queue to go for surgery because of the very real potential of contaminating an operating theatre. So after a very long wait while fasting all day for the general anaesthetic, a porter finally arrived to transport me on a trolley to my destiny. We were escorted to theatre by a very junior nurse who was given the task of carrying my hospital chart. I was duly lined up in the pre-anaesthetic area alongside a row of other similarly nervous patients to await my turn in theatre. My surgeon and his surgical team appeared briefly in an open doorway and made encouraging faces at me. Suddenly, a loud shout came from another direction and to my horror, I heard the theatre sister roar from a distance “get that MRSA patient out of there, NOW!”. I saw the surgeon raise his eyebrows in disbelief at what had been heard and in an attempt to lighten the moment, we exchanged grins about ‘SHE who must be obeyed!’.  The theatre sister however continued to loudly remonstrate the junior nurse for accompanying me (the infectious patient) to the wrong location and any humour in the situation, rapidly dissipated. The junior nurse was mortified to receive such a public dressing-down and I felt very humiliated to be treated like a leper in front of all the other patients and staff. It was as if I didn’t exist as a person – I was purely seen as a health hazard which had to be quickly removed. A nice welcome back to the ‘real’ world after spending so much time alone.

I have since sat in crowded out-patient clinics and had the clinic nurse make insensitive enquiries in front of everyone else. You do get better at handling the ignorance surrounding MRSA but you never get used to it. MRSA patients have enough problems to contend with without having to tackle the issue of stigma as well. The sticker on a hospital chart may change colour once MRSA clearance has been obtained but it appears that you remain a ‘labelled’ patient for evermore. The legacy lives on.

Health Service Exposed

I’ve long been a fan of Prof John Crown, Consultant Medical Oncologist, for the manner in which he speaks out to expose the faults in the Irish health system. John Crown does not mince his words – he says it as it is and in doing so has managed to rattle cages to shame the Department of Health into doing something about the disastrous health service in this country. He writes a regular column in the Sunday Independent which exposes the chinks and cracks in the system, and helps to paint a clearer picture of the problems involved. Last Sunday’s article was no exception where he likened the bureaucrats in the HSE (Health Service Executive) to the dinosaurs taking over in Jurassic Park, and named it ‘Burassic Park’.

In a week when the HSE announced a freeze on recruitment leading to health service cutbacks, they simultaneously announced a scheme of performance bonuses for senior HSE administrators. As John Crown so rightly pointed out, this clearly shows where the priorities of the HSE lie. This latest action by the HSE is a complete insult to those who are expected to continue to work in an already under-resourced and over-burdened health system. I personally feel very uncomfortable about the way in which our Minister for Health, Mary Harney, has reacted to the events that have happened at Barringtons Hospital recently concerning cancer care there. She is insisting that the Dept of Health has no authority over private hospitals and thus she says, it has no authority to take action to intervene. This does not bode well for the future of our health service which will have many more private hospitals coming on stream as the Minister insists on pressing ahead with the co-location debacle. Who will take responsibility when things go wrong in these private hospitals?

John Crown also clarified the problems involved in the stand-off that continues between the Dept of Health and the Irish Hospital Consultants Association (IHCA) over consultant contracts. To his credit, he actually criticised the consultants (his colleagues) for their increasingly unseemly row over private practice rights of their as yet, non-existent colleagues. He believes that the IHCA should concede the inevitable and accept that the new consultants will have to have new contracts which the Dept of Health will ultimately decide upon. He encouraged consultants instead to “channel their energies into the good fight, which is the fight for healthcare reform, universal health insurance and single-tier healthcare”. At last common sense has spoken!

Irish patients deserve equity of health care and a better healthcare service. We owe a great debt of gratitude to John Crown for the role that he plays as a doctor to advocate on behalf of all patients. He is a voice of reason in a world where common sense is sadly lacking. May he long continue to fight the good fight on our behalf.

MRSA Explained

I spotted the article below recently and stored it away for reference at a later stage. I’ve now decided to reproduce it here as I feel it’s a useful explanation of how MRSA (methicillin-resistant Staphylococcus aureus) survives despite exhaustive attempts at infection control.

With thanks to the author whose identity escapes me.

Why does MRSA exist?

It’s all about survival of the fittest – the basic principle of evolution, and bacteria have been around a lot longer than us, so they’re pretty good at it.

There are countless different strains of a single type of bacteria, and each has subtle natural genetic mutations which make it different from the other.

In addition, bacterial genes are constantly mutating.

Some strains’ genetic make-up will give them a slight advantage when it come to fighting off antibiotic attack.

So when weaker strains encounter antibiotics, they die, while these naturally resistant strains may prove harder to kill.

This means that the next time you encounter Staph, it is more likely to be one which has survived an antibiotic encounter i.e. a resistant one.

The advice from doctors who give you antibiotics is always to finish the entire course – advice which many of us ignore.

When you don’t finish the course, there’s a chance that you’ll kill most of the bugs, but not all of them – and the ones that survive are of course likely to be those that are most resistant to antibiotics.

Over time, the bulk of the Staph strains will carry resistance genes, and further mutations may only add to their survival ability.

Strains that manage to carry two or three resistance genes will have extraordinary powers of resistance to antibiotics.

The reason that hospitals seem to be hotbeds for resistant MRSA is because so many different strains are being thrown together with so many doses of antibiotics, vastly accelerating this natural selection process.

Clever things bugs aren’t they! You too can do your bit to keep them at bay. Always finish the entire course of an antibiotic and make sure you wash your hands properly to prevent the spread of germs. After all, this is all about the survival of the fittest.

Nursing Care in Hospital

I was referred to the UK earlier this year to undergo surgery in a specialist unit at an NHS hospital. This operation was unavailable in Ireland unfortunately so I had to pack my bags and head across the water to the unfamiliar territory of the NHS. Having ‘done time’ on numerous occasions in Irish hospitals, I was interested to see how the UK would compare. The conclusion I came to was that nursing care in the NHS has ‘gone bananas’.

My first impression of the hospital was a good one. On admission, my immediate surroundings appeared spotlessly clean and modern – a far cry from the appalling conditions found in many parts of the Irish health service. I was allocated a bed in a tiny room (no en suite facilities) beside the Nurses’ Station – this room had glass doors to it to facilitate observation of the patient. I thought that this easy visibility would limit any hope of privacy but in fact, it worked to my advantage. The glass doors provided a ‘bird’s eye’ view of the daily activities of the ward staff and this was a source of much entertainment throughout my stay. I did wonder however if the fact that I was a ‘Paddy’ with a history of previous MRSA infection (and recurrence) might not be the real reason why I’d been put in this room. Anyway, I was duly installed as a patient and was whisked off to theatre a few hours later, to go under the knife.

When I next ‘came to’ I was back in the same little room but this time I had to share it with all the paraphernalia associated with having had major surgery – the drips, drains, monitors etc. I lay there in a morphine-induced stupor in full view of the nurses and watched the world go by. I waited and waited for a nurse to appear at my bedside to offer some reassurance but as time went on, I realised that this was a false hope. The nurses only came into my room whenever they had to record my vital signs and even then, there was little or no personal interaction. It was like as if the patient was superfluous to the job in hand. When I was originally diagnosed with MRSA, I was barrier nursed but now this was different type of isolation. I could see endless activity at the nurses’ station with nurses filling out forms etc. but it appeared that very little time was actually spent with the patients. In Ireland, the nurses generally (though not always) interact well with their patients despite also being very busy. It soon became obvious that huge differences exist between our two healthcare systems in terms of nursing care. The NHS may be better in some respects than it’s counterparts here but it lacks the personal touch that thankfully still exists in Ireland. I cannot complain about the medical care I received from the NHS but the standard of nursing left me cold. Not once during my stay did any nurse ask the simple question of “how are you today?“. My medication was dispensed at regular intervals throughout the day without any explanations given. I simply wasn’t consulted at all. And there was definitely no humour to be had despite my best efforts to attract a smile. I have a lot of experience of spending time in hospital and so I’m not easily unnerved by hospital procedures but I can still imagine how frightening it must be for inexperienced patients to be left alone to cope in an unfamiliar environment. I appreciate that nursing these days is very hard work and sadly, it is also often a thankless task. However I’m in no doubt that patient care is compromised when nursing loses it’s personal touch.

After several days of observing the activities of the NHS, I devised a plan to put the ‘system’ to the test. Every morning a junior nurse would come into my room to offer a simple breakfast menu of “Weetabix/Cornflakes, Tea and Toast?“. The choice never varied. Each item of food dispensed had to be ticked off on a list by the nurse. I decided to ‘rock the boat’ one day and request a banana with my cereal. The nurse looked at me in despair having studied the menu, and replied “we don’t ‘do’ bananas at breakfast time“. It was hard not to laugh at this reply but I persisted in my request (out of sheer devilment) and the nurse got more and more flustered as she continued to scour her list for a ‘banana’ box to tick. Eventually I had to tell her that I knew that there were bananas in the ward kitchen and all she had to do was to walk a short distance to fetch one. After a long pause, she left the room and returned with the said banana. I felt like I’d scored a victory! Sad, isn’t it? But this is the sort of behaviour you’re reduced to when subjected to hospital care that is not patient-centred. This is a small, but clear example of how target driven the NHS has become. Nursing care it seems, is now all about ticking the boxes. I got such pleasure out of beating the system that day and by the way – the banana was delicious too!

MRSA – The Legacy

Anyone who’s ever tested positive for an MRSA infection will know what I’m talking about here. I’m curious to know when if ever, you can be declared free of this dreaded superbug? The standard procedure seems to be to aim for three consecutive negative screening swabs. Is this really enough to give you the green light for all-clear? Or does a requisite time-frame have to elapse before a recurrence/repeat recurrence can be ruled out? It’s been my own personal experience to discover that the medical profession does not seem to want to know or care about the reality of recurrence. Once you’ve been labelled with an MRSA status, it seems that you are forever more to be viewed as a ‘threat’ to mankind and believe me, it produces some ‘interesting’ reactions.

A close friend of mine (with a very good sense of humour) was admitted to hospital this week to have some neurosurgery performed on his back. He recounted to me the following discussion which took place between him and the admissions nurse.

Question: Have you ever had an MRSA infection?

Answer: No, but I have a good friend who has.

Question: Have you been in close contact with your friend?

Answer: Yes, but if you mean have we had sex – the answer is No! (Ha!Ha!)

Question: (asked with zero humour) Have you been in recent contact?

Answer: Yes, I have – our families meet regularly.

The interrogation terminated at this stage and my friend was then subjected to a full screening for MRSA prior to his surgery. He rang me this evening to tell me what had happened and we shared a good laugh about it together. I have had two reactions to this scenario.

Firstly, it’s good to know that patients are being screened whenever there is any doubt about the possibility of MRSA contamination. However I’d like to point out that the logic for screening in this instance seems to have been as a safety precaution for the hospital rather than for the patient. My friend was admitted on the day of his surgery and therefore the result of the screening would not have been known prior to his operation. Secondly, my friend was not asked for any details about my present status. It seemed to be a case of “once an MRSA risk – always an MRSA risk”.

My situation is that I contracted MRSA osteomyelitis of the frontal bone of the skull following surgery two years ago. I underwent intensive intra-venous antibiotic therapy to eradicate the infection and eventually got the all-clear some three months later following repeated MRSA screening. However my MRSA infection recurred ‘out of the blue’ nine months later and required further intensive antibiotic treatment plus extensive surgery to remove the diseased bone. I have not had any screening since the most recent surgery and yet it appears that I am still to be tarnished with the same ‘leper’ status acquired two years ago. I have been subjected to many strange reactions over the years. I’m aware that a huge amount of ignorance exists around having a positive MRSA status and therefore I can laugh at the consequences – I’ve no doubt that others are hurt and offended by the reaction received. There is a question that remains unanswered here however – “when can someone who has a history of recurrence of MRSA infection, be considered to be risk free?”. I’ve never been able to elicit a confident reply to this question from the medics. I suppose it’s a bit like the uncertainty faced by people who’ve survived cancer – no doctor can tell them with utter confidence that they will remain free of the disease. My conscience has taught me to stay clear of anyone who has had recent surgery or is immuno-compromised and I also avoid newborn babies for the same reason. I otherwise go about life quite normally without undue worries. However, the legacy lives on and I’d love someone to be able to tell me that I can leave it all behind.

Have you got any views on this?

Ireland of the Welcomes

Ireland is now one of the top richest countries in the world. In the mid-1980s, Ireland was a backwater with an average income level that was 30% below that of the European Union. Today, Irish incomes are 40% above the EU average and the Celtic Tiger continues to roar. Ireland’s exceptional economic growth in recent years has led to an influx of immigrants. We may have a booming economy but not everyone enjoys the same rewards. There were tremendous opportunities missed in the early days of the Celtic Tiger. We should have had substantial tax breaks as well as investment in social provision and infrastructure. Instead, most of the money went towards tax breaks for the better off and was used to fuel fancy cars, second homes, exotic holidays etc. while those less well-off were left to struggle to keep their heads above water. Meanwhile, our health service has suffered wanton neglect from years of underfunding by the various governments in power. Put simply, the Irish health service is in melt-down.

Despite a booming economy, we have hospitals that are seriously outdated with facilities that do not match the demands of a rapidly increasing population. An example of this is the rampant spread of health-care-associated infections (HCAI’s). I have written before here about our infection control policies. Comprehensive updated guidelines cannot be implemented despite the best efforts of healthcare professionals because of inadequate resources, sub-optimal infrastructure and a lack of access to relevant expertise locally. A recent death due to MRSA infection outlined yesterday in the Dublin County Coroner’s Court is testimony to this fact. The hospital in question, St. Columcille’s in Loughlinstown, Co. Dublin lacks the necessary resources and has no microbiologist in place to deal with MRSA and other such infections. Hospital staff have to consult with experts at other hospitals if such infections arise. What century are we living in?

Superbugs love this country – we are after all, well-known for being “Ireland of the Welcomes”. And, it looks like our Celtic superbugs are here to stay. Hospital acquired infections are now endemic in Irish hospitals and sadly patients are suffering and will continue to suffer. So much for the luck of the Irish!

Skin Deep

I’m pretty choosy about the television programmes I’ll watch these days but when I see something produced by Mint Productions, I never fail to be disappointed. Last night saw the screening of another programme in the RTE series ‘True Lives‘. It was called ‘Skin Deep‘ and covered the topic of living with a severe facial deformity. The message conferred by the programme was clear-cut – it’s no fun being facially different. Lives are changed forever by a facial deformity. It can have a devastating effect on people who have to cope with being ‘different’ in a world that’s obsessed with image and appearance.

Mr. Michael Early, Consultant Plastic Surgeon, explained how the anatomy of our faces and our facial expressions affect communication. He talked about the ‘triangle of communication’ – the area of the face between the eyes, the nose and the upper mouth. The programme featured five people with a variety of severe facial deformities which had been caused by genetics, or by an accident or as a result of cancer. These remarkably courageous individuals all possessed huge insight into how they are perceived by ‘normal’ people. Some people give them a ‘funny’ look, others look ‘curious’, while some take a ‘serious’ look and then ‘look away’ ashamed to have been caught staring. People who have a facial deformity lose their anonymity and become ‘different’. Their faces look unfamiliar and don’t conform to what ‘normal’ people look like. Society can be very cruel at times.

This programme has certainly helped me to keep my situation in context. I was pleased to learn last night that I’ve already taken the first step towards acceptance of my new look following recent surgery – I’ve got used to seeing my new face reflected in a mirror and no longer search for the ‘old me’. I know that true beauty comes from within. People need to look past the face which is after all, only skin deep – it’s what’s in the heart that really matters.

Voluntary Health Service

Our Minister for Health, Mary Harney, is very anxious to make cutbacks in the health service. You see, she faces a bit of a problem. The huge expenditure required to maintain the high salaries of the bureaucrats within the HSE (Health Service Executive) is eating into the budget that was allocated to improve the Health Service. It’s definitely a case of ‘robbing Peter (the patients) to pay Paul (public servants)’. Patients are fed up waiting for the awful conditions in our hospitals to improve. Hospital buildings are crying out for investment, much of the equipment is outdated and staff morale is at an all time low. So rapid action is needed if Mary is to save face.

First we were told that our Minister is putting a freeze on the employment of new health service workers for the month of September. The fact that the health service is almost on it’s knees from poor staffing levels doesn’t enter the equation. The figures have to balance at the end of the month somehow/anyhow. Now there’s another bright idea brewing. The Minister now wants to introduce a voluntary health service. Harney wants members of the public to ‘volunteer’ their services to provide support for hospital patients. Six month’s training and you’re in! Soon the staffing bill will be minimal as the general public takes over the running of our hospitals. This should also do away with the problem of nurses wanting higher salaries to match their skills when others are seen to work for nothing. This latest idea of course, has nothing to do with the fact that our public hospitals will suffer from staff shortages once the 2-tier health system swings into place. The co-located private hospitals will undoubtedly ‘lure’ highly trained staff over to their better working conditions. This is not about improving the lives of patients, it’s purely a cost saving measure.

Well, I’ve got another idea. Mary Harney should address the real cause of the overspending in our health service. The HSE is bleeding the system dry – she needs to ‘nuke’ it completely and start again from scratch. HSE employees could choose to either vacate their positions voluntarily or to continue their service in a voluntary capacity. That should reduce the bills, no problem!

Miscarriage

I wrote recently on the subject of miscarriage and commented on how things have changed for the better over the years. Well, it appears that hospital practice has yet to change in some hospitals. My heart goes out to the parents in this instance in an NHS hospital in the UK. The treatment they received recently following the loss of their baby through miscarriage, is unacceptable. It will have done nothing to help the grief process. When I miscarried my baby son twenty years ago, my husband and I were asked if we would like to see him. He was brought to us lying in a blue injection tray with his tiny little body covered by paper towelling. I remember thinking that this was an undignified way in which to present us with our baby but as I was so overwhelmed with grief at the time, I never commented on it. However, I’ve never forgotten the distressing image of that blue plastic tray and sadly, my experience is in no way unique.

The Miscarriage Association of Ireland some years ago set about addressing this problem in our maternity hospitals. They designed a little fleece wrap to enable babies that have been lost through late miscarriage, to be handed to their parents with the dignity and respect they deserve. Thankfully today, these wraps are now part of hospital supplies in each maternity unit in Ireland. The NHS, it appears, still has a lot to learn.

Daniel’s Day

This day every year is a special day in our family. It is a time to reflect on what might have been. If only …

Twenty years ago today I miscarried a baby son mid-way through a pregnancy. He was perfectly formed with ten fingers and ten toes but he was very tiny. He was also completely still. He never got to take a breath. I had been admitted to the maternity hospital one week previously with severe pain and bleeding and was put on bed rest for observation. An ultra-sound scan on admission showed that the baby was the right size for dates and was active – I treasure the images I was shown of him sucking his thumb in utero. This was my third pregnancy – my first went full term with a normal delivery (our son) but my second pregnancy had ended in a ‘missed miscarriage’ at the end of the first trimester. I was told at that time that miscarriage was a common occurrence and was unlikely to happen again. I believed them but sadly, I was to prove them wrong. I became increasingly unwell while in hospital, my waters finally broke and some 36 hours later I miscarried the baby. I was taken to theatre for surgery while my baby was taken away for a post-mortem. Leaving the hospital several days later ’empty-handed’ really brought home the enormity of the loss.

No parent ever expects to have to bury their own child. It goes against the natural order of life. My husband and I were grieving and still in shock and yet we were being faced with decisions that no parent should ever have to make. In those days there was no support network in place in the maternity hospitals to help to guide parents through the experience. We finally decided that we would like to have our baby cremated and made the necessary arrangements through a funeral director. It is our own wish to be cremated when the time comes and therefore it was fitting to consider this option for our tiny baby son as well. Cremation in Ireland at the time was still somewhat frowned upon (for religious reasons) though things are very different today. We chose a name for our baby – Daniel – to give him the identity he deserved. We have never regretted any of the decisions we made at that time. Three years later our sorrow turned to joy with the birth of our daughter. Life goes on but you never forget what might have been, if only …

Thankfully, miscarriage is no longer the taboo subject it once was. There is now an excellent support service available through the Miscarriage Association of Ireland. The Association is a charitable body set up by, and with the support of women (and men) who themselves have been through miscarriages. They offer telephone support to bereaved parents and hold monthly support group meetings. They also have a specially commissioned Book of Remembrance in which to commemorate babies lost through miscarriage.

Today, like every other year on this date, I will place an apple from the tree in our garden at the place where Daniel’s ashes lie. For me the apple symbolises the sharing of a part of our family life with Daniel. His time with us was very short but he was an important part of our lives and there will always be a place for him in our hearts. This is his day.