MRSA – who’s to blame?

We live in a world today where sadly the culture is one of blame and shame. When things go wrong medically, we are very quick to point the finger of blame in an effort to console ourselves. I would suggest that the time has come to look at the bigger picture and to take more responsibility for our own health.

Whatever way you look at it, the Irish health service is in disarray. The present debacle in cancer services in this country has come about through years of political mismanagement. Despite massive government spending on the public health service, there is still a serious shortage of beds causing back-up throughout the system and the waiting lists for treatment are a joke – except that it’s not a bit funny if you happen to be waiting on a list. The consultants are unhappy with the new contract on offer from the Department for Health and while the negotiations drag on year after year, there’s still a serious shortage of consultant doctors throughout the country. The NCHD’s, junior doctors, nurses, paramedical staff and ancillary staff are not exactly happy with their lot. The infrastructure of most public hospitals is crying out for re-investment and in many places equipment is lacking or out-dated. Almost every week another story hits the news headlines about the latest failing in the system. This week it emerged that a leading Dublin teaching hospital, Beaumont Hospital, had inadequate facilities for the control and prevention of MRSA as well as for other infections. The report raised serious questions about the safety of patients due to inadequate isolation facilities and a cramped, out-dated intensive care unit. This hospital is the national centre for neurosurgery and kidney transplantation and yet it’s unable to achieve adequate infection control due to lack of resources. Yesterday it was reported that no Irish hospital had scored highly in the first national hygiene audit carried out by HIQA (Health Information and Quality Authority). It concluded that most hospitals should and could do better. This is appalling news at a time when hospital-acquired infections and especially MRSA are causing so much concern. I think what really galls me the most is the fact that our Minister for Health, Mary Harney continues to insist that a 2-tier health system is the way forward and yet she freely admits that she and HIQA have little or no control over private hospitals. Who might I ask will be responsible for them?

When I was first diagnosed with an MRSA infection following surgery some years ago, the source of the infection was not an issue for me. All that mattered was that I got the right treatment and got better. At a later stage in my treatment, I discovered purely by accident that I’d shared a room post-operatively with an MRSA infected patient. Initially, I felt angry about this as I knew it should not have happened but in time I realised that my anger was misplaced. I had no way of proving the source of the infection – MRSA is everywhere and I could have picked up the bacteria from numerous sources within the hospital. I may indeed have already been colonised with MRSA (from previous hospital admissions) when admitted to the hospital – who knows? Many people are carriers without realising it as it does not affect them as long as they remain healthy. Hospitals are reluctant to introduce mandatory pre-admission screening for MRSA. They cite lack of funding and inadequate pathology services as the reason but I suspect that fear of litigation is more likely the cause. My infection had serious consequences for my health but I was lucky, I survived it – many don’t. I had no desire to play the blame game because I knew that it would be a futile course to follow. It was more important to put all my energy into getting better, and staying better.

Patients face many challenges in today’s crowded and strained medical system but there is a great deal that patients can do to protect themselves. Hospital-acquired infections are not new, they’ve been around for as long as hospitals but the amount of antibiotic resistance has changed over the past few years. The overuse of antibiotics in the general community for viral infections like the common cold is also contributing to the MRSA problem and this is evidenced by the recent increase in community-acquired infections (CA-MRSA). Poor hygiene standards in hospitals are only part of the problem. Hospitals are breeding grounds for resistant bacteria due to heavy use of antibiotics and the over-100 per cent bed occupancy rates. Hand-washing amongst staff is extremely important to stop the spread of superbugs and there is a continuous need to improve preventative measures. Any strategy to minimise healthcare associated infections (HCAI) must include the education of all healthcare workers on what is appropriate practice, as well as the education of patients, visitors and the public. Patient’s visitors have a part to play in improving infection control – they should keep hospital visits to a minimum and always wash their hands before and after visiting a patient. If you are unhappy with any aspect of medical care received, you don’t have to put-up with it – make your feelings known. Ask questions – don’t wait to be told. This is the best way to bring about change for the benefit of all. It’s also important to remember that people do have good experiences in hospital as well and hospital staff welcome acknowledgement of this. Personally, I will never go into hospital again for elective treatment without ensuring that I have first tested clear of MRSA, both for my own safety and for the safety of others. The time has come for Irish people to stand up for themselves. We need to let the powers that be in this country know what we want from health care delivery. Politics, both medical and party driven, have influenced decision-making and the patient has been forgotten. The health service holds all our lives in it’s hands. We owe it to ourselves to be informed so that we will be in the best position to manage our own health care.

5 Responses to MRSA – who’s to blame?

  1. Kevin Connolly says:

    The idea that you can’t blame the hospital for the MRSA infection follows the hospital party line perfectly. Public health is an exercise in risk management. Walking across the street is an exercise in risk management. You can’t rule out getting killed when someone runs a red light, but you can reduce the risk of getting killed by looking to see if the light is with you or against you.

    In the hospital setting, the ISOLATION of infection disease patients serves to reduce the risk of transmission. The idea of putting a MRSA-infected patient in a room with a post-surgical patient is nothing less than criminal. It is also par for the medical profession.

    Four years ago, my wife went to hospital with diverticulitis. While she was in hospital, she was superinfected with MRSA. She was in a room with a patient who had just given birth by caesarian. The nurse moved directly from giving hands-on care to my wife to the ob-gyn patient WITHOUT WASHING HIS HANDS. I spent more than a month at my wife’s bedside, developing a case of MRSA Enteritis myself, and not once in the entire month did I see a nurse or physician wash his or her hands, except that I drew the line and would not allow anyone to touch my wife until I saw them wash. Of course, they then went from my wife to other patients without washing.

    I even saw nurses handling my wife’s bedpan (which contained more pus than feces most of the time) without gloving.

    MRSA was created by overuse of antibiotics, non-compliant patients who did not finish their medications, and the cavalier medical profession, for which hand wash and isolation are “yesterday’s news, but there’s so much MRSA in the community, it’s futile for us to try to exterminate it in the hospital.”

    Scary, but true. Stay away from the hospital at all possible costs.

    • jb harshaw says:

      The majority of your post is spot on, but the second to last paragraph:

      >MRSA was created by overuse of antibiotics, non-compliant patients who did not finish their medications, and the cavalier medical profession, for which hand wash and isolation are “yesterday’s news, but there’s so much MRSA in the community, it’s futile for us to try to exterminate it in the hospital.”

      Is in fact completely FALSE (and is as you called it “the hospital party line”).

      Cf http://mrsa-research-center.bsd.uchicago.edu/timeline.html

      MRSA has always existed, naturally — it pre-existed the development of antibiotics — and it didn’t become a problem (wasn’t “created” by) the overuse/abuse of antibiotics (and certainly NOT by “non-compliant patients” — that’s an “urban myth” that doctors & hospitals promote in order to avoid the medical profession taking the blame). Alexander Fleming (the discoverer of Penicillin) was not only AWARE of resistant strains, but WARNED the industry of this aspect in his original papers, and then WARNED THEM AGAIN at several later points in time, not the least of which was his EMPHATIC discussion of it during his Nobel Prize acceptance speech (you can go look that up if you want, it’s well documented).

      No. MRSA started becoming a problem almost IMMEDIATELY — it was isolated and identified *in British hospitals* in 1960 — LESS THAN ONE YEAR from the introduction of the Methicillin antibiotic.And there were many outbreaks IN HOSPITALS in the 1960’s, spreading from Britain to Europe and Australia — almost certainly via medical professionals as the “vector” (because MRSA was entirely unknown in “the community” until the 1980’s at the earliest).

      And the blame lies almost ENTIRELY on the medical profession — THEY were the ones who controlled antibiotics, and THEY were the ones who virtually abandoned proper antiseptic and hygenic practices — because see they had this “wonder drug” that they believed made all of that far less necessary (IOW, they got “sloppy” and arrogant).

      As you have noted (and many others have proven), that kind of sloppiness persists, and indeed one sign of it is the “hospital party line” regarding the shifting of blame, and the poor isolation and poor antiseptic practices that persist (even though everyone now KNOWS it is a major problem).

  2. Steph says:

    Welcome Kevin and thanks for your comment.

    I’m sorry to hear about your wife’s situation and I admire you for taking the stance you did to protect her (and others) from further cross-contamination.

    I’d like to clarify that I didn’t say that “you can’t blame the hospital for the MRSA infection”. What I did say was that I had no desire to play the blame game because I realised that it would be futile course of action. I did however make my feelings known to the medics as to where I felt the problems arose in my own case. It’s very difficult to prove where/when someone picked up MRSA – I’m sure you will have seen the cases in the media – but that doesn’t mean that we shouldn’t continue to be vigilant and and to insist on better hygiene, exactly as you did.

    In an ideal world all infectious patients would be isolated but the Irish health service is far from ideal. If a hospital doesn’t have enough of the proper facilities, then what are they supposed to do? The system is at fault as much as those who work in it.

    I agree with you entirely about staying away from hospital if at all possible – people should only be there when there is no other treatment option available.

    Regards, Steph

  3. emily says:

    i am currently doing a school project on whether hospitals are to blame for the spread of MRSA and after reading through this article i am struggling to understand what point of view you are coming from. i am also struggling to find information on the argument that it isnt the hospitals. i would highly appreciate it if you could help me
    thankyou a lot
    emily

  4. Steph says:

    Emily – Apologies for the delay in getting back to you. I’m not in a position at the moment to answer your query in any detail.

    There are two forms of MRSA – hospital acquired (HA) and community acquired (CA). Ireland is largely free of CA-MRSA but our hospitals are riddled with MRSA. By contrast, the USA has a serious problem with CA-MRSA, I can’t speak for what goes on in their hospitals.

    If you click on ‘MRSA’ in my tag cloud above (this blog is about), you’ll find lots more info on MRSA relative to Ireland. I wish you the best with your project.

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