MRSA Awareness

Everyone has heard of the hospital superbug MRSA and many have a view on how to stop it. I recently came across the results of a survey carried out in Ireland*, to assess the knowledge and perception of methicillin-resistant Staphylococcus aureus (MRSA) among the general public.

The study concluded…

“The public are generally knowledgeable about MRSA but most agreed that they would feel angry and afraid by its diagnosis. Future public education campaigns on MRSA should be aware of this response.”

MRSA infection can be very serious or even fatal so it’s easy to understand why people would be afraid of a diagnosis. I was pretty scared when first diagnosed with MRSA but I can honestly say that I did not feel angry about it. The only time I felt any anger was when I was exposed to the stigma attached to MRSA, by hospital staff who had not been properly trained in infection control. Why is it then that most people in the above survey, agreed that they would feel angry if diagnosed with MRSA?

I can’t help but feel that the media coverage of MRSA has a lot to do with the opinion of the general public. The newspaper coverage tends to be alarmist in nature and is centered around individual’s stories. MRSA is a problem and should be reported but the media should reflect the whole story about MRSA.

Hospital cleaning is part of the answer but so is the reduction of antibiotic use, which is regarded as one of the most effective ways of reducing MRSA. More microbiologists are needed as well as more infection control nurses. Increasing the number of isolation units so those with MRSA can be treated without the fear of infecting others, is also part of the answer as well as reducing bed occupancy rates in hospitals.

And always remember… the most important thing you can do to reduce the spread of MRSA, is to wash your hands thoroughly and often. If soap or water isn’t available, use alcohol-based hand sanitizers.

How do you think you would feel if you, or someone close to you, was diagnosed with an MRSA infection? Would you feel angry?

* This survey was published in the British Journal of Infection Prevention.

Knowledge of MRSA

Did you know that hand washing is an effective way to prevent MRSA contamination and infection? According to a recent survey, the main source of the public’s information about MRSA, is through the media. The results of the survey have shown that there is a clear need to further educate the public on how to prevent the spread of infection. You can find a report here in The Irish Times online. Ever since my own brush with MRSA, I’ve tried to make it my business to become better informed about infection control and to spread the word.

MRSA is a subject close to the heart of The Biopsy Report. Consistently, the top posts on this blog are the ones which contain information on MRSA. The most frequently used search engine terms all refer to queries about MRSA. Terms such as “boils on butt”, “do you have mrsa forever”, “antibiotic resistance”, “chances of mrsa recurrence”, “superbug news”, “what is difference between mrsa and C Diff” and “mrsa nasal swab”, appear regularly and show that there is a huge hunger out there for more information on MRSA. Two funny search terms which appeared recently were “mrsa bed and breakfast” and “steph and staph infection together.” The mind boggles to think what was going through the minds of those people?

There is no doubt that infection control would benefit from greater public awareness. The media coverage of MRSA is far from an ideal source of information because of a tendency towards a sensationalist approach. We need a well-orchestrated campaign to combat the spread of MRSA and where better to start than online. Spread the word, not the germs.

Value for Money?

A new set of draft standards for infection prevention and control, has been published by the Health Information and Quality Authority (HIQA). HIQA was established in May 2007 as an independent Authority, with broad ranging functions and powers, reporting to the Minister for Health. It was set up to drive safety, quality, accountability and the best use of resources in our health and social care services. Our present health service is neither efficient nor cost effective, it swallows up vast sums of money with poor return. HIQA aims to correct this imbalance and deliver value for your money.

The new standards once finalised, will provide a national framework to improve the performance of healthcare settings in order to reduce healthcare associated infections (HCAI’s). These standards are a key component in ensuring quality and safety. As Eithne Donnellan reports in the Irish Times today, “the standards cover accountability, hand hygiene, reducing infection from medical instruments, surveillance of infections, having appropriate multidisciplinary infection-control teams in place which reflect the size and specialities of a facility, informing patients immediately of their infection status, and management of outbreaks“. HIQA now wishes to consult with interested parties and the general public before drawing up a final set of standards to be published later this year. Everyone has a right to have their view considered and submissions can be made online here to the Authority until the 18th July, 2008. HIQA envisages having the standards finalised and ready for ministerial approval by September.

I’m really pleased to see that the Department of Health is taking infection prevention and control extremely seriously but I’m not convinced that we’re getting value for money. You see, I’m aware that the HSE published an updated set of comprehensive guidelines back in 2005, called “A Strategy for the Control of Antimicrobial Resistance in Ireland ( SARI)” but these guidelines, which have a marked similarity to the new standards drawn up by HIQA, were never implemented. It was publicly acknowledged by the HSE at the time that the guidelines failed because of inadequate resources, sub-optimal infrastructure and a lack of access to relevant expertise locally. Has anything changed in the interim, I ask? Forgive me if I’m wrong, but it seems to me that there’s very little new about the report published yesterday other than the change of name. I’d love to know how much it’s cost to date. Meanwhile, the health service continues to struggle on with it’s inadequate resources and sub-optimal conditions. HIQA faces a hard task ahead.

Confused about MRSA?

Hardly a day passes without another MRSA story hitting the headlines. People are right to be concerned about this resistant superbug but sometimes the stories do not match the facts, and misunderstandings occur. I am no expert when it comes to talking about MRSA but I have learnt enough through my own experience of MRSA infection, to be able to share some facts with you.

So, what does it mean when someone says “I’ve got MRSA”?

This seems to be an area where much confusion exists. First of all, it should be clarified that a person can be either ‘colonised’ with or ‘infected’ by MRSA. People who are colonised usually have no symptoms but they still have the potential to pass on the bacteria by touch. Those who have an infection caused by MRSA are usually unwell and will require treatment.

MRSA Colonisation

The significance of being ‘colonised’ with MRSA is often poorly understood. Some people harbour the bacteria in their nostrils or on the surface of the skin without being aware that they are colonised, and they remain well. It is possible to pick it up on your skin by simply touching a contaminated surface or indeed from another person who is colonised but it will not cause harm unless it enters your system through microscopic breaks in the skin. When someone is found to be colonised it does not mean that they will automatically go on to develop an infection. As long as you are well there is no need to be unduly alarmed. You should remain extra vigilant for any unusual skin complaints or if you develop a high temperature and seek medical attention if in any doubt. You will be given instructions on how to de-colonise yourself with topical agents such as nasal ointment and bodywash/shampoo to eradicate nasal and skin carriage. It is important to remember however that a colonised person is a ‘carrier’ of MRSA and has the potential to colonise/infect others through contact. This is the reason why stringent infection control measures are required in hospitals as patients who are already ill, are at high risk of developing an MRSA infection. Many people are carriers without realising it and therefore it is really important that everyone takes the necessary precautions to prevent the spread of bacteria. Hospital visitors should observe good hand hygiene and use alcohol gel on their hands before and after visiting a patient. Ideally, hospital visiting should be kept to a minimum.

MRSA Infection

When somebody receives a diagnosis that they are ‘infected’ with MRSA they are usually already unwell. MRSA is not only restricted to hospital settings. Community-Acquired MRSA (CA-MRSA) is a rapidly emerging public health problem in the USA but it is rarely seen in Ireland. It causes pimples and boils and can infect wounds and grazes. A culture (swab) is required to determine the sensitivities of the bacteria and the duration of treatment will depend on severity of illness and clinical response. However the most prevalent form of MRSA seen in Ireland is Hospital-Acquired (HA-MRSA) infection. It thrives in hospitals where people are in close proximity and may have their defences already weakened by illness. Those who have had recent surgery or who are immuno-compromised are also at high risk of infection. The hospital environment also tends to be rife with multi-resistant bacteria as a result of the heavy use of antibiotics. The types of infections seen are wound infections, chest infections, bone infections or bloodstream infections and these have the potential to cause serious illness, or even death. Hospital acquired infections can be very difficult to treat and usually require long-term intra-venous treatment with a combination of antibiotics.

A reduction in antibiotic consumption levels, frequent and proper hand washing, and improved basic hygiene levels in hospitals are all essential to reduce the level of contamination. Hand hygiene is the single most effective defence against the spread of MRSA. This means that staff, patients and visitors alike all have a simple but important role to play in the fight against MRSA.

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.

Up Yours!

It’s come to that. There’s only so long people can wait for help when their lives are on the line.

It’s been well-documented over recent years that Co Donegal has a raw deal when it comes to cancer services. There are unacceptably long delays for cancer screening in the region and patients who have had surgery, have to travel long distances to access chemotherapy and radiotherapy services. As you can imagine, this places a huge strain physically, emotionally and financially on the patients, and their families. It’s wrong and it shouldn’t be happening. The HSE is well aware of the deficiencies in the system but has failed to take action.

Well, Donegal has got fed-up waiting. A not-for-profit organization, the North West Wellness Committee (a voluntary group), has set about correcting the problem themselves. Through voluntary fund-raising, they plan to buy a breast-screening machine and hope “to have breast screening available to women in Co Donegal as early as next spring. It then aims to build a community cancer clinic within three years and has already had an 11 acre site donated for the purpose. All funds will be raised voluntarily and any profits made will be re-invested back into the cancer services”.

Now that’s what I call efficiency. This group could teach the HSE a thing or two about not-for-profit health care. The HSE should hang their heads in shame and they deserve to have their faces rubbed in it.

Only, please remember to wash your hands afterwards!

The secret to better health

Spread the message – not the germs.

We’ve all heard our Minister for Health harping on about handwashing as the ‘way forward’ in the war against the superbugs. Handwashing is important to our health but it is only one of the many health care guidelines produced by SARI (an offspring of the HSE) for the control of MRSA in Ireland. For the moment, it would appear that the HSE has made it a ‘national priority’ to use handwashing as the weapon of choice. What they’ve failed to communicate properly however, is that handwashing is only effective if it’s carried out frequently and in the right way.

If people don’t wash their hands frequently (especially when they’re sick), they can spread germs directly to other people or onto surfaces that others touch. The correct procedure is for people to wash their hands with soap and water for at least 15 seconds. They should rub in between the fingers, the top and palm of their hands and under the fingernails, the friction being the reason which zaps off the germs. Then rinsing for an additional 5-10 seconds completes the process before patting one’s hands dry with a disposable paper towel.

How does one comfortably measure the 20-25 seconds it takes to have clean, germ free hands without watching a clock? The secret to getting the timing right can be solved by humming the “Happy Birthday” tune twice over in one’s head.

Simple, eh! But if you catch someone singing Happy Birthday out loud while they wash their hands, kindly remind them the washing still works if the birthday song is silent. In fact, tell them it works better if it’s silent!

Bring Back Matron

Those were the days when matron ‘ruled the roost’ – woe betide anyone who stepped out of line! The old matrons ruled with an iron fist and commanded huge respect in the hospitals. They held both power and authority and as a result our hospitals were spotlessly clean.

Nowadays, by comparison our hospitals are filthy and it seems that nobody wants to take responsibility. Better hygiene is the only way to ward off superbugs. MRSA has been shown to survive in dust and dead skin cells. It doesn’t matter how much hand washing is done – to please our Minister for Health – if the hospital environment is dirty, the spread of infection will never be stopped . De-contamination of the hospital wards and equipment is essential if we are to curb the rise of the MRSA superbug.

We need to put Matron back where she belongs – in charge!

Control of MRSA

It is a well-known fact that MRSA in now endemic in Ireland. Today’s infection levels suggest that the guidelines for the Control of MRSA in Ireland, produced by SARI (an offspring of the HSE) were never implemented. Comprehensive updated guidelines, published by the Health Protection Surveillance Centre (HPSC) in September 2005, stated “Responsibility for the implementation of these guidelines rests with individuals, hospital executives and, ultimately, the Health Service Executive. The Infection Control Subcommittee, when reviewing the literature and the evidence, undertook to provide guidelines according to what is currently consistent with best practice. However, it is acknowledged that in many healthcare settings in Ireland, it will not be possible to implement much of what follows despite the best efforts of all healthcare professionals, because of inadequate resources, sub-optimal infrastructure and a lack of access to relevant expertise locally. Nonetheless, these are guidelines that all healthcare facilities should aspire to implement. Where it is not possible to implement some or part of the recommendations, the reasons for this should be highlighted to senior management. In this way, it is hoped that these guidelines, in tandem with other measures, will heighten the profile of infection control and prevention, and also facilitate the provision of the appropriate resources.”

What has the Minister for Health done in response to all of the above? Overall, have sufficient resources been allocated to the problem? No. Have we seen any evidence that appropriate resources have been allocated to improve the Dickensian infrastructure of our public hospitals? No. Has the problem of insufficient personnel in infection control been corrected? No. Have any senior management in the Health Service or HSE, been held accountable for their failure to implement the guidelines? No. Our Minister for Health has instead zoned in on the failure of hospital staff to wash their hands. “Hand washing is essential”, she says. She’s right, but hand washing alone won’t solve the problem!

On 22 August 2006, five years after SARI launched it’s first report, the HSE finally came out with hands up, saying it needed €20 million a year to combat MRSA. They stated that this money was needed to employ more consultant microbiologists, more infection control nurses, more antibiotic pharmacists and more surveillance staff. Recently we were told that the HSE failed to spend almost one fifth (€97.7 million) of it’s allocated budget last year. Now that sort of money would go a long way to help control the spread of MRSA in Ireland! Dealing with hospital infections costs serious money. While the MRSA problem is only one of many areas in our health service which requires an urgent allocation of resources, not dealing with this problem will cost more in the long run. Infection control is cost-effective as well as being life-saving. Prevention is always better than cure.

However, it now looks as though MRSA has reached a stage where it cannot be eradicated in Ireland. Infection control experts must have little to be optimistic about. We are well-justified to be fearful of MRSA. Superbugs rule, ok?

Infection Control saves Lives

We all know at this stage that infection control is a big problem in Irish hospitals. Outbreaks of MRSA and many other dangerous infections are on the increase. Huge investment is now required in the health service to bring about radical change in the control of infection. Here is my list of things-to-do for Mary Harney now that she’s back (where she wants to be) as our Minister for Health. This is not rocket science. These are obvious changes that could be put in place if only the funding was made available.

1. Practice preventative medicine – provide mandatory testing for MRSA colonisation for all patients being admitted to hospital. The present system for testing nasal swabs takes too long for results to be processed (2-3 days). A faster, but more expensive testing mechanism is available and could be used for all patients being admitted through A&E.

2. Microbiology is a key component of infection control. Many more microbiology staff are required and lab facilities need to be urgently expanded and updated.

3. Improve basic hygiene practice by staff on the wards – provide alcohol gel dispensers beside every bed, more hand washing facilities needed for everyone, improve cleaning of equipment etc.

4. Reduce the bed occupancy rate to less than 80% – in Ireland it’s over 100% most of the time (is it any wonder the nurses are moaning about their job lot!) – more beds in public hospitals are needed now.

5. Provide proper isolation facilities for infected patients – it’s like a bad joke the way the situation is being managed at the moment.

6. Clean hospitals = cost-effective health care. Our hospitals are filthy! Stop the present practice of sub-contracting the cleaning of our hospitals to outside agencies. Each hospital needs to take back responsibility for it’s own state of affairs.

7. And please stop messing around with plans for a 2-tier health system and get working on a 1st class health system for everyone!