Super Pillow

I’ve always had a ‘thing’ about bringing my own pillow (if possible) whenever I overnight away from home. And, that includes when I’m admitted to hospital… my non-allergenic, frequently washed pillow comes too plus a supply of my own pillowslips.

Why? There are lots of reasons why but chief amongst them is hygiene. I’ve never liked the idea of burying my head in someone else’s pillow. The crisp, white pillowslips found on hospital/hotel pillows, do not reassure me. According to an article in yesterday’s paper, my reservations are well-justified…

A recent clinical trial carried out by Bart’s Hospital and the London NHS Trust, concluded that the risk of infection from bedding is “grossly underestimated”. “Dead skin, bodily fluids and dandruff found on hospital pillows made them a potential source of more than 30 types of infection”. Read on… if you dare!

Pillow aims to halt the spread of superbugs

Carol Ryan

AN IRISH company has invented a pillow that may help to reduce the risk of picking up a hospital-acquired infection (HAI) such as MRSA from lying on contaminated bedding.

Gabriel Scientific’s “SleepAngel” pillow was the subject of a clinical trial by Barts and the London NHS Trust, which found its product to be more hygienic than regular hospital pillows.

Several international studies have found that hospital bedding can harbour bacteria if they become contaminated with the bodily fluids of a patient who has an infection.

While regular washing is a standard infection-control measure in all Irish hospitals, the Barts study concluded that the risk of infection from bedding is “grossly underestimated in clinical practice”, and that regular cleaning may not be enough.

The inventors of the SleepAngel pillow, Billy Navan and David Woolfsen, both worked in the health industry and saw the problems caused by superbugs in Irish hospitals. They thought the risk of infection from pillows was being overlooked in hospital hygiene policies and spent nine years creating their infection-control pillow.

Most of that time was spent searching for a material that could keep germs out of the interior stuffing while still allowing the pillow to “breathe”. A membrane normally used in heart stents was incorporated into a specially designed filter.

During the Barts study, their product was put to work alongside standard NHS pillows in UK hospital wards. Both were used on cardiac, vascular and respiratory wards and tested after three months.

The results showed high levels of contamination in the standard pillows. Some had bacteria levels which were described by Dr Arthur Tucker, who led the study, as a “bio-hazard”. Dead skin, bodily fluids and dandruff found on the pillows made them a potential source of more than 30 types of infection ranging from flu to leprosy. The SleepAngel pillows tested negative for interior contamination and were much less likely to have bacteria on the outside.

There was also some unpleasant news about domestic pillows – apparently you are never alone in bed because after two years of use, one-third of a pillow’s weight is made up of dust mites, dead skin and bacteria.

Infection control has become a big challenge for hospitals in recent decades. Dr Brian O’Connell, medical director at the National MRSA Reference Laboratory in St James’s Hospital, explained that the superbug problem first surfaced in Ireland during the 1980s and quickly became “endemic” in some hospitals. Rates of infection have declined in the past few years but cross-infection still creates a huge extra workload for hospital staff and puts patients at risk.

Of real concern is stopping the spread of MRSA, a strain of the common Staphlococcus aureus bacteria that has developed resistance to antibiotics, making it difficult to treat. If the bacteria gets into the system through a break in the skin it can cause infections but, in more serious cases, can lead to life-threatening diseases.

The HSE Infection Control Action Plan estimates that about 25,000 in- patients develop a HAI every year in Ireland.

The cost of treating and preventing HAIs is €23 million per year and about one-third of infections are thought to be preventable.

Source: HEALTHplus – The Irish Times

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.

Improving Patient Safety

In recent years a primary concern for patients being admitted to hospital has been the risk of contracting methicillin-resistant Staphylococcus aureus, commonly known as MRSA.

Many cases of MRSA arise from the transfer of germs from patient to patient due to lack of good hygiene. To address this, hospitals have revised their hygiene practice. Measures have included the introduction of hand-sanitising kits and tougher visitor regulations to reduce the risk of infections being brought in from outside. However, the concern over post-operative infections lingers.

The Royal College of Surgeons Ireland (RCSI) is introducing a Surgical Development Initiative for trainee surgeons which will focus on maximising patient safety and preventing infections following surgery. The RCSI initiative is being launched this month to the new group of surgical trainees who commence their basic surgical training in July. It has been developed specifically for trainees to improve practice in the areas of hand hygiene, the optimal use of antimicrobial prophylaxis, the care of wound sites after surgery and the prevention of bloodstream infection that can result from infected intravascular devices.

The RCSI’s new project is in line with the World Health Organisation’s (WHO) recent prioritisation of patient safety, to prevent healthcare-associated infection (HCAI) and its ‘Safe Surgery Saves Lives‘ initiative which is endorsed by RCSI.

In tackling post-operative infections, WHO has recently published it’s WHO Surgical Safety checklist. The 19-point checklist has shown improved compliance with standards and a decrease in complications from surgery in the eight pilot hospitals where it was used for evaluation. It demonstrated a decrease in mortality from 1.5 per cent to 0.8 per cent and a drop in surgical site infection (SSI) rates from 6.2 per cent to 3.4 per cent.

As someone who has battled against serious post-operative infections (MRSA, cellulitis and osteomyelitis), I welcome any initiative which will reduce the risk of surgical site and healthcare-associated infections.

The WHO surgical safety checklist is an essential aide to patient safety. This video demonstrates how the checklist is used at Great Ormond Street Hospital…

Information Source:  The Irish Times

It’s not rocket science

Everyone has heard of the hospital superbug MRSA and many have a view on how to stop it. MRSA is a serious problem in Ireland. A new report released this week has found that MRSA is costing Irish hospitals more than €23 million every year. Ireland ranks fourth in Europe for MRSA bloodstream infection rates with only Portugal, Greece and Italy ahead. Much of the media coverage on reducing the incidence of MRSA tends to concentrate on hospital cleaning and poor hygiene. This latest report addresses the whole story about MRSA.

The MRSA in Ireland: Addressing the Issues report, was conducted by a multidisciplinary advisory group including microbiologists, hospital pharmacists and patient advocates, and sponsored by healthcare firm Pfizer. The report found that the cost of dealing with healthcare associated infections (HCAI) totalled €233.75 million a year, with the MRSA cost representing 10 per cent of the overall figure. The main factor contributing to the cost is the increased length of stay by patients in hospital. Patients with MRSA spend, on average, 2.5 times longer in hospital.

Commenting on the report, Dr Edmond Smyth, Consultant microbiologist at Beaumont Hospital and chairman of the MRSA group, said that we need to “improve patient staff ratios; have laboratories on hospital sites that provide rapid diagnosis for MRSA and other infections; be able to isolate patients; ensure that doctors and nurses and healthcare workers generally wash their hands before and after any contact with a patient; ensure that we use antibiotics appropriately; discharge patients home earlier.”

“It’s the simple things,” Dr Smyth says. “There’s no rocket science here, we just need to do all these simple things at the same time.”

It may not be rocket science but at a time when the health service is facing over €1 billion in cutbacks and with the present economic downturn, I can’t really see all this happening, can you?

Cartoon by Chris Slane

Information source: TV3 News and The Irish Times.

KOKO

I said I’d come back and let you know how my head is faring. Sorry to keep you waiting. I’ve been busy trying to keep on, keeping on!

As you know, I had a fairly easy post-operative phase before the internal splinting was taken out of my head last week. I mistakenly thought that  I was over the worst. How wrong I was. My head felt very raw and painful once the splints came out and especially the side of the nasal septum where the tissue was taken for the graft.  I was also struggling with the return of the chest infection I’d had in the week leading up to surgery. As each day passed, my head got progressively sorer and a horrible facial neuralgia developed. I knew something wasn’t right as I was reaching for pain relief on an increasing (instead of a decreasing) basis so I requested an appointment with the referring surgeon.

I was seen in the hospital two days ago and the surgeon had a good look around the inside of my head. He spotted the problem within seconds. Since having the splints removed a week earlier, my head had been seeping blood internally and despite daily wash-outs, this crud had congealed causing pressure on surrounding structures. He spent about 30 minutes working on my head with surgical instruments before hoovering up all the debris. A final inspection brought the very good news that the graft is healing well with no sign of rejection. I left the hospital with a definite bounce in my step and I’ve not looked back since. Next stop is Nottingham in a month’s time for what I hope will be, a final review.

You may be wondering what the title of this blog post is about. Some time ago, I received a comment on my blog from a new visitor who was delighted to find my personal story. You see Alex has been on an uncannily similar journey to my own with years of fighting infection in her forehead, multiple surgeries, hospital-acquired infections, osteomyelitis and long-term IV antibiotic treatment. She too lives with a hidden disability except for the large dent in her forehead. Alex recently started her own blog called Bugs Drugs and Rock n Roll, to document her journey. It was Alex who taught me about KOKO. When you live with a chronic condition, you soon learn how to keep on, keeping on.

Marching On

Some people go off food when they’re unwell, others take to their beds. I think I’ve discovered a new phenomenon which has yet to be documented in any medical journal. Whenever I succumb to an infection in my head, I lose all appetite for blogging. To understand this, you have to realise that the blogsphere represents the outside world, a world which crumples at my feet each time illness strikes. The battle of the bugs continues…

St. Valentine’s Day marked the beginning of this particular episode. I woke with a severe headache and as the day wore on, pain and pressure started to build behind my right eye. My GP prescribed a tetracycline antibiotic, Doxycycline which has been the stalwart of my treatment in recent years. My symptoms subsided but a week later, my right eye began to close over with swelling and the pain and pressure returned in my head. On account of my previous history, I was seen urgently by a specialist. A swab ruled out MRSA but this new resistance to Doxycycline, was a definite cause for concern. I was started on a cephalosporin antibiotic, Keftid which seemed to work well so after two weeks the dose was reduced with the plan that I would continue on it long term to break the cycle of chronic infection. That plan fell apart when another bacterial superinfection took hold last week. The headaches gradually returned and my life ground to a halt once more. This time my GP prescribed a different cephalosporin antibiotic, Suprax which I’m happy to report, appears to be taking hold. The headaches have eased and so has the sense of despondency which accompanied them. Where to from here?  Who knows but for today anyhow,  I’m happy to have had my world open up again. On I march.

While on the subject of  nasty bugs, one of my regular readers kindly sent me details of a worrying outbreak of the Norovirus (Winter Vominting Bug) in Limerick. This highly infectious virus is usually found in our hospitals and can be potentially dangerous in the very young or old. The outbreak occurred on a college campus which has been temporarily closed while infection control measures are implemented by the HSE. See press release.

It seems that healthcare associated infections (HCAIs) are no longer confined to hospitals. The bugs are marching on.

Rapid MRSA Identification

Ireland is one of only three countries in Europe where antibiotic prescribing outside of hospitals, is on the rise. Antibiotics are frequently taken for viral colds and flu, when in fact they are only effective against bacterial infections. The more frequently antibiotics are used, the more resistant forms of bacteria become to them. The HSE recently launched a national education programme to change prescribing patterns in a bid to curb the use of antibiotics. The level of superbugs like MRSA and C. difficile in our hospitals would fall if antibiotic use was reduced. However, there’s another side to the superbug problem in our hospitals which I believe, has been overlooked.

When I developed serious symptoms of infection some years ago, it took three days for a nasal swab report to come through from the laboratory. In the meantime, I was treated in a ward shared with four other patients, two of whom were recovering from surgery. When my positive MRSA status emerged, I was quickly moved out of the ward and into isolation. You have to wonder at how many patients were cross-infected as a result of this delay in diagnosis. Multiply this by the huge number of MRSA cases passing through our hospitals each year and you get some idea of the scale of cross-infection.

The sad fact is that there is a Rapid MRSA test available which gives same-day results but it appears that the HSE restriction on budgets has ruled out it’s use in Irish hospitals. This decision is short-sighted as rapid MRSA identification can help hospitals make cost savings.

“The 3M BacLite Rapid MRSA test allows fast, affordable screening of patients for MRSA. It also has the potential to improve patient outcomes and decrease treatment costs. Rapidly identifying MRSA colonised patients provides hospitals with another tool to assist in pro-actively managing health care associated infections (HCAI).”

If I’d been rapidly screened, the result would have been available in hours, not days thereby enabling infection control teams to act quickly. My MRSA infection was hospital acquired (HCAI) following surgery and resulted in six weeks of expensive in-patient treatment. The infection recurred a year later and since then I have frequently been screened for MRSA as an out-patient. I always have to wait 2-3 days for a result and as far as I know, a similar delay still applies for in-patient screening.  I’d be very interested to hear if anyone knows different?

Everyone has a role to play in stopping hospital infection, patients and their families included.  However, if the HSE seriously wants to reduce MRSA figures and make reductions in their budgets, then it should address the problem of delayed identification. The rapid MRSA test would ultimately lead to huge cost savings for hospitals and more importantly, save lives.

Infection Control

Ireland’s first National Isolation Unit was opened yesterday by the Minister for Health, at the Mater Hospital in Dublin.  The unit has 12 beds in total and will be used for patients who contract highly infectious diseases such as tuberculosis, SARS and pandemic influenza.  It will also be used to treat patients with other infections including HIV, hepatitis B & C, meningitis, MRSA and malaria. This all sounds pretty good until you stop to think about it more deeply.

Firstly, I was amazed to learn that this highly specialised ‘state-of-the-art’ facility with it’s own infectious diseases multidisciplinary team, is actually the first of it’s kind in the whole country. Six of the isolation beds in this new unit will  be under negative pressure to help prevent airborne transmission of infection by microscopic droplets. Two of the isolation rooms will have different air handling systems to enhance infection control. It begs the question as to what has been happening with highly infectious patients up until now? I know that some of bigger public hospitals already have isolation units which are used to hoard all the MRSA infected patients together but they do not have any specialised facilities.

And secondly, with healthcare associated infections (HCAI) such as MRSA and C. diff now endemic in Irish hospitals, it strikes me that it might make more sense to use the isolation units for the patients who are clear of HCAI’s, to keep them free from contamination?

Spread The Word

Tomorrow, Saturday, a health protest is due to take place in Dublin and I’m in need of your help.

The main objective of the MARCH & RALLY is to have a large gathering of trade unionists, patients, health campaigners and the general public to demand:

– an end to privatisation of the Health Service

– an end to cutbacks

– a first-class, equitable Health Service

The protest has been organised by the Public Health Service Campaign (PHSC) group which is an alliance of the Dublin Council of Trade Unions, the Youth Committee of the Irish Congress of Trade Unions and Patients Together. The campaign is supported by the Health trade unions and a wide range of patients, hospital and medical campaigners.

In the run up to the imminent budget, the campaign aims to put a stop to the underfunding of our Health Service. In recent years, we’ve seen chaos in our A&E Departments, a shortage of hospital beds, reduced services for the elderly, cutbacks in funding for disability services, the misdiagnosis of cancer patients, and an alarming rise in the rate of hospital acquired infections such as MRSA and C. difficile.

“On October 11, we will demand not only that the cutbacks end, but that we get the first class health service we deserve. The PHSC is calling on all trade unions, patient and hospital campaigns, community organisations and the general public to get out on the streets on the day, to achieve the loudest possible protest,” said Patients Together spokesperson, Janette Byrne.

YOUR HEALTH – YOUR PROTEST.

Assemble 2.00 pm, Saturday, 11th October 2008.
Garden of Remembrance, Parnell Square, Dublin, 1.

Speakers at the rally will include:

Prof John Crown, Consultant Oncologist
Liam Doran, Irish Nurses Organisation General Secretary
Janette Byrne, Spokesperson for Patients Together,
Conor Seville, brother of Beverly.
Kevin Callinan, National Secretary, IMPACT
Audrey Deane, Social Policy Advisor, St. Vincent de Paul Society,
Peadar McMahon of the Health Services Action Group and the Monaghan Hospital Community Alliance,
Louise O’Reilly, National Nursing Official, SIPTU,
Dr. Teresa Graham, (SIN) Stop Infections Now Campaign, (MRSA),
Walter Cullen, Unite Trade Union

Live music will be provided by ASLAN members and other artists.

Please spread the word about this protest and if you can support the march & rally, all the better.

Now, this is where I need your help.  What wording do you think I should use on my placard?

UPDATE: No placard was needed as I joined-up with the S.I.N. (Stop Infections Now) campaigners who had produced their own teeshirts and placards for the march and rally. I am very proud to be a SINNER!

This peaceful protest was better organised than the last one in March but I suspect the numbers were down by comparison.  For me personally, the highlight of the day was to witness two consultant doctors represent the rights and interests of patients and advocate for a better health service. I admire them both hugely for publicly taking this stance and for not being afraid to speak out about the faults within the system. If only their colleagues would follow suit.  

Knowledge is Power

I wrote a post recently lamenting the lack of information available to the public on MRSA and suggested that a well-orchestrated campaign was needed to correct this deficit.  Well, now my wishes have come true with the launch of a new campaign group called  S.I.N. (Stop Infections Now). Would you like to consider becoming a SINNER?

Did you realise that members of the public get most of their knowledge about the measures needed to prevent MRSA from the media?  The information given to patients who have acquired MRSA in hospital can be insufficient or sometimes, even non-existent.  The result is that there are some thousands of patients being discharged from our acute hospitals every year with MRSA (in wounds, in bones or in their respiratory systems) and with very sketchy knowledge on how to prevent the spread of the infection to others.

Health Care Acquired Infections (HCAIs) such as MRSA and C. Diff, are a major problem in the Irish health system and many people have been affected.  These infections often result in prolonged stays in hospitals, sometimes with permanent disability or even death occurring.  The human and financial costs are enormous. Appeals to the Minister for Health, the HSE and hospital managements have proved ineffective in preventing HCAIs, so a campaign has been set up to approach the problem from a different angle i.e. people power.

The SIN Campaign has been established to do the following:

– provide information to the public (and to health care staff) about HCAIs, their causes and what is needed to prevent them.

– outline what can be done by a prospective patient before he/she goes into hospital to help prevent infection.

– what to do if an infection is acquired, the questions to ask, and the appropriate responses to demand.

– how to complain in a non-confrontational manner, and the options open if satisfaction is not achieved.  These options include legal action.

This information is contained in a Patient Information Kit which includes a leaflet, flyer and a CD.  Thus informed, it is hoped that people will simply refuse to accept a service which, while being excellent in some respects, is severely sub-standard as far as these infections are concerned. The SIN Campaign will also include research into the social and psychological effects of HCAIs from the point of view of patients and health care workers.

The campaign group is asking for help from individuals and from companies. This help can be in the form of:

– donations or sponsorship of any size to help with the information kits and the research,

– becoming a patron so your name can be used,

– helping with fund raising or introductions to others who can help.

S.I.N. is the brainchild of Dr.Teresa Graham (formerly of MRSA and Families Network) and the Campaign and Patient Information Kit will be officially launched next Wednesday, 10th September in Dublin.  I’ve already become a SINNER by registering my personal details with the campaign group and I’m very much looking forward to attending the public launch and meeting the people behind this worthy campaign.

If you’d like any further information on this campaign, you can contact:

Dr. Teresa Graham at 051 386651 or  tvgraham@gofree.indigo.ie