Yellowland

The colour yellow tends to have negative connotations. Traditionally, it’s been associated with cowardice and deceit. In hospitals, the colour yellow is used to indicate an infection control risk. Last week, Steph’s hospital chart was awarded another bright yellow sticker.

Yes, you guessed right… I’m infected with MRSA again! 

I’ve been fighting a constant battle with recurrent infections in my head since Christmas. Antibiotics gave temporary relief but the infection repeatedly recurred, accompanied by nasty headaches. Two weeks ago, I requested a hospital appointment to get nasal swabs taken and analysed. Shortly afterwards, I was informed that I was indeed MRSA positive. The prosthetic implant which was inserted into my nasal septum last November, was thought to be the source of the infection.

Pacemakers, artificial heart valves, catheters and many other surgical implants commonly become contaminated with bacterial biofilms. The longer a contaminated device remains in the body, the greater the risk of antimicrobial resistance developing. As my infection had been confirmed MRSA positive, I was advised to have the implant removed as soon as possible. Following consultation with my surgeon in Notts, the decision was taken to remove the prosthetic implant.

Sign on door to Steph’s room at the hospital

Last Tuesday, I was admitted to hospital as a day case and nursed in isolation while the prosthetic implant was removed under sedation. This involved another trip to the operating theatre but on this occasion, I remained conscious throughout. When you are MRSA positive, you’re last in the line for everything so as to minimise the risk of cross infection.

When the call finally came, I was whisked directly into an operating theatre, transferred onto the operating table and attached to the various monitors before being given intravenous sedation. I expected to be knocked out by the sedation but far from it. I was able to continue a conversation with the surgeon and anaesthetist while the implant was being yanked from my head. It felt a bit like having a wisdom tooth removed except that it was from my nose rather than my jaw. I was then wheeled straight back to my isolation room to sleep off the effects of the sedation before being discharged home.

It was hoped that the prosthetic implant would remain in place for at least two years to maintain healing of my septum. Instead, less than three months later, the implant now sits in a specimen container while I await further assessment. My head feels a great deal more comfortable now that the source of infection has been removed. What happens next, is anyone’s guess.

I may be labelled yellow… but I ain’t no coward. MRSA watch out!

Do Not Enter

I had a great bit of fun last week on my last night in the A&E department. If there’s one thing I’ve learnt over the years of being admitted to hospital, it’s to use humour to get through difficult situations. This time, it really helped me through a potential emotional meltdown. I won out in the end too!

Those of you who’ve read this blog before, will know that I have a past history of MRSA infection and although I am clear of this horribly resistant bacteria, I’m still regularly stigmatised by it when in hospital. On this occasion, on admission to A&E, I was carefully questioned about my MRSA status and swabs were taken for analysis. A very kind ward manager found me a bed rather than a trolley and it was pushed into a little side room to ‘protect’ the other patients in case the swabs came back MRSA positive.

The side room had four walls, a bed, one chair and a door. No television, nothing. No en suite either which means that potentially infective patients use the same facilities as everyone else. As I was only a ‘suspected’ carrier of MRSA, no restrictions were placed on my movements around a very busy A&E department. On the third night, I came out of the side room to find a new sign on the door… “Do not enter, please contact staff desk first”. My immediate reaction to this was “Help! My swabs must have come back positive”. I went back into the room and lay down on the bed in despair. That’s when the fury hit. “How dare they put up this sign without first informing me of a change in status!”. I was tired and in danger of losing my cool. Humour was called for. I sat up and carefully made a sign which proclaimed “Enter at own risk, I bite!” and using a sticking plaster from my handbag, I stuck it to outside of the door below the other sign. About 30 mins later, a night nurse stormed into the room and asked if I was responsible for the sign. I smiled back at her cheekily and replied,  “two can play at your game you know. Nobody consulted me about the restrictions placed so I didn’t consult you”.  I demanded to know if my MRSA status had changed. She replied that it hadn’t and admitted that they were playing safe. She then left the room clearly annoyed. I chuckled to myself in victory.

Shortly afterwards, she returned with a smile.  “You win”, she said.  We’ve taken both signs down now”.

The following morning, I left the room briefly and on my return, my bed and all my belongings had disappeared. Nobody could tell me what was going on but I was hopeful it might be a sign I was about to be transferred to a ward. Another patient was wheeled into the side room and my bed was eventually found in the middle of the department, lined up with trolleys all groaning with patients. Later that day, I was informed that I was to be moved to a ward and as you can imagine, this news came as a huge relief.

The swab reports came back negative on my fourth day in the hospital. Phew! If I’d tested positive, it would’ve compromised my treatment and also meant that I’d been infective to others in the hospital, for a full four days. Countries like Holland, which has brought MRSA contamination under control in the hospitals, must laugh so hard at the Irish interpretation of  infection control.

The Sky Is Falling In

I’ve been run over by a lorry. Well, perhaps not but it sure feels like it. I was dropped off at the hospital at some unearthly hour on Monday morning and my parting words were that I’d probably be ready for collection by elevenses. Having had many colonoscopies over the years, I knew what to expect, or so I thought. I should have known better. With a medical history like mine, nothing can be taken for granted. I live and learn.

On admission to the day ward,  I was shown to a curtained cubicle and asked to change into a theatre gown. I was duly weighed and labelled and then an overly cheerful vampire arrived to take my blood for a multitude of tests. Shortly afterwards, a nurse began the task of wading through my medical history. It was all fairly routine until we got to the “any previous surgery” question and then it was my turn to wear the pants! When we reached the “MRSA” part, the mood changed again. Despite my protests that all recent swabs have been clear, I was quickly moved to another part of the day unit while the nurse went off to phone infection control at the hospital where I’d been treated in isolation. On her return, I was granted clearance but not before two swabs had been taken for analysis. I was also informed that I would be moved to end of the theatre list as a precautionary measure.  It seems that no matter how hard you try, you can never be rid of the stigma of MRSA.

The scoping itself was no bother. I was told that I needed a gastroscopy as well as a colonoscopy as biopsies were required from both the upper and lower gastrointestinal tract. I was sedated shortly after arrival in theatre and knew no more until I woke up back in the day ward. I was told I was due to have a CT scan later in the day. Shortly after regaining consciousness, I developed severe pain in one side of my abdomen. My doctor explained that the pain was most likely caused by the gas used to inflate the intestines during the procedure and would resolve in time. I was given peppermint water to drink. Despite numerous trips to the bathroom, the pain continued unabated. I soon had to drink half a gallon of contrast solution in preparation for the scan. Once the scan was over, the nurses began to make noises about getting the house-doctor to review my pain. I knew I was at high risk of being admitted overnight so I declined further help and instead took two strong painkillers of my own. An hour or so later, I felt well enough to summon a lift home and a nurse accompanied me to the door of the hospital. The car journey was a nightmare. The pain got so bad at one stage, we had to stop the car so I could put my head between my legs to stop passing out. I lay across the back seat and groaned all the way home.

I had a really uncomfortable night with intense abdominal pain and as I was running a temperature by morning, I gingerly contacted the hospital for advice. The nurse in charge remembered me (how could anyone forget) from the previous day and handled the situation very competently. I was afraid I’d be told to come straight in to the hospital but no, she was happy to contact my specialist and then phoned me back to let me know the plan. The specialist contacted me directly having reviewed the scan, to confirm that there was no evidence of a bowel perforation following the scope. It appears that I’ve had an inflammatory reaction to the procedure and have been prescribed medication to ease the symptoms. So far, the results are encouraging  in that no structural abnormality has been identified but I have to wait another two weeks before the biopsy results and blood tests come back, to find out what’s caused the colitis over the last six weeks. It’s still thought to be antibiotic-associated.

Today I still feel totally buggered (in all senses) and the frequent dash to the loo continues but the sky is no longer falling in. I’m back at my blog (albeit in bed) and that is always a good sign. Comments and emails have been a great boost (thank you) and I apologise that my replies have not done them justice. The saga continues.

Decontamination

Infection control in Irish hospitals is a serious problem as the superbugs are constantly developing resistance to disinfectants. In spite of hospital cleaning regimens, the bacteria can form spores which survive for months or even years in the environment. When a serious outbreak occurs, preventing cross-infection and the further spread of endemic strains requires effective control measures.

In years gone by, there was no range of sophisticated cleaning agents available to disinfect a room following a case of infectious disease. The room was sealed off and a combination of disinfectant and a formalin lamp was used to decontaminate the air.

Here’s another excerpt from Home Nursing in the early 1900’s…

Disinfecting the Sick-Room

Whenever possible the help of a Sanitary Inspector should be sought. If this is not available:-

1.  Open all cupboards and drawers, and hang up dressing-gown and blankets on a clotheshorse or on cords stretched across the room

2.  Paste paper over the fireplace, the framework of the windows, and all other crevices except those about the door.

3.  Paste ready for use the strips of paper required for the door and the keyhole.

4.  Place a formalin lamp on a metal tray (as a precaution against fire) raised from the floor; ignite it, and leave the room quickly. To disinfect a large room, several lamps placed about it will be required.

5.  Close the door; cover the crevices about the door and the keyhole with the prepared strips of paper.

6.  Keep the room closed for twelve hours.

7.  Re-enter the room, open the windows wide, uncover the fireplace, and allow the room to remain in this state for another twelve hours.

8.  Send the bedding and mattress to be dis-infected.

9.  Burn all books, letters, etc., which have been in the room.

After her duties are finished the home nurse must disinfect herself, taking precisely the precautions which has adopted for her patient.

Infection Control

In the first decades of the 20th century, wealthy households employed trained professional nurses to care for seriously ill family members. These nurses stayed in the patient’s home, carrying out the doctor’s instructions, monitoring the patient’s condition and providing general care – making beds, bathing the patient, giving medicines and keeping the sickroom in good order. The role of the private nurse was not an easy one: she had an ambiguous social position – above domestic servants but below family members. Private nursing slowly died out after 1918, at the same time as did the live-in domestic servant.

Here’s another gem I found in my little book of Home Nursing from the 1930’s, on the precautions taken against the spread of infection. The HSE would do well to take note!

The following rules should be observed whenever a case of infectious disease is being treated at home:-

1.  At the outset of the disease soak a sheet in disinfectant and hang it outside the sick-room door, allowing the lower end to remain in a bath containing disinfectant.

2.  Immediately pour a strong disinfectant over all excretions, cover the bed-pan with a cloth, remove and empty it at once unless the doctor desires it kept for his inspection. After emptying the bed-pan scald it out and cleanse with a disinfectant.

3.  Burn in the fireplace in the sick-room all rags, cotton-waste, tow or cotton-wool used for discharges, also all dust taken up in the sick-room.

4.  Place in a pail of disinfectant for one hour at least, all soiled bed linen, including handkerchiefs, before boiling them.

5.  Keep a basin of disinfectant in the room but out of the patient’s reach, in which to wash your hands every time you have done anything for him.

6.  When the patient is declared free from infection, give him a bath to which disinfectant of the appropriate amount has been added, not omitting to wash the head. Put him into a dressing-gown which has not been kept in the sick-room, move him into another room, and dress him.

Disinfecting the Sick-Room to follow.

Fighting MRSA

Hospital cleaners may one day use ionic liquids to clean wards. Scientists at the Queen’s University, Belfast have come up with a new way to kill off bacteria, including the hospital superbug MRSA. In this era of finite resources in our health service, any development which declares war on the superbugs, is to be welcomed.

Many types of bacteria, such as MRSA, exist in colonies that stick to the surfaces of materials. The colonies often form coatings, known as ‘biofilms’, that protect them from antiseptics, disinfectants, and antibiotics. Ionic liquids are up to 250 times better at killing ‘difficult to treat’ biofilms. Ionic liquids are essentially salts which are liquid at around room temperature. The liquid can be sprayed onto a surface where it will kill any existing bacteria. Significantly, the liquid doesn’t evaporate so once it is on a surface, no bacteria can withstand the treatment. It continues to destroy any bacteria that arrive subsequently provided the ionic liquid has not been wiped off. The liquid has low toxicity but has not yet been tested for use in human treatments.

The development was carried out by eight researchers from the Queen’s University Ionic Liquid Laboratories (QUILL) centre, supported by a grant from Invest NI. The research has been published in the journal, Green Chemistry. The Queen’s University group plans to introduce commercial products based on the technology, and is also studying possible uses with humans, eg as hand washes.

The prevalence of superbugs in Irish hospitals is thought to cost the HSE about €200 million a year. Poor cleaning, overcrowding, inadequate facilities, lack of infection control staff, poor management and a lack of accountability have all contributed to unacceptable levels of infection and death within our health system. Almost every year, we hear of a new breakthrough in the war against the superbugs. It remains to be seen if ionic liquids will become the weapon of choice.

Source:  The Irish Times and BBC News Channel (NI).

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?

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.