The fight against MRSA

I spotted this article yesterday in the Irish Times and felt compelled to share it. It’s a new step in the fight against MRSA…

New research has found that as the superbug MRSA resists antibiotics, it becomes less virulent. 

CLAIRE O’CONNELL

LIFE IS full of trade-offs, and it seems the hospital-acquired “superbug” MRSA is no exception. A new study led by Irish scientists has discovered that when the bacterium acquires resistance to antibiotics, it becomes less virulent, at least in a lab model.

The finding could help shed light on why patients who have compromised immune systems are particularly vulnerable to healthcare-associated MRSA infections.

MRSA develops when a bacterium called Staphylococcus aureus (SA) acquires resistance to a number of antibiotics and becomes methicillin-resistant Staphylococcus aureus (MRSA).

The new study, just published in the open-access journal PLoS Pathogens, looked at SA and MRSA infections associated with medical devices that are surgically implanted in a laboratory model, explains lead author Dr Jim O’Gara from UCD’s Conway Institute.

“Bacteria are naturally present on the skin, where they often don’t cause any problem. But if they stick onto medical devices that are put into the body they can get access through the skin’s barrier and then they can potentially establish an infection,” he says.

“They will form biofilms, which are communities of bacteria attached to the medical device, and those biofilms are almost indestructible. In that case you have to take the device out and put in a new one, which is not always a trivial thing for the patient.”

O’Gara and a colleague at Beaumont Hospital noticed several years ago that SA and MRSA biofilms looked different.

“Our early research in this area revealed a hugely surprising result – that MRSA and SA use different ways of forming biofilms,” says O’Gara.

Their discovery was that SA bacterial cells use sugars to stick to each other and to surfaces as biofilms, while MRSA instead use proteins to form biofilms.

With funding from the Health Research Board, his group brought the project further and looked at the effects of turning SA into MRSA in the lab. They used a preclinical model that introduced infection by allowing the bacteria to form biofilms on implanted medical devices.

Again, the results far exceeded their expectations: when SA became resistant to the antibiotic methicillin (and so became MRSA), its ability to cause illness was toned down.

“What the data show is that if you take SA and you make it resistant to methicillin, you change the way it forms biofilms, but you also make it less virulent in a preclinical model,” says Dr O’Gara, whose group at UCD worked on the project with colleagues at the University of Bath, Harvard Medical School and the University of Nebraska.

“It’s like the bacteria are making a decision to divert their energy towards becoming resistant to the drugs, and they are not going to expend energy producing as many toxins or enzymes.”

In essence, the findings suggest that hospital-acquired MRSA may have have adapted to the hospital environment by sacrificing virulence for antibiotic resistance, according to O’Gara.

“This trade-off works for the pathogen because patients in hospital, particularly in an intensive care setting, can be very immuno-compromised and the pathogen does not need to be very virulent,” he says. “On the other hand, the bacterium does need to be very antibiotic resistant, due to the necessarily high levels of antibiotic usage in intensive care units.”

O’Gara is now looking into how the discovery could be used to help make MRSA less nasty for patients who get infected. “It may open up new ways to find anti-virulence drugs,” he says.

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This article makes great sense to me as it goes some way to explain why my sinuses are chronically infected with MRSA yet I’m otherwise well. It also explains why I’ve had problems over the years with medical implants which have had to be removed having become contaminated with MRSA.

The question is… how the hell do you get rid of MRSA once and for all?

Source: Irish Times HEALTHplus magazine

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

Resistant Bugs

Antimicrobial resistance in bacteria is an emerging problem and a serious threat to public health. New research has shown that E.coli and other common bacteria, have begun to pick up a gene which renders them resistant to all but the most powerful antibiotics. The gene, called NDM-1 (New Delhi Metallo-beta-lactamase-1), modifies bacteria making them highly resistant to antibiotic treatment. Worryingly, there’s no emerging class of drugs that can be used to treat such bacterial infections.

A study, recently published in The Lancet Infectious Diseases journal, said bacteria containing the NDM-1 gene were becoming more common in India and Pakistan, and had now been imported into Britain by people returning from these countries.The spread of the gene is being assisted by countries that promote medical tourism, as more and more people travel to get cheaper medical treatments, including cosmetic surgery.

The so-called superbug gene has already been identified in 37 people in the UK , including 1 in Northern Ireland, who travelled to India or Pakistan for elective surgery. Apart from the UK, the resistant gene has been detected in Australia, Canada, the US, the Netherlands and Sweden. No cases of the bacteria have so far been detected in the Republic of Ireland.

Experts in antibiotic resistance have called the gene mutation “worrying” and “ominous” as it has the potential to become endemic worldwide. They are calling for co-ordinated international surveillance of the bacteria, to monitor the spread of this resistant gene.

Information Source: The Irish Times and mahalodotcom.

Sorry if I’ve depressed you with all this talk of resistant bugs. Now, I’d like to introduce you to a friendly bug… meet ‘Doodle Bug’, my 12 year old cat.

(filmed by my son on his new iPhone)

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.

One Year On

I received the lab report from Nottingham today.

My head is still colonised with Staphyloccus aureus but it’s NOT the resistant form of this bug.

I remain clear of MRSA!

Exactly a year ago to the day, I was admitted for surgery in Nottingham with the surgeon who gave me this news today. It’s been a hell of a year since but at least I’m still here to tell the tale.

And it’s really nice to be able to share some good news for a change.

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.

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.

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).

Not MRSA again!

It’s been a strange week after all the excitement of the blog awards. I’ve got a swollen head but for all the wrong reasons. My right eye started to swell on Sunday evening shortly after my arrival home from Cork. I wasn’t unduly worried as this has happened before following a flight and anyway, I was covered by an antibiotic  following a recent infection in my head. By Monday the swelling hadn’t subsided and the pressure behind my eye was growing worse. I also felt rotten and had pus oozing down the back of my throat. On Tuesday morning, I sought urgent help and was lucky to get an appointment to see my surgeon at the hospital. He took a swab of the pus and did his best to reassure me but we both knew that with my previous history, there was real cause for concern. My biggest fear was a return of the superbug, MRSA but it would take another 48 hours before my destiny was known.

This afternoon I had some good news.  I have an MSSA (methicillin sensitive Staph aureus) infection, not it’s resistant relative, MRSA. This is really welcome news as it extends my treatment options. Had it been MRSA again, I might well have been faced with many weeks of IV treatment in hospital due to antibiotic resistance. I was started on a new antibiotic last Tuesday but worryingly, it hasn’t kicked-in as yet.  My eye remains swollen and my head still hurts but I’m feeling good.

You see, in the midst of all my woes, I received a lovely surprise from Absolute Vanilla and it’s really boosted my spirits. AV is a highly creative writer, a hugely talented photographer and a very popular blogger so I’m honoured to receive this award from her.

BEST BLOG THINKER AWARD

To Steph of  The Biopsy Report who has written tirelessly and courageously about illness and the Irish health system.

“This award acknowledges the values that every Blogger displays in their effort to transmit cultural, ethical, literary, and personal values with each message they write. Awards like this have been created with the intention of promoting community among Bloggers. It`s a way to show appreciation and gratitude for work that adds value to the Web.”

This beautifully timed award has worked far better than any antibiotic. I wear it with pride. Dankie! AV.

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.