MRSA and Infection Control

February 13, 2008

A recent report has shown that Ireland has the third highest rate of incidence of MRSA in the EU. The over-prescribing of antibiotics, poor hospital layout and poor hospital and personal hygiene are the main factors responsible for the high rate of MRSA infection. Following my own experience with MRSA, I concluded that our health service has serious infection control issues to resolve.

Some years ago, I was re-admitted to hospital due to complications (orbital cellulitis) following a complex frontal sinus operation. I was assessed in A&E before being transferred to a 5-bedded general ward. I received intensive IV antibiotics but my symptoms failed to respond to treatment and three days later a nasal swab which had been taken on admission, revealed that I was suffering from an MRSA infection. I was immediately moved to an en-suite single room and barrier nursed in isolation while undergoing specialised intensive treatment. So the delay in getting this result had meant that for three days I had been an infection risk to the other patients in the room. This regrettable situation came about simply because our hospitals do not have adequate funding or the laboratory resources to fast-track MRSA screening, and as a result infection control suffers.

Over the following months my infection gradually worsened and I was to be re-admitted to hospital on three further occasions for treatment, each time being processed through the A&E department before being transferred to a hospital bed. This policy would question infection control strategies. By this stage I was an officially ‘labelled’ MRSA patient and on arrival in A&E, I would be quickly escorted to a tiny walled-off area of the unit. This ‘box’ was the HSE’s answer to infection control and it really was worse than a bad joke. It had no en-suite facility so during the many long hours I spent in this hell hole, I used the same toilet facilities as all the other patients thereby defeating the purpose of isolation. No sign of an infection control protocol here. I used to dread the looks I got whenever I emerged from those four walls.

On another occasion after spending the night in A&E, I was transferred to a single room on a busy medical ward. Again this room had no en-suite facilities and I was expected to use shared toilet facilities. No sign of an infection control protocol here. The following morning I was told I was to be moved to the MRSA isolation unit to complete my treatment as my room was needed for another highly infectious patient. I was not happy about this as I instinctively felt that my own recovery would be compromised by moving to the MRSA unit where there is a high risk of cross-infection. If my room had been needed for a dying patient, I would have obliged but it was not my fault that the hospital didn’t have an adequate supply of individual isolation rooms for infection control. I’m afraid I dug my heels in and refused to move despite the huge pressure applied. I’m usually a very amenable sort of person but on this occasion I’d had enough and wasn’t prepared to risk my own health to facilitate any bed manager. Once the fuss had died down, I was quietly told that I’d earned huge admiration from the medical staff for standing up to the powers-that-be at the hospital.

As it transpired, several weeks later I was again re-admitted to the hospital having developed chronic osteomyelitis in my skull and on this occasion I did end up being transferred from A&E to the MRSA isolation unit. I’ve already written about the slack infection control policy here in another post. This unit was everything I’d feared, and worse but after weeks of treatment there I did get the necessary all-clear to be allowed to complete my treatment elsewhere. I assumed I was being transferred to a single room but you can imagine my horror when I found I’d been put back into the same 5-bedded ward where two months previously, I’d first received the diagnosis of MRSA. I again instinctively felt that I posed an infection control risk to the post-operative patients in the neighbouring beds. Despite a fear that I’d be transferred back to the awful isolation unit, I pointed out my concerns to the staff and luckily for me on this occasion, a single en-suite room was quickly made available. This action however sadly confirmed that my concern was justified.

It really is hard to believe the ignorance and confusion that still exists in the whole area of infection control. Comprehensive updated guidelines have been drawn up but they cannot be implemented because of inadequate resources, sub-optimal infrastructure and a lack of access to relevant expertise locally. Laboratories are chronically understaffed and cannot maintain even routine diagnostic work. MRSA is a huge problem that’s not going to go away unless infection control is properly tackled. In the meantime, the response from the HSE has been to spearhead a campaign to place the onus on patients to ensure that medical staff have clean hands. Proper hand hygiene is a major factor in stopping the spread of MRSA but it should be part of a multifaceted approach. If Ireland is to reduce it’s incidence of MRSA, the HSE needs to stop playing silly games with our lives and declare war on the superbugs.

Life or Death

January 24, 2008

There’s been a lot of hype recently in Ireland about the appallingly inadequate hospital services for adult patients with cystic fibrosis (CF), and rightly so. Put simply, our Government’s failure to provide a dedicated CF unit in this country, is costing lives.

The critical issue here is the limited availability of suitable isolation facilities. For optimum management of cystic fibrosis, patients require isolation in individual en-suite rooms to prevent cross-infection occurring but CF patients are being denied this opportunity. Instead, these vulnerable patients must present themselves to A&E where they are exposed to high risk infections while they await admission to a hospital bed. They are then transferred to a mixed ward to be nursed alongside mainly geriatric patients with a variety of illnesses. This practice beggars belief. The high rate of MRSA infection in Ireland has done little to ease the plight of the CF population. Not only is MRSA a constant threat to immuno-compromised CF patients, it’s prevalence has meant that the extremely limited supply of isolation rooms have instead been prioritised for MRSA infected patients.

When I was first diagnosed with an MRSA infection following surgery, I was hurriedly moved out of a general ward into an en-suite isolation room to be barrier nursed while receiving intensive IV treatment. I felt like vermin and in reality, I represented a high risk to those patients whose immune systems are compromised by disease or treatment. I was eventually discharged home on oral antibiotics but the infection recurred and I was re-admitted through A&E for further IV treatment in a single isolation room. I was again allowed home on oral antibiotics but the infection worsened and I soon had to come back into the hospital. On this occasion I was transferred from A&E to the MRSA isolation unit where all patients with MRSA are nursed together. This unit was full of elderly patients, it was poorly ventilated and I felt distinctly uncomfortable with the high risk of cross-infection there. During my stay, I would spend the evenings sitting outside the door to the unit to get fresh air and to escape the blaring televisions. None of the staff ever objected to this practice. As my health improved, I soon ventured further afield to use the hospital coffee bar as a venue for meeting visitors. Nobody advised me otherwise and indeed, I often met doctors I knew while on my travels and they’d stop for a friendly chat. The point here is that as a carrier of MRSA, my outings put other patients at significant risk of cross-infection. This stark reality was brought home to me when listening to the recent public debate on CF issues. At the time, my only concern was self-preservation but now I realise that I should never have been allowed to wander the hospital corridors. If anyone is to blame, it is the hospital authorities for their slack policy of infection control.

Ireland has the highest incidence of CF in the world and yet we have the highest mortality rate and lowest life expectancy. CF patients have been waiting for more than a decade for a dedicated CF unit to be built and they are quite literally, sick waiting. Our Government has failed miserably in it’s duty of care to these young citizens. Lives are being shortened and young people are dying as a consequence of our inadequate hospital services. This really is a matter of life or death.

MRSA – A silent stigma

September 30, 2007

A diagnosis of MRSA (methicillin-resistant Staphylococcus aureus) infection is not something to be taken lightly. It has the potential to become a life-threatening condition and intensive treatment with antibiotics will be required. However, there is another side to the diagnosis which is rarely talked about. There is the stigma attached to having an infectious condition and it forms a significant part of the MRSA journey. Hospital staff are best trained to deal with medical emergencies but their management of patients with an infectious status sometimes leaves a lot to be desired.

When I was first diagnosed with MRSA I was treated with the utmost urgency and received excellent care. I was barrier nursed in isolation whilst undergoing intensive intravenous antibiotic therapy. This involuntary withdrawal from the world took some getting used to but I quickly developed my own coping mechanisms to get through that lonely time. However the ‘fun’ really starts when a patient has to come out of isolation for investigation or treatment. When an MRSA infection is confirmed by laboratory tests, a patient’s hospital chart is labelled with a luminous sticker proclaiming their infectious status. This is a method of alerting staff to take the necessary precautions to minimise the spread of infection. Hospital staff however should be aware of the sensitivities involved for MRSA infected patients.

I had to be taken to theatre for some minor surgery while still being treated in isolation. Patients with a positive MRSA status have to wait until last in the queue to go for surgery because of the very real potential of contaminating an operating theatre. So after a very long wait while fasting all day for the general anaesthetic, a porter finally arrived to transport me on a trolley to my destiny. We were escorted to theatre by a very junior nurse who was given the task of carrying my hospital chart. I was duly lined up in the pre-anaesthetic area alongside a row of other similarly nervous patients to await my turn in theatre. My surgeon and his surgical team appeared briefly in an open doorway and made encouraging faces at me. Suddenly, a loud shout came from another direction and to my horror, I heard the theatre sister roar from a distance “get that MRSA patient out of there, NOW!”. I saw the surgeon raise his eyebrows in disbelief at what had been heard and in an attempt to lighten the moment, we exchanged grins about ‘SHE who must be obeyed!’.  The theatre sister however continued to loudly remonstrate the junior nurse for accompanying me (the infectious patient) to the wrong location and any humour in the situation, rapidly dissipated. The junior nurse was mortified to receive such a public dressing-down and I felt very humiliated to be treated like a leper in front of all the other patients and staff. It was as if I didn’t exist as a person – I was purely seen as a health hazard which had to be quickly removed. A nice welcome back to the ‘real’ world after spending so much time alone.

I have since sat in crowded out-patient clinics and had the clinic nurse make insensitive enquiries in front of everyone else. You do get better at handling the ignorance surrounding MRSA but you never get used to it. MRSA patients have enough problems to contend with without having to tackle the issue of stigma as well. The sticker on a hospital chart may change colour once MRSA clearance has been obtained but it appears that you remain a ‘labelled’ patient for evermore. The legacy lives on.

Nursing Care in Hospital

September 19, 2007

I was referred to the UK earlier this year to undergo surgery in a specialist unit at an NHS hospital. This operation was unavailable in Ireland unfortunately so I had to pack my bags and head across the water to the unfamiliar territory of the NHS. Having ‘done time’ on numerous occasions in Irish hospitals, I was interested to see how the UK would compare. The conclusion I came to was that nursing care in the NHS has ‘gone bananas’.

My first impression of the hospital was a good one. On admission, my immediate surroundings appeared spotlessly clean and modern – a far cry from the appalling conditions found in many parts of the Irish health service. I was allocated a bed in a tiny room (no en suite facilities) beside the Nurses’ Station – this room had glass doors to it to facilitate observation of the patient. I thought that this easy visibility would limit any hope of privacy but in fact, it worked to my advantage. The glass doors provided a ‘bird’s eye’ view of the daily activities of the ward staff and this was a source of much entertainment throughout my stay. I did wonder however if the fact that I was a ‘Paddy’ with a history of previous MRSA infection (and recurrence) might not be the real reason why I’d been put in this room. Anyway, I was duly installed as a patient and was whisked off to theatre a few hours later, to go under the knife.

When I next ‘came to’ I was back in the same little room but this time I had to share it with all the paraphernalia associated with having had major surgery – the drips, drains, monitors etc. I lay there in a morphine-induced stupor in full view of the nurses and watched the world go by. I waited and waited for a nurse to appear at my bedside to offer some reassurance but as time went on, I realised that this was a false hope. The nurses only came into my room whenever they had to record my vital signs and even then, there was little or no personal interaction. It was like as if the patient was superfluous to the job in hand. When I was originally diagnosed with MRSA, I was barrier nursed but now this was different type of isolation. I could see endless activity at the nurses’ station with nurses filling out forms etc. but it appeared that very little time was actually spent with the patients. In Ireland, the nurses generally (though not always) interact well with their patients despite also being very busy. It soon became obvious that huge differences exist between our two healthcare systems in terms of nursing care. The NHS may be better in some respects than it’s counterparts here but it lacks the personal touch that thankfully still exists in Ireland. I cannot complain about the medical care I received from the NHS but the standard of nursing left me cold. Not once during my stay did any nurse ask the simple question of “how are you today?“. My medication was dispensed at regular intervals throughout the day without any explanations given. I simply wasn’t consulted at all. And there was definitely no humour to be had despite my best efforts to attract a smile. I have a lot of experience of spending time in hospital and so I’m not easily unnerved by hospital procedures but I can still imagine how frightening it must be for inexperienced patients to be left alone to cope in an unfamiliar environment. I appreciate that nursing these days is very hard work and sadly, it is also often a thankless task. However I’m in no doubt that patient care is compromised when nursing loses it’s personal touch.

After several days of observing the activities of the NHS, I devised a plan to put the ‘system’ to the test. Every morning a junior nurse would come into my room to offer a simple breakfast menu of “Weetabix/Cornflakes, Tea and Toast?“. The choice never varied. Each item of food dispensed had to be ticked off on a list by the nurse. I decided to ‘rock the boat’ one day and request a banana with my cereal. The nurse looked at me in despair having studied the menu, and replied “we don’t ‘do’ bananas at breakfast time“. It was hard not to laugh at this reply but I persisted in my request (out of sheer devilment) and the nurse got more and more flustered as she continued to scour her list for a ‘banana’ box to tick. Eventually I had to tell her that I knew that there were bananas in the ward kitchen and all she had to do was to walk a short distance to fetch one. After a long pause, she left the room and returned with the said banana. I felt like I’d scored a victory! Sad, isn’t it? But this is the sort of behaviour you’re reduced to when subjected to hospital care that is not patient-centred. This is a small, but clear example of how target driven the NHS has become. Nursing care it seems, is now all about ticking the boxes. I got such pleasure out of beating the system that day and by the way – the banana was delicious too!

Coping with the Diagnosis

July 7, 2007

So where were you in August 2005? I know where I was – I was on a lonely journey in hospital, locked away in a tiny little isolation room having just received a diagnosis of MRSA infection.

The surgeon who had operated on my head, arrived in my room some hours after I’d been told of the MRSA diagnosis. I couldn’t help but laugh as this was the first time I’d seen him wearing the now mandatory gear of barrier nursing (a plastic apron and rubber gloves) but this light-heartedness was short lived. He was clearly shocked by this new development in my infection status. This took me by surprise as I was used to him always being a step ahead and ready for any challenge. I knew then that my instincts had proved correct and that I now had a serious battle on my hands. I had a rampaging wound infection on my forehead following intricate surgery close to my brain and it didn’t take a rocket scientist to work out that the implications of this could be very serious indeed. My surgeon was very reassuring but his disbelief at my diagnosis unsettled me. In fact everyone who came into my room that evening looked at me anxiously and I found myself trying to reassure them to ease the tension.

I didn’t get much sleep that night. I had been commenced on a new regime of IV antibiotics, the main one being Teicoplanin which I was told was the ‘gold star’ of medication to overcome methicillin-resistant Staphylococcus aureus. I tossed and turned throughout the night due to a combination of physical and psychological discomfort. I knew I was in good hands – especially so following a visit from a very kindly consultant microbiologist who’d been called in late at night to supervise my treatment – but I could still sense the aura of concern that hung over my head.

In the early hours of the morning I found myself humming the Monty Python tune “Always look on the bright side of life!” and soon my spirits lifted. I knew I’d found the key to getting through the coming days. I set about making a large sign for the door to my room bearing the above words and accompanied by a 😀 I felt defiant. No super bug was going to get the better of me! Over the following 24 hours, my infection began to respond to the new antibiotics and everyone who entered my room that day did so with a large smile/humming that tune. Even the paper lady used to sing the tune as she made her way down the corridor each morning. That sign achieved more than I could ever have imagined and to this day I still get comments about it.

Anatomy of a True Friend

June 20, 2007

Okay, so I want you to imagine that your friend is stuck in hospital following surgery/having treatment. It’s more than likely that they are ‘bored out of their brains’ and missing family and friends, and the normal routine of life. They’re also probably ‘tired out of their brains’ having tossed and turned in bed all night (that is, if they’ve been lucky enough to get allocated a bed) while everyone else in the ward snored the night away. What do they have to look forward to in the day? The next meal? – I don’t think so. The next session of doctor’s rounds? – definitely not. Maybe some horrible procedure? – no thank you. Let’s face it, it’s a pretty awful experience being in hospital and the days can be interminably long.

So what’s the best thing you can do to brighten up your friend’s life? They may not be well enough to want to receive visitors. But I can bet your bottom dollar that they’d like to receive some text messages from you. For less than €1 a day you can make a huge difference to someone’s day.

When I was in hospital being barrier nursed in isolation because of an MRSA infection, I nearly went out of my mind with boredom. I had a wonderful friend who supported me through those lonely days by sending regular text messages. My friend was on holiday beside the sea at the time. Instead of quizzing me in her texts about my state of health, she sent lovely descriptions of the wildlife she could see in the early mornings, or maybe even some detail of food she’d found in a market or perhaps news of people she’d met on her travels. It was fantastic to have this distraction from my monotonous existence in hospital. It was a vital link with the outside world. If I was feeling too ill/tired to receive a call I’d turn my phone onto ‘silent’ and then it was always a lovely surprise to find a message waiting when things looked up again. I was a friend ‘in need’ and she was a friend ‘indeed’!

So, the next time you hear that a friend/loved one has been hospitalised, don’t get stunned into silence. Go on! Be a true friend and brighten up their day with a text message. It could turn out to be a lifeline.

A Lonely Journey – Part 3

June 2, 2007

MRSA: Major Resistance to Staying Alone! My story continues…

Part 3: The Diagnosis

Shortly after I was moved to a single room, a young woman entered the room and introduced herself as being from ‘infection control’. She had come to break the news that the nasal swab taken in A&E had tested positive for MRSA. To put it mildly, I was gobsmacked!

My mind went into overdrive as I tried to rationalise this news. “She must have made a mistake.” “This can’t be happening.” “Surely MRSA is something that happens to other people.”

It had never even crossed my mind that I might have an MRSA infection and certainly, nobody had mentioned it since my admission. I knew enough about MRSA however to know instinctively on hearing this news that the implications for me, following the recent surgery close to my brain, could be very serious indeed.

My ‘informer’ continued to trot out general infection control information while all I desperately wanted to hear was information relative to my own condition. She could not give me this. All she could tell me was that I was now considered an infection risk to other people and therefore must be isolated and ‘barrier nursed’ from that moment on. I was in effect, to become a prisoner in this new room. She departed leaving behind a general information leaflet on MRSA. No reassurance was given, nothing.

I was left alone in this room with endless opportunity for my mind to run amok. I remember lying there thinking “Help! what does all this mean?” “Is it really serious?” “How do I tell my family and my friends?” “Will they be able to visit me?” In the hours that followed I felt very alone, and somewhat ashamed. The word leper springs to mind.

Someone appeared in my doorway wearing a face mask, a surgical apron and gloves and proceeded to place a large bin in the room bearing an illuminous sticker proclaiming “Danger – infection control.” No words were exchanged. The door to my room was also labelled with an equally alarming sticker “Do not Enter – Barrier Nursing – contact Nurses Station.”

By this stage, my emotions were all over the place. No reassuring visit came from any nurse/doctor – I was left for several hours totally on my own, to my own imagination as to what might follow. This should never have happened and in hindsight, I can see that maybe if I’d made more of a fuss, someone would have come to my rescue. I think I was too terrified at the time to make my views known. After a long wait, someone finally did arrive from the surgical team that I’d come to know at the hospital and I have to admit that from then on, my care was good.

It’s been a long hard road since. MRSA infection did result in having very serious consequences for me (see below). These days I’m better informed about MRSA but I will never, ever forget the loneliness of those first few hours of my MRSA journey. I have not contacted any of the various support groups as I feel that I’ve developed my own coping strategies over the years. It is a real luxury to have this outlet in which to air my views. I welcome comments.