Link: The Herald.
Doctors and surgeons in Scotland have called for the introduction of what would be the strictest MRSA infection control measures in the UK.
All patients would be screened for the so-called superbug as they enter hospital and then kept in isolation if considered a health risk under the plans.
People who have had recent stays in hospital, who have had repeated courses of antibiotics, or who have open wounds would be among those considered at risk.
They would be kept separate from others needing care until swabbed, and those who tested positive would then be treated separately.
The Royal College of Physicians of Edinburgh and the Royal College of Physicians and Surgeons of Glasgow unveiled the guidelines aimed at beating meticillin-resistant staphylococcus aureus (MRSA) yesterday. They said the costly measures would put Scotland at the forefront of controlling the disease in the UK.
The colleges have called on the Scottish Executive to fund assessment studies of how such a plan could be implemented.
Healthcare-acquired infections (HAIs), of which MRSA is the main one, are believed to be a factor in nearly 2000 deaths a year in Scotland and cost the NHS �186m annually.
The expert group report says clinical risk assessments should be carried out on all patients admitted to acute units, like medical, surgical and maternity wards, the nature of whose work brings an increased risk of MRSA through wounds or operations.
There should also be targeted surveillance measures, like nasal swabs, for patients at the highest risk of carrying MRSA, like past carriers or those who have recently been in another hospital.
The report also calls for studies into how much it would cost in cash and staff to implement bigger versions of successful local schemes to fight MRSA, like one at a Grampian hospital which cut MRSA rates from 40% to 16% over four years.
Gwyneth Jones, a doctor who, along with her newborn baby, contracted MRSA after being admitted to the old Simpson’s Maternity unit in Edinburgh, said: "I was a healthy,
fit, doctor who had just been appointed as a hospital consultant, but that all changed following the birth of my son.
"We were both infected by MRSA and I became seriously unwell requiring re-admission for surgery and treatment with stronger antibiotics."
Dr Dugald Baird, consultant microbiologist and chairman of the Scottish Infection and Standards Strategy (SISS) group which developed the guidelines, said: "Quite simply, the evidence speaks for itself; seek and destroy policies, involving risk assessment, screening and isolation, can be highly effective in reducing and controlling MRSA and could save many lives every year if implemented in practice.
"There can be no room for half measures."
An executive spokesman said: "A healthcare associated infection task force working group is currently drawing up our national MRSA Strategy for Scotland.
"The SISS discussion document will be passed to our working group, and will be viewed with interest."
Deadly condition
MRSA is resistant to conventional antibiotics and first appeared in the 1960s.
In Scotland, healthcare-acquired infections (of which MRSA is the main one) are a factor in almost 2000 deaths every year. They cost the NHS �186m annually.
In 2001, a pilot scheme in Grampian saw new admissions subjected to risk assessment, targeted surveillance and isolation. It resulted in MRSA rates falling from 40% to 16% over a four-year period.
The majority of cases occur in adults because they spend more time than children in hospital, where the bug is most commonly picked up.
The Scottish Executive said virtually every other European country is seeing an increase in MRSA, but Scotland is one of the few countries where rates have stabilised following a rise in the 1990s.
Doctors and surgeons in Scotland have called for the introduction of what would be the strictest MRSA infection control measures in the UK.
All patients would be screened for the so-called superbug as they enter hospital and then kept in isolation if considered a health risk under the plans.
People who have had recent stays in hospital, who have had repeated courses of antibiotics, or who have open wounds would be among those considered at risk.
They would be kept separate from others needing care until swabbed, and those who tested positive would then be treated separately.
The Royal College of Physicians of Edinburgh and the Royal College of Physicians and Surgeons of Glasgow unveiled the guidelines aimed at beating meticillin-resistant staphylococcus aureus (MRSA) yesterday. They said the costly measures would put Scotland at the forefront of controlling the disease in the UK.
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This is all too little too late!
I contracted MRSA in 1999 whilst in the old Princess Margaret Rose Orthopaedic hospital undergoing a left hip revision and pelvic bone-graft. As a result, I am now in a wheelchair with no left hip joint, half my femur missing and a large percentage of my pelvis deficient due to the fact that, during the 1999 operation, the MRSA also infected my newly-performed pelvic bone-graft. The infection did not come to light until 2001, by which time it was too late for anything to be done except to remove the hip joint and all the fragments of bone from the pelvic bone-graft. AT THE TIME OF ADMISSION I ASKED IF I COULD BE PUT INTO A SINGLE ROOM AND ‘BARRIER-NURSED’ – this measure was refused, presumably because the infection was already in the hospital. But what of all the other patients in my Ward?
This was before the building of the New Royal Infirmary of Edinburgh (NRIE). When I asked what measures would be taken to ensure that the MRSA did not find its way in the NRIE, I was told that all necessary precautions would be taken – fair enough. I was treated with antibiotics – at first a broad-spectrum antibiotic until the sensitivity of the MRSA could be established – I was then put on a ‘cocktail’ of antibiotics to combat the MRSA – within three weeks I had liver failure and jaundice and was admitted to the Old Royal Infirmary. I will decline from describing that experience except to say that, from admission into A & E until arrival on a Ward was a time period of thirteen hours.
I remained on this drug regime for several months and the MRSA was brought under control – it will always remain in my system and could be triggered off again by a trauma to the location of my left hip.
In 2003, when I needed my other hip replacing (this time in the new NRIE) – I was surprised to find on arrival that I had not been allocated a single room, bearing in mind my history, I was in a four-bedded room. By this time every patient was being swabbed at their pre-admission clinic and I was told that my results were clear – fair enough. I wonder what happened to the patients whose swabs were not negative?
Having watched the workings of various hospitals during my long lifetime, my comments are these:-
Go back to the old-fashioned ways of asepsis by -
1) Making sure all nursing staff and doctors change their outdoor clothing and use uniforms (of whatever kind) ONLY INSIDE THE HOSPITAL. They should not be allowed to go out into the community wearing their hospital apparel or uniforms.
2) Asking the Surgeons and Doctors to stop wearing ties and wear some kind of special coat (similar to a dentist’s jacket) – no-one will think any the less of them for doing this – they could even be colour-coded coats according to status!
3) Stopping doctors, nurses and patients from sitting on the beds! This is a sure-fire way of cross-infection!
4) Instead of cursory cleaning of vacated beds, ensuring a thorough cleaning of beds – frames, mattresses AND lockers – before the next patient occupies the bed.(I cannot tell you the number of times I have cleaned my own lockers with antiseptic wipes before putting my own things into them over the years!)
5) Ensuring a very much higher standard of toilet & bathroom cleanliness, especially TOILET cleanliness – this is vital.
6) Enforcing the use of antibiotic cleansing gel before and after each patient for Surgeons, Doctors and nurses – NO-ONE should be exempt.
7) Isolating patients known to be infected and BARRIER-NURSE them – ensuring all staff and visitors wear gowns, gloves and masks for visiting.
Monitoring more closely the sterilisation of surgical instruments.
This isn’t ‘rocket science’ – it is basic hygiene as it was known in The London Hospital in the days when my mother worked there in the 1930s.
Sadly, the stable door has already been opened wide and the horse has bolted and run riot!
I am lucky – I AM one of the survivors! There have been many, many more who have not been so lucky. The statistics we are given, generally, in the public domain do NOT reflect the real extent and severity of the problem – my own view is that we are not given the true statistics. I have refused major reconstructive surgery because the risks are too great – they outweigh the possible benefits. This has been a major life-changing experience for me – not one which I would have chosen!
MRSA was known about in 1992! If you look up the House of Lords Hansard papers of that year, you will discover debates which went on way back then! 1992 – how long does it take to ‘GET IT RIGHT!’?