Environmental factors, such as dirty hospitals, are responsible for only 10% of methicillin resistant Staphylococcus aureus (MRSA) infections, Mark Enright, senior research fellow in microbiology at Bath University told a conference organised by the Patients Association in London last week. “If you make nurses wash their hands [between seeing each patient] you can control 80% of it,” he said, explaining that one of the highest risks was in catheterisation.
Dr Enright said that the current rates of MRSA were due to the emergence in the early 1990s of the two particular strains of the bacterium which had proved resistant to treatment with the antibiotic methicillin and were particularly virulent. In the early 1990s, the percentage of drug resistant infection rose dramatically, he said.
Had screening of all patients entering hospital been introduced then, and those carrying the infection been isolated from the outset, it might have been possible to contain the infection, he suggested. The Netherlands had managed to keep its rates low by adopting these measures, Dr Enright said. “But it is only effective when you have low MRSA numbers,” he said. “As soon as you have rates of 20% you don't have the space to isolate them.”
Christine Parry, communications coordinator for the Infection Control Nurses Association, warned that government targets that aimed to avoid people waiting more than four hours in emergency departments could mean that people were inappropriately placed on wards where there was a high risk of infection. Orthopaedic wards were particularly high risk for a medical patient, she said.
The Conservative health spokesman, Andrew Lansley, whose party has made cleaner hospitals a pledge in its election manifesto, said he wanted to do away with targets which undermined the ability to ensure hospitals provided a suitable standard of care, including washing hands between seeing patients.
Both he and the Liberal Democrat health spokesman, Paul Burstow, agreed that clearer information was needed on infection rates for individual clinical departments within a hospital, rather than the hospital as a whole. The government has required hospital-wide rates to be reported on a mandatory basis since April 2001. Previously reporting was voluntary.
But Labour's health spokesman in the House of Lords, Norman Warner, said that the collection of hospital-wide figures was better than the previous voluntary arrangement. “We didn't even know the scale of the problem before,” he said.
He criticised the Conservative party's leader, Michael Howard, for sending out a letter to people in the Harrogate area in Yorkshire that claimed that 247 constituents had contracted MRSA at one local hospital trust. In fact, the figure at the local trust, Harrogate and District NHS Foundation Trust, was six. “This is taking politics a bit too far when the chair of the trust has to write to a political leader asking them to retract their statement,” said Lord Warner. A Conservative spokesperson later said that the letter should have made it clear that the figure referred to the total number of MRSA cases in all local trusts in the area, not just one single trust.
Meanwhile, the Patients Association is due, in the next four weeks, to launch a 100 day challenge, checking on what hospitals have done in a 100 day period to improve cleaning standards in hospitals and introduce safer hygiene procedures to try to reduce the spread of MRSA infection.