The actress Lesley Ash nearly lost her life from an infection with methicillin-sensitive Staphylococcus aureus. While this infection may not be as serious as methicillin-resistant S. aureus (MRSA), it can be life- threatening. The following is an edited extract of her speech to the House of Lords (19 January 2006), where she was invited to appear as a guest speaker for the NHS Trust Association.

 “Estimates on the number of deaths in the NHS from hospital-acquired infections are just that – estimates. But what has become apparent over recent years is that many deaths in hospital have been recorded in a way that may not have given the most accurate picture of infection rates – so the cause of death may have been recorded as pneumonia, while the infection picked up in hospital that caused the pneumonia went un-noted. "But it is generally accepted that around 5,000 people a year die from hospital acquired infections. It’s dirty hands on dirty instruments in dirty wards in dirty hospitals.

There are absolutely basic, fundamental, simple procedures of cleanliness that we need to have in place that are quite clearly not in place. “These bugs don’t just kill people: they also ruin lives. The infection in my spine terrified me, traumatised my family, put my career on hold and has left me with serious walking problems. I hope to make a full recovery but it’s been a long, hard road.

“We are training our nurses to become more and more technical, and certainly the pace of medical change demands they are able to understand more and more complex treatments. If it’s no longer the nurses’ job to clean things, fine. But let’s bring people in whose job it is to do so, and do so properly!

“Perhaps we should remind people that keeping hospitals, instruments, hands and patients clean is an act of care as important and as fundamental to the NHS as the most brilliant heart or brain surgeon, the most expensive CAT scan, the finest chemo treatment. Without that first line of hygienic care, the brilliant, the wonderful NHS is wasting our money, and our lives.

“And what about personal responsibility? We can’t expect perfection from the NHS and we can’t expect overnight change. We do have a right to demand that change takes place, and I think we have made a start. Everyone can play a part in keeping hospitals clean and our loved ones safe. I’m not going to stop fighting for change on the national scale but while I was ill I had a lot of time to think about those personal small steps we can all make.”

The facts

• MRSA can live under false nails for up to one month regardless of regular hand washing.
• MRSA in the community is on the increase. Tests have shown MRSA to be present on surfaces of phones and computers.
• The most bacteria-infected object outside of hospitals was found to be the handles of shopping trolleys.

The ease of transfer of bacterium such as MRSA is highlighted in a report on the use of a doctor’s pen on a ward round.

The doctor greets the first patient and uses the available basic alcohol gel. He examines the patient and then writes out the notes. Bacteria picked up from the patient are now transferred to the pen and notes. The doctor then moves on to the next patient, uses the hand gel, examines the patent and writes out the notes; again more bacteria are transferred to the pen.

The doctor leaves the ward. At the end of the ward round the pen is highly contaminated. The next time the doctor uses the pen all bacteria are transferred to the hands.

To be effective, hand washes and gels need to leave biocidal residues that remain active for up to six hours. Gels that just use alcohol as the antibacterial agent are not the most effective in clinical trials. In addition, nurses have reported that some Muslim healthcare workers were not using alcohol-based hand gels because of the worry of offending their religion with alcohol products.

Education on hospital-acquired infection is not only key for health workers but also for patients and visitors. Most handbags, for example, tend to spend half their life on the floor on public transport and toilets without coat hooks – areas where harmful bacteria are rife. The first thing the hospital visitor does is put the handbag on the bed or, worse, the bedside table. The bottom of the bag is a breeding/transfer ground for all manner of ‘superbugs’.

More education is needed, not just posters about hand washing, but in all aspects of personal hygiene. Wherever possible, patients need to improve their personal hygiene before being admitted to hospital. In some parts of the country one of the first things nurses have to do is wash the patient, but this is not always possible.

Hajo Grundmann MD, of the Centre for Infectious Disease Epidemiology in the Netherlands, recently warned in The Lancet (21 June 2006) that if certain strains of MRSA take root in communities, the MRSA situation in hospitals – which remains out of control in many countries – could potentially become explosive. He and his colleagues have called for worldwide efforts to step up MRSA surveillance and prevention efforts, especially in hospitals.

“Of the expected 2 billion individuals carrying S. aureus worldwide, conservative estimates based on either Dutch or US prevalence figures would predict that between 2 million and 53 million carry MRSA,” write Grundmann and colleagues.

RSA is now resistant to amoxicillin, penicillin and oxacillin, as well as methicillin. While it doesn’t resist all drug treatments, it’s been quick to adapt to new ones. MRSA infections are most common among people with weakened immune systems living in healthcare centres. Infections can appear around surgical wounds or invasive devices, such as catheters or implanted feeding tubes.

But community-acquired MRSA has also shown up in healthy people who haven’t been hospitalised. As it becomes more common, it will worsen hospitals’ MRSA situation, Grundmann’s team predicts: “MRSA is at present the most commonly identified antibiotic-resistant pathogen in many parts of the world, including Europe, the Americas, North Africa, the Middle East and East Asia.”As some countries don’t monitor MRSA, the researchers made their own global estimate, coming up with the 2 million to 53 million figure.

Hospital overcrowding

Overcrowding in specialist hospitals across England could be responsible for increasing rates of MRSA infection, according to research from a University of Ulster team, published in the British Journal of Nursing. The researchers found that three-quarters of English hospitals exceed the recommended 82 per cent bed occupancy rate – with a third of trusts having occupancy rates of 87 per cent or greater.

This could mean that there is too little time between one patient being discharged and another being admitted to disinfect properly the bed and surrounding area. In a continuation of their research into the relationship between rates of MRSA infection and bed occupancy in Northern Ireland, first published in the Journal of Hospital Infection in November 2005, the researchers have now found that the same relationship may exist in hospitals across England.

References

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