MRSA:"It is endemic in every hospital."

Villain

A close family member of mine got MRSA in a top Irish hospital about 8 years ago and that time nobody in the media was talking about and very few people knew what it was or how patients were getting it.

At that time I remember reading an article from Australia which stated that when hospital's there had MRSA infections they closed down the hospital's level by level until they were confident that the MRSA threat was gone, the thinking was you couldn't have a hospital being used by patients and get rid of the infection at the same time.

We are 8 years on and we are trying to get rid of MRSA from hospitals that are badly overcrowded and Harney was at cabinet for all of those 8 years, changing Ministers doesn't mean that the Government can excuse the issues, FF and PD's have had 10 years to make an impact on Health and Crime and they have FAILED.

BreakingNews.ie has the article below which Dr Maureen Lynch, a consultant microbiologist at the Mater Misericordiae Hospital, said: “It is endemic in every hospital.” when she was talking about MRSA.

Full article:

A father of five died from a deadly strain of the MRSA superbug which a medical expert today told an inquest is endemic in hospitals here.

Thomas Murdiff, 52, from Athboy in Co Meath, died on December 14, 2004 after he contracted the infection while in one of three hospitals.

Dr Maureen Lynch, a consultant microbiologist at the Mater Misericordiae Hospital, said: “It is endemic in every hospital.”

MRSA is an antibiotic resistant superbug often acquired in hospitals and it can, if it gets into the bloodstream, prove fatal.

Almost 600 patients tested positive for MRSA bloodstream infections in Irish hospitals in 2005.

The inquest at Dublin City Coroner’s Court heard Mr Murdiff had been in three hospitals – the Mater Public Hospital, the Mater Private and Our Lady’s Hospital in Navan, Co Meath – in the eight months before his death for treatment for heart problems and diabetes.

The coroner said on the balance of probabilities it was likely he contracted MRSA while in hospital.

Dr Lynch said it was first detected when he was an outpatient and the hospital acquired strain can also be contracted in the community.

She said Mr Murdiff, an Evening Herald sports journalist, was a high risk patient due to his diabetes which left him with broken skin areas and his repeated admittance to hospitals.

The inquest heard 86% of people with it fit the case definition of acquiring it in hospital.

Dr Lynch also said MRSA was extremely common with about 30% of people carrying it in their nose or skin.

But she said 60% to 70% of people found to carry MRSA respond well to decolonisation treatment including baths and creams.

Mr Murdiff was tested for MRSA on four occasions after being admitted to the Mater public hospital in May 2004. All the swabs proved negative.

In July, a month after he was discharged, he tested positive and was treated successfully.

Mr Murdiff developed problems with another toe which had to be amputated by surgeons at the Mater private hospital. Prior to this further tests at the diabetes clinic at the public hospital showed MRSA had returned to the heel of his foot.

Ross Maguire, the family’s lawyer, said there was a genuine issue of public interest for a patient’s charts to be transferred when they move hospital.

“It is virtually impossible to eradicate MRSA from broken skin in people with underlying skin problems,” Dr Lynch said.

Dr Lynch also said the facilities for isolation were not there, and the Coroner Dr Brian Farrell agreed it was a question of resources.

The inquest heard he was discharged on December 2 and was admitted seven days later to Our Lady’s Hospital in Navan with a suspected chest infection. He was found to have MRSA and was transferred to the Mater where he died shortly before Christmas.

The coroner said he needed time to consider the verdict, adjourning the inquest until February 28.

Shame on FF and the PD's they have blood on their hands.

gandalf

My father had a stroke in April 2005, it was a serious one and he clung onto life for the following 8.5 months. During that time he contracted MRSA twice, considering lung infections and pneumonia took his life eventually; I think MRSA had a major hand in ending his life.

The hospital ward(s) were filthy, there weren't enough nurses to take care of the patients and the cleaners only could give the wards a quick once over because the wards were all full so couldn't be emptied.

This governments inaction has led to peoples death, unnecessary suffering for alot of others and additional strain on loved ones and family due to their incompetence & inability to deliver a service at a time when they had resources other Governments could only have dreamt of.

InFront

Sorry hear about that, it is important for people, and indeed politicians also to remember that there are families on the end of this topic who have lost family members before they come out denying or avoiding the significance of this disease. We have the highest levels of MRSA in Europe, endemic is exactly the word.

There's a major RCSI study starting on in Beaumont at the moment using rapid tests for new admittances and a new method of cleaning the wards which is looking very good for reducing MRSA and VRE incidence. It will be interesting to see what happens with it.

Obviously this is of little comfort to anyone who has already been subjected to the disease.

seamus

Cross-infection has been a major issue for a lot of Irish hospitals since World War II. It's really only become a major issue now because of increased education (people are more confident to question consultants) and MRSA's resitance to drugs.

In the past, people would become infected, but the consultants would say nothing and prescribe antibiotics to clear it up. People didn't question the doctor's orders.

My maternal grandmother died when my mother was a child. The hospital informed my mother's family that she had died of complications arising out of childbirth, and that was it. The child had died in birth.
It was only after my mum did some digging that it turned out her mother wasn't all that unwell after the birth, but was placed into a ward where three other post-natal women were dying after contracting dysentry after having their child. She contracted the disease and died too.

My girlfriend's grandfather died in the 90's. He contracted septicaemia after undergoing a routine operation.

I would hazard a guess that infections arising after after arriving into hospital are the biggest contributing factor to most deaths within the hospital system.

Villain

Well my parent got a relapse of MRSA again late last year and was admitted to Waterford General Hospital which was digustingly filthy I ended up cleaning the room and emptying bins when I visited and when I highlighted this to the staff I was fobbed off. I also highlighted that I had seen nurses attend to my parent and not wash their hands this was meant with a very angry response so after a lot of phone calls they were transferred to Cappagh where the care was much better and the room was a lot cleaner. There was an MRSA ward and everyone uses capes and washed their hands.(The ambulance cost €900!)

Its the basic things that we need addressed here, it doesn't take billions to clean hospitals or highlight the threat to patients, visitors and staff to ensure hand washing etc.

We do need overcrowding to be addressed and that will cost money but we have the money and I know there is more complex issues than simply building new beds but we have less beds now than we had in the 80's and we have a bigger population.

10 Years FF and the PD's have had to address these issues and MRSA is more of an issue now than it was then. 10 Years people and this government has failed to even contain the threat of MRSA, many people are coming out of hospitals worse off than they went in because of MRSA and if you ask a Government Minister why they haven't done something they will just waffle off figures about spending and increases in spending.

I DON'T CARE HOW MUCH THE GOVERNMENT HAS SPENT, THEY HAVE FAILED MY FAMILY AND MANY OTHERS.

Irish1 my mum died in a fully private hospital largely as a result of MRSA which she contracted whilst in there.
I won't name the hospital,except to say you'd be surprised.
There were several other patients in the same hospital that we were aware of that also had MRSA.
My Dad also died of MRSA also in a private hospital.

I can't blame Mrs Harney for either.I can only wholy blame incompetent,almost wreckless staff members who didnt bother washing their hands,only half cleaned floors and used the same utensils to clean MRSA patients rooms as those who apparently didnt have it.
This was not a resource issue, it was a pure "couldn't be bothered" attitude in my opinion.
Ok the Doctors and the nurses did their very best medically but whats the point of that when basic rules that I can look up on the interweb were not followed.
The care ,love and attention by the staff was mostly good with some exceptions,I won't fault that too much.

I fully accept that the situation (must be) much worse in public hospitals and I know from experience it is.
BUT I reckon myself whats needed is a good kick in the arsé to those not doing their jobs properly.
However, you have to get through the union garbage to sort that out as they would go mad at the very suggestion(I reckon ) of any fault for MRSA lying at their doorstep.
And they do have the blame for much of it in my opinion.

That said,contract cleaning and corner cutting in hygene is an absolute bloody disgrace and that part should be where Mrs Harney is hauled over the coals.
I doubt you'll ever get a nurses union to recognise that some hospital medical staff are lax when it comes to hygene,which creates a difficulty in policing the need for hygene.

gandalf

Tristrame, you're actually wrong, as the acting head of the Health Service and Department of Health the buck stops with Mary Harney. She obviously cannot handle or fathom this department and she should have relinquished the Department when she realised she didn't have what it took to lead the PD's.

Oh I'm not disputing who the buck stops with,I'm just outlining how its not simple.I'm not making excuses for Mrs Harney either.
I've no faith in any T.D from any party having the Gumption to tackle this issue properly.
They'd upset a too cosy situation from what I can see.
Politicians are all very good at talking about something but when they get into power,thats it, their salaries are secured for another 4.5 years and then they'll try to fool us into thinking they care for the 6 months prior to the election.

I've seen it all before.

*edit* In case I'm misunderstood-
When I said that I can't blame Mrs Harney for either of my parents deaths,I meant that they died in hospitals run by the private sector with little or no public involvement and hospitals that had the best of facilities.
The MRSA issue there was one of a total break down in the priority of clinical hygene.
They had the place looking like the four seasons alright but thats no use if clinical hygene is not looked after.

Anyway I've made the point I wanted to make here and it wasnt a strictly political one.
It was to do with the coal face problem of that shur it will do attitude that pervades hospital management.
If I go on any further I'll only go into a rant and I'm not going there-besides ... etc.

Villain

Well after 10 years of failure I think someone else deserves a chance they can't be any worse for sure.

Oh I don't dispute your sentiments there.
It's just that from experience,I think you could have 10 years of an alternative government and then be looking ironically back to this lot for to cure the next lots failures.

Call me cynical but personally I've long since rejected the possibility that we can attain utopia by musical political chairs.
The only point I'd make on that is ,in my view it isn't healthy not to have change every now and again.

Mind you on the MRSA issue,I wouldn't call it failure,I'd call it a complete and total nothing done.
Thats the problem-politicians that are in power are of the view that votes have to be bought and that these votes can't be bought by spending time on a creaking health service.
They seem to be stuck on that record.

Villain

Well stop paying minimum wages to contract cleaners is one place to start, when it comes to MRSA the cleaners are more important than the doctors imo.

Agreed.You'd have to train them too though and instill the importance in the cleaners and the rest of the medical staff(many already have this but it only takes one or two to make the mess) of clinical cleanliness.

You also need serious sanctions for shortcomings.I don't believe that there is or ever will be the political will to do this as it ruffles too many feathers.

There was a piece on the Late late show a forthnight ago and someone made a very good point and that was that there is more clinical cleaning procedures for visitors entering pig farms than Irish hospitals.It's crazy.

Villain

I would love to hear Mary Harney explain why hospitals are so dirty, I think the HSE need to recruit from outside the public sector for certain managment jobs, if the HSE was a company the managers would have their P45's by now including Harney.

nesf

Tristrame wrote:

I doubt you'll ever get a nurses union to recognise that some hospital medical staff are lax when it comes to hygene,which creates a difficulty in policing the need for hygene.

This, unfortunately, very true. There is a reality that if someone does go into hospital they will have a risk of contracting some other illness, I don't believe that this is avoidable in ward situtions there is always going to be a certain level of cross-infection due to the nature of the place (I've a friend who works in a hospital who recently contracted TB for instance). The thing is as much as we might whine about Mary Harney, the HSE etc, the people directly responsible for a lot of this are the front line staff in hospitals.

I would agree with Tristrame in that I don't believe that political musical chairs will magically solve this issue, and quite a few others in the health service, the change will have to come from those working in the health service and attitudes there will have to be shifted. If every nurse scrubbed their hands after touching a patient this would help but I know from both being in hospital and visiting others at them that this definitely does not happen. Some change can come from the top but I believe with the strenght of the unions that it would have limited effect in practice.

Raskolnikov

I don't think the government can be made complete scapegoats for this. Sure, they're not responding to this fast enough, but this epidemic isn't confined to Ireland. It's also important to understand that MRSA is still a relatively new phenomenon. Not only that, but the rate of infection is increasing on a worldwide scale. It's highly infectous, can be carried without showing symptoms, can be transmitted by animals, can survive for days outside of a host, often completely resistant to anti-biotics, is borne over air, touch and fluids, etc. It's an extremely virulent infection, not only that though, it has already developed into even deadlier mutations.

tallaght01

nesf wrote:

The thing is as much as we might whine about Mary Harney, the HSE etc, the people directly responsible for a lot of this are the front line staff in hospitals.

If every nurse scrubbed their hands after touching a patient this would help but I know from both being in hospital and visiting others at them that this definitely does not happen. Some change can come from the top but I believe with the strenght of the unions that it would have limited effect in practice.

Many people are blaming nurses and doctors for the MRSA problem. IN Nesf's post, it's the nurses getting it. I'm a doctor.I would argue that the hand hygiene of nurses is by and large excellent. Doctors' hand hygiene is also excellent. I have said before on a similiar thread that I have rageingly inflammed cracked skin all over my hands from washing them with the rough, cheap crappy soap that is provided in hospitals for us to use. However, I'll continue to observe stricy hand hygiene. The national hygiene audit of hospitals also agrees in it's conclusions that medical and nursing staff are very good at washing their hands, and are not the root of this problem.

Before you have a go at nurses bear in mind the following:

1) MANY MANY people have MRSA before they come into hospital, but it becomes problematic for them in hospital as they are ill. They don't all catch it within our 4 walls.

2) Nurses are worked to the bone as it is. It adds a tremendous time burden to your day when you wash your hands between every single patient. However, they do it. They rarely get thanked. They just get blamed for MRSA. There are many more bigger issues here than handwashing.

Villain

Raskolnikov wrote:

I don't think the government can be made complete scapegoats for this. Sure, they're not responding to this fast enough, but this epidemic isn't confined to Ireland. It's also important to understand that MRSA is still a relatively new phenomenon. Not only that, but the rate of infection is increasing on a worldwide scale. It's highly infectous, can be carried without showing symptoms, can be transmitted by animals, can survive for days outside of a host, often completely resistant to anti-biotics, is borne over air, touch and fluids, etc. It's an extremely virulent infection, not only that though, it has already developed into even deadlier mutations.

Its not new, I know Beaumount confessed to having it in their hospital 8 years ago and I'm sure it was there long before that. Other countries are controlling the virus a lot better than us, our stats on the issue are a total disgrace, we are the second richest country in the EU and we have one of the worst records for MRSA.

So when you say "not responding fast enough" I think you are underestimating the slowness of the Government to respond, I was in an MRSA ward in 1999 and I was in one 2006 and things were worse not better, we'r not even moving in the right direction. Our Government have failed to control MRSA.

There is some issues I might discuss on here and slate the Government over that I don't know enough about but this is not one, I have seen what this bug does first hand and I have seen how hospitals deal with it over a period of 8 years and I can assure you the Government have failed here. They manage the system the book stops with them, they have to be accountable.

tallaght01

irish1 wrote:

Our Government have failed to control the virus.

.

Also, it's not a virus

Villain

Well if you want to get technical no I guess its not, but sorry if I don't appreciate your smiley on this issue when I almost lost a parent to it.

tallaght01

and I don't appreciate u trying to dubiously steal the high moral ground here, by relating my smiley to somebody's illness.

Raskolnikov

tallaght01 wrote:

Also, it's not a virus

I was going to say that too. :P

People talk about cleanliness in hospitals being a factor, this is only partially true. The MRSA bacteria can lay dormant for long periods of time on clean dry surfaces. A hospital could "look" absolutely spotless but still be riddled with MRSA. Likewise, a hospital could be absolutely filthy and not have a trace of MRSA. Also, as Tallaght said, there is a serious problem with people coming into hospital with the disease and spreading it and as I mentioned, people are able to carry the bacteria and spread it without realising it. Not only that, but it's finding it's way into the food chain (through pigs in Holland). Because it's often untreatable, people can carry it for life, becoming infectous when the disease flares up.

The most effective solution is to completely isolate infected MRSA patients. This is extremely costly though, as the Dutch have found out.

Villain

You can have the high moral ground I just thought a smiley wasn't needed thats all.

Anyway back on topic

tallaght01

Raskolnikov wrote:

I was going to say that too. :P

People talk about cleanliness in hospitals being a factor, this is only partially true. The MRSA bacteria can lay dormant for long periods of time on clean dry surfaces. A hospital could "look" absolutely spotless but still be riddled with MRSA. Likewise, a hospital could be absolutely filthy and not have a trace of MRSA. Also, as Tallaght said, there is a serious problem with people coming into hospital with the disease and spreading it and as I mentioned, people are able to carry the bacteria and spread it without realising it. Not only that, but it's finding it's way into the food chain (through pigs in Holland). Because it's often untreatable, people can carry it for life, becoming infectous when the disease flares up.

The most effective solution is to completely isolate infected MRSA patients. This is extremely costly though, as the Dutch have found out.

I work in the UK, and we try to isolate patients with MRSA, or any infectious disease. You're right though, it's a real drain on resources. We would very rarely have an MRSA patient on an open ward, but we still have reasonably high levels of the bug. However, as I've said ad nauseum before, it's not as big a health issue as smoking, drugs, our booze culture and our poor diets....but hey we can't blame other people for those, so lets focus all our energies on MRSA.

Cynical, moi?

Villain

Raskolnikov wrote:

I was going to say that too. :P

People talk about cleanliness in hospitals being a factor, this is only partially true. The MRSA bacteria can lay dormant for long periods of time on clean dry surfaces. A hospital could "look" absolutely spotless but still be riddled with MRSA. Likewise, a hospital could be absolutely filthy and not have a trace of MRSA. Also, as Tallaght said, there is a serious problem with people coming into hospital with the disease and spreading it and as I mentioned, people are able to carry the bacteria and spread it without realising it. Not only that, but it's finding it's way into the food chain (through pigs in Holland). Because it's often untreatable, people can carry it for life, becoming infectous when the disease flares up.

The most effective solution is to completely isolate infected MRSA patients. This is extremely costly though, as the Dutch have found out.

3 days is the max it can survive on a surface AFAIK, when you talk about looking cleaning you are right but its hard to accept that a hospital can be dirty looking and believe that it doesn't help the spread of MRSA.

People may well bring it into hospitals but I know for a fact that my parent contracted it in a Beaumount operating theatre, I have seen nurses and doctors at first hand fail to wash their hands between MRSA patients, there is no one issue that is causing the rise in the spread but not enough is been done.

The HSE should also be looking at alternative treatments like Manuka Honey which has proved very effective on wound dressings.

InFront

Tristrame wrote:

BUT I reckon myself whats needed is a good kick in the arsé to those not doing their jobs properly.
However, you have to get through the union garbage to sort that out as they would go mad at the very suggestion(I reckon ) of any fault for MRSA lying at their doorstep.
And they do have the blame for much of it in my opinion.

In fairness, while most people do not relate to this problem at a level that you guys would, we should not sperate ourselves from the facts. One of my own lecturers Hilary Humphries has been on the national radio in recent weeks reiterating that improvements in medical practices are not tackling MRSA.

A much more effective way of controlling this bug is in catching it at the front entrance, and that seems to be the way forward. To do this, hospitals and GPs and community health clinics need diagnostic resources and lab infrastructure and that is where politics does come into it.

If particular isolation was afforded to post-op and wound patients (and the other guys who are at increased risk of contraction), this would be an additional benefit, but the infrastructure is not there.

Nobody is saying doctors and nurses shouldn't wash their hands at all, but lets be reasonable about it. To assume that this is the fault of medical staff who need a kick up the ass as you put it, is far too simplistic.
You can have a patient picking up MRSA in work, bringing it into a hospital, and giving it to another patient in the canteen, or from sitting on the bed chatting to them, or other means of transmission which are quite simply practically unavoidable in large hospitals.

The generally accepted opinion is that if you can tackle MRSA as close to admission as is possible, and isolate patients, you will put a dent in the figures.
Medical staff standing under washbasins all day whilst patients roam around the corridoors and visitors come and go is going to do precious little in solving the problem. Should doctors wash after every time they touch a door handle? Pick up the stethoscope? Answer the telephone? Turn on a machine? Scratch their heads? Lets be realistic about it.

Also, before everybody starts blaming medical staff, lets point out the massive underuse of preventitive gels amongst visitors. This is one of the most frustrating thing that any doctor, nurse or other medical workers witness on a daily basis on behalf of patients who often demand that its the medics who are causing this problem.

The point I'm making isn't aimed at anyone in particular, but throwing the election rubbish out the window for a minute, there does need to be greater poltical leadership and action, there does need to be early intervention and diagnoses, there needs to greater action on behalf of visitors, and there does need to be vigilance on behalf of medics and cleaners. But simply heaping this problem on the latter group is going to mean one thing, and that is the perpetuation of this awful and unnecessary situation, and more grief for more people.

Villain

tallaght01 wrote:

However, as I've said ad nauseum before, it's not as big a health issue as smoking, drugs, our booze culture and our poor diets....but hey we can't blame other people for those, so lets focus all our energies on MRSA.

Cynical, moi?

Well my father's health problems were the direct result of MRSA not smoking, drink, drugs or poor diet so forgive me if I concentrate on blaming what did cause it.

nesf

tallaght01 wrote:

Many people are blaming nurses and doctors for the MRSA problem. IN Nesf's post, it's the nurses getting it. I'm a doctor.I would argue that the hand hygiene of nurses is by and large excellent. Doctors' hand hygiene is also excellent. I have said before on a similiar thread that I have rageingly inflammed cracked skin all over my hands from washing them with the rough, cheap crappy soap that is provided in hospitals for us to use. However, I'll continue to observe stricy hand hygiene. The national hygiene audit of hospitals also agrees in it's conclusions that medical and nursing staff are very good at washing their hands, and are not the root of this problem.

Are you working here or in the NHS? The problem is that there are a lot of doctors and nurses who are very good at their jobs, fastidious about hygene and work very hard. The reason why this is a problem is because of the small percentage who aren't. When I say that there are issues with hygene at the front lines with nurses and doctors it instantly brings a response such as yours where you interpret it as me saying that all of them are at fault and you list out how hard you work etc. This is why there is such an issue with the unions, if one of you is critisised you all get up in arms about it. Or at least the vocal ones anyways.

The reality is that it only takes a small fraction of the nurses and doctors to not have good hygene practices to spread diseases in hospitals, it doesn't matter that the majority might scrubbing the skin off the bone in their hands. As a doctor you know this.

Before you have a go at nurses bear in mind the following:

1) MANY MANY people have MRSA before they come into hospital, but it becomes problematic for them in hospital as they are ill. They don't all catch it within our 4 walls.

2) Nurses are worked to the bone as it is. It adds a tremendous time burden to your day when you wash your hands between every single patient. However, they do it. They rarely get thanked. They just get blamed for MRSA. There are many more bigger issues here than handwashing.

You'll have to excluse me if I ignore your posturing here.

Hygene is a problem in hospitals, and since you work in them I assume you've met and seen staff who seem to have no regard for it. A minority sure, but they do exist unfortunately. All professions and vocations attract some of them.

Diseases can and will be brought in from the outside and there isn't a whole lot that you can do to stop this, but cross-infection within hospitals is something that can be limited to some degree by staff. I'm not arguing that nurses, or doctors, are the cause or should take the blame for MRSA, I'm saying that there are hygene problems in hospitals amoung a minority of staff and that this is contributing to the problem (and not just with MRSA but with pneumonia etc).

jimmycrackcorm

My wife is a nurse and was talking about this last week. She was saying about some of the efforts that take place when they get a case of mrsa where she works. But she says, while they might steam clean the beds, have the floors and walls washed down, wear gowns etc, they get cross-contamination from members of the public who totally ignore the signs and don't bother to even wash their hands.

tallaght01

nesf wrote:

Are you working here or in the NHS? The problem is that there are a lot of doctors and nurses who are very good at their jobs, fastidious about hygene and work very hard. The reason why this is a problem is because of the small percentage who aren't. When I say that there are issues with hygene at the front lines with nurses and doctors it instantly brings a response such as yours where you interpret it as me saying that all of them are at fault and you list out how hard you work etc. This is why there is such an issue with the unions, if one of you is critisised you all get up in arms about it. Or at least the vocal ones anyways.

The reality is that it only takes a small fraction of the nurses and doctors to not have good hygene practices to spread diseases in hospitals, it doesn't matter that the majority might scrubbing the skin off the bone in their hands. As a doctor you know this.



You'll have to excluse me if I ignore your posturing here.

Hygene is a problem in hospitals, and since you work in them I assume you've met and seen staff who seem to have no regard for it. A minority sure, but they do exist unfortunately. All professions and vocations attract some of them.

Diseases can and will be brought in from the outside and there isn't a whole lot that you can do to stop this, but cross-infection within hospitals is something that can be limited to some degree by staff. I'm not arguing that nurses, or doctors, are the cause or should take the blame for MRSA, I'm saying that there are hygene problems in hospitals amoung a minority of staff and that this is contributing to the problem (and not just with MRSA but with pneumonia etc).

So we can accept that only "a minority" of hospital staff have poor handwashing hygiene? Fair enough. If you believe that a tiny minority of hospital staff not washing their hands is responsible for this endemic, rather than huge problems of infrastructure, then you are seriously seriously misinformed.
I work in the NHS, but it's the same bug. It's a huge multifactorial problem.

nesf

tallaght01 wrote:

So we can accept that only "a minority" of hospital staff have poor handwashing hygiene? Fair enough. If you believe that a tiny minority of hospital staff not washing their hands is responsible for this endemic, rather than huge problems of infrastructure, then you are seriously seriously misinformed.

As I said earlier, I didn't think it was the cause or anything, I believe that it's contributory and that it would be generally a good thing to improve in any case and it would reduce to some extent the spread of diseases (not just MRSA) within hospitals, which we can all agree is a good thing.

I work in the NHS, but it's the same bug. It's a huge multifactorial problem.

I was just curious really, I appreciate that it's a big issue over there too, I've friends who work in the NHS. But as you said it's a huge multifactorial problem and there are many ways to reduce, if only in small ways, the problem. Attitude shifts in the unions allowing for some realisation that criticism of a minority of their membership is not a criticism of the profession might go some way towards helping matters.


The depressing thing is that MRSA is only the headline grabber and is only the tip of the iceberg regarding the whole issue of cross-infection in hospitals.

oscarBravo

jimmycrackcorm wrote:

...members of the public who totally ignore the signs and don't bother to even wash their hands.

I've mentioned before being in a hospital public toilet and seeing people walk from a cubicle straight out the door without washing their hands. Filthy pigs - it should be a criminal offence.

tallaght01

nesf wrote:

As I said earlier, I didn't think it was the cause or anything, I believe that it's contributory and that it would be generally a good thing to improve in any case and it would reduce to some extent the spread of diseases (not just MRSA) within hospitals, which we can all agree is a good thing.



I was just curious really, I appreciate that it's a big issue over there too, I've friends who work in the NHS. But as you said it's a huge multifactorial problem and there are many ways to reduce, if only in small ways, the problem. Attitude shifts in the unions allowing for some realisation that criticism of a minority of their membership is not a criticism of the profession might go some way towards helping matters.


The depressing thing is that MRSA is only the headline grabber and is only the tip of the iceberg regarding the whole issue of cross-infection in hospitals.

I dunno what the story is with all this chat about unions. I don't really know about the situation in Ireland though. IN the UK, the doctors' union is so poor, and is so lacking in power than only about 60% of docs are members (i'm not a member) and the nursing union is only slightly more powerful. Over here, our unions are certainly not reacting to criticism of us.

I keep up to speed, more or less, with Irish health news, and don't remember the INO or the IMO vociferously defending a tiny majority of their members on this issue, but I'm happy to be corrected.

I would imagine it's more likely that they're defending their members because many many many people think that clinical staff are a major cause of MRSA outbreaks, when there are many more, larger issues at play.Whenever you hear about MRSA, somebody mentions handwashing. Like I said before, the national hygiene audit was very favourable towards nurses and doctors, with regard to their handwashing practices.

Dr Galen

just on the Union point, can i just say that its really been a policy issue for us in the INO to get rid of MRSA in what ever way possible.

IN our union magazine we regularly have articles etc on the topic, and on a political and lobbyong front, the INO has been constantly lobbying for reduction in bed occupancy rates in Irish hospitals, which as has been said before, is a big reason for the spread of MRSA and other hospital acquired infections.

I'm not trying to all pro-union on this, just putting the information out there.

I also accept your points that although the majority of medical staff are very good with their hygiene there is a minority who aren't. Though in my 4 years in the hospital I'm in at present I've definitely seen a major improvement. A few people definitely need a kick though!

SOmeone else mentioned that as far as they were aware, MRSA can only live for 3 days on a surface, as if that wasn't really all that long.......well our hospitals are so over stretched, that in a busy week, my ward (and many others) could have as many as 5 patients through a room/bed. this is a major reason for the spread. thats 5 patients, plus visitors, plus staff, plus all the other things that could carry ANY infection in a relatively small space.

nesf

tallaght01 wrote:

I would imagine it's more likely that they're defending their members because many many many people think that clinical staff are a major cause of MRSA outbreaks, when there are many more, larger issues at play.

Essentially that is what it comes down to. People tend to generalise poorly and people tend to have herd instincts when it comes to their profession being criticised. Also people are poorly educated on what actually causes cross-infection in hospitals and outbreaks of MRSA etc, they usually go on whatever their choice of media tells them.

People want some group to blame, confuse correlations with causations and get all confused when it comes to estimating the chances of certain things happening and have a nasty tendency to view x increases the chance of y as x is the cause of y.

The end result is interest groups such as unions and representitive associations, management etc all doing their best to appear as if they have no relationship with MRSA happening for fear of people or media deciding that they are the cause of it. The problem is that if you repeat something often enough you might start believing it and risk ignoring problems that are actually there.

faceman

nurse_baz wrote:

SOmeone else mentioned that as far as they were aware, MRSA can only live for 3 days on a surface, as if that wasn't really all that long.......well our hospitals are so over stretched, that in a busy week, my ward (and many others) could have as many as 5 patients through a room/bed. this is a major reason for the spread. thats 5 patients, plus visitors, plus staff, plus all the other things that could carry ANY infection in a relatively small space.

That doesnt sound right, sure that would mean that doctors and nurses alone are the reason for the spread of MRSA??

Im kidding of course, but its things like this that dont get highlighted as a MAJOR factor in the spread of it.

nesf

nurse_baz wrote:

I also accept your points that although the majority of medical staff are very good with their hygiene there is a minority who aren't. Though in my 4 years in the hospital I'm in at present I've definitely seen a major improvement. A few people definitely need a kick though!

The problem is giving them that kick. It's difficult to police hygiene effectively and how do you exactly deal with them once you've caught them. Should there be a disciplinary procedure or should it be rather draconian and lead to supensions etc? Go too softly and it won't change much, go too harshly and the unions (quite rightly) will probably kick up a fuss since there would be bound to be a few people caught in the net where it was down to fatigue rather than negligence.

Dr Galen

now there's the question!
answers on the back of used twenties

badlyparkedmerc

Did the report referred in the title of the thread tell us anything that we didn't already know, I was assuming the reason the media were picking up on it is that they didn't understand the meaning of the word endemic - but because it sounds like epidemic must be something really bad.

from wikipedia

"In epidemiology, an infection is said to be endemic (from Greek en- in or within + demos people) in a population when that infection is maintained in the population without the need for external inputs."

Incidentally since we're told it's endemic this more or less implies that MRSA isn't in general brought in by visitors or that there's enough MRSA present in the hospitals for visitor brought in MRSA to not matter.

faceman

badlyparkedmerc wrote:

Did the report referred in the title of the thread tell us anything that we didn't already know, I was assuming the reason the media were picking up on it is that they didn't understand the meaning of the word endemic - but because it sounds like epidemic must be something really bad.

Ur probably bang on there. Its the same media afterall who told us 100% of banknotes in circulation contained cocaine.

InFront

badlyparkedmerc wrote:

Incidentally since we're told it's endemic this more or less implies that MRSA isn't in general brought in by visitors or that there's enough MRSA present in the hospitals for visitor brought in MRSA to not matter.

That is a completely silly interpretation of the article and of what endemic means, it does not 'more or less' imply that.
Endemic means that something is characteristic of a region, and in popular parlance, that it is commonly observed therein. For goodness sake, MRSA does not arise out of thin air, it is always 'brought in' to a hospital.
I really doubt that Dr Lynch was attempting to pass secret messages to the readership of the breakingnews.ie website or anywhere else her opinion might be published.

InFront

InFront wrote:

it is always 'brought in' to a hospital.

Now that is simply not the case.Many Patients without MRSA do contract it in hospitals for the first time.
Unfortunately many of them die or endure considerable pain or both unnecessarally as a result.

InFront

'Many' is a conveniently fuzzy term. You cannot put numbers on that.

My question is how do people think MRSA got into every hospital in the first place? You think it only sits on the people with scrubs on? Invariably, MRSA will have been 'brought in' to a hospital by someone from the outside. What is the point in doctors and other staff washing hands every seven or eight minutes of the day when patients and visitors just constantly wander in, walk straight to their relative or friend, and don't do anything on their part to help prevent the spread of MRSA?
That is why I consider badlyparkedmerc's interpretation of the word endemic to mean that visitor MRSA "does not matter" to be completely off the wall.

You simply cannot differentiate between MRSA that came in two hours ago and MRSA that "ultimately" arrived in two years ago. That's why this differentiation between "Hospital Associated MRSA" and "Community Associated MRSA" is such rubbish.

nesf

InFront wrote:

What is the point in doctors and other staff washing hands every seven or eight minutes of the day when patients and visitors just constantly wander in, walk straight to their relative or friend, and don't do anything on their part to help prevent the spread of MRSA?

Just because a disease may be brought in from the outside doesn't mean that steps shouldn't be taken to prevent it spreading inside the hospital. Hospital staff are exposed to a lot more patients than any visitors, if they didn't have a good hygiene system then the situation would be far worse and diseases could spread far more rapidly through hospitals.

InFront

nesf wrote:

Just because a disease may be brought in from the outside doesn't mean that steps shouldn't be taken to prevent it spreading inside the hospital.

Again, that isn't the point. I'm saying this is all important, but that another poster's comments in relation the possibility of visitors bringing in MRSA doe not matter is completely wrong. I don't see how it can be any clearer.

Originally posted by nesf
Hospital staff are exposed to a lot more patients than any visitors

Right, and a lot of patients 'are exposed to' far more visitors than they are to doctors. If you watch visitors when they come in the first thing they do is walk over and shake hands, and sit around the bed. Next time you're ina hospital, ask visitors in the next bed to wash their hands/ use the gel and see what sort of reponse you get.

InFront

InFront wrote:

'Many' is a conveniently fuzzy term. You cannot put numbers on that.

Whereas you were prepared to imply with certainty that there are none..
I'm afraid you had lost some credibility at that point.

My question is how do people think MRSA got into every hospital in the first place? You think it only sits on the people with scrubs on? Invariably, MRSA will have been 'brought in' to a hospital by someone from the outside.

Now that is,whats this you said about someone posting earlier-lets use your words.. thats a completely silly interpretation... on reality.A hospital should be clean,it should not have bugs of its own regardless of their origin,there should be no residuals ready to infect the next innocent MRSA free patient.
There should be an effective barrier.

What is the point in doctors and other staff washing hands every seven or eight minutes of the day when patients and visitors just constantly wander in, walk straight to their relative or friend, and don't do anything on their part to help prevent the spread of MRSA?

Oh lovely.
If their relative has MRSA, they are risking their own health by not taking precautions.The doctors and nurses should be washing their hands at all times and of course wearing gloves and aprons when dealing with MRSA patients given that they will be also treating as yet non MRSA patients.
If med staff or visitors are routinely allowed (or to put it a better way tollerated) to mix and move without recourse to simple barrier routines then that is the hospitals fault.They are being lax with their rules.

That is why I consider badlyparkedmerc's interpretation of the word endemic to mean that visitor MRSA "does not matter" to be completely off the wall.

You simply cannot differentiate between MRSA that came in two hours ago and MRSA that "ultimately" arrived in two years ago. That's why this differentiation between "Hospital Associated MRSA" and "Community Associated MRSA" is such rubbish.

Thats all academic to be honest.
Hospitals should not allow any situation that spreads the disease to occur.It's not rocket science.All it takes is a little divorce from the lazy couldnt be bothered or ah shur it will do approach.

InFront

Tristrame wrote:

Whereas you were prepared to imply with certainty that there are none..

It's a pity you can't even attempt to back that up with a quote. I did not imply that, which if you read my posts, should be pefectly obvious to most people.

A hospital should be clean,it should not have bugs of its own regardless of their origin

No bugs? Get real.
Also, can you comprehend how lingering MRSA has nothing to do with medical staff, but to do with resources available to them and to cleaners?

If their relative has MRSA, they are risking their own health by not taking precautions.The doctors and nurses should be washing their hands at all times

But I haven't said that doctors and nurses should not wash their hands... are you reading the same posts as I am here? My point is that the responsibility extends heavily onto visitors and relatives, especially those with MRSA

Hospitals should not allow any situation that spreads the disease to occur.It's not rocket science.All it takes is a little divorce from the lazy couldnt be bothered or ah shur it will do approach.

Presuming that extends to evicting visitors from the hospital who simply walk in and make contact with patients without bothering to use the required precautions first and to clean their hands, then I agree with you.
People like you who blame this all on medical staff and fail to recognize their own responsibility are a huge part of the problem.

nesf

InFront wrote:

Right, and a lot of patients 'are exposed to' far more visitors than they are to doctors. If you watch visitors when they come in the first thing they do is walk over and shake hands, and sit around the bed. Next time you're ina hospital, ask visitors in the next bed to wash their hands/ use the gel and see what sort of reponse you get.

Without completely isolating patients diseases will manage to find their way into the wards. Considering that we can't completely isolate all patients, stopping the spread of these diseases within hospitals is extremely important.

Think of it in terms of probabilities, your chance as a patient of picking up MRSA or whatever from the handful of people who visit you is very small. Now, say there are 500 people in this hospital, the odds of one of them picking up MRSA is significantly higher than just you. Now if the hospital staff don't have a good hygiene the disease will spread out from the one or two cases that caught it from the outside. It will tend to spread expotentially and very quickly as more patients get ill. The odds of you picking up the disease if this happens are far more significant. Then add in patients themselves who come in with it and your odds of getting it become, well, problematic. We can't MRSA-proof hospitals, no more than we can keep any infectious disease completely out, we can however prevent the spread of the disease once it gets in and prevent an isolated 'freak' case becoming a mulititude of cases.

Steps can be taken to try and 'stop it at the door' but in reality some will get in and there have to be actions taken by both hospital staff and management to try and stop diseases spreading once this happens. Most of the staff take these actions already, thankfully, but there are a minority that don't and that is a significant issue in this.

InFront

nesf, that is not contradictory to what I've said at all, I can agree with it entirely. There are excellent hygiene facilities as it is, and unfortunately not all staff members and students observe them. But the point that some people are missing is the huge importance of visitor hygiene. As I said earlier, medics and nurses and all other hospital workers have a major responsibility with regard to MRSA. That responsibility extends to visitors too.
The amount of visitors whose first thought is to simply sit down and chat or to shake hands, ignoring the notices, is completely baffling.

InFront

InFront wrote:

It's a pity you can't even attempt to back that up with a quote. I did not imply that, which if you read my posts, should be pefectly obvious to most people.

Look,I'm not going to trade smart comments with you because we will only further mis understand each other.
You said it is "always brought in to a hospital" here .
I rejected that statement as false here

No bugs? Get real.
Also, can you comprehend how lingering MRSA has nothing to do with medical staff, but to do with resources available to them and to cleaners?

Well earlier I alluded to 2 rather snazzy private hospitals not short by any means on resources being rife with MRSA which suggests resources are not the problem.

But I haven't said that doctors and nurses should not wash their hands... are you reading the same posts as I am here?

Again I have no interest in trading smart comments with you I've already pointed out that you have denied that you said MRSA is always brought into a hospital and clearly such a definite cannot be said.Patients without it get it in hospital when they shouldn't.
Regarding your earlier comments on doctors and nurses not washing their hands, you said whats the point of them doing that if visitors don't do the same.
The simple reality is they of all people should be doing that as a minimum.There is a point to it even if the visitors to individual patients don't as the visitors aren't in close contact with other patients.
Allied to this, if the hospital is practising proper barrier nursing, then non MRSA and MRSA patients arent mixed - ergo further underlining the point of Doctors and nurses washing hands between visits to those patients.

My point is that the responsibility extends heavily onto visitors and relatives, especially those with MRSA

Not heavily,I would say equally.It is the responsibility of the hospital to run itself properly.
A hospital not enforcing barrier nursing properly when it comes to MRSA is as serious as sharing needles.It has the same relative impact ie the lack of simple policing of rules spreads MRSA.

Presuming that extends to evicting visitors from the hospital who simply walk in and make contact with patients without bothering to use the required precautions first and to clean their hands, then I agree with you.

Good.

People like you who blame this all on medical staff and fail to recognize their own responsibility are a huge part of the problem.

I'll take exception to that straight away as I always adhere to barrier nursing methods.
I'll also point out that I'm emphasising the hospitals responsibility to enforce barrier rules when it comes to MRSA as part of a duty of care to their patients and clearly that is not happening otherwise our incidence of MRSA would be like that of Holland or somewhere that theres an iota of respect for how to tackle MRSA.
I never put the total blame on all medical staff either,I emphasised their responsibilities.
It's all a programme and its sadly defecient in most hospitals.Lives could be saved were it to be tackled effeciently and it is not.

On a more political note,health pen pushers and politicians won't close wards due to MRSA infestation,it might get the opposition screaming about more ward closures.That just makes the problem bigger.

hunnymonster

I've only skimmed this thread but thought I would add my personal experience. I had MRSA about 6 years ago. It was detected when I was in the Louth Co Hospital and my care would not have been better. As soon as the test results were returned, I was moved into an isolated room. A single nurse atteneded to me and (s)he was gowned, masked and gloved all the time. I was restricted to one visitor (my mum) who also had to gown up and wash hands etc before and after visiting me.

InFront

Tristrame wrote:

You said it is "always brought in to a hospital" here .
I rejected that statement as false here

Yes, I said it is always 'brought in' in response to a poster who was suggesting that MRSA was in hospitals regardless of the conduct of the visitor. My point to him is, quite simply, that you can just about eradicate MRSA from a hospital and one careless visitor will begin the entire cycle again. Given the persistent nature of this bacteria on inanimate objects, good medical practice and diligent cleaners alone will not solve the problem. In every hospital in the country, MRSA has come in from an outside source.

Staph aureus can be on around a third of the general population at any one time. Whilst staff hygiene is of major importance, and lack of hygiene is inexcusable, the importance of visitor hygiene is also absolutely necessary. You think that this responsibility does not extend "heavily" onto them, I'm sorry, but that is just incorrect.
I'm really not trying to shift the blame, or anything like that. As I said earlier, the reasons why MRSA is a problem is: bad infrastructure and lack of beds, lack of isolation, exposure of wound, post-op and delicate patients, bad medical practice/ hygiene, bad or incomplete cleaning, and people bringing in the bacterium on their bodies. There is also an attitude issue to antibiotics of course
All staff need to observe best practice. But anybody (and I don't think you believe this, but in general) who thinks that doctors washing their hands diligently is going to solve the MRSA crisis on its own, is just fooling themselves.

Well earlier I alluded to 2 rather snazzy private hospitals not short by any means on resources being rife with MRSA which suggests resources are not the problem.

Oh okay, resources have nothing to do with it do they not? Why are we even bothering with the million-Euro Beaumont study if Tristrame can give us the answers... lets just go off and buy a truck of soap and hope for the best. MRSA has nothing to do with resources, apparently. I wonder if that study you carried out would stand up to more comprehensive exams.
In private hospitals, you also have a phenomenon you spoke about yourself in your post, not wanting to close off areas because of an MRSA incidence. In public hopsitals, this is impossible because of resources, in private hospitals, it's to do with a private income, a bit like a hotel not utilising its bedrooms: A very cross manager. What kind of cleaning was carried out? What kind of access was given to MRSA patients? What procedures were in place for their rooms and in terms of isolation? How early or late were the problems seen?

A hospital not enforcing barrier nursing properly when it comes to MRSA is as serious as sharing needles.

It's very serious, but to say it's as serious as sharing needles sounds a bit hysterical.

On a more political note,health pen pushers and politicians won't close wards due to MRSA infestation,it might get the opposition screaming about more ward closures.That just makes the problem bigger.

Oh, so the opposition ought to apologize quietly for that other government blunder - the absence of infrastructure - while this one is being sorted out? No. The problems are connected, the government have to do their part. If they're after making a mess of things over the past decade, nobody is going to apologize for them, and rightly so.
There are major resource problems within the health service. Keeping quiet about that so the government can put band-aids on individual problems serves to do nothing but endow the government with an artifically good name in order to help to bring them back again, that's not the job of the opposition, and I'm surprised anyone would even suggest otherwise.