MRSA in our Hospitals

havetoquit

If this thread not permitted here, please guide me to the one that is, as cannot seem to find it.

Just like to hear people's views on why our hospitals have such a high incidence of MRSA and what can be done to lower it.

Thanks in advance to anyone who can contribute, as the subject interests me and hopefully others too. Cheers

Silverfish

Moved from the Ladies Lounge, hopefully better suited to here.

havetoquit

Thank you so much admin and sorry to have given you the hassle. I shall give my own wrist a good smack and make sure it does not occur again!

Have a nice Sunday evening.

edellc

hygiene hygiene hygiene i cant say it enough people need to wash their hands visitors doctors nurses the cleaners and people who work in the canteen and shops
my mother has a long term terminal illness and is in and out of hospital all the time she is always putting off going in as she is terrified of dying not from her illness but from MRSA/SWINE FLU/WINTER VOMITING BUG and so on

havetoquit

What I have a problem understanding is why certain countries such as Holland has long introduced a protocol which deals with the problem efficiently and with a good sucess rate and have at last check the lowest in MRSA percentage in Europe and yet our rate does not change. Is it not possible for us to adopt their protocol in dealing with the problem? I am not by any means well informed on the subject, but would love to hear comments/views/suggestions from those who may be. It is a serious issue and one I hope to see discussed here.

edellc

problem in the govt spends too much money on too many admin and unnecessary staff in the hse rather than the standard of care provided
like the welfare system the health system needs a complete overhaul

havetoquit

edellc wrote: »

hygiene hygiene hygiene i cant say it enough people need to wash their hands visitors doctors nurses the cleaners and people who work in the canteen and shops
my mother has a long term terminal illness and is in and out of hospital all the time she is always putting off going in as she is terrified of dying not from her illness but from MRSA/SWINE FLU/WINTER VOMITING BUG and so on

So sorry to hear that. Have you noticed how so many doctors and other medical staff go about their duties with no uniform/protection and with the same shoes they wear outside? I had reason to be admitted to a hospital in another european country and all medical staff and nurses wore a uniform and white washable hospital shoes and cotton socks. They did not go home in this uniform. It was left in the laundry area of their changing room where showers were also provided and special spray for their footwear. Some may argue that visitors dont wear any protection etc, but lets be honest the visitors do not carry out procedures and go from one patient to another. Then you often see medical staff eating in the visitors canteen. It just seems very slap dash when you think of it.

Traumadoc

Ask any nurse why they prefer the navy uniform to the white one and they will answer you because they stay cleaner longer:rolleyes:

They should never have gotten rid of the hospital laundries. All staff ( Admin +consultants included) should change into white hospital uniform when they arrive at work.

havetoquit

Really appreciate your comments and would be great if there were even more people interested. I so agree with you about the uniform. How disgusting to think of a nurse wearing the same uniform each day. It doesn't bear thinking about really. While we are having our justifiable rant here, have you ever noticed how noisy some hospitals are? Female doctors traipsing around on tiled floors in heels, also receptionists and other staff. I fail to see how that is being considerate to very sick patients, as hospital wards are noisy enough as it is. I have to say, I foolishly harboured a dream when the so called Tiger was with us, that this wonderful new-found wealth would be used primararily to transform our hospitals. Build 2, 3 & four-bedded airy rooms with shower and wash basin as in many parts of Europe. I am not referring to private patients here. Well managed and organised hospitals with a good quota of staff, 1st class hygiene practices and fully equipped so that very sick elderly patients would not be required to travel all over the place for hours to have treatment and then back again that night. That is all wrong. I have accompanied friends who are still nauseaus after Chemotherapy and other treatments and expected to travel long journeys back home. Our doctors, specialists and nurses were second to none, and where do you find many of them??? Working in some of Europe and America's top hospitals, where they have a better standards, better equipment at hand and the reward of being able to give their patients faster and often better care. I see this also as a Government issue and cannot conceive that they are such a selfish and uncaring group of individuals who are letting down the very people who put them where they are and who pays their way over the top salaries for doing what exactly? Sorry about the rather harsh nature of this post, but I feel so very passionately about the frail, the sick and vunerable in our country and we all know how much our older generation who have been through so much deserve. They deserve the best medial care possible and to be treated with dignity with the basics such as a bed, not a hard trolley with no space to move. It's so sad. Then we will get the self righteous telling us how luck we are in comparison to third world countries etc. Anyone can compare with the worst. We are not discussing those countries, but our own who owe it's people who come through so much over the years. Surely health care would be a priority.

bleg

Situation in Ireland

Background

Due to the major public national debt that existed until the mid to late 1990s, antimicrobial resistance has only recently become a priority in Ireland:

In 1995, the first national guidelines on the control and prevention of MRSA were produced by the Department of Health and Children11
In 1999, the North/South study of MRSA in Ireland was carried out which include a review of infection control facilities throughout the island.12
The Strategy for the control of Antimicrobial Resistance in Ireland (SARI) was drafted by a multi-disciplinary group and the document was launched in 2001. The strategy provided recommendations for the future approached to AMR and their implementation 1
Ireland has participated in the European Antimicrobial Resistance Surveillance System (EARSS)13 since its inception in 1999.
EARSS

Ireland is one of 31 countries contributing to the European Antimicrobial Resistance Surveillance System (EARSS), which aims to provide comparable and validated data on the prevalence and spread of major invasive bacteria with clinically and epidemiologically relevant antimicrobial resistance in Europe.

Compared with other European countries, we have high rates of MRSA, pencillin-resistant pneumococci, and other resistant bacterial pathogens. 14,15

This high level of antimicrobial resistance may partly be explained by our relatively high consumption of antimicrobial agents, compared with other European countries, such as the Netherlands and Denmark. Detailed analysis of out antibiotic consumption data has shown that 15,16

The rate of antibiotic consumption has been increasing, while other European countries have succeed in reducing their level of antibiotic consumption
A high proportion of antibiotics used in Ireland are "broad spectrum" antibiotics, and the proportion of antibiotic use accounted for by these drugs is increasing. This contrasts with many European countries where the predominant antibiotics used are "narrow-spectrum" drugs
There is marked seasonal variation in antibiotic consumption in Ireland, with antibiotic consumption considerably higher during the winter months.
These three patterns of antibiotic use are all predictive factors for high levels of antibiotic resistance.


SARI

The Strategy for the Control of Antimicrobial Resistance in Ireland (SARI) was launched in April 2001.1 This outlined the scale of antimicrobial resistance in Ireland and provided a plan for improved surveillance and intervention to control and prevent infections caused by antimicrobial resistant microbes. The main recommendations were as follows

Development of a National Framework (Local, Regional and National)
Surveillance of Antimicrobial Resistance (Clinical and Public Health Level)
Monitoring of the use of Antimicrobials (e.g. Using legislative controls, collecting and analyzing data)
Antimicrobial Guidelines (Evidence-based national guidelines)
Education (Undergraduate, clinical professional groups, the general public)
Future Research (Development of new agents, establishment of reference labs, evaluation of interventions to improve prescribing etc.)
The various committees and bodies that have emerged following the publication of SARI have resulted in:

increased surveillance of antimicrobial resistance in Ireland
the provision of national guidelines on hand hygiene and the updating of guidelines on the control and prevention of MRSA17,18
the education of general practitioners on antimicrobial prescribing
the education of healthcare workers and the general public about Healthcare Associated Infection (HCAI) and Antimicrobial Resistance (AMR).

havetoquit

Dear Blegg
Thank you so much for taking time to respond with such an informative piece and much appreciated.

In your opinion does our hygiene practices in hospitals also play a huge part in the spread of MRSA and do you believe that our standards are acceptable? I would like to hear your opinion on some of the points that were made regarding uniform, changing rooms with showers for staff, hospitals with fewer patients sharing the same space etc. I have to say I cannot find anything positive about open wards and the lack of privacy at a time when people are ill. One so often hears of patients relating after discharge that they quite often heard all that was said at the next bed during the doctor's round. Some patients hesitate to ask their doctor questions because they do not wish for the patients either side of them to be a party to the conversation which is quite understandable. Then there is the importance of rest and recovery, which is also hampered by the constant comings and goings and noise.

I spent 4 months in a Plastercast due to spinal injury in a German hospital and I cannot speak highly enough of the standards I witnessed and the privacy, peace and quiet afforded me in a 2 bedded room. Once eventually on my feet, I so appreciated the shower room with toilet and wash basins all in the one room. I was not a private patient, but my care was most definately first class and thereafter I was sent to a four star recuperation clinic in a healthy mountain region for 8 weeks. All patients had their own room with balcony, telephone, tv etc and each floor of the clinic which had 20 rooms had a treatment room in addition to the huge hydra therapy, physiotherapy and other treatment rooms which were downstairs and could be accessed by lift. It was incredibly well organised and managed. The cleanliness and the lack of noise were very evident in all areas of the clinic. It truly lent itself to recuperation.

Would it not have been a wonderful opportunity when the country had the means, to have built hospitals of better design rather than building more houses and hotels than we shall ever need? I have no faith in the Governenment right now and feel that their last priority is the Health Service.

Is it possible with my limited knowledge on the subject that I am laying blame where it doesn't belong? I have no wish to do this, but the stark contrast in hygiene practices in some European hospitals in comparison to our own led me to belive that we are not as disciplined in this area as we should be. It is of course only my opinion and no asperations are being cast at our often over-worked medical and nursing staff, which as I said, are second to none. I just don't think that their working conditions are up to the standard they could be and should be, which leads so many of them to emigrate.

I would like to have a better insight into the subject and value the opinions of others.

Thanks again for yours.

Sitric

Bleg that was a great post, thanks. I had read some of the EARSS reports on antibiotic consumption and the development of resistant species across Europe and there seems to be a clear correlation. I got interested in this last yr in Scandinavia, all anyone ever seemed to get was penicillin unless really needed.

I believe an effective stategy to tackling this is to give microbiologists or infection control departments in every hospital the authority to restrict the antibiotics that doctors can use.

Hygiene is of course absolutely vital within hospitals too but it's function is to avoid the spread of infection, not the development of the resistant species.

Sitric

If anyone wants to have a look at the numbers

http://www.rivm.nl/earss/result/Monitoring_reports/Annual_reports.jsp

Sitric

Traumadoc wrote: »

Ask any nurse why they prefer the navy uniform to the white one and they will answer you because they stay cleaner longer:rolleyes:

They should never have gotten rid of the hospital laundries. All staff ( Admin +consultants included) should change into white hospital uniform when they arrive at work.

It's kind of nice wearing pajamas at work too!

You're right though, even wearing your everyday shoes in a hospital is pretty disgusting.

RacoonQueen

havetoquit wrote: »

So sorry to hear that. Have you noticed how so many doctors and other medical staff go about their duties with no uniform/protection and with the same shoes they wear outside? I had reason to be admitted to a hospital in another european country and all medical staff and nurses wore a uniform and white washable hospital shoes and cotton socks. They did not go home in this uniform. It was left in the laundry area of their changing room where showers were also provided and special spray for their footwear. Some may argue that visitors dont wear any protection etc, but lets be honest the visitors do not carry out procedures and go from one patient to another. Then you often see medical staff eating in the visitors canteen. It just seems very slap dash when you think of it.

Staff are NOT supposed to wear outdoor clothes or shoes in hospitals though. I buy shoes especially for work and bring home my top at the end of each day to be washed, my trousers also worn in work only get changed twice a week unless they need to be laundered more often. I wouldn't in a million years dream of wearing my dirty work clothes home, I'd be more worried about what I was bringing home than what I was bringing into the hospital.

I know a lot, or most staff wear their uniforms outside of work but it doesn't mean we all do. One person I work with cycles in in their uniform which I find rather gross.

havetoquit

Good points and of course I wasn't for one minute suggesting that all staff carry out this unhygenic practice by any means. I would have thought that there would be a hospital regulation forbidding unforms, hospital shoes etc to be worn/brouhgt home. Is it because some hospital does not supply a laundry service, changing rooms with showers or what would be the reason that some do this? There surely has to be control. One would also assume that medical staff in particular would show the best example by wearing quiet hospital shoes and their white coats when on the wards. Some do, some don't. One just does get the impression that hygiene is that important looking round some of our hospitals. Nor is any attempt to keep the wards quiet as possible. The loud voices sometimes and the clacking of heels among all the usual ward proceedings is anything but conducive to recovery. I don't wish to come across either as being critical for the sake of it with practices in my own country, but if it helps to highlight issues which really do genuinely concern me, then I hope my comments are acceptable. I see nothing wrong with comparing to practices in other countries and feel that we could all learn from each other. Is that not what Europe is all about? Sharing ideas, looking at what really works and discussing how best to adopt these procedures. If a system is seen to be successful in another country I see nothing wrong with looking into that and then see if we can make positive changes to our own system. There are so many positive things within our hospital system that are also deserving of mentioning here; the hihghly qualified and generally wonderful, humane and friendly staff, who give the highest standard of care possible within the system they have to work under for a start. I believe that they should have a huge say with regard to their hospital's hygiene practices. They should be listened to and their suggestions/complaints/comments taken seriously by the management responsible for such issues. I met one very kind and higly skilled Irish surgeon in Germany who stated categorically that he found our hospital management system very inferior and would not consider returning here to practice unless things changed dramatically. He felt that the mental health system was particularly lacking, with some hospitals putting mere children on wards with adults and that is only one example from a long list. I could understand how the frustration of working within such a system would have proved too frustrating for him and many others. So wrong that we have lost such competant and skilful people from our shores.

havetoquit

Good points and of course I wasn't for one minute suggesting that all staff carry out this unhygenic practice by any means. I would have thought that there would be a hospital regulation forbidding unforms, hospital shoes etc to be worn/brouhgt home. Is it because the hospital does not supply a laundry service, changing rooms with showers or what would be the reason that some do this. One would also assume that doctors who are obviously very aware would show the best example by wearing quiet hospital shoes and their white coats when on the wards. Some do, some don't. One just does get the impression that hygiene is that important looking round some of our hospitals. I don't wish to come across either as being critical for the sake of it with practices in my own country, but if it helps to highlight issues which really do genuinely concern me, then I hope my comments are acceptable. I see nothing wrong with comparing to practices in other countries and feel that we could all learn from each other. Is that not what Europe is all about? Sharing ideas, looking at what really works and implementing these procedures. If a system is seen to be successful for all concerned in another country I see nothing wrong with looking into that and then see if we can make positive changes to our own system. There are so many positive things within our hospital system that are also worth mentioning;; the generally wonderful, humane and friendly staff, who give the highest standard of care possible within the system they have to work under for a start. I believe that they should have a huge say with regard to heir hospital's hygiene practices. They should be listened to and their suggestions/complaints/comments taken seriously by the management responsible for such issues. I met one very kind and higly skilled Irish surgeon in Germany who stated categorically that he found our system very inferior and would not consider returning here to practice unless things changed dramatically. He felt that the mental health systme was particularly lacking, with some hospitals putting mere children on wards with adults and that is only one example from a long list.

mcdermla

I've seen a consultant anaesthetist administer an epidural having only rinsed his hands. I'm told that doctors should scrub in to perform this before an operation (as in use special disinfectant and put a gown on). I've also seen nurses wearing gel nails when they're supposed to have short clean nails free of polish.
Kids carry a lot of germs and I've been on wards where it says 'no children allowed' but unfortunately this isn't always adhered to.
There was a good point here made about shoes worn by hospital staff; seems hypocritical to ban crocs but not have any other stipulations regarding shoes.
I remember advising one visitor who was about to enter a ward that very clearly said there was a vomiting bug inside, that he ought to wash his hands, to which he replied, 'It's ok, I have an iron stomach.' People don't realise that they can spread germs and tend to ignore signs in hospitals.

Just like to mention that while the above may be corrected, I'm going by what the medical professionals at my hospital have told me, and the protocols and policies of the wards I've been on.

sharkbite1983

i was in a bad accident in may 2002, fractured my right shin bone several times. surgeon said my bones look like crushed ice!!

i got an external fixater put on, (think forest gump leg braces, except the pins go straight through my leg in 6 places) which soon became infected with MRSA. I had never heard of this before and wasnt too concerned. I trusted the staff that were looking after me. to be honest, i still do, i spent 6 months in hospital instead of 5 days, 10 operations instead of 1, and im left with really horrendious scars down my right leg (hence the name sharkbite ) but i could not fault the staff in James' hospital.

Granted there was a few times they didnt wash their hands comin in and out of my room, but id remind them. and as for washing getting rid of MRSA, a doc could come into my room, inspect my wound, go home have a shower, scrub for hours, and come back in fresh clothes, still carrying MRSA washinghands is a feeble attempt, and blaming staff is an easy way out.

The main reason our infections are getting stronger is because people are taking anti biotics like theyre going out of fashion, and everytime an infection is beaten with one, it can come back resistant to it.

as im sure most of you still bothered reading this, already knows, the SA is the name of the infection, and MR is methicillian resistant. Methicillian used to be our strongest defence against SA, now its Vancomican. (Im sure my spelling is wrong, but you get the drift!!) it took 7 years to make Vancomican, the strongest anti biotic in the world, i was given it on an IV drip, straight into my heart every 12 hours for 6 months, it was barely out on the market at this stage, but thankfully, after the longest 6months of my life, it healed up my leg.

I was only out of hospital a week when i read about a woman in america who went to get an ingrown toe nail removed, and got VRSA. the infection has already become resistant to Vancomican. that is scarey!!!!

SomeDose

That sounds like a pretty horrific situation for you to have suffered - bone and joint infections, even without the added risk of MRSA, are notoriously hard to eradicate and usually require prolonged courses of antibiotics. Although it's probably of no comfort to you now, the good news (relatively speaking) is that advances in antimicrobials mean that patients with these kind of infections no longer have to spend extended periods in hospital while being treated. MRSA may be treated either at home / on an outpatient basis with a once-daily intravenous drug, or even with oral antibiotics in some cases. This has the massive advantage of removing the risk of patients contracting other hospital-acquired infections. In addition, hospitals have also implemented strict policies where surgical patients at risk of contracting MRSA will receive prophylactic antibiotics prior to the operation, in order to minimise the risk of wound & systemic infections.

The thing is though, MRSA tends to grab all the headlines and enjoys great infamy amongst the general public. Arguably this is justified, but it is the emerging gram-negative resistance amongst hospitalised patients which is possibly more sinister. Already there is significant resistance amongst pseudomonas and enterobacter species, and where I work we have identified klebsiella resistant to our "most powerful"* antibiotic (meropenem). The relative lack of new antibiotics being developed to treat these kind of bugs means this is something we're really concerned about, understandably.

*It's not correct to describe antibiotics as powerful/strong etc - only their spectrum of activity is relevant. So whilst Vancomycin is active against MRSA, it is also has a fairly narrow spectrum of activity therefore it is useless against lots of other pathogens. Meropenem, on the other hand, has perhaps the broadest spectrum of any antibiotic in widespread clinical use and is active against most clinically-significant bacteria. As a result, it's basically the "nuclear option" and should only be used as a last resort in resistant infections.