- For years it has been the silent killer lurking in hospital
wards, but it can no longer be ignored - new figures show that cases of
the MRSA superbug have rocketed by 600 per cent in less than a decade.
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- Even doctors are running scared of the deadly bug which
is immune to many antibiotics and poses a particular threat to the young
and the old.
-
- An Observer investigation has learnt of paediatricians
advising parents to take sick children home from hospital - rather than
keeping them in overnight for observation - to reduce the risk of catching
the bug. There is also evidence that some NHS doctors are now paying to
have their own routine operations performed in private hospitals, where
the risk of infection is reduced.
-
- Health officials are battling to reassure the public
that the bug, full name methicillin-resistant Staphylococcus aureus, can
be controlled.
-
- The case of actress Leslie Ash who was left temporarily
paralysed by a bug that displays a number of properties similar to MRSA,
has added to the sense of panic. Now experts are warning that the true
scale of the MRSA threat, which last year contributed to the deaths of
more than 800 people in the UK and caused hundreds of people to undergo
amputations and fall seriously ill, is only starting to become apparent.
In the United States, experts have recently identified new strains of MRSA
which appear to thrive outside hospital conditions.
-
- 'While it would be wrong to present these latest findings
as a shock-horror scenario, it is fair to say there are now some nasty
strains out there that are not appearing in hospitals. They seem to spread
much more readily than their predecessors,' warned Professor Barry Cookson,
director of the Laboratory of Healthcare Associated Infection at the Health
Protection Agency.
-
- MRSA is usually carried on the skin or in mucus and is
only dangerous when it breaks through the skin, often via a surgical wound,
which is why it is dangerous in hospitals, especially those that perform
high levels of surgery among vulnerable patients. A recent survey showed
North Middlesex Hospital, which has large paediatrics and accident and
emergency departments, had the highest MRSA infection rates in the country.
-
- But the new so-called 'community' strain MRSA, which
is spreading outside confined areas and causes boils and sepsis - a form
of blood poisoning which can result in paralysis and death - suggests MRSA
is becoming more virulent. Worse, it is also becoming more difficult to
predict.
-
- 'We are going to have to watch this space when it comes
to the new generations of the bug. I always say never try to predict Staphylococcus.
It will always prove you wrong,' Cookson said.
-
- And then there is the nightmare scenario. Scientists
in the US have detected a fledgling bug called VRSA, or vancomycin-resistant
Staphylococcus aureus, so called because it cannot be treated by vancomycin,
the 'ultimate' antibiotic which doctors prescribe when all others have
failed.
-
- Fears that it is only a matter of months before what
is described as 'the mother of all superbugs' appears here were raised
recently after an influential medical journal noted that a patient had
contracted a hybrid of VRSA and MRSA. The revelation has prompted concerns
that soon there will be no drugs capable of treating the new breed of superbugs.
-
- It is a frightening prospect for the government, which
has been attacked for masking the true scale of the problem. The Department
of Health has made it mandatory for trusts to record MRSA rates. Even so,
privately health officials still fear the current figures represent only
a fraction of the bug's true infection rate.
-
- Some experts say that to appreciate the true scale of
the threat, the UK should draw comparisons with the US where more than
two million people out of a population of 290 million are affected by the
bug each year. Similar figures extrapolated for the UK suggest that more
than 400,000 people are affected by MRSA and that the bug plays a role
in the death of some 18,000 patients every year.
-
- Currently most death certificates fail to record whether
MRSA played a part. The government has now charged the Health Protection
Agency with developing a new way of auditing MRSA-associated deaths by
2005.
-
- In addition, electronic death certificates are to be
introduced which can record multiple factors that contributed to death.
-
- But these measures will do little to alleviate public
anxiety and, in the long run-up to an election, MRSA has become an issue.
Rival parties point out that, after Greece, Britain tops the European rankings
when it comes to superbug infection rates in hospitals.
-
- The Conservatives draw on statistics showing that MRSA
is not nearly as prevalent in private hospitals as in those in the NHS,
suggesting patients are getting a poor deal from the public sector.
-
- In a report released today, the Liberal Democrats accuse
the government of 'utter and extreme complacency' in tackling the issue.
They say there were 7,300 reported cases of MRSA last year, compared with
1,000 in 1996.
-
- 'People go into hospital to get better. But they are
getting sicker because of staff shortages and because infection control
is not a high enough priority,' said Paul Burstow, the Lib Dem health spokesman.
-
- The new report notes that hospitals scored themselves
only six out of 10 when it comes to implementing infection control standards.
'This report proves the lack of real progess being made in making our hospital
wards cleaner and safer. It is a black mark against the government's record
on NHS hygiene,' Burstow said.
-
- The government argues it is doing more to combat MRSA
than ever before. 'There is no complacency about the issue - tackling hospital
superbugs is one of my top priorities,' the Health Secretary, John Reid,
said.
-
- But, in a sign the government is now nervous about the
issue, it will dispatch the Chief Medical Officer, Sir Liam Donaldson,
on a fact-finding mission this week to the Netherlands, where MRSA rates
are a fraction of those in the UK.
-
- A key challenge for the government is to change people's
attitudes. Only a couple of decades ago health experts maintained that
hospital environments had little impact on infection rates. But now a number
of studies suggest elementary hygiene practices, such as washing hands
and keeping MRSA-infected patients isolated from others, has a dramatic
impact on reducing the rates.
-
- A recent study at St Thomas's hospital in London found
traces of MRSA on everything from TV remote controls to door handles, undermining
widely held views that the bug cannot survive in the open for more than
a few hours. After specialist cleaning, only 1 per cent of swabs taken
from wards which had housed MRSA patients contained the bug.
-
- But educating health staff and buying new hygiene products
is expensive, not to mention complicated for the hospitals involved. 'There
are an awful lot of snake oil salesmen out there who claim to have invented
all sorts of ways for killing the MRSA bug. There's an awful lot of bullshit
around,' said one NHS hygiene expert.
-
- Last month, the government announced a £68 million
hospital clean-up programme and issued a new cleaning manual to all NHS
staff. Supplies of alcohol handrub have increased by 35 per cent. But many
staff appear reluctant to heed warnings. The National Patient Safety Agency
published a report two months ago that found only 40 per cent of necessary
hand-hygiene procedures were being carried out in NHS hospitals.
-
- Keeping patients with MRSA in isolation is not easy either.
The Lib Dem report points out that there are now 3,000 fewer hospital beds
since Labour came to power and that most NHS trusts cannot afford to separate
MRSA-infected patients from others.
-
- Health experts agree that doing nothing is no longer
an option. Infectious diseases cost the NHS £1 billion a year and
claim 5,000 lives. These figures are expected to rise as new strains of
superbug cross the Atlantic, bringing not just death and disease but another
serious problem. This month's edition of the US journal Infection Control
and Hospital Epidemiology warns that MRSA 'causes increased length of hospitalisation,
increased morbidity, increased mortality and increased costs. In addition,
these pathogens cause large numbers of lawsuits, driving up insurance and
healthcare costs.'
-
- As one NHS hygiene expert puts it: 'If a mounting death
toll doesn't prompt the government to act on MRSA, a tidal wave of lawsuits
just might.'
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- Guardian Unlimited © Guardian Newspapers Limited
2004
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