Here are 10 easy steps to beat the superbugs

By Gary Moug HOSPITAL superbugs are back in the news after a health watchdog attributed 90 deaths at three Kent hospitals to Clostridium difficile. Health Secretary Alan Johnson described the deaths as “scandalous” and police are now investigating whether the local NHS Trust should be prosecuted. The Healthcare Commission said a “litany” of errors in infection control had caused the “avoidable tragedy”. And the country’s top microbiologist, Professor Hugh Pennington, agrees there’s “not a shadow of doubt” this outbreak could have been avoided. He said, “The news was very disappointing. To have one outbreak is bad enough but the second one is inexcusable. If this had been a food poisoning issue there would already be a public inquiry. “We know who C. difficile causes problems in and why. It can be avoided if hospitals react soon enough and have their eyes on the ball. “These infections are caused by people not doing the things we know work. It’s not about rocket science, just attention to details.” Prof. Pennington believes this latest tragedy could make people more scared of visiting hospitals and some may even cancel non life-threatening operations rather than have to enter hospitals. But he reckons such fears could be allayed if everyone followed his simple 10-point plan to beat hospital superbugs. 1. FOR MRSA, there should be more screening of patients before they go into hospital. It’s the only superbug that can be successfully screened for so we should find those who are already carrying the bug and treat them.  For example, someone might be going into hospital for a hip operation and could be carrying a bug without realising it. If we could find out these problems in advance and treat them there and then, we could reduce the number of bugs entering our wards. Prevention is the key thing. It would also be quite cheap to test patients in advance in situations where there is time to wait for results. 2. Separate affected patients from unaffected ones. This can involve using isolating facilities and individual rooms. Staff working with affected patients must obey all standard rules for barrier-nursing, from washing hands after attending to each patient to treating bedpans as potentially very dangerous sources of infection. 3. BED OCCUPANCY rates are too high. The more patients there are in hospital the increased risk there is of infection.  We have a very cheap health service in terms of the money spent on each patient.  Hospitals must become less full than they are at the moment. Fewer patients would also give staff more time to look after each patient and more time to do the important things, like hand washing and not rushing. 4. HIGH STANDARDS of training for ALL staff who come into contact with patients, not just nurses. Each staff member must be aware of all sources of infection and what to do if they find infection. 5. THE PUBLIC must regard hospitals as being quite dangerous places. Visitors should not be using them as meeting places and just come and go as they please.  While I don’t think there’s a serious issue regarding visitors bringing infections into hospitals, if there are large groups of them it gives staff more people to monitor and may lead to them taking their eye off the ball. Fewer visitors might make a difference and it’s important staff have more control over them. 6. GOOD CONTROL of antibiotic use. Some patients are given antibiotics unnecessarily for a whole range of conditions, either in hospital or from their own GPs. Overuse of antibiotics can weaken patients’ ability to fight serious infections and put them at greater risk. 7. We need to look at the culture of hospitals and make infections a higher priority. Hospital managers must make this their number one priority, even ahead of reducing waiting times.  Managers must have the guts to stand up to politicians and tell them there are other targets to meet. I’m sure patients would rather wait an extra week or month for, say, a hip operation if it meant reducing their chances of infection. 8. THERE MUST be very good monitoring of what’s happening in hospitals and proper testing for infections. Too often, infections are taking a grip before people realise it and by then it’s often too late. Some hospitals have not been sharp enough to do the necessary testing. 9. HOSPITALS MUST be kept in a consistently high state of cleanliness. In particular, communal areas such as toilets, showers and baths must be rigorously cleaned. 10. THERE MUST be eternal vigilance. We should be constantly on the lookout for new challenges. MRSA lurked around for a while and we didn’t do enough to nip it in the bud.  By the time it took off, it was too late. We were too relaxed about it for too long.  We should not just be looking at the current challenges but watching for new ones because we know they will happen sooner or later.   A GP's verdict on Alan Johnson's health plans By Professor Hugh Pennington Last Updated: 2:39am BST 26/09/2007 Alan Johnson told the Labour Party conference that matrons would be empowered to "fight infection on the front line", that the "war" against Clostridium difficile must be intensified, and that a new regulator - Ofcare - will be given powers to fine dirty hospitals and close wards.  He told GMTV that he wanted to see MRSA eradicated from wards - with a target of reducing its incidence to zero. Great stuff! But will matrons be able to deliver? Are spotless wards the answer? Can MRSA be eradicated? My answer to these questions are no, no, and no. Controlling hospital-acquired infections is a complicated business. Matrons have very important roles as leaders and drivers of cultural change – surveys show that hospital staff are very poor handwashers, for example, and their role in improving this dismal statistic could be vital. But what about microbiologists? They need empowering as well. We have always been fighting on the front line – but have usually been regarded by hospital managers as boffins in the background whose budgets can be raided for front line clinical services. Matrons regard us as deliverers of bad news that comes in technical language that their training has poorly equipped them to understand. Team work, not just dragons stalking the wards, is the way forward. It is reasonable to suppose that a dirty hospital is poorly run. If its public spaces are unclean, what is it like behind the scenes? But the converse is not necessarily true. Clostridium difficile does not grow in dust. In hospitals it is spread by diarrhoea from its victims getting into or onto places that it should not – like the hands of nurses - and then from them into the mouths of susceptible patients. Old-fashioned barrier nursing is the answer. Cleaning is easily to inspect, evaluate and score as a performance indicator. It would be a great pity if meeting Ofcare targets for it drew attention away from handwashing, which is much more difficult to measure but which is much more important in preventing infection. Eradicating MRSA soon – if ever - is a pipe dream. It is so well-established in Britain that optimistic models for its control which start with the assumption that all the necessary preventative steps are in place and are working perfectly predict that bringing its level down to an acceptable one would take at least six years. But none of the preventative steps are fully in place, and none are working perfectly. They are nowhere near as good as the Draconian "search and destroy " measures that have been in operation in Norway and the Netherlands for years - and they still have MRSA from time to time. Even if we saw off the two main villains of the piece, EMRSA 15 and 16 (E stands for 'epidemic'), their parent, MSSA, is still going to be there. Thirty per cent of us carry it in our noses. It also causes infections after surgery. And it is very good at evolving in response to antibiotics. I have nothing against matrons, or cleanliness, or stiff targets for MRSA. My prescription for progress is different, however. It is for a crash programme installing isolation facilities and much more money for microbiology. The good news is that Gordon Brown favours the first. I hope he comes on board with the second. Prof Pennington, emeritus professor of microbiology at the University of Aberdeen and the president of MRSA Action UK, is one of Britain's leading experts on public health and hygiene http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/09/26/nlabour726.xml Hand washes: Cleaning up? The Sun Published: 07 Nov 2007 FILTHY hospital wards, tummy bug fears and our attempts to avoid winter colds and flu, have seen sales of antibacterial gels and wipes surge with High Street giant Boots reporting sales rising by 80 per cent a year.   Manufacturers claim their products kill almost all bacteria. But hospital deaths from clostridium difficile prove they won’t combat all killer bugs. The spores that spread C.diff are immune to antibacterial gels. Some microbiologists believe these products have encouraged C.diff by destroying the harmless bacteria which would normally keep it in check. Professor Hugh Pennington says: “We live in a bacterial soup. In our bodies there are more bacterial cells than our own cells. Our skin is a happy hunting ground for a range of different bacteria, but we have a kind of relationship with them.” Families tend to share the same bugs, and Prof Pennington says some of these microorganisms even produce their own antibacterial substances. So are antibacterial products our first weapon against illness or a waste of time and money? In a special Sun Health investigation we carried out our own laboratory tests and asked Professor Pennington to score them out of five. For each product we swabbed the tester’s hands before use, five minutes after use, and an hour later. We added an extra swab when testing those said to work for longer periods. A leading lab then cultured the swabs to see what bugs grew in 48 hours. As the professor expected, most produced a growth of “mixed skin flora” – bacteria we all have on our hands – ranging from “scanty” which was the least, to “plus 3”, the most. What's bugging you? MANY bacteria and viruses we get are harmless, others are easy to get rid of. Here Prof Pennington, gives a bugwatch guide. RHINOVIRUS is the umbrella term for more than 100 viruses that cause colds. Most commonly spread via airborne droplets but can also survive on surfaces. STAPHYLOCOCCUS AUREUS is carried by one in three people and can cause anything from minor skin infections and boils to pneumonia. MRSA is “staph” that has grown immune to antibiotics. It is harmless on the skin’s surface but can be deadly if it gets into the blood-stream. SALMONELLA can cause anything from mild to fatal food poisoning. You are most likely to get it from eating contaminated chicken, not hand contact. But hands can transfer the bug from chicken into the mouth or on to food. STREPTOCOCCUS includes many harmless bacteria but also covers bugs that can cause anything from a sore throat to meningitis and flesh-eating bug necrotising faciitis. ROTAVIRUS is the most common cause of diarrhoea in children aged under five. NOROVIRUS is thought to cause half of all cases of vomiting and diarrhoea. Incredibly tough to kill. HIV is the virus that causes Aids. It’s actually very difficult to catch and is spread only via contaminated blood and other body fluids. Making sense of Microbes BACTERIA – single-cell microorganisms. Some cause disease and infection, others are essential for good health. Most are killed by antibiotics VIRUS – parasitic microscopic particles that can only reproduce by invading other cells. Immune to antibiotics FLORA – the bacteria in and on our bodies PATHOGEN – a bacteria or virus that makes us sick POLYMER – a film created by a fine mesh of molecules ENTERIC BACTERIA – bacteria found in the intestines SKIN FLORA – bacteria found on the skin ION – a particle with an electric charge   Click here to go back to MRSA Action UK Homepage