News MRSA cases on the increase according to Health Protection Agency figures   25/04/2008   The bid to beat MRSA has stalled, Health Protection Agency figures reveal. Despite the Government's "deep clean" drive to stamp out the superbug, cases in England rose by 0.6 per cent between October and December 2007 to 1,087. Clostridium difficile fell eight per cent in patients aged 65-plus in the period. But the MRSA increase may hamper aims to halve hospital infection this year. Derek Butler, chair of MRSA Action UK, said: "These figures show there is little progress in the battle to beat healthcare infections that affect so many people."     http://www.mirror.co.uk/news/2008/04/25/mrsa-cases-on-the-increase-according-to-health-protection-agency-figures-89520-20394219/   Superbug shame of our Welsh hospitals Apr 20 2008 by Matt Withers, Wales On Sunday DOCTORS and nurses could be treating patients while carrying lethal superbugs including MRSA, we can reveal. Many trusts do not take their staff off wards automatically if they are found to be carrying one of the most deadly hospital bugs, MRSA, which can be spread by human contact. A survey of trusts carried out by Wales on Sunday reveals that few routinely screen staff for the infection, or even keep records of the number of employees infected with MRSA. They claimed such a policy was in line with Welsh Assembly Government guidelines. But a comparison with ultra-stringent techniques adopted in Europe highlights how shamefully lax our system is. Countries like Iceland, Norway, Sweden, Holland and Denmark – which have some of the lowest superbug rates in Europe – have introduced policies like: - “Search and destroy” investigations to eradicate infections; - isolating infected patients so that doctors move around the hospital, rather than those carrying bugs; - establishing isolation rooms with negative air pressure to stop germs being wafted outside; - ensuring bed occupancy remains under 85% so hospital staff aren’t stretched. Shadow Health Minister Jonathan Morgan yesterday described the policies implemented on the continent as “very simple, very basic things that could be done here”. He said: “There are some very, very interesting policies here, especially the screening of patients and staff and the use of isolation rooms. “The examples here are clearly best practice that is being used in parts of Europe and that the Assembly Government and British Government ought to be making use of and considering. “The fact that Sweden aims to keep occupancy rates at 85% is clearly helping, whereas occupancy rates in Wales we know are 96, 97%. “Staff and clearly patients need to be screened the way they are in Iceland. We need to be learning from best practice.” But he did add: “The screening of patients and staff, isolation rooms, occupancy rates as low as possible – all these are very difficult to provide in the framework of the current NHS.” A spokesman for the Welsh Assembly Government said the focus in Wales has been to reduce all healthcare associated infections “rather than concentrate on one specific organism and latest independent figures show that our efforts have paid off”. He said: “The UK and Ireland study showed that the overall infection rate in (hospitals in Wales) was 6.4%, which is lower than England and the UK and Ireland rates. “While healthcare associated infections will never be entirely preventable, there are measures in place to reduce the risk and spread of infection. “It is difficult to make accurate comparisons between European countries as there are many different structures and measures in place on infection control. This can lead to misreporting and misunderstanding about such infections. “It must be noted that while Holland is usually held up as an exemplar for infection control and does have low rates of MRSA, a study at two Dutch hospitals between 2001 and 2004 showed an overall prevalence rate for all infections of more than 10% – significantly higher than Wales or the UK.” The Welsh approach to tackling superbugs can be neatly contrasted with that in Norway, which has a similar publicly-funded health service to Wales, but where hospital staff are regularly screened and sent home if positive. The Norwegians’ MRSA rates are 1/80th that of the UK. While the meticulous methods favoured on the continent have reaped rewards, the Welsh approach is backed by many unions – including one that warned that a hardline policy could damage its members’ financial well-being and career prospects. Health trusts told Wales on Sunday that in many cases, staff are only taken off wards where there is a particularly high risk of infection. A spokeswoman for Abertawe Bro Morgannwg NHS Trust confirmed they did not automatically take staff with MRSA off wards, but added: “In certain high risk areas, like neonatal units, staff may be excluded from work whilst receiving treatment.” She also said they did not screen staff, saying: “The trust’s policy reflects national guidance. Screening of staff is not recommended routinely. “Further screening, such as during outbreaks, will be carried out at the discretion of the infection control team.” A spokesman for North East Wales NHS Trust said: “If staff are merely carrying MRSA they are treated with a topical treatment to get rid of the colonisation and are allowed to remain working, unless an infection develops.” A spokeswoman for Conwy & Denbighshire NHS Trust said: “Generally staff are offered appropriate treatment, care and advice to help get rid of the MRSA. “Staff are advised of adhering to appropriate infection control measures and do not generally require to be taken off their normal duties.” And a spokeswoman for North West Wales NHS Trust said: “We don’t screen for MRSA. “As 25% of the population carries MRSA anyway without showing any symptoms at all we wouldn’t know if a member of staff had MRSA.” Patients’ pressure group MRSA Action said they were “really surprised how relaxed the attitude is” and demanded all medics be screened with those testing positive being taken off frontline duty. Chairman Derek Butler said: “We need screening to try and prevent it from being spread around the hospital. Hospital staff are members of the public. They are not isolated. “They are actually exposed to the risk of MRSA to a greater extent because they are working with it day in day out so they are more likely to contract it than you or I. The incidents are higher. “They should screen staff. If staff are positive, remove them from frontline service. We’re not saying send them home, they can find them some other duty until they are given treatment… “We understand the argument about it being damaging to nurses financially and damaging to their career prospects, but you’re putting the patients at risk. You can’t put a price on patients’ lives. It’s no use you or I washing our hands or taking extra precautions if staff have got it up their nose.” Welsh Assembly Government guidelines state: “All staff should understand the impact of infection and infection prevention and control practices and recognise their role in reducing infections. “Patients should be treated in physical environments that minimise the risk of infection.” The Royal College of Nursing guidance on MRSA claims that forcing infected staff to stay away from work until they are clear “will lead to staff shortages and can affect the employment prospects, career opportunities and income of these staff.” Martin Semple, clinical lead and head of the RCN Wales Institute said they shared MRSA Action’s concerns, but added: “The RCN recommends a number of approaches such as mandatory infection control training for all health and social care staff, empowering nursing staff to ensure healthcare premises are clean and decontaminated as well as an increase in the number of specifically appointed infection control nurses that can lead on to addressing infection. “We have already seen that these steps can make a real difference and that Wales has a lower infection rate than England.” But in contrast to Wales, Great Ormond Street Hospital in London, one of the 20 best trusts at controlling MRSA, excludes staff found to be carrying the bug. http://icwales.icnetwork.co.uk/news/health-news/2008/04/20/superbug-shame-of-our-welsh-hospitals-91466-20791496/ The Patients Association The Weekly News. Week Starting 7th April   Doctors with MRSA continue to treat patients Hundreds of hospital trusts are allowing doctors and nurses testing positive for superbugs to continue to treat patients as normal.   Many trusts were found to fail to immediately remove healthcare professionals from duty even when they are carrying the potentially lethal methicillin resistant staphylococcus aureus (MRSA), which can be spread by human contact. This in contrast to health services in countries such as Holland, who suspend staff from service immediately if they are found to be carrying MRSA, and, incidentally, have one of the lowest rates of MRSA in Europe.     The survey of hospital trusts by the Independent on Sunday also found that many trusts fail to routinely screen staff for MRSA or record those who are found to be infected.   This approach to infection control was described by many trusts as being completely within the government guidelines. The policies also claim support from a number of unions, who claim that sending infected staff home would lead to staff shortages, as well as damage healthcare staff’s financial wellbeing and career prospects.   However, the findings are not without controversy. Patient groups and Medical experts have criticized the approach of these Hospital Trusts, as well as the Government’s failure to clamp down on this trend. The Chairman of MRSA Action UK, Derek Butler, commented, "This is one of the hidden problems of MRSA. We are talking about people who come in from the outside every day and could well be bringing this infection in with them. Staff should be screened regularly and if they are colonized with this infection they should be taken off duty until they are clear.” http://www.patients-association.com/News/202 Concerns raised over MRSA-infected staff Date: 08/04/2008 The trusts surveyed claim they are acting in line with Government guidelines but medical experts and patients groups condemned the "relaxed approach" to the infection risks posed by staff. "This is one of the hidden problems of MRSA," said Derek Butler, chairman of MRSA Action UK. "We are talking about people who come in from the outside every day and could well be bringing this infection in which them". "Staff should be screened regularly and if they are colonised with this infection they should be taken off duty until they are clear." Government guidelines on MRSA state that "screening of staff is not recommended routinely but if new MRSA carriers are found among the patients on a ward, staff should be asked about skin lesions." A spokesperson for the Department of Health said: "It is important that staff who contract MRSA are properly dealt with, both for their own and for their patients benefit." "Staff with known active infection with Staphylococcus aureas should not be engaged in direct clinical work until their lesions are healed."   http://www.britsafe.org/feedcontents.aspx?id=423740   MRSA-infected medics allowed to keep working Brian Brady, Whitehall Editor Sunday, 6 April 2008 Hospital trusts are allowing doctors and nurses to continue treating patients even after testing positive for potentially lethal superbugs including MRSA. Hundreds of trusts do not take their staff off wards automatically if they are found to be carrying one of the most virulent hospital bugs, methicillin-resistant Staphylococcus aureus (MRSA), which can be spread by human contact. A survey of trusts carried out by The Independent on Sunday revealed that few routinely screen staff for the infection, or even keep records of the number of employees infected with MRSA. They claimed such a policy was fully in line with government guidelines. The approach is backed by many unions – including one that warned that a hardline policy could damage its members' financial well-being and career prospects. But the British approach to medical professionals with MRSA contrasts sharply with that in the Netherlands, where hospital staff are regularly screened and sent home if they test positive. The Dutch have one of the lowest MRSA rates in Europe. Medical experts and patients' pressure groups last night condemned the "relaxed" attitude to the risks posed by doctors and nurses arriving for work on NHS wards every day. Derek Butler, the chairman of MRSA Action UK, said the Government had to impose tighter rules on staff if it was to "get serious" about tackling an infection that contributes to more than 1,600 deaths every year. "This is one of the hidden problems of MRSA," said Mr Butler. "We are talking about people who come in from the outside every day and could well be bringing this infection in with them. "Staff should be screened regularly and if they are colonised with this infection they should be taken off duty until they are clear. Given that it is commonly carried in the nose, people who are carrying it should at least be required to wear a mask to prevent it being transmitted to patients." Government guidelines on MRSA state that "screening of staff is not recommended routinely, but if new MRSA carriers are found among the patients on a ward, staff should be asked about skin lesions". The advice continues: "In principle, only staff members with colonised or infected hand lesions should be off work while receiving courses of clearance therapy." Professor Mark Enright, a microbiologist at Imperial College London, said the fact that some 30 per cent of the population carried MRSA could mean a tougher testing regime would damage the careers of health staff by banning persistent carriers from areas of risk, including operating theatres. The Royal College of Nursing guidance on MRSA claims that forcing infected staff to stay away from work until they are clear "will lead to staff shortages and can affect the employment prospects, career opportunities and income of these staff". But Professor Enright said: "There is an argument for tighter rules on staff. The impact it could have on careers is a big problem, but if the Government is serious about dealing with this, it may have to consider all options." Paul Weaving, nurse consultant on infection prevention and control at the University Hospitals of Morecambe Bay NHS Trust, said staff screening was normally carried out only when there was an unusually high incidence of MRSA on a ward. "In practice, staff found to be colonised with MRSA will be offered treatment but will continue to work. This is because MRSA is transmitted almost entirely by touch, and the standard infection control precautions that should be practised by all staff with all patients will be sufficient to prevent transmission." In contrast, Great Ormond Street Hospital in London, one of the 20 best trusts at controlling MRSA cross-infection, excludes staff found to be carrying MRSA from work until they have had three negative tests at 48-hour intervals. A spokesperson for the Department of Health said: "It is important that staff who contract MRSA are properly dealt with, both for their own and for their patients' benefit. "Staff with known active infection with Staphylococcus aureus should not be engaged in direct clinical work until their lesions are healed." The growing threat 17 strains of MRSA detected by experts, all showing varying degrees of drug resistance 51 Death certificates mentioned MRSA in 1993 1,652 Death certificates mentioned MRSA in 2006 96,000 hospital patients carrying the infection in 2004, as estimated in research carried out for the Conservative Party 20-40% of the population carry MRSA, mostly in the nose or on the skin – a total of up to 24 million people £57.5m in funding ploughed into a "deep clean" of hospitals, announced by Gordon Brown. The exercise was condemned because many health trusts missed the deadline set for it, and because it didn't tackle the issue of people bringing the bug into hospitals in the first place £1bn being spent every year by the NHS on the battle against the superbug http://www.independent.co.uk/life-style/health-and-wellbeing/health-news/mrsainfected-medics-allowed-to-keep-working-805247.html