Reducing MRSA

Manchester Conference Centre

14 November 2007

Chaired by Professor Brian Duerden

Inspector of Microbiology and Infection Control

Department of Health



Delegates to the event on reducing MRSA were asked to present their three challenges for reducing MRSA.  MRSA Action UK focussed on the patient and patient safety, with our three priorities focussing on involving and engaging patients.


  • How can you make the patient feel involved and feel safer in the current climate of fear and anxiety around healthcare infections?
  • How can we make everyone understand that hand-hygiene applies to them, and that infection prevention is everyone's business?
  • The greatest challenge for everyone was saving lives.


Derek emphasised legislation around patient involvement, it was augmented by legislation. There was a statutory duty to involve the patient within the Health Act 2006.  The Code of Practice for the Prevention and Control of Health Care Associated Infections 


Duty Five:

The duty to provide information on healthcare associated infections to patients and the public.

You must ensure that you make suitable and sufficient information available:

to patients and the public about the organisations' general systems and arrangements for preventing and controlling healthcare infections and to each patient concerning:

any particular considerations regarding the risks and nature of any healthcare infection that are relevant to their care, and any preventative measures relating to healthcare infections that a patient ought to take after discharge.


Fact: Patients with C diff can re-infect themselves

  • Do your patient information leaflets tell them this?
  • Hand hygiene is important for everyone, patient and carer alike
  • Advise the patient to keep their finger nails short, and yes tell them to wash their hands when using the lavatory and before eating


Derek outlined COSHH - The Health and Safety At Work Act, the jury was out on whether Clostridium difficile and MRSA were pathogens that should be treated within these regulations.  We believe that they are.  The Act came about after Aberfan, 144 people, not employees died as a consequence of a public body's negligence, 116 of them children.  Yet more people were harmed by healthcare infections and lost their lives to healthcare infections.  What an outrage there would be if 116 of them were children.


Patient Choice

In the healthcare setting we tend to think about the patient choosing where or when they have surgery, and in end of life decisions when we talk about engaging the patient

To help patients make choices they need information


Patients can vote with their feet

One of the most common questions we are asked is "which hospital is the safest?"

High infection rates influences patients' choice over which hospital they will use. This is an obvious driver for hospitals to reduce infection rates because now the system allows the patient to choose which hospital they wish to be treated in.


How could delegates make the difference that will make patients want to be treated by your Trust?

Frustration and anxiety caused by not being given sufficient information is the common denominator in the vast majority of people we have helped and spoken to regarding the acquisition and treatment of healthcare infections

  • Remove the fear by giving better information
  • By being honest
  • Information is key in helping the patient understand how they themselves can influence decisions about their care and their safety, and how they can participate


The patient and carer is constantly being put at risk

  • Derek prepared his profusely infected stepfather with the nursing staff after he died
  • Maria helped with a procedure to aspirate fluid from her mum's lungs with MRSA pneumonia, she was not told about the MRSA, the doctor gowned and protected herself, Maria did not and was splattered with the fluid, she worked with vulnerable people at the time
  • We both helped other patients who were unable to feed themselves or get a drink

- did we worry

  • Not then, no-one told us
  • Did we wear PPE?
  • We did wash our hands, however?
  • More than some doctors we saw
  • Why isn't there 100% compliance with hand hygiene from the medical profession?


Prevention and Control of avoidable infections is everyone's business

  • Ultimately patient safety is your responsibility, however
  • You need to involve the patient in the design of their care, particularly in relation to the risks involved in acquiring infections, and if they do get an infection what they need to do, carers need to know too


Should we be telling you to wash your hands.?

  • You may be expected to be reminded by the patient, however
  • You need to take into account those who feel awkward in asking, and those unable to ask
  • A famous quote:
    "We are what we repeatedly do, excellence, then, is not an act, but a habit" Aristotle


Best Practice

  • The best practice we have seen for documenting the history of the patient journey in the UK was developed by the Lincolnshire Integrated Care Pathway Partnership
  • The Integrated Care Pathway for the treatment for MRSA is an excellent tool for helping design safe patient care and to communicate with everyone involved in the patient's journey, not least the patient


In conclusion the top three tips for engaging patients in reducing MRSA

  • Make sure your staff are confident to talk to the patient if they have questions about healthcare infections
  • Document their care and make sure everyone knows if the patient has an infection
  • Be proactive and open about providing information about infections and what the patient and carers need to do

 It's not only a statutory duty to do this, but your duty of care, Derek concluded the presentation with an image from Westminster Abbey - a tribute to all those lost and all those affected by healthcare infections 19th July 2007



There were a number of presentations that dealt with the patient experience in case studies, these can be found below, there was one in particular that was taken from the MRSA Discussion Forum, relating to one of our members:

Patient quote from Christine's Presentation

"My mum was never the same after she had MRSA she only survived a short time as she had terminal cancer, but the after affects of the MRSA left her exhausted. Of course we were told it was because she had cancer, but mum endured two years of surgery and chemotherapy, during that time she never lost to the will live or a zest for life, with one exceptional period - that is during the 6 weeks of her illness with MRSA - because of the way she was treated she actually asked to die during that period.

MRSA left my mum exhausted, depressed and terrified of the medical profession, something she never recovered from."

 Source: MRSA Discussion Forum

There were other quotes used that were very poignant, Christine outlined how this made her feel as the quote used related to a patient in her NHS Trust.

Making a difference: Consensus on critical factors in reducing MRSA

Throughout the day delegates and speakers were asked to put forward their top three tips for reducing MRSA in practice and the top three challenges and barriers. These were collated to gain consensus on good practice and discussed with the audience.

Summary given by Professor Brian Duerden and the key messages that came from delegates:


Critical Success Factors in Reducing MRSA

Number of times mentioned by delegates and speakers

Hand Hygiene Compliance


Changing mindsets, education communication and clinical engagement


Stricter regulations and policy




Patient involvement, information and education


Rapid screening


Antibiotic prescribing


Break down hospital and community boundaries


Risk management including route cause analysis




Doing everything right frst time every time



Summary of Programme for the day and presentations:
10.00 Chairman's introduction

Chairman: Professor Brian Duerden

Inspector of Microbiology and Infection Control Department of Health


10.40 Is it realistic to try to eliminate MRSA? lessons from Europe

Dr Stephan Harbarth

Senior Lecturer in Infectious Diseases, Associate Hospital Epidemiologist and Member, Infection Control Committee Geneva University Hospitals, Geneva

  • a zero tolerance approach to MRSA: is it feasible in the UK?
  • successful approaches in Europe and from WHO
  • lessons and suggestions for improvement


10.10 MRSA: National developments, Progress, Challenges and Targets

Professor Brian Duerden

Inspector of Microbiology and Infection Control

Department of Health

  • an update on national developments, progress, challenges
  • increasing public confidence in hospitals
  • further "winning ways": reviewing and refreshing roles
  • high impact interventions: what works to reduce MRSA
  • case studies of good practice from the MRSA improvement


11.45 Monitoring and surveillance of MRSA and Clostridium difficile: an update

Dr Georgia Duckworth


Department of Healthcare Associated Infection and Antimicrobial Resistance, The Centre for Infections, Health Protection Agency

  • monitoring and surveillance of MRSA: current issues
  • national developments and implications for local systems
  • learning lessons and understanding trends from monitoring and surveillance: examples in practice


12.15 Involving and engaging patients

Derek Butler

Chairman, MRSA Action UK

  • the patient perspective on what works to reduce MRSA
  • how to involve and engage patients in reducing MRSA in practice
  • case studies and examples of good practice


12.35 Involving, engaging and empowering frontline staff

Christine Perry

Associate Director of Nursing (Infection Control) NHS South West

  • motivating clinicians and frontline staff to change practice
  • engaging clinicians: what works
  • lessons and tips from the Institute including NHS case studies


14.00 Recognising, assessing and managing risk on the wards: ensuring each MRSA outbreak is treated as a clinical incident and properly investigated

Dr Louise Teare

Consultant Microbiologist and Director of Infection

Prevention and Control

Mid Essex Hospitals NHS Trust

  • using audit, screening and risk assessment tools to identify high risk MRSA areas
  • implementing risk assessment training and developing competence
  • the role of incident reporting in MRSA investigation and management
  • a walkthrough a root cause analysis of an MRSA outbreak


14.30 Reducing MRSA: an organisational perspective

The Hammersmith Organisational Model for Infection Prevention

Dr Alison Holmes

Director of Infection Prevention and Control and Senior Lecturer in Hospital Epidemiology and Infection Control and Consultant in Infectious Diseases Imperial College and Hammersmith Hospitals NHS Trust

  • MRSA prevention as an indicator of delivering on patient safety and quality improvement
  • developing an integrated approach
  • our multifaceted approach and the impact on MRSA rates in Hammersmith


15.00 Questions and answers followed by tea and exhibition at 15.10


15.30 Reducing MRSA in primary and community settings

Helen Jenkinson

Infection Control Policy Lead The Healthcare Commission

  • raising the profile of infection control in primary and community care
  • tools and techniques to reduce MRSA in the community
  • ensuring information is shared across healthcare boundaries


16.00 Reversing the trend
a. Changing services and practice

Martin Kiernan

Vice Chair The Infection Control Nurses Association and Nurse Consultant, Prevention and Control of Infection Southport and Ormskirk Hospital NHS Trust

  • understanding the root causes of a MRSA outbreak
  • actions and practice to reverse the trend
  • our approach and


16.30 Reversing the trend
b.Working with a DH MRSA improvement team

Jim Mackey

Chief Executive, Northumbria Healthcare NHS Foundation Trust

  • developing an action plan and strategy for sustainable change
  • our experience of working with a DH MRSA improvement team
  • monitoring the impact in practice


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