(c) MRSA Action UK June 2010
Edwina Currie Patron of MRSA Action UK spoke at the East & North Herts Annual Infection Prevention & Control Study Day, on Tuesday 5 October, at Graveley, Stevenage
Earlier this year the Charity courted controversy when significant regional variations in performance were highlighted, the figures are presented as numbers but ordered in terms of cases per population, these figures only account for a tiny proportion of all infections that patients get both in and out of hospital. Promoting infection prevention and control outside of hospital is equally important and good practice in other areas featured in Edwina's presentation.
The Health Protection Agency publishes information on MRSA bloodstream infections and cases of Clostridium difficile by hospital trust and primary care organisation each month. From July 2010 weekly figures on MRSA bacteraemia and Clostridium difficile have been broken down by hospital. There are significantly more hospitals that now have fewer infections, compared to the high numbers recorded in 2004, reflecting the commitment that staff had put into reducing infections.
It should be noted however that the MRSA figures exclude many infections caused by this organism and accounts for only 6-7% of all infections, surgical site, urinary, and catheter infections are not included in the figures. The Clostridium difficile figures given for Acute and Primary Care Trusts indicate that on average, of the 40,243 reported cases, 66% (26,744) were recorded outside of hospital in the 13 months from July 2009 to July 2010. Of the 2,975 MRSA bloodstream bacteraemias, 66% (1,958) were attributed as being contracted outside of hospital in this period, so not all healthcare associated infections are attributable to hospital care, increasingly these are being recorded outside of the hospital setting. The graphs list the regional variants in order according to the proportion of infection cases per head of population.
Yorkshire and the Humber SHA work in the community to promote hand hygiene and awareness of preventing infections with the "Give Soap a Chance" campaign, developed in partnership with local businesses and Hull and East Yorkshire NHS Hospital Trust. It has the added benefit of being promoted in schools to encourage future generations' awareness. The Trust hold an annual symposium which concentrates on areas such as judicious antibiotic prescribing. East Midlands SHA has a hand hygiene awareness campaign that has used posters on the backs of buses, on the radio and TV. Both have been involved with the NHS Institute for Innovation and Improvement in developing materials for a national campaign.
North East SHA pioneered a programme of performance management in Care Homes to meet the CQC Registration requirements. Measures have shown that better communication is taking place between hospitals and care homes in the North Tees PCT area where the programme was developed, the use of higher risk broad spectrum antibiotics has reduced and infection with Clostridium difficile is reducing.
The presentation reflects on the people behind the figures and it is their stories related by Edwina that inspired East and North Herts to get in touch, so that their staff could share the patient and relative perspective. Our members' stories say the rest.
Colin aged 32
Colin contracted MRSA through an IV line when being tested for suitability for a liver transplant. This is what his mum has told us.
"On 23 June 2003 Colin had asked that morning for the good news or the bad news and that Colin had expressed the view that he was dying - asking the Doctor to tell us too. I will never forget our shock and the pain of seeing Colin's face ... looking at each of us he was sat up in his bed as we tried to hold back our tears whilst the Doctor told us that Colin was dying - that all of his organs were failing and he also had Pneumonia. He told us that CPR wouldn't be given if his heart stopped. And because his liver had packed up the medication Vancomycin, would eventually affect his brain. Colin was incredibly brave - thinking only of us. He was so bedsore and said sometimes when he requested a bedpan, they would just drop it on the bed - it was impossible for him to sit on without help, other times they would be too busy or forget to help him off. I find this so heartbreaking and hard to bear - he would never wish to be a nuisance to anyone."
John aged 54
Derek Butler tells us "MRSA took the life of the truest friend I will ever have. John was not only my Stepfather, he was the kind of friend that no matter what you did he was always there standing by your side. The hardest thing that I have ever had to do, was to watch helplessly as my friend John died in my arms, the memory is something that will live with me for the rest of my life. MRSA not only killed my friend, but it has destroyed my other true friend, that being my mother. Nothing can ever be the same for us, because on the night that John died a part of us died with him. Our pain however didn't stop there because 5 months after John's death we found out that he had died Profusely Infected with MRSA and that the hospital knew of this, yet they said nothing, he is one of thousands who is not recognised in the published statistics as this was never recorded on his death certificate."
Claire aged 23
Claire, was driving home from a pre-natal class, she was eight and a half months pregnant, and she had a car accident, no other vehicle was involved. Claire had to undergo an emergency caesarean delivery to remove her from the car safely. Her baby, Thomas Charles, died on the way to hospital. Claire underwent surgery for a broken arm, leg and pelvis. After 2 weeks in hospital Claire was diagnosed as contracting MRSA. Claire endured 5 weeks of drastic weight loss, changes of antibiotics and swings in recovery, after a total of 7 weeks in hospital, Claire tragically passed away.
Patricia Margaret aged 68
Patricia contracted MRSA when she had a liver resection following the spread of cancer. She initially recovered well from her operation, and was moved to a surgical ward where she contracted MRSA in her wound site. The MRSA spread to her lungs although the family were never told, they learned this after her death through obtaining the medical records.
Patricia was carrying MRSA on discharge from hospital, but no follow-up was ever done to check that she was clear even though she was attending Oncology for palliative chemotherapy, her swab tests from the Health Protection Agency showed positive on the last test she had. She passed away with heart failure on the 23 October 2004, prior to her heart stopping and her husband carrying out CPR, Patricia had displayed signs of infection with rigours and vomiting, no post-mortem was carried out as Patricia had requested not to be readmitted to hospital or to let anyone do a post-mortem due to her experience of contracting the MRSA, she said she had had enough. During her 18-month battle with cancer she always wanted to fight back and had a zest for life, MRSA took this from her.
Patricia aged 78
Patricia died as a consequence of receiving treatment from a community dentist. Patricia was treated at home and had ulcerated gums. The dentist did not wash his property, did not wear gloves and the dental nurse mixed amalgam on a piece of cardboard. Patricia's post mortem revealed she died as a result of an MRSA bacteraemia, her GP told the family this was almost certainly as a result of the poor clinical practice of the dentist and encouraged the family to pursue this with the PCT. The dentist admitted his poor practice, the dental nurse denied she had done anything wrong, he was suspended whilst the investigation continues, the nurse continues to practice. The cause of death was recorded as endocarditis brought on by MRSA septicaemia, the only one of these people to have MRSA recorded on their death certificate.
Derick aged 67
In the summer of 2008 Derick lost the chance to have life saving chemotherapy for lung cancer as he had contracted MRSA and died within weeks. His relatives are upset and angry because they were not told. They only learned of the MRSA after he had died. The wards where he was treated were filthy and the staff were overstretched. Baby Megan will never get to know her grandfather. What the relatives went through makes us very angry and determined to fight.
Sammie aged 17
On April 3, 2008, Sammie was feeling poorly after a virus so her mum took her to hospital. Blood tests showed she had an imbalance which needed chemotherapy treatment. They took a bone marrow sample from her hip and started on the chemo. Sammie's mum says:
"The first two wards Sammie was in were filthy. There were sticky patches on the floors and instead of changing the bedding properly, the nurses just took the bottom bed sheet, put it on top and then put a new one underneath. I came in once and found dried blood stains on the sheet covering her. It was also difficult to communicate with the nurses as their English wasn't great. My mum mentioned the problems to a nurse, but Sammie asked me not to complain as she was worried something would be said to her when she was on her own.
I noticed the wound on her hip where they'd done a bone marrow test had swollen up and I was told she had MRSA on May 1. I had no idea what it was and a nurse just gave me a leaflet. But my mum used to be a nurse and the look on her face said it all. They had done the MRSA test on April 29 and in my opinion she should then have been put in isolation.
She was moved into isolation on May 2, and her kidneys failed. I couldn't believe my little girl, who'd been quite healthy before her hospital stay, was now unconscious and covered in tubes. She'd had a great chance of recovery but now the consultant was saying she had just a 10 to 20 per cent chance of survival. She died on May 9. I miss her terribly and so does her little sister Alex, who is 14. The Government have not done enough to tackle MRSA. People think it's gone away but there seems to be a new scandal every day. I don't want any other mum to go through the pain my family has."
The presentation highlighted awareness events in October and November. 18th November is European Antibiotic Awareness Day, 2010 is focusing on antibiotic stewardship in hospitals, Imperial College Healthcare NHS Trust are running an event on the day in Hammersmith and there are campaign ideas on the ECDC website http://ecdc.europa.eu/
Edwina will take the same presentation to Heart of England Foundation Trust.
Edwina's presentation is available here
If you or someone you care about has been affected by a healthcare infection and you wish to discuss this with us, please contact us at firstname.lastname@example.org