MRSA Action UK Informal meeting with members of the Health Select Committee

27^th October 2008

 

Present:

Kevin Barron MP, Chairman, Health Select Committee

Sandra Gidley MP, Liberal Democrat Shadow Health spokesperson

Dr Richard Taylor MP, Independent MP for Wyre Forest

Edwina Currie, Patron, MRSA Action UK

Derek Butler, Chair, MRSA Action UK

Maria Cann, Secretary, MRSA Action UK

 

Informal meetings present an opportunity for a wide range of organisations with an interest in the health sector to discuss current health policy in an informal setting. Organisations have the opportunity to present useful background information that, in this instance, the information presented by MRSA Action UK could be used to inform the Inquiry into Patient Safety, which we are certain will include the thousands of people being affected by Healthcare Associated Infections.

 

MRSA Action UK took the opportunity to present documents for consideration by the Health Select Committee on addressing the serious issues around the contraction of avoidable Healthcare Associated Infections so prevalent across all of our care settings.  The disparities in bringing about improvements across the Acute setting were highlighted, despite the efforts being made in many other Acute hospitals. The discussion covered a range of issues across the healthcare economy, as outlined by MRSA Action UK.

 

Education and Information

 

We believe there should be an Information Campaign on Healthcare Associated Infections similar to that on AIDS in the 1980's in helping to eliminate as far as is reasonably practicable all avoidable Healthcare Associated Infections, there has to be a fundamental exercise in education as to the importance of individual roles, people need to know what to expect from healthcare professionals, and what part they have to play.

 

Government Programs, Initiatives and Legislation

 

There needs to be a fundamental review of the Government Initiatives such as Deep Clean, Screening, Bare Below the Elbows. The cost effectiveness of these initiatives as they stand are piecemeal and need to be developed into a coordinated, holistic response to tackle the problem

 

Hospital Deep Clean

 

The Deep Clean - why we believe it was a waste of Tax payer's money. There was 57 million pounds invested on the Deep Clean, yet there has been not one follow up study on the benefits of this program. There is no fundamental system to ensure that once we have removed these bacterium strategies have been put in place to maintain the cleanliness of those facilities, without strategies to maintain an environment that reduces the carriage and transmission of bacterium - this investment is wasted.

 

Screening of Patients in Healthcare Facilities

 

Screening for Healthcare Associated Infections has to be strategically and comprehensively planned in the hospital environment, and in other care institutions with sufficient resources for staffing of the labs that will be required to test samples from the wards and hospitals.  There needs to be screening on discharge for high risk patients needing ongoing care, particularly when moving to other care institutions.

 

Hand Hygiene and Bare Below the elbows

 

Bare Below the elbows. Hand Hygiene and the poor compliance with this policy and why. The policy of Hand Hygiene is still lacking in commitment from the medical profession even after 3 years of campaigning. The question to be asked is why? In the Netherlands hand hygiene assiduously done without question, unlike the UK. We need to make hand hygiene more user friendly to perform for both patients and healthcare providers.  There must be recognition and compliance with the WHO standard on the Five Moments for Hand Hygiene by all practitioners, as advocated and promoted by the National Patient Safety Agency.

 

Policy on the control and elimination of avoidable Healthcare Infections

 

Policies such as the "Search and Destroy" and tools such as "Human Performance Tools and Techniques" can be used in bringing about changes in behaviour and reducing the incidence of Healthcare Infections.  An inquiry to look at the feasibility of introducing these policies in this country, using the best brains nationally and internationally (such as they have in the Netherlands). Using Lord Darzi's study into the NHS on the working group we were involved in - what has happened with this review with regard to Healthcare Associated Infections and patient safety?

 

Research on Healthcare Associated Infections in understanding how they change and evolve

 

There needs to be a better understanding of how these bacterium interact with those they come into contact within all our healthcare settings. Research funding should be made available for the best minds in this field to be given the opportunity to study these microbes that kill 20 times the number of people compared to AIDS.  At present just 3.5 million pounds is given to cover all forms of bacteria compared to 13.8 million pounds on AIDS. The Inquiry should also look at the prevalence around the country of healthcare associated infections and to try to understand what it is we are actually fighting. There is a clear lack of knowledge as to the way these bacterium move and operate. There has to be more research into the long-term effects these bacterium have on the human body such as endocarditis and osteomylitis, and other symptoms - there is anecdotal evidence to suggest long-terms affects on survivors are having a significant impact on their quality of life. There needs to be research into how these bacterium evolve, and how we can make better use of our existing stock of antibiotics to encourage less resistance, by looking at cyclical use.

 

Hospital Inspections and Hygiene

 

There is a clear lack of Strategic Planning and use of resources both in financial terms and in logistical man-power.  There needs to be full implementation of the Hygiene Code across healthcare providers and breaches of any part of the Hygiene Code should not be tolerated.  Department of Health guidance for Care Homes published in 1996 recommends that commodes are washed with hot soapy water, and not cleaned with chlorine disinfectant, anecdotal evidence from staff in some Care Homes suggests that CSCI have issued an edit that bleach cannot be used, this has the potential for catastrophic effects on the spread of spores and outbreaks of Clostridium difficile.

 

The cost of Healthcare Infections in monetary terms to Patients and the public purse

 

Survivors of Healthcare Infections are often left with a legacy of ill health that we believe needs to be researched further. Most research performed in the past has tended to study the effectiveness of anti-microbial treatment and patient survival rates. As a Charity that sees the effects of healthcare associated infections at first hand, we believe that there must be extensive research into the total cost to society that these infections have on our national well-being.

 

Whose problem is it?

 

In the UK, the changing environment within hospitals has hampered implementation of effective MRSA control measures. Reduced numbers of hospital beds have resulted in increased inter-ward transfers of patients, which increase the spread of MRSA and other bacterial infections. Reduced lengths of stay have resulted in patients being discharged before their MRSA infection becomes apparent. The inter-city transfer of patients has encouraged the national spread of MRSA

 

However, MSRA is not only a problem within hospitals. The emergence of community-acquired MRSA is presenting a new challenge in many countries. This is a problem in Western Australia for example, where despite low levels of hospital MRSA infections, there is a high rate of community-acquired MRSA. Western Australia is now considering employing their effective hospital "search and destroy" policy within the community setting. The emergence of Community Acquired MRSA in our society has to be seen as a warning of the potential danger of this type of bacteria becoming just as prevalent as it has in the United States of America. There has to be a fundamental review of the way we deal with this problem now before it becomes endemic in the community.  Search and Destroy policies show there is less of a problem in the community where these are strictly applied.  The emergence of the PVL gene in MRSA and the resulting rapidity of its virulence give our Charity cause for concern, along with the rise of other pathogens such as GRE, VRSA, ESBL e-coli and more worryingly the threat of a pandemic flu from the H5N1 strain. The resultant infections that follow, if developing transfer of resistance of the MRSA strain, could cause more deaths than the flu itself.

 

NHS Redress Act

 

Provision for those people who have suffered as a result of avoidable healthcare infections, a Compensation Scheme should be offered.  Those who have lost limbs, livelihoods, relationships and health should be speedily recompensed without having to go through lengthy and expensive legal cases.  Although healthcare associated infections are not excluded from the Act, it is proving extremely difficult for people who are affected to get fair redress.

 

MRSA Action UK has submitted written evidence for the Inquiry into Patient Safety.