World MRSA Day 

World MRSA Day, raising awareness and looking beyond 50 years since the discovery of MRSA

October 2nd is World MRSA Day.  Here in the UK Kings College Hospital held an awareness day on Friday 1st October 2010.  The day was well under way when Derek Butler and Maria Cann arrived to kick-off things here in the UK.  They were invited to give the patient and relative perspective remembering those who have suffered, and to remind everyone of the significance of this important day, there were stands at the hospital for patients and the public to visit and ask questions.  There will be awareness raising events throughout October and MRSA Action UK will also be visiting other NHS Hospital Trusts giving patient and relative case studies during infection prevention and control training events with staff and meeting the public.
MRSA Action UK kick-off event, Friday 1st October 2010
10:30am - 12:00pm, The Hambleden Wing, Kings College Hospital
The event will be broadcast on NHS 247 TV

Staff at Kings College Hospital held their awareness event in the Golden Jubilee wing, where all staff and members of the public could join in and learn about the key things for infection prevention and clean, safe care.  Derek is pictured with Ogra Marufu and her team at the 'pod' in the Golden Jubilee wing.


Pictured from left to right:

Public Governor Timothy Mason, Derek Butler, Ogra Marufu, Infection Control Nurse, Erika Grobler Trust Infection Control Lead, and Dr Geraldine Walters, Executive Director of Nursing & Midwifery in the Hambleden Wing where Derek presented to staff at Kings College Hospital.

The focus of the day was the global problem, and for patients and their relatives MRSA awareness day was every day.

MRSA was discovered on October 2nd and first seen in UK hospitals in 1961, and initially not thought to be of major concern, however outbreaks continued and by the 1970's many countries were experiencing outbreaks in healthcare facilities.  A disturbing rise occurred over the last decade with a rise in the spread in the community too.  Patient groups have formed alliances with healthcare professionals and are campaigning for continued action to take effective measures to combat antimicrobial resistance.  Jeanine Thomas, founder of MRSA Survivors Network in the USA, founded World MRSA Day, MRSA Action UK has formed a strong allegiance with Jeanine's organisation and is helping to promote October as World MRSA Awareness Month here in the UK.

The presentation outlined how the charity was formed by people who had all been affected by the contraction of MRSA with some tragic consequences.

Derek related the reason for his personal involvement in  the Charity.  His stepfather John had collapsed with a heart attack in late summer 2003 and died 15 weeks later at Christmas profusely infected with MRSA.  He was a special friend and had given him the passion to work with the Charity.  John's standard of care was not what anyone would expect in the NHS.  There were a catalogue of errors that meant that John suffered and so did the family.  The infection was not discussed, in fact when asked about the nature of the infection, the possibility of MRSA was denied.  It was not until after John's death that the medical records revealed the extent of the MRSA infection that had caused John's death.  John was just 54.

Claire was just 23 and expecting her first baby, Thomas.  She was involved in a car accident when returning from a prenatal appointment.  An emergency caesarean was performed at the scene, sadly Thomas died.  Claire was treated for a broken arm and pelvis but contracted MRSA, six weeks later she passed away, devastating her family, she was our Vice Chair Paul's only daughter, he lost two generations, one through the contraction of an avoidable infection.

Derek spoke of the impact this had on his mother who was an outgoing person before this had happened to John.  She had become a virtual recluse.  She visits John's grave every day and says just one word.... Sorry.

For all of the things that happened no-one seemed to want to take responsibility or have answers.  How had we come to this position?  Over-reliance on antibiotics and not paying enough attention to hygiene and aseptic techniques has to be instrumental in the way attitudes to infection evolved.

Antiseptic techniques were developed by Joseph Lister and published in the British Medical Journal in 1867, Joseph Lister, who also practised at King's College Hospital, is renowned as its first advocate in preventing infection.

Alexander Ogston discovered Staphylococcus aureus in Aberdeen.  The antiseptic methods developed by Joseph Lister in Glasgow in the late 1860s and early 1870s was the most effective of all the preventive measures introduced against staphylococcus, its impact has never since been matched.  Before its introduction the mortality rate of "cold" non-traumatic orthopaedic operations done by the most experienced surgeons was about 9%.  Wound infection was virtually universal.

In 1884 William McEwen reported his series of 804 antiseptic limb-bone operations at Glasgow Royal Infirmary. Only 8 became infected, and only 3 died, one of pneumonia, one of tuberculosis, and one of diphtheria.

Alexander Fleming's discovery of penicillin in1928 was historic, and would mark a change in attitude to infection in the future.  He had warned of resistance, and did indeed discover the first resistance to penicillin shortly after its introduction during the Second World War.

The first patient to be treated was in a clinical trial performed by Howard Florey and his team at Oxford.  Constable Albert Alexander had an infection of his face from a rose thorn scratch which had spread to his lungs and shoulder.  There was little hope for Albert, and when he first received penicillin on 12 February 1941, he improved dramatically.  But resources were scarce in the war and even with the recycling of penicillin from his urine, the supply ran out, he relapsed, dying of staphylococcal septicaemia on 15 March 1941.  Despite the outcome the trial showed that the penicillin had been effective against the infection and its use became widespread. It wasn't long before staphylococcal resistance to penicillin became endemic in hospitals.  Methicillin was developed in response.  In an advertisement for "Celbenin" (methicillin) the ability to deal with resistance to penicillin was heralded as a breakthrough and the editorial from the Lancet (1960) was seen on the advert:
"A new penicillin has been prepared which is active against the usual penicillin-sensitive microorganisms and yet resists staphylococcal penicillinase.  This is a major event in chemotherapy.  From the information given in the British Medical Journal last week and in the three papers appearing in our present issue there is good reason to hope that the new BRL 1241 ('Celbenin', Beecham Research Laboratories) will be a means of controlling the staphylococcal infections which have plagued hospitals throughout the world during the past ten years."

Signs of resistance to methicillin were already appearing under the microscopes of bacteriologists during 1959 and 1960, demonstrating that the bacteria was evolving quicker than the development of antibiotics even then.

Antibiotics are the golden bullets that make many advanced surgeries possible, but should be preserved and treated as such.  Judicious use and a sound understanding of how best to use them is needed if we are to keep up with the constant evolution of bacteria and their ability to respond to whatever we develop with relative ease.  Over reliance on their use is not sustainable if we are to reduce the burden of resistant pathogens in our NHS.  Prevention is key, through effective handwashing and aseptic techniques, many infections can be avoided.

Derek presented "A Healthcare Infection - A Lifetime Legacy" showing how the contraction of avoidable infections impacts on everyone involved.

Derek quoted Benjamin Franklin.  "If there is a wrong it's incumbent on those who have the ability to correct a wrong to have placed upon them the responsibility to correct that wrong".  He spoke of the need to speak up and say if colleagues had concerns and knew infection prevention measures weren't followed, and not to be afraid to ask or challenge.

Derek related Colin's story.  He was admitted to hospital to assess his compatibility for a liver transplant following diagnosis of haemochromatosis due to over-prescription of iron and damage to his liver.  He contracted MRSA through an IV line.  Colin died one day before his 33rd birthday, Colin's birthday was July 5th, the anniversary of the birth of the NHS.

The Memorial Event and inscription on the card summed up how families felt when something that was avoidable ended in such tragic circumstances, "Loved by a love beyond all telling and missed by a grief beyond all tears"

Derek showed the impact on four more families through the loss of their loved ones.

Patricia Margaret, aged 68, was being treated for cancer and was receiving palliative care.  Maria was asked to assist with an aspiration of her mum's lungs due to no nurse being available to help during an emergency procedure.  Maria had found her mum in distress and alerted staff who were not answering her call, and raised the alarm.  It was not until after her mum had been discharged and had passed away that she learned of her mum's lung infection.  There were no infection control measures in place, Maria was splattered with blood and fluid during the procedure.  Information on Patricia's infection status was not passed on to those looking after Patricia on discharge, she was still colonised with MRSA, discovered in her notes after her death.  Patricia's cancer treatment was exemplary, but she died with heart failure, presenting signs of infection with rigours, high temperature and sickness at home on a Saturday afternoon, expressing the wish not to go back to hospital due to the experience of MRSA, the lack of cleanliness and staff not washing their hands and paying attention to infection control.

Patricia, aged 78, died with endocarditis, the only lady featured here to have the cause of death as MRSA on her death certificate.  Patricia contracted MRSA through treatment by a community dentist.  He failed to wash his hands and failed to follow infection prevention procedures, his dental nurse mixed amalgam on the cardboard packaging rather than use a sterile environment.  Patricia's ulcerated gums became infected with MRSA which entered her bloodstream and her heart.  This devastated her family who were well aware of how to prevent infections, and were aware of Patricia's concerns about the continuing threat from MRSA, and fear that one day she could become a victim.

Derick, aged 67 is pictured with his granddaughter Megan who will not know her granddad.  His treatment for lung cancer had to be halted due to contracting MRSA, as a consequence he died.  One day his family will have to explain why it was she didn't get to know her granddad.

Sammie was diagnosed with auto-immune liver disease when she was 11, and although she had to take medication daily she was healthy and lived a normal life.  She was studying photography at college and loved chatting to pals.  On April 3, 2008, she 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 chemotherapy.

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.  Her mum found dried blood stains on the sheet covering her.  Sammie's nan mentioned the problems to a nurse, but Sammie asked her mum not to complain as she was worried something would be said to her when she was on her own.  A wound on her hip where they'd done a bone marrow test had swollen up and Sammie's mum was told she had MRSA on May 1.

They had done the MRSA test on April 29 and in her mum's opinion she should then have been put in isolation.  There were women on her ward with leukaemia who were at massive risk and Sammie's immune system was weak too.  But instead she was moved into isolation on May 2, where she started getting more and more poorly.

Her kidneys packed up, Sammie's mum says "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 aged just 17.  "I miss her terribly and so does her little sister Alex, who is 14."

Derek spoke of some successful outcomes experienced by his family and other members.  The picture of his father when he was 18 showed a young man in his uniform who spoke very little about his experiences during the war. 

In October 1958 when he was 33, he had a car accident and staff at Preston hospital saved his life.  He had life-threatening skull injuries and brain damage.  The surgeons had to remove part of his skull and fit a silver plate.  His brain swelled and the plate was replaced after six weeks.  During that time he was kept strapped up in bed and did not contract and infection, which would have undoubtedly seen his demise. 

This remarkable treatment saved his life and he has since been back to the Royal Preston Infirmary twice where he had contracted E.coli infections in the community.  On both occasions the care was exemplary, keeping the family informed and bringing him back to full health at the age 89.

Derek showed Hayleigh and Jamie, Hayleigh wanted to be the Charity's mascot in memory of her Uncle Colin.  Jamie is pictured aged 4.  He is now 21.  When he was 10 he had an accident building a tree-house, his leg was severely injured and torn from his thigh to his ankle.  Surgeons at the Bristol Royal Infirmary warned his parents that the greatest risk for him was infection.  They worked for 9 hours to repair his leg, after care was exemplary and after months of physiotherapy he came back to full strength.  He tells the girls that the scar is a shark bite.  Sadly his nan Patricia Margaret didn't survive her brush with MRSA.

Derek reminded everyone of a quote from Aristotle "We are what we repeatedly do, excellence then is not an act, but a habit"

Doing the right thing correctly every time we give care and challenging poor practice should become a habit, making zero tolerance to avoidable infections a reality.

Charles Darwin's lesson from history "it is not the strongest of species that survive, or the most intelligent, but the one most responsive to change"

We need to be as responsive as the bacteria in the battle against infections.


Dr Geraldine Walters, Executive Director of Nursing & Midwifery  thanked Derek for the presentation which gave staff an opportunity to hear the patient and relatives perspective on the care they had received.

Activities continued in the entrance to the Golden Jubilee wing, which was apt since Staphylococcus aureus if often referred to as 'golden staph' since it can appear golden when viewed under the microscope.

Rachael gives staff and visitors the opportunity to test their handwashing technique with a light box.  Rachael agrees that infection prevention is everyone's business, when we told her a question we usually ask at conferences and awareness events is "how many infection control staff have you in your hospital?" we expect the staff to say "everyone is part of the infection control team".

                                Staphyloccus aureus

Jenny's stand had information for staff on IV lines and a checklist outlining the standards that are expected. Derek talks to Caroline Rawlinson at the stand.

Derek's presentation can be downloaded 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

kick-off event at Kings College Hospital 1st October 2010