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MRSA Action UK in the News - July to September 2008 Archive

BBC News

Published: 2008/09/29 23:05:15 GMT

Penicillin bug genome unravelled

Dutch researchers have decoded the DNA sequence of the fungus which produces penicillin.

It is hoped that uncovering the genome of Penicillium chrysogenum will boost the development of new antibiotics to overcome problems of resistance.

The findings come just in time for the 80th anniversary of the discovery of penicillin by Sir Alexander Fleming.

Full details of the 13,500-gene sequence will be published in Nature Biotechnology in October.

Penicillium chrysogenum is used in the production of antibiotics such as amoxicillin, ampicillin, cephalexin and cefadroxil.

If we understand the genome we might be able to manipulate the genes - Professor Hugh Pennington

Its use in killing bacteria was discovered in 1928 after mould spores accidentally contaminated a petri dish in a laboratory.

Further work discovered it was safe for use in humans.

About one billion people are thought take penicillin every year around the world.

But antibiotic resistance is becoming an increasingly serious problem, as for example has been shown with MRSA.

UK experts have repeatedly cautioned against overuse of antibiotics and warned there is an urgent need for industry to develop new drugs.


Researchers said in addition to combating resistance, the genome sequence may also help to improve the manufacturing of antibiotics.

Dr Roel Bovenberg, a researcher at DSM Anti-Infectives, the biotechnology company behind the genome sequencing, said the four-year project had thrown up “several surprises” which they were investigating further in collaboration with academics.

“It provides insight into what genes encode for, know-how in terms of manufacturing and new compounds to be identified and tested.

“There are genes and gene families we did not think would be involved in biosynthesis of penicillins - they weren’t on our radar so that is our follow-up work.”

Professor Hugh Pennington, an expert in bacteriology at the University of Aberdeen, said the genome sequence might well lead to the development of new antibiotics.

“If we understand the genome we might be able to manipulate the genes.”

He said traditionally antibiotics had been found just from looking at what fungi produce, but in recent years scientists had been trying to modify existing treatments.

“All the easy targets have been hit by one drug or another so it’s proving very difficult to find new compounds and we’re going to need some lateral thinking.

“If the genome helps to do antibiotic development quicker, then that can only be a good thing.”

Story from BBC NEWS:

Published: 2008/09/29 23:05:15 GMT

Copyright: BBC MMVIII

Scottish scientists’ superbugs discovery

By Ryan Crighton

Published: 29/08/2008

Scientists at two Scottish universities have made a historic breakthrough which could be the first major step towards wiping out the MRSA and Clostridium difficile superbugs.

Results of research carried out at Aberdeen and St Andrews universities were welcomed around the world last night after it was revealed potential new ways to stop the spread of deadly bacteria have been discovered.

The team has been studying how tiny openings on the cell walls of bacteria open and close to release pressure.

If these openings did not operate properly, pressure would be allowed to build up, and the bacteria would explode and die.

The researchers say that, by controlling the openings, it would be possible to slow the growth of bacteria - or even kill them.

Last night, Health Secretary Nicola Sturgeon welcomed the discovery, while the UK’s leading microbiologist Hugh Pennington said it “opened new territory” in the fight against antibiotic-resistant bugs.

Recent figures from the Scottish Audit of Surgical Mortality show deaths from superbugs such as MRSA and other similar bacteria continue to rise across Scotland.

In 2006, hospital-acquired infections were a contributing factor in 422 deaths, up from 401 in 2005. Of these, 398 patients had an operation, up from 380.

Just last month, NHS Grampian was ordered to launch a fresh inquiry into patient deaths linked with the C diff superbug.

Experts are worried about the number of fatalities at both Aberdeen Royal Infirmary and the city’s Woodend Hospital, where the bug has been identified as a factor in 34 deaths in recent years.

In a paper published today in the premier journal Science, the researchers describe for the first time the mechanism of a bacterial pressure-release valve, or channel, which helps protect bacteria inside the human body.

The findings of the two university’s teams could now pave the way for new drugs to combat superbugs by controlling these channels.

Professor Ian Booth, who led the team at Aberdeen University, said their findings are the “first step towards the eradication of MRSA and C diff”.

“Channels in bacteria perform key roles in cell survival,” he said. “We have been able to show how this channel opens and closes.

“Understanding how they work will play a major role in inhibiting the survival of bacteria and could have applications as basic as cleansing hospital equipment and wards or helping to make food safer. These channels are found in MRSA and C difficile and this knowledge has not yet been exploited. The future path is to find new chemicals and processes that exploit the importance of the channels to these bacteria.”

The work is the culmination of molecular studies at Aberdeen combined with structural studies at St Andrews. The two groups have been working together for several years.

Professor James Naismith, who co-ordinated the St Andrews team, said: “The system is mechanical - the channel senses the pressure inside the bacteria. As a result the channel alters its shape and creates an opening, releasing the pressure.

“Not only is this a major step forward in scientific understanding of a fundamental process in biology, but it paves the way for the development of new drugs against bacteria.

“It is vital to the bacteria that the channel fully closes and only opens at the right times as mistakes either way would be fatal.

“New chemicals designed to force channels to stay open or shut are likely to kill, or at the very least, greatly slow down the growth of bacteria.

“Slowing down the growth gives the body’s natural defences time to tackle its bacterial invader.”

Last night, Aberdeen-based microbiologist Hugh Pennington welcomed the discovery.

He said: “There is an urgent need to think outside the box to tackle antibiotic-resistant bacteria, and this research gives a new direction for the drug discovery people to target their work. This is a very elegant piece of work.”

Coming to Britain - the Australian flu virus that has already killed hundreds

By Daniel Martin

Last updated at 10:53 PM on 28th September 2008

A flu virus more deadly than any seen in two decades is threatening Britain.

The strain originates in Australia where it has claimed hundreds of lives, including those of children.

Called Brisbane H3N2, it is so virulent that health chiefs have had to change the make-up of flu vaccines to deal with it.

It affects three times the number of victims hit by other strains, with many deaths resulting from pneumonia.

Viruses from the southern hemisphere strike in their winter months - our summer - and tend to travel north for our winter.

And although that did not happen after Brisbane H3N2 ravaged Australia last year, experts fear Europe will not escape it this winter.

Hugh Pennington, professor of bacteriology at Aberdeen University, said: ‘If this flu has been busy in Australia, it is reasonable to suppose that we may get a similar situation in the UK. Viruses travel round the world very quickly now. We have had some very quiet flu years recently and every year we have to assume that it will be busier than last year.

‘Sooner or later we will have a big outbreak, and the more cases there are, the more deaths there will be.

‘There is no doubt that elderly people are more at risk. It can tear through an old folk’s home and cause a lot of harm.’

The last major outbreak in England and Wales came in 1989-90, when 23,046 people died, compared with a seasonal average of around 4,000. The elderly are those most at risk because they have weaker immune systems.

The Australian flu outbreak affected even fit young adults, and New South Wales saw more than 800 deaths from pneumonia in just five weeks in June and July 2007. Many children died.

Experts speculated that several winters of mild flu had left the population with little immunity. Last year the Australian inventor of the flu vaccine, Dr Graeme Laver, said the outbreak in his country meant Britain was also in danger. ‘If the seasonal flu is as bad as it was in Australia, you are in for a pretty bad time,’ he said.

‘You could have a really severe epidemic. Thousands will be ill and many will die.’

The World Health Organisation and Sanofi Pasteur, a vaccine manufacturer, have combined the Brisbane strain with two others, one also named after the city, in their latest flu vaccine.


- Six influenza pandemics have struck Britain in the 100 years: 1918, 1947, 1957, 1968, 1977 and 1989

- Flu, like the common cold, is high contagious because it is spread by droplet infection, through coughs and sneezes

- The three types of flu, known as A, B and C, all attack the respiratory tract. Antibiotics offer no defence

- Last month the body of Sir Mark Sykes who died of flu 90 years ago was dug up in the hope his DNA could help treat bird flu. The British diplomat died in France at the height of the 1918 pandemic

- The Spanish flu pandemic of 1918, which killed more than 50million worldwide, is thought to have originated in the Far East

Professor Bruno Lina, head of the National Influenza Centre in Lyon, France, said: ‘The upcoming season is notable in the sense that among the three new vaccine strains, there is one that has proved to be very virulent in Australia.

‘This further reinforces the importance to comply with health authorities’ recommendation for seasonal flu vaccination.’

Influenza comes on suddenly and is characterised by fever, tiredness, dry cough, sore throat, nasal congestion and an aching body. Many victims fail to seek remedies, spreading the disease further.

In Britain, flu vaccination is offered to everyone over 65, many carers of the elderly or disabled and those with a range of conditions including asthma, heart disease and diabetes.

Residents of care homes are also offered the vaccine because a virus would spread very quickly among them. Health workers are routinely vaccinated because of the dangers of them passing flu on to vulnerable patients.

The Department of Health is considering offering the jabs to pregnant women as well.

Dr Laver warns, however, that the vaccine cannot always be relied on. He wants the Government to make drugs such as Tamiflu, which is taken after flu symptoms strike, to be available over the counter.

A Department of Health spokesman said: ‘Preventing and treating flu is a serious issue, and the NHS is well prepared. Seasonal flu vaccination is available free to everyone in the at risk groups.

‘England’s seasonal flu vaccination programme has one of the highest uptake rates in Europe. In 2006-07, 74 per cent of people in the over-65 group were vaccinated.’

Brown sends thankyou letter to all NHS staff as MRSA infections drop 57 per cent in four years

By Jenny Hope

Last updated at 12:13 AM on 19th September 2008

Gordon Brown yesterday congratulated Health Service staff on a ‘dramatic fall’ in MRSA infections.

In an open letter, he said the Government had finally met its target to halve the number of infections since 2004.

The Prime Minister said the ‘tremendous achievement’ of a 57 per cent overall reduction in cases was due to NHS staff who had also managed to produce significant falls in waiting times.

MRSA infections have fallen by a third since 2007, which the government says is because of a hospital ‘deep clean’ campaign

The message was put out via several websites used by NHS staff and emailed to directors of nursing, senior managers and communications staff who are expected to pass it on to staff.

However, campaigners attacked Government spin over the way the target was set and for bringing forward the ‘good news’ announcement before next week’s Labour Party conference.

The independent Healthcare Commission also criticised variations between trusts, with some falling far short of the reduction claimed by the Government.

The MRSA target was set by then health secretary John Reid who pledged by 2008 to halve the 7,700 bloodstream infections recorded in 2004.

Last year the Government interpreted this to mean the quarterly average for 2004 of 1,925 would have to be 963 or lower.

In the first quarter of this year there were 969 infections - just outside the target. But Health Protection Agency figures released yesterday show from April to June this year the number of cases fell to 836, which is 57 per cent lower than the quarterly average of 1,925 in 2004.

Mr Brown also said there had been a 32 per cent fall in C.diff cases over the last year, although latest figures will not be released until next month.

The Prime Minister announced at last year’s Labour Party conference that every NHS hospital in England would be given a ‘deep clean’. The programme was finished in March.

Anna Walker of the Healthcare Commission said the figures were a ‘big success’ in the war against

MRSA, but warned of variations in the performance of trusts.

She said: ‘There are some trusts that don’t have the necessary systems to fight outbreaks if they do occur and some are falling far short of targets to reduce rates of MRSA.

‘We should also remember that it is only one of a number of infections that pose a risk to patients.’

Derek Butler, chairman of MRSA Action UK, said the Government was relying on major reductions in infections at a few hospitals to make the overall picture look good, but this masked the fact that some hospitals were making virtually no headway or had got worse.

In the last quarter, one-third of trusts had more MRSA cases than the previous quarter while a further one-fifth had made no improvement. Seventeen hospitals had more MRSA cases last year than in 2004.

Tory health spokesman Andrew Lansley said: ‘It is a disgrace that there have been more than 800 cases of MRSA in our hospitals in just three months.

‘Labour have let down patients by caring more about spin than doing what it takes to root out infections. For years even the Government’s own advisers have been telling them that we need to identify infected patients as early as possible and then isolate them to make sure the infection doesn’t spread.

‘But Labour have broken their promises on this and three-quarters of hospitals still lack proper isolation facilities.’

MRSA kills almost 2,000 hospital patients a year in the UK based on mentions on death certificates, although experts believe the toll is closer to 5,000 victims.

Superbugs’ grave threat

Superbugs are threatening to return the world to ‘a pre-antibiotic era’ and devastate modern medicine, experts have warned.

A global response is needed to address rising bacterial resistance caused by use and abuse of antibiotics, according to Professor Otto Cars and colleagues.

All antibiotic deployment ‘uses up’ some of the effectiveness of that drug and diminishes the capacity to use it in the future, they say, and antibiotics can no longer be considered a renewable source.

Writing online in the British Medical Journal, they point out that existing antibiotics are losing their effect at an alarming rate while the development of new antibiotics is declining.

More than a dozen classes of antibiotics were developed between 1930 and 1970, but only two have been developed since.

Professor Cars, of Uppsala University, Sweden, said: ‘Without effective treatment and prevention of bacterial infections, we risk rolling back important achievements of modern medicine such as major surgery, organ transplantation, and cancer chemotherapy.’

Daily Mail Comment

A clean start?

NHS staff were yesterday praised by Gordon Brown for a ‘dramatic fall’ in MRSA superbug infections. To this, the Mail adds our own congratulations.

No newspaper has been more ferocious in attacking the scandal of disgusting, filthy hospital wards, and the loss of countless lives to MRSA through a lack of simple, basic hygiene.

So it is only fair we recognise the hard work that has reduced the overall number of cases by 57 per cent, meeting a target set by Ministers back in 2004.

But a note of caution: big reductions in some trusts mask the fact that, elsewhere, infection rates are actually getting worse.

There can be no complacency, either. The New Labour years are littered with targets which - once met - were abandoned, allowing the problem to return more virulently than before. What an unforgivable, fatal mistake that would be.

Gordon Brown hails cut in MRSA Superbug infections
Rates of the hospital superbug MRSA have dropped by a third in a year meaning the Government target to reduce infections has been met

By Rebecca Smith, Medical Editor

Last Updated: 6:08PM BST 18 Sep 2008

Official data shows the number of patients suffering MRSA bloodstream infections dropped by 36 per cent in the last three months compared to the same period last year.

This latest fall means the Government target to cut infection rates by half from the 2003/4 baseline has been met and exceeded by seven per cent.

Gordon Brown wrote an open letter to all NHS staff thanking them for a ‘tremendous achievement’ in hitting the target.

But critics warned these cases are only the most severe infections where the bug is circulating freely around the bloodstream. The NHS does not count the number of people who have isolated MRSA infections where the bug has infected a wound but not entered the bloodstream.

The latest figures from the Health Protection Agency show that there were 836 cases reported in England during the April to June quarter of 2008.

This is a 14 per cent decrease on the previous quarter when 969 reports were received.

In the same period in 2007 there were 1,306 reports of bloodstream infection were received.

A spokesman for the charity MRSA Action UK said they welcome the reduction but with ‘trepidation’ as “we fear we are not recording the true extent of the problem with this particular bacterium”. He said the reduction in cases has not been uniform across the country and a ‘postcode lottery’ still exists.

Professor Peter Borriello, Director of the Agency’s Centre for Infections, said: “The reduction of health care associated infections is a big challenge throughout the world and the falls we are seeing in cases of MRSA bloodstream infections demonstrate the huge efforts being made by NHS staff to tackle these infections.”

Health Secretary Alan Johnson said: “Our strategy for tackling infection is clearly delivering results and the NHS continues to work hard to ensure hospitals are clean and safe for patients. But we are certainly not complacent and we won’t stop here. Healthcare associated infections present a huge challenge to health services across the world and we will continue to do all we can to tackle them.”

BBC News
The bug that can kill within hours

Tuesday 16 September 2008

By Paul Burnell

BBC File On 4

Harry was a fit and healthy 27-year-old, who thought he was suffering from flu-like symptoms after a foot infection but within hours his life was hanging in the balance.

As he struggled for breath doctors at the Royal Devon and Exeter Hospital diagnosed pneumonia and contacted consultant microbiologist Marina Morgan, who recognised immediately that Harry might be suffering from the infection PVL (Panton Valentine leukocidin).

His chances of survival were rated as less than 50/50 at one stage.

PVL is a toxin which is produced by Staphylococcus Aureus bacteria (the same bug family as MRSA) and destroys white blood cells.

It can spread to the lungs causing fatal pneumonia, or lead to blood poisoning or necrotising (flesh-eating) infections.

People under 40 are especially vulnerable to this infection.

The first fatality in the UK came in 2005 when a Royal Marine soldier, Richard Campbell-Smith aged 18, died after cutting his leg in training. The following year a patient and health care worker died in Stoke-On-Trent.

“Doctors suggested I might lose my foot, I think at that time I wasn’t really aware, of how ill I was,” Harry told BBC File On 4.

Fortunately Harry, unlike some who have been affected by this bug, has suffered no lasting effects.

Superbug fight

As hospitals battle with superbugs like MRSA and C-Diff, some microbiologists are concerned about the growing incidence of PVL-MRSA in the community and whether enough priority is being given to spot and prevent it.

“I am seeing a dramatic increase in ordinary PVL,” said Dr Morgan, who expects this to lead to a rise in the mutant strain of MRSA.

Prompt diagnosis is essential but as she explained, “In the early stages it is easy to miss.”

The Health Protection Agency is charged with co-ordinating health protection across the UK, with its English-based centre for infections liaising closely with its equivalent in Scotland, Wales and Northern Ireland.

Its monitoring of PVL related diseases in England and Wales identified more than, 1,361 cases last year, a threefold increase on the previous year.

Professor Brian Duerdan, the Inspector of Infection Control at the Department of Health, admits however that many aspects of this virulent bug are a mystery.

“We do know that it spreads in the community amongst close contacts, families, people who share the same sporting events.

“But we still need to know a lot more about its exact prevalence in the community,” he said.

However there are microbiologists who fear too little funding is being devoted to a bug, which would be extremely difficult to control if it hit epidemic proportions.

Hugh Pennington, Emeritus Professor at the University of Aberdeen, and President of MRSA Action, told the BBC that the HPA lacks the resources to keep proper surveillance on outbreaks of infection from this strain of bugs.

“The scandal here is that we know what to do, the technology’s there to spot these things as they are appearing and we know how to react to them.

“It would be quite wrong if we allow these things to develop and of course history tells us that it we do neglect these bugs, we neglect them at our peril.”

Suspect PVL samples are sent to two laboratories one in Colindale and the other in Glasgow, with test results available three days at the earliest.

Microbiologists such as Professor Richard James, from the University of Nottingham, said new rapid diagnostic techniques should be used in hospitals.

Epidemic fear

Prof Duerdan however said the government strategy is not merely based on PVL testing but on enabling medical staff to diagnose it clinically.

The fear remains however that the UK could suffer a similar level of infection, to the USA where some microbiologists say it has reached epidemic proportions.

“I think the HPA and the government are doing a fair amount to deal with this. The problem is that this is one bug you cannot afford to be complacent with,” said Dr Morgan.

“The longer the bug is ignored, the longer it has to mutate to change into some other form and to produce other toxins.”

Using antibiotics for colds increases superbug resistance, says HPA
Patients should not ask their GP for antibiotics for simple coughs and colds, the Government’s public health watchdog has warned, as it said that increasing resistance has created an “urgent” need for new drugs to fight superbugs.

By Kate Devlin, Medical Correspondent

10 Sep 2008

A move to over-the-counter antibiotics could make the problem worse, the Health Protection Agency warned.

Doctors are running out of medications for potentially deadly infections, the organisation said, although new drugs have been found which could help to stabilise the number of cases of MRSA.

Rising resistance levels mean that some bugs are treatable only with antibiotics previously used as a “last defence”.

The number of potentially fatal E.coli blood poisoning cases which are resistant to a “last” antibiotic have tripled in the last six years, and now make up 12 per cent of all cases.

In these cases doctors are left able to use only less effective antibiotics, which can be toxic, and raises the prospect that a strain could become entirely resistant to antibiotics.

Dr David Livermore, the agency’s top scientist, warned that the problem posed a major public health threat.

Patients should not request antibiotics from their GPs when they are simply suffering from a cough or a cold, for which the drugs are useless, he said.

He said: “Most common cough and colds are caused by viruses and therefore patients should not be asking their doctor for an antibiotic.”

He added: “The doctor should also know that they are not necessary and the patient should know that they are not appropriate.”

Last year Sir Liam Donaldson, the Chief Medical Officer for England, warned doctors to stop giving antibiotics for viruses, including ear infections, because the practise was increasing resistance to the drugs.

Around 38 million antibiotic prescriptions are handed out by GPs every year, at a cost 175 million pounds.

Studies estimate that between 25 per cent and 35 per cent of those drugs were given for viruses.

Dr Livermore also said that there was a “concern” that providing an antibiotic over the counter could increase resistance.

He also called for action to increase the amount of research into new antibiotics.

Studies have shown that it costs around 1 billion pounds to bring a new style of drug to market, including the cost of unsuccessful trials.

In recent years pharmaceutical companies have found that antibiotics, which are generally taken for a short time, are not as lucrative as things like heart drugs, which can be taken for decades.

He called for a change in the rules of clinical trials so that drugs only had to prove that they were safe and effective before they could be used,.

The situation was “worsening”, he warned.

Most resistance of E.coli occurred in older patients who represented complicated cases and tended to have already had repeated courses of antibiotics.

He added: “But it is becoming more resistant. Hospitals are having to use what were second-line antibiotics first.”

Derek Butler, the chairman of MRSA Action UK, agreed that more antibiotics were needed.

“One problem is that at the rate at which we are using them, resistance is building up very fast.

“To make back its investment a drug needs to be used for 10 to 15 years, which means there it is not very profitable if resistance starts to build up within five.”

Monday 8th September 2008

Liz Barclay interviews Professor Hugh Pennington and Derek Butler about the latest Government claims that the MRSA target has been met. A transcript of the interview is given below, with an account from a patient who describes their experience in hospital after contracting MRSA twice.


Liz Barclay: The Department of Health looks like it has met it’s target of halving the rate of MRSA infection in England over 4 years. Progress in reducing the rates of MRSA has been hailed by the Health Secretary Alan Johnson as “a remarkable achievement”. Rates of that other notorious hospital infection C. difficile have also fallen, but as with all statistics it depends on when you take your snapshot and how good the reporting is. Whatever the trends the numbers involved are still high, almost a thousand cases of MRSA in the first three months of this year alone, with almost thirteen thousand cases of C. difficile over the same short period.

So what are we to make of all the figures? Well, before we move onto an expert panel, let’s hear from someone directly affected, Leone from Birmingham who has twice contracted MRSA in the course of surgery for a recurring breast cancer. After discovering that her wound had become infected with MRSA the second time she went into hospital so that the tissue could be surgically removed.

Leone: I was admitted to a ward and placed in a side-room and told I was nil by mouth because I would be having the operation the following morning. I was advised I would not be able to leave the room or use any of the toilet facilities because of fear of passing on any MRSA to other patients and I understood that fully. The following morning I was seen by the doctor and he said no the operation wouldn’t take place, that they would need to pack the wound, observe it for a while with the tissue viability nurse who wouldn’t be available for another two days, and I would have to stay in hospital.

For me it was an awful scenario because I felt I could be at home, rather than wait in hospital. I wasn’t allowed to leave this room, I had a commode brought in, I couldn’t use it properly because the curtains in the room didn’t actually close properly, and I was overlooked by another ward where people obviously could see into my room. Despite there being a trolley outside the actual room with gloves and alcohol gel and aprons, members of the public just kept constantly walking into the room. My drug chart wasn’t actually held on the ward, it was sent down to the actual pharmacy for it to be made up. It was down there all day and as a result I wasn’t given any pain relief, I wasn’t actually fed because I was in this room isolated, they had actually forgotten I was there. And by the end of the twelve hours again I’d had enough so I just discharged myself and left.

Liz: What would you say has been the overall impact on your living with cancer, of the fact that you have also contracted in hospital MRSA twice?

Leone: You are already trying to cope with the fact that you’ve got cancer, for me it was the third time and I was beginning to think for me is this the episode where my time is up, to then have the MRSA and be treated like a leper, psychologically I was traumatised. I was in a substantial amount of pain. People just don’t seem to understand your paranoid about catching other bugs, you are paranoid about how people are going to react to you when you say that you’ve had MRSA. I still don’t sleep properly of a night-time because my actual wound, the way it healed, it was just a lump sticking in my chest that was constantly there, the pain it’s indescribable. I’m scrupulous about cleanliness to the point where I’m scared of getting OCD - obsessive compulsive disorder. I don’t go anywhere unless I’ve got hand-gel, and I use it religiously, and I insist on people coming into my house using it, because I’m so paranoid about bugs.

Liz: Leone whose been infected with MRSA. Hugh Pennington is Emeritus Professor of Bacteriology at Aberdeen University. Professor Pennington a remarkable achievement with reduced rates of MRSA in England according to the Health Secretary, is that claim fair enough would you say? ....Professor Pennington... I’ll go to another of our guests, Derek Butler chairs MRSA Action UK, that’s a national pressure group which supports people who have hospital infections, can I put that question to you then, it has been described by the Health Secretary as a remarkable achievement, this hitting of the target for reducing MRSA over a four-year period. What is your take on the latest set of statistics?

Derek: Our take on the latest set of statistics is quite simple, that the Health Secretary is being very economical with the truth. He has said that they are within touching distance, what the Health Secretary has forgotten is that infections have risen faster under this Government, than any Government in history. Now we’ve done our own analysis of the figures and we’ve found at least seventeen hospital trusts with higher infection rates of MRSA bacteraemias now than four years ago.

Liz: Well that’s seventeen Trusts out of how many?

Derek: It’s seventeen Trusts out of one hundred and seventy, but it’s still ten percent. If you look at the figures again sixty-four percent of those hospital trusts across England and Wales failed to achieve the fifty percent target set by John Reid on the 5th of November 2004.

Liz: Let’s bring Doctor Sara Mumford into the discussion, she’s the Director of Infection Prevention and Control at Maidstone and Tunbridge Wells NHS Trust in Kent, and she’s formerly from the Health Protection Agency. Why would you say it is then that as Derek Butler points out that although overall infection rates may be reducing, the performance of different Hospital Trusts varies so widely?

Doctor Sara Mumford: I think there are problems generally with different trusts, they have different challenges and therefore they will perform differently. We all know what it is we have to do, and everybody’s working very hard to achieve that but there are sometimes circumstances of outbreaks that occur which are unpredictable, which then have to be dealt with, which can actually skew the figures very greatly in a very short space of time. When you are dealing with very small numbers of cases as most Trusts are, then just one or two extra cases can skew your figures quite dramatically.

Liz: Well, Hugh Pennington is with us now, I wanted you to talk Professor Pennington about the figures which have been described by the Health Secretary as a remarkable achievement. Let’s deal with rates of MRSA in hospitals in England to start with. We’ve just heard from Derek Butler that they can vary widely from hospital to hospital with ten percent of hospitals performing worse than they did four years ago. But overall is the claim fair enough? Are the rates coming down?

Professor Hugh Pennington: Well, the rates are not getting any worse, and there is a trend downwards, but I think one thing must be remembered about the MRSA figures, that these are not infections, these are bloodstream infections?

Liz: The most serious ones?

Hugh: Well, yes they are, and they are preventable by for example looking after ventlons and intravenous lines and so on. A lot of attention is paid to that, and that impacts on the MRSA figures. It doesn’t necessarily tell us that the MRSA itself is getting any less common, it’s just an indirect measure. Leone for example, the patient we are hearing from, her infections probably wouldn’t appear in the statistics at all, unless she had a bloodstream infection, it didn’t sound as though she did, so she would just go under the radar, and lots and lots of patients will be going under the radar because they are not being measured. There are good reasons why bloodstream infections are a good measure of bloodstream infections because their technology is very sound and hospitals generally use the same method so they are comparable. They give a trend, they give an impression that MRSA is at least not getting any worse, I wouldn’t go any further than that.

Liz: Now these figures are for England, what is the situation in other parts of the UK with MRSA, let’s start with that?

Hugh: Well, certainly in Scotland which clearly is where I work, the figures are roughly similar perhaps, we are not doing quite as well, but the trend there is not as statistically significant a trend downwards for MRSA bloodstream infections, but there is a sort of hint in them, yes they are getting better, they are certainly not getting any worse. So I think overall in Scotland and in England the figures are really quite similar, perhaps not the same decrease in Scotland to the same degree as in England, but the same generally. The problem is not getting any worse is the best thing one can say about it.

Liz: And Wales?

Hugh: Much the same.

Liz: What about C.difficile?


Well, C.difficile is quite a different kind of problem, MRSA is something that evolved in hospitals. It’s a hospital acquired infection essentially. C.difficile is quite common out there and if you have antibiotic treatment, you can get C.diff as a consequence of that, never mind hospitals, its hospital spread as well, because the C.diff problem is much bigger than the MRSA problem. It kills people more often unfortunately. And we had a very bad outbreak in Scotland when quite a number of people perished in a hospital, due to hospital spread of the organism, so C.diff is proving a very, very difficult problem to crack, and of course it doesn’t fall to alcohol gels, in fact they make it worse, so all the effort that’s gone into MRSA has got to be redoubled for C.diff, and also we have to look at different approaches too.


Doctor Sara Mumford, the Trust that you have now joined in the past has been notorious for hospital infections, but you’ve managed to cut infection rates by three quarters over a single year, how has that been done?

Doctor Sara Mumford: Well we’ve actually put a whole system change into action within the Trust, so everybody’s become involved right from the Board right down to the ward level. We’ve put lots of different strategies in place. Our cleaning has increased, we are spending more than a million pounds extra every year on cleaning compared to when we had the outbreak. Everybody has a huge level of awareness, we are regularly giving all of the staff updates on infection control. We’ve put very strong hand hygiene protocols in place, so that everybody’s cleaning their hands very, very regularly. We’ve got all the staff bare below the elbows. We’ve banned neckties for anybody who is going on the wards to work. We’ve just generally increased our levels of infection control. We also have isolation wards where all of the C.diff patients are nursed together by specialist nurses so that they receive a very high standard of care, they also have a multi-disciplinary team approach to the treatment of C.diff, so that we involve clinicians, microbiologists, nutritionists, tissue viability nurses, so that we can really give them a very high standard of care which is protocol driven.

Liz: Derek Butler, the Prime Minister ordered a high profile deep clean of all NHS hospitals in England, earlier this year, do you think it made any difference?

Derek: In a simple answer, no. The Prime Minister has been very good with his populist figures. A good example of that would be on the 18th of September. Normally the quarterly figures come out in January, April, July and October for C.diff and MRSA infections. This year for the first time the Government has decided to bring the MRSA figures out for the April to June period on the 18th of September, conveniently two days before the Party conference, now doesn’t that give you some impression of what this Government is doing with healthcare infections with the numbers and things like that for their own belief.

Liz: Hugh Pennington, there is isn’t there now this gap in credibility where statistics are concerned?

Hugh: Well yes, it’s always been there ever since the days of Florence Nightingale, who used statistics very, very ably as a political weapon. I think we must remember that statistics are used either to justify what you are doing or to attack the opposition or whatever it is and they all have to be looked at very, very carefully, and as I was saying the MRSA figures are only telling you a part of the story. They are not telling you about how many people are getting infections in their hip operations and that kind of thing. But at the end of the day we certainly are getting better at these figures we are getting better at collecting them and they are getting more reliable. And one of the most important things about these figures is to look at the trends of course, and I think it’s a little early to say yet that we’ve licked the problem. We must remember that we have ten and twenty times more of these problems certainly with MRSA than countries like Holland and Norway which have had a very, very strict control on them, doing what Sara’s describing in Maidstone, and doing it for many, many years. We are only starting to do that now, and the scandal really is that we weren’t doing it ten and twenty years ago.

Liz: Professor Pennington, Derek Butler, Sara Mumford we leave it there and the Department of Health sent us a statement saying that they have set a target now to deliver a thirty percent reduction in C.difficile over the next three years, and they say that they will have been investing two-hundred and thirty million pounds every year to try to meet it.


Radio 4 You & Yours
Hospital Infections

August 29, 2008

Big bang moment in fight against hospital superbugs

Mike Wade

Scientists at two Scottish universities have discovered a way to make bacteria explode, a breakthrough that may lead to new methods of killing hospital superbugs such as C. difficile and MRSA.

The scientists at St Andrews and Aberdeen universities were able to manipulate a tiny channel found inside bacteria cell walls that acts like a pressure-cooker valve and helps to keep bacteria alive. By using chemicals to close the channel, the scientists prevented the release of pressure, causing the bacteria to explode and die.

The channels are also present in MRSA and C. difficile and the scientists believe their findings could help them develop new antibiotics to combat the drug-resistant bugs.

Professor Ian Booth, who led the team from the University of Aberdeen, said: “Channels in bacteria perform absolutely key roles in cell survival. We have been able to show how this channel opens and closes.

“Understanding how they work will play a major role in inhibiting the survival of bacteria and could have applications as basic as cleansing hospital equipment and wards or helping to make food safer.”

He added: “These channels are found in MRSA and C.difficile and this knowledge has not yet been exploited. The future path is to find new chemicals and processes that exploit the importance of the channels to these bacteria.”

The discovery was hailed by Nicola Sturgeon, the Scottish Health Secretary, and Hugh Pennington, Professor of Bacteriology at the University of Aberdeen, who said that it “opened new territory” in the fight against antibiotic-resistant bugs.

C. difficile and MRSA are linked to poor hygiene and the over-use of antibiotics. Recent figures from the Scottish Audit of Surgical Mortality show that deaths from MRSA and other similar bacteria have continued to rise in Scotland. In 2006, hospital-acquired infections were a contributing factor in the deaths of 422 people, up from 401 in 2005. Of these, 398 had an operation in the lead up to their deaths, up from 380.

This year nine patients at Vale of Leven Hospital died as a direct result of an outbreak of C. difficile, with the bug cited as a ‘contributory factor’ in the deaths nine other patients.

The discovery of the channel, which is reported in the journal Science, is the culmination of molecular research at Aberdeen and structural science at St Andrews.

Together, the teams were able to exploit the fact that all bacteria have tiny channels in their walls. These operate like the valve on a pressure cooker, opening and closing to release pressure in the cell.

James Naismith, Professor of Chemical Biology at St Andrews University, said: “The system is mechanical; the channel senses the pressure inside the bacteria, and as a result the channel alters its shape and creates an opening, releasing the pressure.

“The motion is just like that of a camera iris and being able to see this motion is an amazing discovery.

“Not only is this a major step forward in scientific understanding of a fundamental process in biology but it paves the way for the development of new drugs against bacteria.

“It is vital to the bacteria that the channel fully closes and only opens at the right times as mistakes either way would be fatal.

“New chemicals designed to force channels to stay open or shut, are likely to kill or at the very least, greatly slow down the growth of bacteria.

“Slowing down the growth gives the body’s natural defences time to tackle its bacterial invader.”

The two groups have been working together for several years and were supported by the Scottish Universities Life Sciences Alliance, which was launched a year ago by the Scottish Funding Council. They received a 1.5million pound grant from the Wellcome Trust and funding from the Medical Research Council, the Biotechnology and Biological Sciences Research Council and Unilever.

Professor Booth said: “This was a very demanding project and is down to tremendous team work in both universities.”

Lib Dems challenge MRSA performance

Published: 21 August 2008 09:00 Author: Charlotte Santry

Nearly two thirds of trusts failed to hit the government’s MRSA target, the Liberal Democrats have claimed.

The party compared infection rates for 2007-08 with 2003-04, to see whether the target to halve MRSA rates by March 2008 had been hit.

Their figures contradict official statistics released in July, when the government announced it was within “touching distance” of the target, calculated using quarterly averages.

The Liberal Democrats said it was fairer to compare annual figures rather than quarterly averages because the baseline was the total number of cases in 2003-04.

“No one’s disputing there have been improvements but there’s still a long way to go”

Liberal Democrat health adviser Rachel Spring said the government’s measurement had been “unexpected” and gave the Department of Health “room for manoeuvre”.

Last year’s public service agreement target requires that the average annual number of MRSA bacteraemias for 2008-09 to 2010-11 should be less than half the 2003-04 figure.

Missed targets

The comprehensive spending review states: “The total number of cases for each year should be below 3,848 (half the 2003-04 baseline).”

The Liberal Democrats’ analysis shows 64 per cent of trusts did not meet the target and in 23 trusts MRSA rates rose.

In January, opposition parties accused the DH of moving the deadline for the target to include April to June 2008 figures.

A memo leaked to HSJ last year revealed DH fears that the target was likely to be missed. A spokesman said the target had always been recorded in the same way and needed to use April to June figures to take into account improvements made at the end of March.

Response from MRSA Action UK

Saturday 23 August 2008

MRSA Action UK absolutely agree with the stance taken by the Liberal Democrats, and stand by our statement made about the figures on the 15th August 2008 The target has been missed. There are big improvements in many trusts, but there has also been deterioration and not enough effort put into preventing avoidable infections in others. We know that great strides have been made in many hospitals and those staff should be applauded, but a postcode lottery remains and this should be recognised by the Department of Health. Moving the goal posts and ignoring the concerns of the public and patient representatives and stating that publicising the truth is a “breach of trust” is frankly outrageous. If there is any breach of trust this falls on the way the figures were reported when statements were made to say that the NHS were “just short of the target”. Public confidence is at an all time low and this kind of massaging of figures and moving of goal posts does nothing to restore it.

From The Sunday Times
Doctors’ dirty hands spread MRSA
A quarter ignore crucial hospital hygiene guidelines, figures show

August 10, 2008

Stuart MacDonald

A quarter of hospital doctors are ignoring hand- washing guidelines designed to halt the spread of deadly superbugs such as MRSA and clostridium difficile.

New figures from Health Protection Scotland (HPS) show that the number of medics failing to observe the basic hygiene procedures has risen despite a national campaign to encourage health workers and hospital visitors to wash their hands.

While 90% of nurses and 85% of ancillary staff are meeting World Health Organisation hand hygiene standards, only 75% of doctors are doing so. This represents a 3% drop from the previous quarter and is well below the Scottish government’s target of 90%.

The HPS states that “hand hygiene is the single most important factor” in reducing and preventing hospital- acquired infections.

Last week Nicola Sturgeon, the health secretary, called for a zero-tolerance approach to hand hygiene in the wake of a damning report by HPS into a clostridium difficile outbreak at the Vale of Leven hospital in Dunbartonshire.

Nine patients died as a direct result of the infection, which was linked to a further nine deaths. NHS Greater Glasgow and Clyde could face criminal charges after the report was referred to the local procurator fiscal.

There were 285 deaths linked to clostridium difficile in Scottish hospitals between December last year and May this year, almost double the rate for the whole of 2006. MRSA kills a similar number.

Professor Hugh Pennington, emeritus professor of bacteriology at Aberdeen University, said some doctors considered themselves above the rules. “There’s no excuse for doctors not complying with this. They are supposed to know all about the reasons why hand hygiene is important having had a long and expensive medical education,” he said.

Margaret Watt, chairwoman of the Scotland Patients Association, said the hand-washing figures were “shocking” and called for disciplinary action to be taken against doctors who failed to wash their hands.

Sturgeon stressed that hand hygiene needed to be practised by all NHS staff. “Hand hygiene is widely known to be the single most important measure in prevention and control of healthcare-associated infection,” she said.

Health boards have already introduced schemes aimed at improving hand-washing standards such as voice boxes that remind people when they go in and out of wards, and ultraviolet lights that help people to see whether their hands have been properly washed.

Fresh MRSA cases

Ben Turner

6/ 8/2008

AT LEAST two patients have contracted the MRSA superbug at Macclesfield Hospital since April following intravenous injections by staff.

Refresher training has since been carried out amid fears the technique used in inserting cannula tubes into the patients may have caused the bacteraemia (bloodstream) infection.

John Wilbraham, chief executive of the East Cheshire NHS trust, which runs the hospital, said: “MRSA is often linked to cleanliness but this is about technique. Infection can occur when cannulae are not inserted properly.

“What has been identified is an issue with some of the ward staff’s methods of doing a cannula.”

The two injections were carried out by nurses or junior doctors, he added.

Both patients have since recovered and are not thought to be in hospital anymore.

They are among five cases of MRSA within the trust in three months, with one patient still in hospital - although one patient was already suffering from the superbug before entering the premises. Mr Wilbraham said he did not believe the other two hospital cases were cleanliness-related either.

Derek Butler, chairman of the charity, MRSA Action UK, said: “It is a concern. We are hearing of these cases on a regular basis but a lot of them could be easily avoided. Cannulae shouldn’t be inserted unless absolutely necessary. Unfortunately, in most hospitals they are a routine procedure whether needed or not.”

One problem was that too few staff were trained to do it, he said, so cannulae were often left in for days at a time to avoid finding a nurse who could re-insert it.

Alift Harewood, currently Macclesfield’s deputy mayor and also a trained nurse, urged for someone to be answerable if there had been any human error.

“If you are entering a vein, you must be expert and training must be done frequently - it is not like injecting into a muscle,” she said. “It is something not all nurses are trained to do - I am not myself. Being injected intravenously means an infection travels within the blood very quickly.”

Mr Wilbraham added: “What we are learning from is individual cases. Four is a very small number and stands up to comparison.

“The Clostridium Difficile rate is (also) dropping and I think that is down to our cleanliness agenda.”

The government-set target for the whole year - a Department of Health priority - is ten and hospital bosses insist they can still achieve that figure. Three of the cases occurred in June.

Intravenous line infections are one of several ways MRSA - which about a third of us carry on our skin - can enter the bloodstream.

Others include an ulcer, abscess or infected wound according to Department of Health public guidance.

A trust spokesman said: “There is no implication of blame or negligence in these cases. Bacteraemia is a well recognised risk when inserting lines into the blood system.”

Of the two patients specifically, he added: “The cannulae were identified as a high risk factor rather than the definitive cause of the bacteraemia. Such cannulae are inserted for a variety of reasons, but particularly to ensure rapid access for drugs and fluids to very sick patients.”

The trust failed to hit its target of ten last year when there were 14 cases of MRSA between April 2007 and April 2008.

Antibiotics crackdown in war on superbugs

Published date: 20 July 2008

By Kate Foster

MEDICINES for hospital patients are to be rationed under radical new plans to halt the spread of killer superbugs. New guidance has been issued to doctors and nurses urging them to cut and delay doses of commonly prescribed antibiotics because of their role in the rise of hospital-acquired infections.

The initiative is an attempt by health officials to slash the use of antibiotics in hospitals by up to 25% each year, scrapping up to 83,000 routine prescriptions for conditions such as chest and gut infections.

Experts say the move will help the fight against the superbugs Clostridium difficile (C diff) and MRSA because although antibiotics kill some bugs, they cause others to spread.

Doctors and campaigners welcomed the plan, but critics warned individual patient care must not be compromised.

The guidance has been issued to health boards by the Scottish Antimicrobial Prescribing Group (SAPG), a panel of medicines experts, as part of the Scottish Government’s drive against hospital-acquired infections.

The current culture of administering general antibiotics to many emergency admissions ‘just in case’ they respond to treatment will end. Instead, tests will be carried out to establish which, if any, antibiotics would be the most effective, delaying treatment by 24 hours.

Certain widely used antibiotics, cephalosporins and quinolones, believed to be particularly linked to the spread of C diff and MRSA, will be strictly rationed.

Antibiotics are implicated in the spread of superbugs because of they way in which bacteria respond to them. In the case of C diff, they kill ‘good’ bacteria in the gut that prevent C diff from growing and spreading. In the case of MRSA, the bacteria have grown resistant to certain types of antibiotic.

Professor Dilip Nathwani, chairman of the SAPG, said antibiotics “are being given for too long and the wrong ones are being given”.

“Doctors and nurses need to think about whether patients need antibiotics and what the risks of antibiotics are.”

Doctors would also be asked to keep duration of antibiotic courses to a minimum. “In most situations it can be three, five or seven days,” Nathwani said.

“We are not being arrogant about it, we are going to measure and monitor this.”

The move comes amid an alarming rise in cases of C diff, which causes diarrhoea and can be fatal. There were 1,861 cases in patients older than 65 in Scotland between January and March - a 16% increase on the previous three months.

In recent weeks an outbreak of C diff at the Vale of Leven Hospital in Alexandria, West Dunbartonshire, affected more than 50 patients, killing nine.

Official figures released last week showed that in 2006, 40 patients were killed by C diff in the area covered by NHS Lothian and a further 36 in Greater Glasgow and Clyde.

The C diff superbug has overtaken MRSA as the one most feared by patients. MRSA cases have dropped from 985 in 2005 to 881 last year.

GPs have already cut back on prescribing antibiotics for colds and flu.

Dr Charles Saunders, chairman of the British Medical Association’s consultant committee and a public health doctor in Fife, said: “The risk benefits of antibiotics have changed over the years and now is the time to reassess how quickly you should use them.

“I think this will complicate things a bit for doctors, but it will improve patient care. It is likely they are going to have to do investigations and wait before prescribing.

“A lot of patients expect antibiotics and it can be difficult to explain to them why they are not getting them at that stage.

“But doctors aim to make patients better. In the long term this is an education for doctors and the public.”

Derek Butler, chairman of the campaign group MRSA UK, said: “We would also like to see quicker tests that give results sooner so patients can be given the right antibiotics within a few hours, instead of waiting days. Obviously, other measures are also critical in tackling superbugs, including hand hygiene and cleanliness.”

Families of patients affected by hospital superbugs have also welcomed the guidance.

Linda McCafferty, whose 82-year-old mother Nellie died after becoming infected with MRSA following a stay in Glasgow Royal Infirmary, said: “I support this move and I also believe patients should be swabbed for superbugs both on admission and on leaving hospitals.”

However, Scottish Conservative health spokeswoman Mary Scanlon warned: “It is crucial that patients are monitored and that whatever happens is in the best interests of the individual patient.”

MRSA Action UK sceptical of vaccine

Charities aid foundation

15 July 2008

Charity MRSA Action UK has warned that a proposed vaccine against MRSA may not be as effective as promised.

According to the organisation, they support the potential development of such cures but believe that health professionals should remain “cautious” about the prospects of the vaccines.

The Chief Medical Officer has heralded a medical breakthrough which scientists claim may be able to prevent infection with c-difficile in five years and MRSA in anywhere between five and ten years.

However, MRSA Action UK warns that promises of a cure do not offer help to those suffering now, adding that there are at least 11 strains of antibiotic-resistant bacteria.

It added that the evolution of the bacteria will make the production of any sort of panacea very difficult.

The charity called on the Government to “wake up to the fact that other more dangerous and virulent bacteria are just over the horizon, and unless we bring in the most stringent policies on hygiene in our hospitals we will lose the battle against these bacteria”.

At the end of June, MRSA Action UK criticised the Government’s “deep clean” of hospitals, saying that 85 percent of hospitals did not use the correct cleaning products during the process.

(c) Adfero Ltd

Superbug vaccines no quick fix, charity warns

Sarah Boseley, health editor

The Guardian, Monday July 14, 2008

Vaccines against MRSA, Clostridium difficile and other “superbugs” will not prove a quick fix to the serious problem of patients becoming ill through hospital-acquired infection, a charity warned yesterday.

The chief medical officer, Sir Liam Donaldson, will today say in his annual report on the state of the country’s health that vaccines are well under way, with one against C diff expected within five years.

But MRSA Action, which is chaired by the microbiologist Professor Hugh Pennington, warned that the hunt for vaccines against dangerous bacteria like MRSA predated the discovery of antibiotics to treat infections. Research was undertaken by Alexander Fleming’s boss, Almroth Wright, in the 1920s and 30s, but nothing came of it.

“History has shown that bacteria grow well on agar plates; however, nothing has been that simple with bacteria that infest our hospitals,” said a statement from MRSA Action. “Whilst as a charity we welcome the development of vaccines against these bacteria, we would be cautious in raising hopes of being able to control these bacteria with a vaccine.”

The task of formulating effective vaccines against the most dangerous hospital infections is even harder because they do not present a single, simple target. Both MRSA and C diff had many different strains, said the charity. Research had shown there were at least 10 different bandings which evolved rapidly. Donaldson said vaccines would not remove the need for hygiene and handwashing. (c) Guardian News and Media Limited 2008

MRSA: Medical chief hails superbug vaccine ‘Breakthrough’ to end MRSA deaths
Drug will be available within 10 years

Gaby Hinsliff, political editor

The Observer, Sunday July 13, 2008

New vaccines designed to destroy the hospital superbugs that kill thousands of Britons every year will be available within 10 years, according to the government’s chief medical officer.

Professor Sir Liam Donaldson described the immunisation of patients against the twin menaces of MRSA and clostridium difficile as a ‘big breakthough’, predicting in his annual report, to be published tomorrow, that a vaccine against clostridium difficile will be ready within five years, and one against MRSA within five to 10 years.

He told The Observer that vaccines against the two most common superbugs, which between them killed 8,000 patients in 2006, could be used in two ways. ‘One would be protecting the individual, somebody who was going into hospital for a major operation. The other way of looking at it would be to try to interrupt the chain of transmission - to study the pattern of infection in the community, in hospitals and nursing homes, and try to eradicate the pools of infection.’

Doctors could identify high-risk areas such as certain nursing homes or certain parts of a city likely to produce people at high risk and immunise them all as a precaution.

However, Donaldson warned a vaccine would not mean nurses could abandon hygiene measures such as washing hands, since the threat of some new infection emerging would always be present. ‘You might be able to get close to eliminating them [with a vaccine]. But if you didn’t concentrate on hygiene measures, something else would come along to replace them.’

Derek Butler of the patients’ group MRSA Action, whose president is the eminent microbiologist Professor Hugh Pennington, said it would welcome a vaccine but warned the timescale could be optimistic. ‘Professor Pennington has made clear that it is a long way off, because the [MRSA] bacterium is always evolving and changing: you can never get ahead of it. Hygiene is always the first line of defence with regard to infections - we relied on technology for the last 80 years with antibiotics.’

Donaldson will also say a new flu vaccine effective against a much wider number of strains could be ready in as little as three years, offering the best hope so far of preventing a future deadly flu pandemic which forecasts suggest could kill up to 750,000 people.

However, Donaldson - whose annual reports in the past five years have sounded the alarm over problems from binge drinking to bird flu - said obesity still remained his main concern in public health. And he gave cautious backing to David Cameron’s argument that overweight people should take personal responsibility for getting fat. He said blame was ‘not helpful’ in public health, but added: ‘I do think you need both. [Former health secretary] John Reid coined quite a nice thing. He said: “We don’t want the nanny state but we don’t want the Pontius Pilate state either.”’

He also called for an MMR ‘catch-up’ campaign to get older children who missed out on the vaccine immunised. He said public confidence in the jab was growing after a string of major studies rejected claims that it was linked to autism, but uptake remains low in some areas - raising the risk of a serious measles outbreak.

‘It’s really now only the older grandparents who can remember the implications of diseases such as polio: as far as parents are concerned, the fear factor that motivated them to get the vaccination has disappeared because they’ve never seen the diseases,’ he said. ‘Measles, mumps and rubella are not mild diseases.’

He rejected calls from some Labour MPs to make the vaccination compulsory before starting primary school, however, arguing it should not be necessary to force parents into giving the jab. (c) Guardian News and Media Limited 2008

Conference delegates tested for MRSA hospital superbug

HELEN PUTTICK, Health Correspondent July 11 2008

Nearly 200 doctors were tested for the superbug MRSA at a medical conference in Scotland.

Researchers from Edinburgh University screened delegates attending the British Medical Association’s annual representative meeting in the city, and also swabbed their mobile phones. Almost 400 samples were taken.

Richard Brady, who is leading the study, said little said little was known about the levels of MRSA carried by healthcare workers.

Yet staff with no symptoms can spread the bacteria to people who are sick and susceptible to MRSA infections.

Mr Brady said: “This study allows us for the first time to sample a large number of doctors, outside the hospital environment, to detect if they carry MRSA within their nasal cavities.

“This is one of the most common areas for MRSA to colonise.”

He described the research as a vital contribution to the debate over whether healthcare workers should be screened for the bug.

Mr Brady added: “It will also hopefully stimulate much-needed funding of research into this critical area.”

Derek Butler, chairman of the charity MRSA Action UK, welcomed the study, but said: “I would rather they tested doctors in hospitals, where they have dealings with patients. The government is very keen to tell us that one third of the population carries staphylococcus aureus and 10% of that carry MRSA. The staff in hospitals are the general public.”

Initial results from the swabs are expected in a matter of days, but further analysis will follow and the findings are expected to be published in a medical journal.

Overcrowding in hospitals ‘is behind the high rates of MRSA’

By Jenny Hope

Last updated at 10:49 PM on 23rd June 2008

Overcrowding in hospitals is creating a ‘vicious circle’ of superbug infections, researchers say. Seven out of ten wards are exceeding bed occupancy targets, an analysis found yesterday.

This is putting patients at increased risk of contracting MRSA, according to a report in The Lancet Infectious Diseases medical journal.

Infected patients are forced to spend longer in hospital, which contributes to ‘bed blocking’ and also makes them more likely to contract other hospital-acquired diseases.

MRSA campaigners predict that around 40 per cent of trusts will breach the Government’s target of halving infection rates this year.

Of 89 foundation trusts, 36 had breached the target at the end of March, according to the regulatory body Monitor.

The latest research, from Australian scientists at the University of Queensland, found that overcrowding and understaffing in hospitals are contributing to the spread of MRSA.

Lead researcher Dr Archie Clements said: ‘The drive towards greater efficiency, by reducing the number of hospital beds and increasing patient throughput has led to highly stressed healthcare systems with unwelcome side effects.’

He added that staff shortages and higher workloads meant it was more difficult for nurses and doctors to comply with hygiene rules such as hand-washing.

There was also insufficient space for isolation facilities to reduce the spread of infection, he said. The report compared-MRSA rates across several countries.

In the UK, higher hospital admission rates, together with reduced numbers of beds, have led to 71 per cent of NHS trusts exceeding the Government’s bed occupancy target of 82 per cent, Dr Clements said.

Occupancy rates are a measure of what percentage of a hospital’s beds are in use at any one time. The scientist added: ‘Overcrowding and understaffing have had a negative effect on patients’ safety and quality of care, evidenced by the flourishing of healthcare-acquired MRSA infections in many countries, despite efforts to control and prevent these infections occurring.’

Derek Butler, chairman of the MRSA Action charity, said microbiologists were in agreement that bed occupancy of over 85 per cent contributed to infection rates.

He said: ‘The ideal figure for hospital bed occupancy is 65 per cent, which is the level followed by the Dutch who have an excellent record on hospital-acquired infections.’

But a spokesman for the Department of Health said a study published in December showed no correlation between MRSA rates and high rates of bed occupancy in England.

She added: ‘We do not think it is sensible to dictate to well-performing hospitals that may have bed occupancy rates over 85 per cent that they should bring those rates down. That is for them to manage.’

Viewpoint: How dare we let these dirty hospitals kill 8,000 a year?
By Edwina Currie

Last updated at 12:54 AM on 17th June 2008

A record number of people are dying in NHS hospitals from superbugs. According to figures recently released, death certificates for 2006 showed that more than 8,000 patients in England and Wales died from either MRSA, the drug-resistant bug that infects surgical wounds, or from Clostridium difficile, a virulent form of diarrhoea.

Each year, we now kill more people with C.diff than die on our roads, while deaths from MRSA are the equivalent of two train crashes a week.

In fact, more than 55,000 cases of C.diff occur each year, and the number is rising. That’s more than 1,000 new cases every seven days. Both infections are preventable, and both are treatable if caught soon enough.

Yet where are the politicians making speeches about this scandal? I can’t name any. It makes me seethe.

What’s more, those deaths are probably an underestimate, since most hospitals don’t bother testing for MRSA until a patient is obviously affected. By the time the results arrive, often the poor soul has died, been certificated and dispatched to the undertakers.

The MRSA superbug, which contributes to the deaths of over 8,000 hospital patients each year

Until April last year, we didn’t even bother counting cases of C.diff among patients under 65 - as if they didn’t matter. True, mortality is lower among young people, but they’re just as likely to spread it as anyone else.

The Government’s own target, set in March 2004, is merely to halve the number of MRSA cases. That is a pathetic failure of will.

It’s five years since infection control managers were ordered for every NHS Trust. Well-paid but powerless, they’ve made not a scrap of difference.

This spring, a ?40 million hospital ‘deep clean’ took place, but what is the point if wards are as neglected the following day as before? Yesterday, official figures showed that more than a quarter of health trusts are failing to meet basic hygiene standards.

Ministers should check out practice in other countries. In Holland and Scandinavia the policy is ‘search and destroy’.

All patients are tested, cases are isolated and treated until they get the all- clear, so only occasional examples of MRSA occur. Their standards of cleanliness and vigilance are awesome by comparison.

The answer is simple: hospitals must be clean, clean, clean. Florence Nightingale knew this, in the days before antibiotics made us lazy.

It is not a question of money but of good practice. Plain soap and water on floors, beds, shelves, door-handles, everywhere; hygiene maintained ferociously, but especially around bathrooms, toilets, kitchens.

Actress Leslie Ash, whose own battle with MRSA caused her to lose feeling from her waist down and needing a walking stick

Thorough sterilisation of equipment, particularly if it’s going to be used many times; clean uniforms; and more than anything, staff washing their hands before they touch a patient. Over and over again.

Recently, I’ve visited friends in hospitals. The standards were not bad; the wards were fairly clean. But bed curtains hung off their hooks and needed a wash.

Beds were too close together - an invitation to cross-infection. I didn’t see anybody using alcohol gels and when I checked (this was a teaching hospital), several of the dispensers were empty.

There wasn’t a sink nearby in the ward; apparently they aren’t designed that way any more. The Government advises a ‘bare below the elbow’ uniform, to encourage hand-washing; on one ward with elderly folk prone to C.diff, the doctors were in scruffy clothes, sleeves down to the wrists.

It took half an hour before one old lady was assisted to get out of bed to go to the toilet. Last time, I was told, they didn’t get to her quick enough and she ‘went’ in the bed. Then they wonder why they still have problems?

There’s a climate of complacency and even ignorance in some of the worst-offending hospitals. At an NHS conference last week I was asked by one senior woman manager why the Press are so critical.

She had got her staff retrained; she claimed her hospital was a success story. I asked how many cases of MRSA they’d had in the past year and she didn’t know.

But she knew how many they’d had last week, and it was four. That works out at several hundred a year. She believed this was a cause for congratulation and got shirty when I disagreed.

Yet when hospital managers take control of the situation, outcomes can improve.

The Royal Worcester Hospital replaced all its old commodes and every mattress and its infection rates dramatically fell.

Campaigning charities such as The Patients’ Association and MRSA Action UK urge patients to take a stand.

If a member of staff does not wash their hands, insist they do. If a commode is unclean, tell somebody. Challenge bad practice and praise good work, too.

If staff from doctors to kitchen hands remembered they, too, might be a patient next week, suffering the same grubby regime as the rest of us, then maybe things would change.

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(c) MRSA Action UK June 2008


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