Dr Foster Gave Early Warning About Mid-Staffordshire Hospital Trust Failings
(PRLEAP.COM) The Healthcare Commission's recent report detailing the failings in patient care at the Mid-Staffordshire Hospital Trust has criticised the trust for blaming poor coding and data rather than investigating the quality of care.
The Dr Foster Unit at Imperial College had identified that mortality ratios at the Mid Staffordshire NHS Trust were higher than expected and flagged a warning with the Healthcare Commission in July 2007 and again a month later.
The Healthcare Commission also noticed potential problems on its own data system and launched a full investigation.
Media coverage has highlighted how the early warnings provided by the Dr Foster Unit at Imperial College and the 2007 Dr Foster Hospital Guide were not acted upon quickly enough.
The West Midlands Strategic Health Authority has also come under fire for responding to these mortality alerts not by investigating potential patient care issues, but by commissioning a report into data from public health academics at the University of Birmingham.
Background to the investigation
A Dr Foster analysis of the Mid-Staffordshire Hospital Trust showed that it had the fourth highest
hospital standardised mortality ratio (HSMR) in England for the three-year period 2003 to 2006.
The Trust purchased Dr Foster's Real-Time Monitoring (RTM) system in early 2006, and used this for its internal surveillance of clinical outcomes.
The Trust then gave Dr Foster information generated using RTM for non-elective admissions for the financial year 2007/08, which showed that the trust had a significantly high mortality ratio in 10 'patient groups', and a significantly lower than expected mortality ratio outcomes in four groups.
The Healthcare Commission report stated that the Trust only began to monitor clinical outcomes after the publication of the high rate by Dr Foster in 2007.
The Healthcare Commission was provided with output from the Mid-Staffordshire Foundation Trust's RTM system for non-elective (emergency) admissions for 2007 to 2008, which helped instigate the current investigation and reveal the failings at the hospital. They found the likelihood of this many alerts within a single trust being false alarms to be very small.
Tim Kelsey, Chair of the Executive Board, Dr Foster Intelligence stated: "The NHS is now one of the most closely monitored health economies in the world and the alert that triggered the Mid Staffordshire investigation is evidence that this new system is working and that the NHS is beginning to use information and data effectively."
The charity MRSA Action UK said it had called on the Department of Health to make better use of data and highlighted that Dr Foster's Hospital Guide revealed that Stafford General Hospital was not the only hospital with poor outcomes for some procedures.
Derek Butler, Chair of MRSA Action UK, added: "The [Dr Foster] data which is freely available and in the public domain should be used as a management tool, not only by the Hospital Trust Boards and managers, but by the regulators."
You can access Dr Foster's
Hospital Guide to find out how your local hospital performs against other hospitals in England.
Find out more about Dr Foster's
Real-Time Monitor tool on the Dr Foster corporate site.
Editors' Notes:
1. HSMRs: Dr Foster publishes HSMRs as one of a basket of quality indicators in its annual Hospital Guide and over
www.drfosterhealth.co.uk. Dr Foster has always advised that HSMRs should not be used in isolation in evaluating the quality of a hospital.
2. About Dr Foster: Dr Foster is the UK's market-leading provider of information, analysis and targeted communications to health and social care organisations. An independent organisation, Dr Foster Intelligence was launched in 2006 as a joint venture between Dr Foster Ltd and the NHS Information Centre for health and social care. Dr Foster Intelligence aims to set a new standard in information for health and social care providers and their users and is legally required to follow a code of conduct that prohibits political bias and requires it to act in the public interest. The Dr Foster Ethics Committee is an independent body empowered to adjudicate on complaints and oversee the code of conduct.
3. About Dr Foster Health: Dr Foster Health is the leading innovator in benchmarking public services and communicating information about services to the public. We produce authoritative and independent guides to health services in the public and private sectors. Our aim is not only to inform, but also to act as a catalyst for change.
Weightmans gets the movie bug as firm takes key role in disease control film.(News)
Mar 17 2009 by Ben Schofield, Liverpool Daily Post
WEIGHTMANS - India Buildings offices were briefly turned into a film set last week.
The firm starred in a fire service film highlighting the importance of infection control.
Office head David Lewis took part alongside healthcare solicitor Sonia Appleton.
The DVD will also feature Edwina Currie, patron of MRSA Action UK, and chief fire officer Tony McGuirk, and is aimed at emergency service workers who are exposed to a range of viral hazards on a daily basis.
David Lewis, head of the firm's Liverpool operation, and co-star Sonia Appleton, explain the ins and outs of the law when it comes to infection control.
Mr Lewis told LDP Legal: "Merseyside Fire Authority is a valued client of ours and this is an important issue so of course we were happy to help them out with this DVD.
"Infection Control is a hot topic within the emergency services, since those at risk are exposed to infections and other viral risks on a daily basis.
"Hopefully, this DVD will offer a new and easy way for those in the danger zone to learn about the risks and, of course, prevention."
Mrs Appleton said: "Our role in this film is an educational one; explaining the regulations already in place and the legal implications for those who fail to follow them. The intention is not to scaremonger."
Faster acting drugs needed to combat MRSA
Monday 9th March 2009
MRSA expert Dr Bill Love has called for the NHS to use faster acting drugs to implement Sir Richard Branson's proposal for MRSA screening for hospital staff. Dr Love's drug development company Destiny Pharma is currently undertaking clinical trials for a new anti MRSA drug codenamed XF-73 which aims to allow a faster eradication of the hospital 'Superbug'.
In his role as Vice President of the Patients Association, Sir Richard Branson is campaigning for all hospital staff to be regularly screened for MRSA and treated immediately if found to be carrying the Superbug. Despite discouraging reactions from the British Medical Association, Dr Love has given his support to the campaign in a statement released today.
One of the main objections to screening and decolonising staff MRSA carriers is that it can take up to two weeks to effect MRSA eradication and taking staff off wards for this long would put massive pressure on NHS resources. Dr Love argues that this could be overcome with faster-acting drugs that could eradicate MRSA in a much shorter period. In addition, the new drug, XF-73, has shown to have continued effectiveness against MRSA after multiple exposures, indicating MRSA may find it hard to become resistant to this new drug's action. Therefore XF-73 could be used in a more widespread fashion allowing for a greater proportion of MRSA carriers in hospitals to be cleared of the Superbug, and assist in reducing MRSA infections even further.
This addition to the debate on hospital infections comes just before the NHS' deadline for implementing MRSA screening of patients. Back in October 2007 the Government promised that all hospital patients would be screened for MRSA as part of standard procedure by March 2009. Results of this roll out are yet to be released so it is not known whether the Government has managed to meet its target. So far this intervention seems to be having a positive impact on the number of MRSA infections, albeit there is still a long way to go.
Dr Bill Love commented: "Eradication of MRSA from patients must be the first priority. Once this is in place the next logical step to quickly lower MRSA transmission and infection rates is to screen hospital staff for MRSA and treat them immediately if they are found to be carriers.
All of the people who have opposed Sir Richard Branson's proposal have done so on the grounds of the impracticality and cost involved in putting members of hospital staff out of action for two weeks. Yet effective MRSA decolonisation does not need to take two or even one week to effect - this is just the treatment protocol for the drugs that are currently available. Better drugs are needed alongside a commitment to screening."
Derek Butler, Chair of MRSA Action UK added: "I have seen for myself the devastation infections like MRSA can have on people and families and we welcome the screening program introduced by the Government. We do however have concerns that the screening program may be brought to a halt in the not to distant future because of the growing resistance to existing treatments and the lack of new drugs for decolonisation available to combat this bacteria.
History has shown that bacteria are the best biochemists on the planet and that they quickly adapt to prolonged use of treatments, this is why we welcome new drugs such as XF-73.
We believe universal screening of all patients for MRSA is having a positive effect in bringing down MRSA rates. However we must not take our eye off the ball, and instead concentrate our efforts to screen both patients and staff for MRSA so that we can help to eradicate as much as possible this scourge in our hospitals.
Hygiene inspectors for Scots hospitals
New move to help beat 'healthcare-associated' superbugs like MRSA
By Tom Gordon, Scottish Political Editor
March 01 2009
PATIENTS AND their families will be able to report dirty hospital staff and wards directly to a new hygiene inspectorate under government plans to tackle superbugs.
The new inspectors will also be able to make random and unannounced visits to hospitals to check on cleanliness and levels of bacteria causing healthcare-associated infections (HAIs).
Nicola Sturgeon, the health secretary, expects the inspectorate to begin next month. Hospital staff who persistently ignore hygiene rules could be disciplined and ultimately sacked.
"The creation of the new inspection team will give patients, relatives and hospital visitors a point of contact to whom they can report any concerns they have about dirty wards or staff not washing their hands properly.
"Inspectors will have the power to arrive unannounced at hospitals across the country to investigate these concerns, which is part of an overall strategy to improve hygiene levels and reduce the number of cases of superbugs such as C. diff Clostridium difficile and MRSA."
The development coincides with 400,000 pounds of government investment in specialist "deep clean" equipment to reduce infection levels.
The money will be buy 250 steam-cleaning machines, with around 60 going to Greater Glasgow NHS board, 32 to Lothian, 26 to Lanarkshire, and 22 to Grampian. At present there are 20 such machines for the whole of the NHS in Scotland.
Used with special cloths, the machines are seen as particularly effective against C. diff, the bug linked to the deaths of 18 patients at the Vale of Leven Hospital in Dumbarton last year.
"Cleanliness is crucial in our hospitals and is a simple way to help combat infections like MRSA and C. diff," said Sturgeon. "Tackling healthcare- associated infections is my top priority because it's vital that the public have confidence in the care they will receive if they need hospital treatment."
Recent research at Glasgow's Southern General found that cleaning "hand touch" sites such as bed rails, door handles, lockers, switches, pumps and other equipment near patients was the best way of tackling MRSA. Mopping floors and steam cleaning curtains was far less effective, however.
Labour's Cathy Jamieson welcomed the extra cleaning power, but said the government had to use a much more comprehensive approach to tackling infections. She said that steam cleaning facilities should be available in every NHS hospital as part of a 15-point action plan, drawn up by Labour with the help of micro-biologist Professor Hugh Pennington.
"Nicola Sturgeon's response to C. difficile has been complacent and piecemeal," she said.
"Scottish Labour has offered the government an effective action plan with an ambitious target to cut the number of C. diff cases by 50% by March 2011. Professor Hugh Pennington has told us that it could save thousands of lives."
She also called for better hand-washing facilities and an independent commissioner to drive progress.
"The plan has cross-party support and the government should adopt it in full," added Jamieson.
Sturgeon, who also has responsibility for housing, wrote this weekend to the chancellor, Alistair Darling, demanding an extra 500 million pounds from the Treasury for Scotland's building industry. She urged him to take "radical steps" and put the money into affordable housing in his budget on April 22. The money would create around 5000 jobs and support another 3000, she said.
Jamieson accused Sturgeon of "breathtaking hypocrisy" on the issue and said the Scottish government had cut grants to housing associations, forcing them to borrow 10,000 pounds for every new home they built.
Nurses attack muddled plan for superbugs
Published Date: 01 March 2009
By Kate Foster
HOSPITAL workers are struggling to win the war against superbugs because of sporadic and uncoordinated Government initiatives and a "political agenda", the leader of Scotland's nurses warned last night.
Theresa Fyffe, director of the Royal College of Nursing in Scotland, said numerous action plans against MRSA, C.diff and other potential killers over the past few years had left nurses unsure which rules to follow. Politicisation of the issue risked creating anxiety and pressure on the wards, she added.
Fyffe said the Government needed to put an expert in overall charge of its superbug strategy and increase the number of staff tackling the problem by up to 50% in some areas.
Her comments are likely to embarrass the Scottish Government, which has made a number of high-profile pledges to tackle hospital acquired infections (HAIs), backed by 54million pounds of extra funding. Fyffe's criticisms were echoed last night by experts, patients' groups and opposition politicians.
Cases of C.diff have soared in Scotland and the bug was linked to 600 deaths last year. Deaths linked to MRSA more than tripled in a decade to 230 last year.
The rise of the deadly bugs has sparked four major national action plans and dozens of new rules and regulations.
But Fyffe, whose organisation is represented on the Government's HAI Taskforce, said there were now so many new policies that staff did not know what to expect next.
She said: "I want to be clear there's a coordinated approach, not a sporadic approach where staff don't know what's coming at them next week.
"We need to check that everything we are doing is working together. When you are at the centre of it, as our nurses are, it's not always easy to understand where all these actions are coming from.
"There's a risk of duplication. Staff need to be sure that it is done in a coordinated way. Some nurses are not so sure it feels coordinated. We need to make sure every effort does deliver and we are all going in the right direction."
So far there have been four major action plans on superbugs, including three Delivery Plans from the HAI Taskforce and a National Action Plan 2008. In addition there have been a number of further action plans on subjects including dress codes, drug prescribing, staff screening, surveillance, handwashing and alcohol handrubs, introducing dozens of new rules and regulations.
Fyffe added: "There's a momentum on it, it's a very political agenda, and that can create a level of anxiety."
Fyffe called on the Scottish Government to fund more staff such as consultant nurses and surveillance experts and to improve hospital facilities such as old sinks to reduce infection rates.
Fyffe's comments were backed last night by leading microbiologist Professor Hugh Pennington. He said: "We are making progress and everything is in the right direction, but we could do it faster and better.
"There is a need for someone to stand over the whole thing. There is a need for a crash programme in the provision of isolation facilities and the staff to run them."
Margaret Watt, chairwoman of the Scotland Patients' Association, said: "We support Fyffe in everything she says. We need more staff and better equipment in hospitals to deal with infections."
Fyffe will raise her concerns at a fringe meeting at the Labour Party Conference in Dundee on Friday, hosted by MSP Jackie Baillie.
Baillie said yesterday: "Part of the problem Nicola Sturgeon has when she approaches hospital infections is she has clearly lost an argument about funding round the Cabinet table, and to some extent that ties her hands."
But Health Secretary Nicola Sturgeon last night defended her policies. She said: "Nobody should doubt this Government's commitment to tackling HAIs.
"We have acted swiftly, increasing spending by 260% and putting in place a comprehensive programme which the latest figures show is now beginning to reap rewards.
"This is vital work and it's crucial that we continue to make progress in this area."
Curtains and pyjamas to become weapons against superbugs
Hospital curtains, bedding, and even patients' pyjamas could become weapons in the war against hospital superbugs
By Laura Donnelly, Health Correspondent
Last Updated: 11:00PM GMT 28 Feb 2009
A study has found that an antimicrobial treatment, which could be incorporated into dozens of surfaces on the ward, can kill MRSA on contact, reducing the risk of infection between patients.
Scientists hailed the discovery by researchers from Imperial College London as a "very significant" step in the war on hospital superbugs which kill 10,000 people a year.
The study found the product was 1,000 times more potent than its rivals in eliminating MRSA, and could be used on dozens of surfaces, creating environments which eradicate bugs instead of harbouring them.
Paint, light switches, medical equipment, staff uniforms and even pens and paper could be treated with Cliniweave, which uses a technique invented by a British company to incorporate an antimicrobial compound into textiles.
The five-year study, published in the International Journal of Antimicrobial Agents, found that within 60 minutes the treatment eliminated MRSA entirely. In tests on three rival treatments, the bug continued to multiply.
The agent in Cliniweave works by destroying the enzymes in existing bacteria and preventing their multiplication.
Professor Mark Enright, professor of microbiology at Imperial College London, which carried out the study, said: "The results are very promising; a fabric that can kill bacteria on contact could be a really significant way to reduce levels of infections in hospitals".
The leading infection expert said professionals had long known that different parts of the ward could form "hotspots" for infection, but said treatments for surfaces had shown limited effectiveness until now.
Separate research published by The Lancet found that in hospital wards tackling superbug outbreaks, MRSA could be detected on dozens of surfaces.
Of the sites tested, 41 per cent of bed linen was found to be contaminated, along with 40 per cent of patients' clothing, and 27 per cent of furniture, including bed frames.
Nottingham University Hospitals trust have now begun replacing curtains on 100 wards at two sites with fabric treated with the product, which has already been introduced to wards at hospitals run by Blackpool, Fylde and Wyre Hospitals trust.
Hugh Pennington, Emeritus Professor of microbiology at Aberdeen University, said the study findings appeared to be "extremely significant".
He said: "We know that MRSA is often found on surfaces in hospitals, and anything that we can do to reduce the number of places from where patients can become contaminated should be pursued when so many lives are at stake."
Prof Enright said his team were now seeking funding to carry out further research to establish the effectiveness of the product in hospitals, where it could be used to treat as many surfaces as possible.
"We want to carry out a trial using two intensive care units, where we can treat as many fabrics as possible - the staff uniforms, the bedding, the paint on the walls - to see how far we can reduce the risk of infection," he said.
George Costa, managing director of Intelligent Fabric Technologies (IFT), which invented Cliniweave, said the technology meant antimicrobial treatment could be incorporated into dozens of textiles ranging from paint to plastic.
IFT part-funded the peer-reviewed research, but played no part in the design of the study, or in carrying out the work or interpreting the findings.
While the risks of infection with bugs such as MRSA can be reduced if those who come into contact with patients have washed their hands, environments harbouring bugs leave staff, relatives and patients at constant risk of picking up new bacteria which can infect wounds and get into the bloodstream, sometimes proving fatal.
Latest annual figures show there were more than 1,500 deaths linked to MRSA in NHS hospitals in 2007, although the number of infections has since begun to fall.
Figures published in December showed the number of infections reduced by one third in 2008, after new measures were introduced by hospitals to promote hygiene. Latest annual figures show in total almost 10,000 people died from hospital infections, including MRSA and Clostridium Difficile.
MRSA
20 February, 2009
MRSA (sometimes referred to as the superbug) stands for methicillin-resistant Staphylococcus aureus (SA). SA is a bacterium from the Staphylococcus aureus family.
Brought to you by NHS Choices
Overview
Introduction
About one in three of us carries SA on the surface of our skin, or in our nose, without developing an infection. This is known as being colonised by the bacteria. However, if SA bacteria get into the body through a break in the skin they can cause infections such as boils, abscesses or impetigo. If they get into the bloodstream they can cause more serious infections.
Most SA infections can be treated with antibiotics such as methicillin (a type of penicillin). However, SA is becoming increasingly resistant to most commonly used antibiotics. MRSA bacteria are those types of SA bacteria that are resistant to methicillin (and usually to some of the other antibiotics that are normally used to treat SA infections).
MRSA is no more infectious than other types of SA bacteria. However, MRSA infections are more difficult to treat due to the antibiotic resistance of the bacteria. Antibiotics can still be used to treat MRSA, the infection may simply require a much higher dose over a much longer period, or the use of an antibiotic to which the bacteria is not resistant.
Symptoms
Symptoms of MRSA
Staphylococcus aureus (SA) bacteria are common, and about one in three people are colonised by the bacteria. Most of those who are colonised with SA do not develop an infection and so do not have any symptoms.
However, if SA bacteria are able to enter the body they can cause infection. The symptoms will depend on the type of infection they cause.
Most SA infections are skin infections, including:
- boils (pus-filled infections of hair follicles),
- abscesses (collections of pus in pockets under the skin),
- styes (infection of glands in the eyelid),
- carbuncles (infections larger than an abscess, usually with several openings to the skin),
- cellulitis (infection of the skin and the fat and tissues that lie immediately beneath it), and
- impetigo (a skin infection that produces pus-filled blisters).
You should keep an eye on minor skin problems like spots, cuts or burns. If you have a wound that becomes infected you should see your doctor.
Although most SA infections are skin infections, if SA bacteria are able to enter the bloodstream (bacteraemia) they can affect almost any part of the body. They can cause:
- septicaemia (blood poisoning),
- septic shock (widespread infection of the blood that leads to a fall in blood pressure and organ failure),
- severe joint problems (septic arthritis),
- bone marrow infection (osteomyelitis),
- internal abscesses anywhere within the body,
- inflammation of the tissues that surround the brain and spinal cord (meningitis),
- lung infection (pneumonia), and
- infection of the heart lining (endocarditis).
SA bacteria can also cause scalded skin syndrome and, very occasionally, toxic shock syndrome.
Causes
Causes of MRSA
When bacteria encounter an antibiotic, such as methicillin, some of the bacteria may survive. Bacteria are able to mutate (change), so those bacteria that survive may develop a resistance to the antibiotic. The surviving antibiotic-resistant bacteria can then multiply, ready to infect someone new. In this way, some types of staphylococcal aureus bacteria have become resistant to many antibiotics, forming MRSA.
The number of antibiotic-resistant bacteria has increased in recent years due to:
- people not finishing the full course of antibiotics they have been prescribed, which allows some bacteria to survive, develop a resistance to the antibiotic, and then multiply, and
- antibiotics being overused, which has allowed bacteria to develop resistance to a wide range of antibiotics.
MRSA bacteria is usually spread through person-to-person contact with someone who has an MRSA infection, or who is colonised by the bacteria. It can also spread through contact with towels, sheets, clothes, dressings or other objects that have been used by someone with MRSA. MRSA can also survive on objects or surfaces such as door handles, sinks, floors and cleaning equipment.
MRSA will not normally cause an infection in a healthy person. Although it is possible for those outside hospital to become infected, MRSA infections are most common in people who are already in hospital. Those in hospital are more likely to develop MRSA infections because they often have an entry point for the bacteria to get into their body, such as a surgical wound, a catheter, or an intravenous tube.
Those who are most at risk of MRSA include those who have:
- a weakened immune system, such as the elderly, newborn babies, or those with a long-term health condition such as diabetes, cancer or HIV/AIDS,
- an open wound,
- a catheter (a plastic tube inserted into the body to drain fluid) or an intravenous drip,
- a burn or cut on their skin,
- a severe skin condition such as leg ulcer or psoriasis,
- recently had surgery, or
- have to take frequent courses of antibiotics.
Although MRSA infections usually develop in those being treated in hospital, particularly patients in intensive care units and on surgical wards, it is possible for hospital staff or visitors to become infected if they are in one of these higher risk groups.
Diagnosis
Diagnosing MRSA
MRSA infections are diagnosed by testing blood, urine or a sample of tissue from the infected area for the presence of MRSA bacteria. If MRSA bacteria are found, further tests will be done to see which antibiotics the bacteria do not have resistance to, and so which can be used to treat them.
Many hospitals now test everyone who is being admitted to see if they are colonised with MRSA. Swabs from the skin and nose, urine and blood samples may be tested for the bacteria. It can take 3-5 days for the results to come back.
If you are colonised with MRSA you will still be admitted, but doctors may give you treatment to reduce or remove the MRSA bacteria.
Treatment
Treating MRSA
Treatment of MRSA depends on whether you are infected with Staphylococcus aureus (SA) bacteria, or only colonised. You are considered to be infected with MRSA if the bacteria have entered your bloodstream, such as through a break in your skin. However, if you have SA bacteria on the surface of your skin without developing an infection, you are said to be colonised.
If you have an MRSA infection, you will be given antibiotics that are still effective and a type that the bacteria have not yet become resistant to. Most MRSA infections can be treated with the antibiotics vancomycin, or linezolid, which are normally given through injection or intravenously (through a tube straight into your vein). Most MRSA infections will require treatment in hospital and antibiotic treatment may need to continue for several weeks.
If you are colonised with MRSA bacteria, you may be treated, particularly if you need to go into hospital for a procedure such as an operation. If you have a local or serious MRSA infection, you may need to continue having treatment when you go home.
If you require treatment to remove MRSA bacteria before going into hospital, before being admitted, a special antibiotic cream will be applied to your skin, or to the inside of your nose, to remove the bacteria. You may also need to wash your skin and hair with an antiseptic shampoo and lotion.
If you are in hospital and you have an MRSA infection, you may be moved to a private room or to a room with others who have the bacteria, to stop MRSA spreading.
MRSA does not normally cause harm to healthy people (it cannot harm pregnant women, children or babies, providing they are fit and healthy), so if you have an MRSA infection you will still be able to have visitors as normal. However, it is essential that all visitors wash their hands thoroughly before and after visiting every patient. Fast-acting, special alcohol rubs or gels are used in most hospitals, with dispensers usually located by patients' beds.
Some people are more at risk of MRSA (see the Causes section). If you have an MRSA infection and someone who is at increased risk wishes to visit you in hospital, you should ask the hospital staff for advice before they visit.
Prevention
Preventing MRSA
If you are prescribed antibiotics you should always make sure that you complete the full course.
MRSA is usually passed on by human contact, often from the skin of the hands. You should always wash your hands thoroughly before and after visiting someone in hospital.
Hospital staff who come into contact with patients should maintain very high standards of hygiene and take extra care when treating patients with MRSA. Before and after caring for any patient, hospital staff should make sure they have thoroughly washed and dried their hands. Many hospitals now use fast-acting, special antiseptic solutions, like alcohol rubs or gels - you may find dispensers placed by patients beds and at the entrance to clinical areas for use by staff and visitors. Staff should wear disposable gloves when they have physical contact with open wounds, for example when changing dressings, handling needles or inserting an intravenous drip.
If you are concerned about hygiene, do not be afraid to ask the doctor or nurse treating you, or your visitors, if they have washed their hands.
If you are in hospital, you can reduce your risk of infection by taking the following sensible precautions.
This article was originally published by NHS Choices
Charity calls for MRSA screening of NHS staff
Published: 18 February 2009 16:23
A charity that promotes awareness about MRSA has called for all NHS staff to be screened for the healthcare-associated infection
Derek Butler, chair of MRSA Action UK, said the UK should adopt the Dutch 'search and destroy' method to eradicate MRSA, which involves screening healthcare staff and decolonising those who test positive.
'Staff should be screened regularly and if they are colonised with the infection they should be taken off duty until they are clear,' he said.
But Martin Kiernan, president of the Infection Prevention Society, rejected the idea. 'There is no evidence to support blanket screening of staff. As long as NHS staff follow good clinical infection control practices they should pose no risk to patients,' he said.
The comments follow figures revealed last week in parliament by health minister Ann Keen, which estimate that more than 66,000 NHS clinical staff are colonised with MRSA - between 3% and 5% of the workforce.
From 31 March all NHS elective patients must be screened for MRSA, which will be expanded to include emergency admissions from 2010.
Related article: Staff screening for MRSA: the facts
Hospital bug action plan launched
Holyrood's five opposition parties have united to launch an action plan to tackle hospital-acquired infections.
The proposals, drawn up with the help of expert Professor Hugh Pennington, aim to halve the number of C.difficile cases within two years.
The move came after an outbreak at Vale of Leven hospital in Dunbartonshire, in which 18 patients died.
Health Secretary Nicola Sturgeon said much of the plan's content was already being implemented in Scotland.
However, she has asked the national task force on healthcare associated infections to consider it.
"I do believe this issue is not about party politics," Ms Sturgeon said.
"It requires the combined efforts of everyone in this parliament, as well as the entire Scottish population, if we are to succeed in reducing infection rates."
'Complacent approach'
The opposition party action plan, which has the support of Vale of Leven families, has gone beyond current government action by suggesting a new hospital infection tsar be appointed to police hospitals.
The plan, which was debated at Holyrood, also called for the fitting of automatic, sensor-operated taps to cut the spread of infection, and isolation facilites for all C.diff or MRSA patients.
A total of 55 people at the Vale of Leven hospital were affected by the bug, and 18 patients died, between December 2007 and June 2008.
An initial review of procedures at the hospital, published in August, found "inadequate" infection controls, although a follow-up report this week said improvements were now being rapidly implemented.
Labour MSP Jackie Baillie, whose constituency takes in the hospital, welcomed progress but renewed calls for a public inquiry.
"Nicola Sturgeon's approach to C difficile has been complacent and piecemeal," she said.
Ms Sturgeon has not ruled out a public inquiry and said the issues highlighted at Vale of Leven were also being taken forward across Scotland.
Copyright BBC MMIX
When controlling infections, some things never change
Public Service Review: Health Issue 18 - Thursday, February 05, 2009
Professor Hugh Pennington, an emeritus professor of bacteriology, looks back at the treatment of infectious diseases at the turn of the 20th century and says that the 100 year old recommendations would still help to prevent infections today
"History is bunk," said Henry Ford. How wrong. For microbes, providers of healthcare ignore its lessons, not so much at their peril but for that of their patients. For some infections, we have developed effective controls, like vaccines against diphtheria, whooping cough and tetanus. But so far, only smallpox rests in the dustbin of history, and remedies like antibiotics, while still lifesavers, are becoming less effective for many conditions because their causative microbes evolve in real-time, making resistance common. Some antibiotics even have side effects that facilitate second infections, like Clostridium difficile associated disease.
A century ago, most of the major pathogenic bacteria that we are familiar with today had been discovered. For many of them, laboratory diagnostic methods like the agar plate haven't changed much. But effective treatments for the majority of their diseases lay far in the future. The emphasis had to be on prevention. Good things were done. Lessons were learned.
Nevertheless, very important ones have been forgotten. That rediscovering them has been slow is unfortunate. But the real scandal is that memory of them faded in the first place.
Take asylum dysentery. Historically, we think of Shigella infections in adults in terms of prisons and military campaigns. It killed many more soldiers in the Crimea than the Russians. But one of its natural homes used to be the mental hospital. In most of them, it was continually present. It was normal for a few patients at any one time to have diarrhoea. They attracted little interest. However, from time to time, it broke out in epidemics with high mortality. The interest of pathologists and bacteriologists was aroused. A particularly important outcome was the 'Report of Drs Mott and Durham on Colitis or Asylum Dysentery' presented to the Asylums Committee of the London County Council in May 1900. Mott and Durham recommended, among other things, that patients with a suspicious diarrhoea should be isolated, that the accommodation provided for isolation should not be used for other purposes, that all cases of diarrhoea should be notified, that 'while recognising the desirability and necessity of the transference of patients from ward to ward for purposes of treatment and administration, great discretion is necessary when diarrhoea, however slight, exists', and that much attention be paid to staff training, disinfection and handwashing.
Sadly, there is a very familiar ring to these recommend-ations. If they had been followed more than a century later at Stoke Mandeville and Maidstone, the enormous Clostridium difficile outbreaks there would never had happened. And even more recently, in Scotland, at the Vale of Leven Hospital, where an outbreak festered away for several months without being recognised as such, it could have been the same.
At this point, I am obliged to declare an interest. My grandmother was a nurse in the first isolation hospital to be established in an English mental hospital, purpose built in Lancaster out of bunter sandstone at the end of the 19th Century.
Another personal interest is in food-borne infections, particularly those caused by E. coli O157. From time to time, it reminds us of Shigella. The asylums are gone, but the residents of institutions providing care for the elderly are now subject to attack. Like Shigella, E. coli O157 provides a stern test for control of infection procedures because of the ease with which it spreads from person to person. Both have very low infectious doses.
In 1996-7, I chaired an investigation into Britain's largest E. coli O157 outbreak in Scotland. Now I am chairing a Public Inquiry into Britain's second largest outbreak, in Wales. Both had very similar features. So it is not surprising that a food safety blogger from Kansas has said that I have 'become unstuck in time...like Bill Murray in Groundhog Day'. Why don't we learn from history? Everyone has heard of Semmelweis, but many fail to follow his example. I only wish I knew why.
Cases of superbug C. diff cut by a third in one year, new figures reveal
Last updated at 7:58 PM on 15th January 2009 Cases of the superbug C diff on hospital wards have fallen by more than a third in a year, official figures have showed.
In total, 7,061 cases in patients aged 65 and over were recorded from July to September last year - 35 per cent lower than the same period in 2007.
The latest quarterly figures for England from the Health Protection Agency also reveal a 19 per cent fall compared with the three months before.
Overall, there were more than 45,000 cases between October 2007 and September 2008 across all age groups, the health watchdog found.
Clostridium difficile produces toxins which damage the lining of the bowel, resulting in severe diarrhoea, and is usually spread through the hands of healthcare staff and via contaminated surfaces.
The over-65s are most at risk.
Health Secretary Alan Johnson and the Health Protection Agency welcomed the figures and called for the hard work by hospital staff to continue.
Tory health spokesman Andrew Lansley also welcomed the figures.
But he added: 'It's shameful evidence of Labour's failure that deaths from Clostridium difficile every year are now more than eight times higher than they were when Labour came to power.'
Derek Butler, chairman of MRSA Action, said although the drop was welcome, it 'started from a very high baseline'.
'[It's] because C. diff got out of control and it's a pity that many patients have suffered and died as a result.'
http://www.mailonsunday.co.uk/health/article-1117305/Cases-superbug-C-diff-cut-year-new-figures-reveal.html#
Fight against superbugs hampered by doctors failing to wash their hands
By Simon Johnson, Scottish Political Editor
Last Updated: 4:25PM GMT 14 Jan 2009
The fight against hospital superbugs in Scotland is being hampered by doctors not cleaning their hands properly, new NHS figures have suggested
While nurses and other staff are heeding the message, doctors are still falling short of a target for compliance with hand hygiene rules.
Other statistics reveal that rates of Clostridium difficile and MRSA are falling, albeit at too slow a rate in the case of the former to meet official targets.
Nicola Sturgeon, Scottish health minister, welcomed the figures but Scottish Labour claimed a new 'superbug tsar' is needed to tackle the scourge.
The statistics were released after it was revealed police are interviewing nurses at Vale of Leven Hospital in Alexandria, Dunbartonshire, about a C. diff outbreak in which 18 people died.
They reveal that last November nurses complied with hand hygiene rules 95 per cent of the time, but for doctors the figure is only 84 per cent.
The overall figure for all NHS staff was 93 per cent, against a target of 90 per cent, an increase of five percentage points on test results gathered six months previously.
Dr Charles Saunders, chair of the British Medical Aassociation's Scottish consultants committee, said staff, patients and visitors are now much more aware of the need for good hand hygiene in tackling hospital superbugs.
"It is disappointing however that today's figures show that while doctors are making sustained improvements in compliance with hand hygiene guidelines, as a group it stills fall just below the target," he said.
The latest statistics published by Health Protection Scotland show there were 1,433 cases of C diff in Scotland in the three months to September 2008.
This compares with 1,732 the previous quarter and 1,861 in the quarter before that, but this still means more cases per month were reported on average in 2008 than 2007.
Miss Sturgeon has demanded a 30 per cent fall in C. diff cases by 2011 for the over-65s.
The MRSA rate is at its lowest since recording began in 2006, with 522 infections reported between July and September last year.
This means the NHS is on track to cut the number of MRSA cases by 30 per cent by 2010.
Miss Sturgeon welcomed the figures, saying: "While seasonal factors may be partly responsible for the reduction from the previous quarter, it is encouraging that there has also been a drop compared to the same quarter last year."
But she warned: "There is no excuse for not washing hands and our new zero tolerance approach means that staff who do not follow the proper hand hygiene procedures can expect to be challenged."
Labour published a 15-point plan to reduce the incidence of superbugs, drawn up with the help of two bacterial specialists, Professors Hugh Pennington and Brian Toft.
The party argued for the creation of a new commissioner post to co-ordinate action and randomly inspect for hospitals to ensure guidelines are being followed.
Jackie Baillie, a Labour MSP, called for the Executive targets to be revised to reduce C. diff cases by half.
She said: "We need better washing facilities, a detailed electronic surveillance system that enables infection control teams to track the spread of infection in real time and a single NHS commissioner to drive progress."
Branson attacks hospital infection rates
Tuesday, 23, Dec 2008 12:00
Virgin boss Sir Richard Branson has said if the airline industry had the track record of the NHS on hospital infection it would have been "grounded years ago".
In an interview with the BBC the new vice president of the Patients Association criticised the government for not doing more than "tinkering" with the problem.
He pointed to the difference between examples of best practice elsewhere in the world like Perth in Australia and Britain's infection-ridden hospitals.
And he backed the introduction of testing and treatment for MRSA for all those who work in hospitals as a key first step to take.Sir Richard suggested up to 30 per cent of people who work in hospitals are carriers for the disease and therefore pass it on to patients.
And he backed calls by groups such as MRSA Action for full publication of infection rates in Britain, by ward, hospital and even clinician.
"The problem is that in the industry in England there's no industry-wide compulsory standards at all and there needs to be," he said.
"There have been some improvements but the facts speak for themselves and the facts are still horrific."
The government has met its target of halving the number of MRSA cases in hospitals between 2004 and 2008, by extending the target period by three months.
It says hand-washing, increasing the number of matrons and screening admitted patients for MRSA have had an impact.
But Sir Richard believes more could be done.
"It feels like they've tinkered with the problem rather than really got to the heart of the problem," he added.
"Hospitals are there to heal people. They're not there to kill people."
