MRSA Action UK attended Newcastle-Under-Lyme college as a result of Sam's friend Jade Hampton getting in touch wishing to pay tribute to her friend and to give her colleagues at the college an opportunity to understand the infection MRSA and what precautions we can all take to reduce the risk of becoming ill with an infection, either when receiving healthcare or in day to day activity. 

 

 

 

Derek Butler gave a presentation which related Samantha's tragic story and gave a history of MRSA and how this had now become endemic in our hospitals.

 

The bacteria that entered Sam's body was MRSA, Sam was diagnosed with MRSA after a bone marrow sample was taken from her hip.  MRSA is resistant to common antibiotics, and in someone whose immune system is compromised, can cause serious illness and sadly, death.  The Department of Health know this, and are now taking stringent measures to ensure that hospitals and places where we receive treatment are taking the necessary measures to ensure patient safety.  This was too late for Sam and for many of the people attending who had also lost people they love to healthcare associated infections. 

 

 

 

What precautions should be taken when patients are undergoing invasive procedures to keep them safe?

There should be:

-          A safe, clean environment

-          Safe, sterile equipment

-          Well trained staff using 'aseptic' techniques

-          Attention to hand-hygiene, carried out correctly and at the right time

-          Good preparation before any invasive procedure

-          A good knowledge of anti-biotic therapy and the correct treatment in the event of an infection occurring

-          Facilities to isolate patients who have an infection to minimise the risk of infection spread and outbreaks

 

Derek outlined that these standards of care are what everyone should expect when going into hospital or any other situation where they are being cared for.  If any one of these things doesn't happen then this means a person receiving care is put at risk of contracting an infection.

 

What do we all need to know to help keep us safe when receiving care and in our everyday lives?

Derek said it helps if we understand a bit more about the microbes and bacteria that we all encounter every day.  Microbes, which include bacteria and viruses, are the oldest form of life on earth. Microbe fossils date back more than 3.5 billion years to a time when the Earth was covered with oceans that regularly reached boiling point, hundreds of millions of years before dinosaurs roamed the earth.  Without microbes, we couldn't eat or breathe.  Without us, they'd probably be just fine.  The bacteria MRSA is a microbe.

 

What does MRSA stand for?

M stands for methicillin, a chemical derivative of penicillin. R stands for resistant; the development of methicillin resistance in a hospital was first detected in October 1960, by Professor Patricia Jevons whilst studying a petrie dish at Colindale Laboratories, London.  SA stands for Staphylococcus aureus, the bacterium that causes boils, carbuncles, abscesses, osteomyelitis and most wound infections after surgery.  It was discovered in the late 1870s by Alexander Ogston, a surgeon at the Aberdeen Royal Infirmary.  The name Staphylococcus is derived from the Greek word staphyle or 'bunch of grapes' because of the characteristic cluster-like appearance of the bacteria under the microscope.

 

There are 32 species of staphylococci, but only 17 are indigenous to humans.  Staphylococcus aureus is especially prevalent due to its surface proteins, which allow the organism to bind to tissues and foreign bodies coated with collagen, fibronectin, and fibrinogen.  This permits the bacteria to adhere to devices such as sutures, catheters, and prosthetic valves.

 

Alexander Fleming was studying Staphylococcus aureus when he discovered penicillin in 1928, and the first patient to be treated in the first clinical trial of the new antibiotic at Oxford was infected with it.  His discovery was made in St Mary's Hospital London.

 

The first person to be treated with penicillin was Albert Alexander, a 43-year-old policeman, who was suffering from a spreading infection on his face that had started with a rose thorn scratch.  He had lost an eye and the infection had spread to his lungs and his shoulder.  On 12 February 1941 he was injected with penicillin made by Howard Florey and his team.  Alexander's condition improved dramatically.  Treatment continued for five days.  Penicillin was extracted from his urine and used again.  But ten days later he relapsed, dying of staphylococcal septicaemia on 15 March, the supplies of antibiotic had run out.

 

Penicillin revolutionised the treatment of staphylococcal infections.  But its power over them began to wane soon after its general introduction.  The first naturally occurring penicillin-resistant staphylococci were noted by Fleming in 1942.  Between April and November 1946, 12.5 per cent of Staphylococcus aureus strains isolated at the Hammersmith Hospital in London were penicillin-resistant. By early 1947 the percentage had tripled.  The bacteriologist Mary Barber showed that this rise was not due to the development of resistance while patients were being treated, but to the spread of a penicillin-resistant strain in the hospital.  Some staphylococci had the ability to make penicillinase, a penicillin-destroying enzyme.  The introduction of penicillin gave them an evolutionary advantage over strains killed by the antibiotic.  Methicillin was developed in response.

 

Florence Nightingale had revolutionised healthcare in the Crimean War, and following her methods after the turn of the century wards were well ordered and clean, strict attention to hygiene, assiduous hand washing and aseptic conditions meant every precaution to avoid infection was taken.  We were however about to become over reliant on antibiotics, and a culture developed where the strict discipline and skills needed to do the sick no harm seemed to relax.

 

With bacteria developing more and more resistance, and the most common surgical bacteria Staphylococcus aureas evolving, the first culture of Staph aureas found to be resistant to Methicillin was identified under a microscope at Colindale Laboratories in London by the late Patricia Jevons, on October 2nd 1961.  This was followed by an outbreak at Queen Mary's Children's Hospital, Carshalton in 1962.

 

MRSA has now evolved and has become endemic in our hospitals, and now in the community.  The countries in Northern Europe adopt a strict Search and Destroy policy that was developed here in Britain.  The Royal Free had an outbreak in 1985 and controlled this by using this policy.  However, it was believed to be too expensive and consequently more outbreaks occurred until it became endemic. The policy that works is to Search, Isolate and Destroy the bacteria.  Strict screening and decolonising is carried out before patients are admitted to hospital, if patients have to be admitted as emergencies they are put into isolation.  Judicious prescribing of antibiotics is also a key in reducing resistance, using the correct antibiotic at exactly the right dosage and time.  Over use of broad spectrum antibiotics is not only responsible for resistance but for the problems we have with another killer superbug Clostridium difficile.

 

We are now beginning to reintroduce the strict policies here in the UK in an effort to bring this under control.

 

Patients who are going into hospital for surgery are being screened to see if they carry MRSA.  If they are found to be carrying it on their skin then they are decolinised with antibacterial wash and an antibiotic cream for the nose.  If they are found to be MRSA positive in hospital then hospitals should be placing patients into isolation until it has cleared.

 

Some hospitals are more effective than others, and measures are being taken to make sure that those who are not so good are visited by regulators to help them implement better controls.  It is now a top priority for the Department of Health.

 

Because we all have microbes which include bacteria on our skin the most effective way of preventing the spread of infection by touch is to make sure we wash our hands regularly.  Washing hands effectively after visiting the lavatory is important, as is washing hands before eating and preparing food. 

 

 

If we are receiving any invasive procedures, either surgery, injection, blood transfusion, having your ears pierced, or any other invasive procedure then strict attention to hand hygiene, is essential.  Washing with antiseptic soap to kill any bacteria that are carried in the gut, and then with alcohol rub to kill other bacteria such as MRSA is important.

For more help and information

For more information visit the British Body Piercing Association Members of the British Body Piercing Association (BBPA) have to sign up to a code of conduct that includes strict rules on hygiene and sterility. Members of this association will not carry out body piercing on anyone under the age of 14, and 14 -16 year-olds need to be accompanied by a parent or guardian.

Derek spoke of other people in attendance who also had lost loved ones to MRSA, Paul Kelly spoke of the tragic loss of his daughter Claire in a road traffic accident in the USA.  She survived the car crash but contracted MRSA which killed her and her unborn baby.

The day was very moving and MRSA Action UK would like to thank the college for inviting us in.  Jade will be organising a fun run in Sam's memory at the end of July, proceeds will go to MRSA Action UK, members of MRSA Action UK will also be taking part in the event, thank you Jade for thinking of us all.

A Tribute to Sammie