Infections are posing serious problems for Irish hospitals, writes Eithne Donnellan, Health Correspondent
Hospitals have been reluctant to release information on the number of patients who pick up infections while they are treating them.
This is hardly surprising given the litigious age we live in. However, patient representatives have argued that unless hospitals are required to release this information, they will not be under the same pressure to curb the spread of superbugs among patients.
The recently formed patient action group MRSA and Families claims the extent of MRSA is being covered up. It has outlined instances where patients found out accidentally they had contracted the potentially fatal superbug while in hospital.
It is clear from figures released to The Irish Times under the Freedom of Information Act that hospital-acquired infections of different types, not just MRSA, are a major issue for hospitals.
Given that thousands of patients have tested positive for a range of superbugs in the past year and that there are insufficient infection-control staff and isolation facilities in many hospitals, it is inevitable that cross-infection is taking place. Its extent is unknown. More than 6,000 patients were found to have MRSA infection on their bodies, in over 20 hospitals, both large and small, last year. Some of these include cases detected in patients seen in A&E and in outpatients as well as inpatient wards. And given that MRSA is found in the community as well as hospitals, it will have been brought into a hospital, in some cases, by patients being admitted from the community or transferred from one hospital to another for specialist treatment.
The figures indicate a higher prevalence of MRSA in some hospitals than others but it is important to note that some hospitals actively look for the bug and some don't. As Dr Margaret Hannan, consultant microbiologist at Dublin's Mater hospital said, the number of cases detected depends on whether the hospital has an active surveillance system. "If you don't look for it, you won't find it and you don't know, therefore, who it will transfer to," she said.
The figures show the number of patients found to be infected with another lesser-known hospital superbug Clostridium difficile is almost double the number of MRSA bloodstream infections. Yet not all hospitals routinely collect data on the number of patients who present with Clostridium difficile or another antibiotic-resistant bug called VRE. That means the number could be even higher than the figures indicate. Dr Hannan said all hospitals should collect this data.
Dr Robert Cunney, consultant microbiologist with the Health Protection Surveillance Centre, formerly the National Disease Surveillance Centre, said yesterday some hospitals still have no infection-control nurses and there are some areas with no consultant microbiologists. Hospitals needed to be adequately resourced to carry out proper infection surveillance, he said. A cap on recruitment had hampered attempts to put more of these staff in place, he added.
When MRSA gets into the bloodstream it can prove fatal but it is not known how many deaths it or other hospital superbugs are responsible for in the Republic every year. However, MRSA has been cited at a number of inquests as a factor in patient deaths. Dr Hannan said the bugs would "without doubt" contribute to patient deaths, particularly the deaths of patients who already had other illnesses.
One of the biggest factors militating against the control of infection is overcrowding, said Dr Cunney. "You end up with medical patients in the middle of an orthopaedic ward, with patients going into beds that have hardly cooled down from the previous patient." Other factors are lack of personnel for infection control and the physical infrastructure of hospitals - large wards allow infections to spread easily.
Minister for Health Mary Harney had said that if nuns were still running our hospitals, they would be cleaner and there would be fewer bugs spreading between patients. Dr Cunney said these comments should be taken with a pinch of salt. There were hospital-acquired infections 20 years ago but they just weren't detected.
The conclusion seems to be that unless Mary Harney delivers on a Government promise in 2001 to provide an extra 3,000 hospital beds, the threat of picking up infections in hospital will remain.
The superbugs: explained
Methicillin-resistant Staphylococcus aureus (MRSA):
Many people have a common type of bacteria known as Staphylococcus aureus (SA) in their noses, which can cause minor skin infections, such as pimples and boils. Methicillin is one group of antibiotics used to treat SA infections and the term MRSA refers to a type of SA that does not respond to treatment with antibiotics such as methicillin.
Patients can have MRSA on their skin or be "colonised" by MRSA, without it affecting their health. However, if it gets into the bloodstream, it can be deadly in vulnerable patients. It can be treated with other antibiotics. It almost always spreads by contact, not by air.
Clostridium difficile:
This bacterium is commonly found in the intestinal tract; during or after a course of antibiotics and, in some cases, can inflame the colon.
It is thought to cause several million cases of diarrhoea and colitis around the world each year. The primary treatment is to stop using the antibiotic or use a particular group of antibiotics. It usually affects the elderly, and can prove fatal if antibiotic treatment fails to kill all the spores in the gut.
Vancomycin-resistant enterococci (VRE):
Enterococci are bacteria found in the faeces of most humans and many animals. Occasionally they cause human disease. The commonest are urinary-tract and wound infections. The bacterium is common only in patients who have been in hospital for long periods, those on certain antibiotics and those fed by nasogastric tube. Most outbreaks have been in kidney dialysis, transplant, haematology and intensive-care units.
Winter vomiting bug
The small round structured virus, or SRSV, is a particularly resistant microbe spread through the air and by personal contact. Symptoms include severe often projectile vomiting, diarrhoea, abdominal pain and mild fever. Most vanish in 48 to 72 hours, leaving sufferers able to cope without medical help.