KOS Media’s campaign to promote hand hygiene in hospitals and healthcare centres across Kent continues this week with an in-depth look at the superbugs.
Simply washing your hands with alcohol gel or liquid soap and water is the best way to help the county’s hard-working doctors, nurses and other health professionals in their battle against killer healthcare-acquired infections.
Consultant microbiologist James Nash spoke to KOS Media about the main superbugs – MRSA and Clostridium difficile – as well as the bugs emerging as possible problems.
Although different in their transmission, symptoms and other characteristics all bugs are spread by poor hygiene and overuse of antibiotics.
MRSA is the original superbug. Dr Nash, who is the director of infection prevention and control for East Kent Hospitals NHS Trust, said it started to emerge in the 1970s gradually becoming more common accelerating in the 90s.
Asked why superbugs are a fairly new problem, he said: “It was largely encouraged by a period when the NHS was not paying sufficient attention to keeping hospitals clean and controlling antibiotics. Up to the year 2000 things were out of control.
“We’ve improved a lot but we are left with a legacy – there are large numbers of people carrying [MRSA] on their skin. They can either suffer an infection or act as a source of infection for other people.”
Dr Nash said most people have Staphylococcus (Staph) on their skin but what makes it MRSA (or methicillin-resistent Staph aureaus) is resistance to a lot of antibiotics.
It is not dangerous when it lives in areas such as the armpits and nose, but it is more difficult to treat when it get infected, he said.
Surgical wounds, people who have chemotherapy and therefore damaged immune systems, urinary catheter entrance points – anything that breaches the normal protective barrier of the skin – is susceptible to infection.
MRSA is treated with special antibiotics.
It causes a range of symptoms depending on the part of the body infected but include abscesses, boils and can lead to septicaemia or blood poisoning.
It is transferred mainly by hand contact.
Dr Nash said: “It is transient, if you don’t wash your hands you can pick it up on one patient and transfer it to another.”
He said it was hard to know for sure but experts believe around three per cent of the population are carriers of MRSA.
The trust scans everyone admitted to its hospitals and has found that the rate increases to around six per cent.
In elderly people the rate of carriage rises to 10 to 20 per cent particularly among those in nursing homes.
The best way to kill the bug is alcoholic gel hand wash, which is now available in all hospital wards.
Dr Nash said the UK is fortunate, at the moment, not to have a significant number of cases of the particularly virulent strain that is currently affecting America.
“In the US they’ve got strains out in the community that are spreading and are much more difficult to treat with antibiotics – some require surgical drainage of the abscess.
“These have not appeared in this country in any significant numbers but they may be the next thing that comes,” he said.
The chance of so-called C MRSA spreading to the UK is high because the infections spread easily from country to country, he said.
Nationally rates of MRSA infections have decreased over the past two years and the Department of Health hopes to half cases by 2008 – a target Dr Nash said it was likely to get very close to.
Kent is following the national trend and in the east of the county infections have dropped by 50 per cent on the previous year.
This has been achieved through better hygiene and establishing control over the use of antibiotics, Dr Nash said.
Controlling the use of antibiotics is particularly important to tackling the other well-known superbug – Clostridium difficile, he said.
C diff attracted unprecedented media attention after a Healthcare Commission investigation found it was responsible for the deaths of at least 90 patients during two outbreaks in 2004 and 2006 at Maidstone and Tunbridge Wells NHS Trust hospitals.
Dr Nash explained how C diff is a gut organism that is the commonest cause of antibiotic-associated diarrhoea.
Antibiotics kill off a lot of the normal bacteria, allowing the C diff that might be there in low numbers to grow, which produces a very powerful toxin, he said.
Discovered in 1978, C diff was thought to be a normal outcome for some patients on antibiotic therapy.
But in 2000 experts became concerned after reports from the US about a more severe strain of the diarrhoea bug that was killing more patients.
It was not until 2004 when two outbreaks at Stoke Mandeville Hospital led to 33 deaths that strain had arrived in the UK.
Coupled with the outbreaks at Maidstone, NHS trusts now take the infection very seriously and rates are low across the country, Dr Nash said.
C diff can be treated with antibiotic or probiotic treatments and in some severe cases patients may have to have surgery to repair damaged intestines.
However, alcogels do not kill C diff – soap and water is necessary to defeat the bug’s spores.
In east Kent the trust has seen infection rates drop almost 70 per cent in the past two years.
Dr Nash said: “We think we’ve moved from [C diff] being endemic to a situation where we have clusters. We think if we can keep it up we won’t see high rates of C diff again.”
But he said that health professionals were not complacent because new superbugs were emerging and new antibiotics need to be developed so that they can continue to be treated.
He said: “We need to operate higher levels of hygiene than we have been to keep the NHS prepared to have higher numbers of isolation rooms so it is better equipped to prevent infection spreading.
“It is important to make sure hospitals are not overcrowded and are adequately staffed with the necessary experts otherwise infections spread.
“Good policies will not be enough without enough nurses to adequately manage the number of patients. These are issues the NHS will have to watch carefully.”
Dr Nash warned of other bugs to watch.
Pseudomonas is a bacterium that is found in water and can be a problem if medical equipment is not decontaminated properly or if it becomes contaminated.
An outbreak in 2005 at Guy’s Hospital in London left one woman dead and 18 patients infected.
Dr Nash said the outbreak happened because pseudomonas hid in crevices and cracks in the inner lining of febreoptic endoscopes, which then contaminated the next user.
Strains of the bacteria can be resistant to antibiotics making it difficult to treat and manage.
He said in east Kent incidences of the infection had declined because of more sophisticated methods for protecting ventilated patients from infection and greater use of disposable equipment.
“However, it is one of the organisms that we need to keep monitoring,” he added.
ESBL Klebsiella is an organism associated with urinary tract infections, which used to be easy to treat with antibiotics, Dr Nash said.
Doctors are now encountering a strain that cannot be treated with oral antibiotics and needs intravenous therapy.
If these become more common in the community people will have to be admitted to hospitals to treat simple infections like cystitis.
Dr Nash said: “It is not common yet but it has become more common in the past few years. We are running out of antibiotics and we need new ones to be taken by mouth.”
Acinetobacter, Dr Nash said, is a bug that is causing problems in intensive care units because it is resistant to antibiotics.
Outbreaks of the infection have already been seen in London but it has not yet proved a problem in Kent.
POSTED: 16/02/2008 09:00:00
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