Ward infections: acquired or identified?

My musings on the value of old-fashioned techniques for sterilisation reminded me that there is another myth, sadly believed by politicians, that there is an important problem called hospital-acquired infection. There is a problem with hospital infections, but is it rightly named and if we changed a word might it take some of the hysteria out of MRSA?

Let me make it clear that I have no doubt that patients may acquire MRSA or Clostridium Difficile during a hospital admission. That’s why we had a policy on my rehabilitation unit that no patient ccould be admitted without being screened first – not that our bed managers cared, and we had frequent occasion to complain when unscreened patients were dumped on the unit so that A&E patients could be decanted within the four hour target time[1]. Indeed I got into trouble when our experience was reported in “BMA News Review” in 2004[2] and I was threatened with disciplinary action for breaching the hospital’s whistleblowing policy, which I hadn’t (and it was unedifying to see managers lying about the issue). But MRSA doesn’t spontaneously appear like magic on a hospital ward, does it? I was seized with schadenfreude when, in a letter of response to my resignation, our Chief Executive told me how wonderful the Trust’s success has been in reducing hospital infection – when all he had done is introduce my seven-year-old plan which he had never read!

One of the good things to come from targets (and the target is to reduce MRSA septicaemia, not actual surface infection) is that our microbiologist had to develop a good data set both to look at numbers of MRSA infections on wards and where in each case it had come from. Analysis over several months in 2009 revealed an interesting but perhaps unsurprising conclusion; the vast majority of MRSA came from the community. Patients did not acquire it after hospital admission. They came in with it. Of course we all know that out there in the community the district nurses carry it about and the care homes let it spread among their inmates – or that’s how it seems to me when I compare the lazy, laissez-faire attitude to MRSA colonisation with the stringent curative and preventative measures on my rehab unit. But it underlines the truth – that most MRSA is not hospital-acquired, it is hospital identified. How then it is government writ that a hospital can be penalised for high MRSA rates is beyond me, when its only “fault” is that is admitting unscreened patients who are ill, and then testing them! So let’s have a campaign to distinguish acquired from identified, realise the scale of the problem is not that great, and concentrate on dealing with the source – the place where everything is better – the community!

Politicians like to pretend that they have fixed things, and I was particularly amused by a report in the “Sunday Times” in mid-April 2010 in which the Health Secretary, Andy Burnham, trumpeted the news that good ideas from the NHS were to be exported worldwide – including how to manage MRSA! I found this rich coming from a government that, when my experience on how to manage MRSA was reported, threatened my managers; it was this that resulted in the attempt to silence me with disciplinary threats when all I had done was describe my unit’s good practice.

I went to Venice for a long weekend. It was tempting to visit of the many shops catering for Carnival and purchase a Venetian cloak and hat together with a plague doctor’s mask, and wear this into the hospital during the next norovirus outbreak…

[1] Bamji A Tackling MRSA. Hospital Doctor, 22nd April 2004

[2] Alex Wafer. A&E Targets damage MRSA safeguards. November 13th 2004

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