Opinion Former Briefing: Swine Flu and MRSA

Wednesday, 11, Nov 2009 12:00

A second wave of swine flu cases could lead to a rise in the amount of MRSA infections, senior medical staff have cautioned.

The MRSA Working Group and National Concern for Healthcare Infection and the Patients Association are calling for:

- Early discharge of patients in hospital

- Vigilance in MRSA infection prevention.

MRSA action comments:

"We are fully aware of the pressures that will be placed on the NHS with bed occupancy if there is a dramatic rise in patients being admitted to our hospitals because of the swine flu.

"We are also aware that hospital management will have to weigh up the options between patients in their care and who can be discharged home from hospital to relieve the pressures on bed occupancy.

"We know that as bed occupancy rates edge over the average of 85% that infection rates do in most cases rise accordingly so from our point of view we understand why the MRSA Working group and the patient groups mentioned have concerns with the possibility that added pressures on bed occupancy rates could see a dramatic rise in infections such as MRSA and C-diff.

"Therefore it is understandable why the MRSA Working Group and those patient groups have called for early discharge of patients from hospitals. However we have concerns with the comment made from Dr Matthew Dryden, consultant microbiologist at the Royal Hampshire County Hospital and General Secretary of the British Society of Antimicrobial Chemotherapy were he says that:

"The NHS has been working really hard to plan for swine flu and ensure there will be enough hospital beds available for patients who need to be admitted. What we don't want to see is an increase in infections such as MRSA, which have been linked to high bed occupancy rates".

"A way to get around this is to support patients with infections to get out of hospital earlier with outpatient and home care and good antibiotic stewardship."

"Whilst we agree with him that there have been major improvements in infection rates in our hospitals with both MRSA and C-diff our concern centres around the comment he makes on behalf of the group that:

"A way to get around this is to support patients with infections to get out of hospital earlier with outpatient and home care and good antibiotic stewardship."

"Unless the Department of Health and the Government are prepared to support this initiative with extra resources and staff for the Primary Care Trusts all we will do is transfer one problem from our hospitals over to the community were people will be exposed to these infections with out any controls.

"The PCT's will need the extra resources to manage this initiative if it is followed up by the hospitals because if the discharged patients are to be given what Dr Dryden says above about support and to have people monitoring it because of the good antibiotic stewardship.

"We know from our own President Professor Pennington Emeritus Professor of Bacteriology at Aberdeen University that the biggest threat from a second wave of flu will not only be the flu itself, but the infections that naturally follow it. He has informed us that:

"If novel A (H1N1) takes off in the UK a reasonable prediction is that there will be deaths from staphylococcal pneumonia, a well known complication of influenza. Staphylococcus aureus was isolated from lungs/sputum in 288 of 467 deaths that occurred in the first 4 months of the 1957 pandemic. Antibiotic sensitivity testing and phage typing were used to identify hospital strains. 35% of strains from those who died within 48h of admission (mostly patients in the 0-14 yr age group) were hospital strains. This rose to 70% for those who died 3-7 days after admission, and was 100% for those who died 8 days or more after admission.

"Of the 61 paediatric deaths in the 2008-9 US flu season, 13 had positive bacteriology and S.aureus was isolated from 8, of which 3 were MSSA and 5 MRSA.

"MRSA is still ubiquitous in UK hospitals; patients admitted to hospital must get protection. It is disappointing to note that the Department of Health 'Pandemic Influenza: Guidance for infection control in hospitals and primary care settings' document updated in November 2007 only mentions MRSA once, in passing, fails to point out the importance of protecting patients with influenza from a staphylococcal infection, and offers no guidance about how this could be done."

"We believe that the MRSA Working Group, along with those patient groups have good intentions with their initiative. However we think it would have been much better to apply the pressure to the government to ensure that the Public and the Patients are well informed about what they need to do to prevent them from contracting either the swine flu or a healthcare infection.

"We believe that a public and patient campaign would better serve to help reduce the pressures on our hospitals by preventing as many people as possible from contracting either. The PCT's will in our opinion have to lead on this in getting the information to those members of the general public in preventing as many people as possible from contracting the flu and a healthcare infection."