MRSA Action UK: Search, isolate and destroy is the most effective way to deal with MRSA and C.diff

Wednesday, 24 June 2009 12:00 AM

MRSA Action UK is of the opinion that strategies similar to those employed by Northern Europe to search, isolate and destroy super bugs are beginning to show dividends here in the UK. Analysis of statistics from Dr Foster Research and the Health Protection Agency show correlation with reductions in the numbers of people with C.diff and MRSA, and policies on screening, isolation and antibiotic prescribing. The Charity believes this may be having a considerable impact in helping staff reduce infections, and would encourage Strategic Health Authorities who have struggling Hospital Trusts to follow the example of their peers who are winning the war on super bugs.

The East of England Region has seen the biggest reduction in patients with Clostridium difficile disease from the levels at the end of March 2008. Analysis of Dr Foster's data from the 2008 survey of NHS Trusts show the East of England Strategic Health Authority had more Hospital Trusts with dedicated isolation wards than any other region and the second highest proportion of Hospital Trusts employing antibiotic pharmacists. C.diff levels in the region reduced by 49% over the last year according to the latest Health Protection Agency data.

We believe that prudent use of antibiotics and isolating patients who have Clostridium difficile is having a tremendous effect on Trusts efforts to reduce the burden of infections. It is worth noting from the analysis of the data that the regions that fared less well at reducing the number of people contracting Clostridium difficile had fewer Trusts with dedicated isolation wards, and the struggling North East were also near bottom in the proportion of Trusts with antibiotic pharmacists.

There is also some correlation with more significant reductions in MRSA bloodstream infections, and screening and isolation policies. The differences are not so striking compared to the reductions in Clostridium difficile, as bloodstream infections account for around only 6% of all infections therefore the MRSA figures do not show the full picture and represent only a tiny proportion of people affected by MRSA.

Using rapid testing for A&E patients would appear to have an impact on the significant reductions in MRSA bacteraemias in three Strategic Health Authority Areas, West Midlands the North East and London. Knowing the patients' infection status earlier enables isolation facilities to be used more effectively and if a patient does have an infection, the most appropriate antibiotic can be given quickly, giving a better chance of recovery.

Dr Foster's survey took place before mandatory screening of elective patients came into force on the 1st April 2009, and many Trusts are screening A&E patients ahead of the 2011 deadline for mandatory screening of A&E patients. We would therefore expect to see further reductions when these policies are employed together with the high impact interventions in Saving Lives.

We would hope that Hospital Trusts and regulators are making good use of the available data to home in where assistance and guidance is needed on strategies to reduce the risk to patients, and tough targets are set for Trusts with higher infection rates. A lot remains to be done with a slight increase in infections in the last quarter when compared to the same quarter in the previous year, so we must not take our eye off the ball.

References:

Latest infection control update from Dr Foster (March 2009) - Dr Foster Health
http://www.drfosterhealth.co.uk/features/infection-control.aspx

Results of the Quarterly HCAI mandatory reports (June 2009) Health Protection Agency
(1) C. difficile infection tables: Acute Trust and primary care organisation results by quarter and by financial year. April 2007 onwards

(2) MRSA bacteraemia tables: Acute Trust results by quarter and by financial year. April 2006 onwards

Derek Butler
Chair
MRSA Action UK
http://mrsaactionuk.net
07762 741114
Derek.butler@mrsaactionuk.net

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