MRSA Action UK: Variation in Trust performance on MRSA and Clostridium difficile still evident with infections

Friday, 4 December 2009 12:00 AM

The Health Protection Agency is now publishing data on a monthly basis, which is welcomed by MRSA Action UK. The quarterly report was published this week and the overall trend in reduction continues for both MRSA bacteraemias and Clostridium difficile infections. This gives an opportunity for up-to-date analysis and can help patients and GPs make informed choices on where to go for surgery. The data can also be used for benchmarking and management information by Primary Care and Acute Trusts. We have produced regional analyses showing breakdowns by hospital and primary care organisations from the Health Protection Agency data which can be found on the monthly statistics page of our website. The London region has seen a slight increase in MRSA bacteraemias this month and is at the same level as October last year; East of England has also seen a slight increase this month and has also increased on the same period last year. There were a total of 2,496 MRSA bacteraemias recorded over the 13 month period from October 2008 to October 2009.

General Medicine, General Surgery, and Geriatric Medicine account for about 65 per cent of MRSA bacteraemias. Nephrology (renal medicine) accounts for the highest rate per 100,000 bed days followed by Clinical Haematology.

The highest rates of Clostridium difficile infection are in Critical Care Medicine, Nephrology, Medical Oncology, and Clinical Haematology.

Our own analysis of the data has shown that over a period of 13 months, from October 2008 to October 2009 of the 49,261 people who were recorded as having Clostridium difficile, 64 per cent were diagnosed outside of the Acute hospital setting. Whilst there is some debate over previous hospital treatments and the likelihood that a significant proportion may have originally had contact with the bacteria in the hospital environment, this should be regarded as a significant public health risk.

Information on how to reduce the risks from contracting the illness should be made more publicly known than it is. Awareness is key and we reiterate our dismay at the decision to delay the Public Information Campaign that was promised for summer of this year.

If we look closely at the statistics there are Trusts who are actively engaged in raising awareness of the importance of hand hygiene and taking measures to reduce the prescribing of high risk antibiotics, and recorded infections are reducing at a more significant rate. Other Trusts are not doing so well. The evidence may be anecdotal but merits further consideration for a strategy to reduce the burden of healthcare associated infections and bacterial infections that are becoming more prevalent with growing problems to antimicrobial resistance. With marked differences in performance between Trusts it is evident that the work of the Improvement Teams is far from over and must continue.

Information was also published on the mandatory reporting of surgical site infection in orthopaedic surgery this week. Approximately one in 100 patients undergoing hip replacement, and one in 200 undergoing knee replacement, developed a surgical site infection; over 50 per cent of these infections affected the deeper tissue or joint.

Approximately one in 100 patients undergoing reduction of a long bone fracture developed a surgical site infection; of these 52 per cent were deep or joint infections.

The risk of surgical site infection is higher in procedures to repair the neck of femur where approximately two in 100 patients developed a surgical site infection; nearly 50 per cent of these were deep or joint infections.

Trends in rates of surgical site infection following orthopaedic surgery have continued to decline since the mandatory surveillance commenced in 2004. The introduction of surveillance for surgical site infections in patients readmitted to hospital after surgery has increased the total numbers of surgical site infections reported to the surveillance system this year, giving a more accurate estimate of the rates.

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

References:

Health Protection Agency. Quarterly Analyses: Mandatory MRSA Bacteraemia and CDI in England (July, 2007 to September, 2009). London: Health Protection Agency, December 2009

Health Protection Agency. Fifth Report of the Mandatory Surveillance of Surgical Site Infection in Orthopaedic Surgery. (April 2004 to March 2009). London: Health Protection Agency, December 2009

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