Opinion Former Article

Mentions of MRSA and C.diff on death certificates reduce, however MRSA Action UK advocate better surveillance to track superbugs to save lives

MRSA Action UK welcomes the phenomenal work that has been undertaken in hospitals across the UK in continuing to reduce the incidence of MRSA bloodstream infections. Clostridium difficile cases remain high in some hospitals, but overall the picture has shown a reducing trend. The news that deaths from MRSA and Clostridium difficile is reducing is received with a cautious welcome, as it would be expected that a reduction in mortality would occur where there are reductions in the high numbers of people who have been affected. There may still be significant under-reporting however as there is no consistency in the way micro-organisms are mentioned on death certificates, despite recommendations from the ONS and recently retired Chief Medical Officer's guidance.

There is still work to do with a proportionally higher incidence of Clostridium difficile and MRSA bloodstream cases manifesting in the community, although acquired during healthcare, there are now fewer cases counted as hospital acquired.

There are still worryingly high incidence of Staphylococcal bloodstream infections in our healthcare settings, and the latest available data from the European Antimicrobial Surveillance data shows that resistance is at 30.7% for the UK for MRSA, suggesting that the true estimate for people who succumbed to bloodstream Staphylococcal gram positive infections is nearer the 10,000 mark over the 13 month period. Added to this, gram negative Staphylococcal infections account for a staggering 17% of all bloodstream infections and are on the increase. Deaths will continue if measures are not taken to counter the problem.

Over a thirteen month period, from May 2009 to May 2010 Clostridium difficile figures reported for Acute and Primary Care Trusts indicate that on average, of the 41,146 reported cases, 66% (27,192) were recorded outside of hospital. Of the 3,053 MRSA bloodstream bacteraemias, 65% (1,996) were also attributed as being contracted outside of hospital.

Other micro-organisms and surgical site infections that go unreported need to be tracked and reviewed, as these contribute to mortality and additional suffering for patients. It is not only our ageing population and the very young that are at risk, our own membership have harrowing experiences of young healthy adults who have succumbed to infections that were avoidable with tragic consequences.

It is important that the Government do not become complacent, and inhibit the progress that has been made. The momentum towards zero tolerance to avoidable infections must continue and we look to the Government to continue with the investment in preventing infections.

Frontline services, with well resourced and well trained staff must be maintained, cleaning regimes and hygiene must remain a priority. Screening, judicious use of antibiotics and improved surveillance of other significant pathogens needs to be kept on the radar to safeguard future generations from the constant emerging threats of resistant micro-organisms.

Last year the National Audit Office reported the lack of a national surveillance system to record the most common healthcare associated infections, including urinary tract, pneumonia and skin infections. Further work to understand the origin and type of infections was recommended. The report also recognised that the recorded MRSA and Clostridium difficile figures accounted for approximately just 15% of all healthcare associated infections. Furthermore the report cited the requirement for post-discharge surveillance of surgical site infection. From July 2008, the Department of Health asked hospitals to establish systems to identify patients re-admitted with a surgical site infection and this data was to be used to provide clearer information. As yet we have not seen this come to fruition, despite these recommendations being a repeat of what was cited in 2000 and 2004.

The number of episodes of coagulase negative Staphylococcal bloodstream infections doubled since 2003 and accounts for 17 per cent of all reported bloodstream infections. We are concerned that there is little being developed in the range of gram negative antibiotic research, so it is not surprising that this threat is on the increase.

The Government needs to step up to the challenges that lay ahead if we are to truly say that we are committed to zero tolerance to avoidable infections and provide better information as recommended by the National Audit Office in its reports in 2000, 2004 and 2009. We cannot afford to wait for another five years for these recommendations to be acted upon, the cost in suffering and loss of lives in the future is too great a price to pay.

The medical profession need to heed the instruction issued by the Chief Medical Officer to record micro-organisms that have been the cause or contributing factor to deaths from MRSA, Clostridium difficile and other significant pathogens if we are to have the best surveillance available to drive down avoidable infections and deaths.

Derek Butler
MRSA Action UK
07762 741114

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