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MRSA

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Julie Pal

Methicillin Resistant Staphylococcus Aureus (MRSA) is a type of staph bacteria that is resistant to certain antibiotics. MRSA can cause infections in wounds, ulcers, intravenous lines, lungs, and the bloodstream. The Healthcare Commission assesses UK hospitals on infection control standards including MRSA rates. Data on three London hospitals from 2005-2008 shows declining MRSA infection numbers, with rates dropping below targets over time at two hospitals and reaching zero at one hospital by 2007-2008.

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Methicillin Resistant Staphylococcus Aureus (MRSA) Healthcare Commission (HCC) Assessing Hospital Trusts on cleanliness standards The Healthcare Commission (HCC) is the independent watchdog for healthcare in England. HCC assess and report on the quality and safety of services provided by the NHS and the independent healthcare sector. One of the core standards which is assessed by HCC is infection control1 What is MRSA? S.aureus is just one of a family of staphylococcal bacteria. Their normal home is on human skin. This is generally harmless on the skin, however, the bacteria can cause significant infections if it enters wounds on medical devices such as artificial hip joints or heart valves, or when staff use intravenous catheters to access the bloodstream. This is especially so for severely ill patients such as those in intensive care units or those undergoing cancer chemotherapy. Moreover, Staphylococcus aureus is a very common cause of bacterial infections such as boils, carbuncles, infected wounds, deep abscesses and bloodstream infection (or bacteraemia). Types of infections Staphylococcus aureus, including those that are MRSA, cause a wide range of infections from asymptomatic colonisation, where the MRSA is doing no damage but is still capable of causing clinical infections, to fatal septicaemia, which is the most severe form of blood stream infection. Wound infections S.aureus / MRSA is the commonest cause of wound infection - either after accidental injury or surgery. The symptoms are a red, inflamed wound with yellow pus. The wound may break open or it may fail to heal and can cause a wound abscess to develop. Superficial ulcers Pressure ulcers, varicose ulcers and diabetic ulcers are all due to poor blood supply and superficial skin damage, these are often sites of MRSA infection. Intravenous line infections 1 Core Standard 4a: Healthcare organisations keep patients, staff and visitors safe by having systems to ensure that the risk of healthcare acquired infection to patients is reduced, with particular emphasis on high standards of hygiene and cleanliness, achieving year on year reductions in Methicillin-Resistant Staphylococcus Aureus (MRSA).
MRSA may infect the entry site of an intravenous line causing local inflammation with pus. MRSA can enter the blood stream through the intravenous line and cause a bacteraemia, which is a blood stream infection. Deep abscesses If MRSA spreads from a local site into the blood stream it can infect various sites in the body such as the lungs, kidneys, bones, liver, and spleen. This can then cause one or more deep abscesses which are at a distant from the original site. The abscesses are often painful and the patient will have a high fever, a high white cell count in the blood and signs of inflammation near the infection. The patient will be very unwell and may have rigors (shivers) and low blood pressure (shock). Over a period of time, the body will enter a catabolic state with breakdown of tissue, loss of weight and failure of essential organs. This is usually linked with an associated septicaemia. Lung infections MRSA / S.aureus is a rare cause of lung infection except in Intensive Care Units. There, the patient is on a ventilator with a tube in the trachea, bypassing the defences of the nose and throat. MRSA can gain entry to the lungs via the tube and cause pneumonia which may be fatal. Bacteraemia / Septicaemia MRSA / S.aureus can enter the normally sterile blood stream either from a local site of infection such as a wound, ulcer, and abscess or via an intravenous catheter. Bacteraemia describes the presence of MRSA / S.aureus in the blood. Septicaemia can follow and is the clinical term for a severe illness caused by the bacteria in the blood stream. The symptoms are not specific to MRSA and can be the same for other bacteria that cause septicaemia. The usual symptoms can include high fever; raised white cell count; rigors (shaking); disturbance of blood clotting with a tendency to bleed and failure of vital organs. This is the kind of MRSA infection that has the highest death rate. All MRSA bacteraemia are reported and treated as serious incidents so that hospitals can learn from each incident and prevent re-occurrence.
MRSA Infections in Barnet Hospitals The following graphs show the incidence of MRSA and how this compares with their targets in Barnet Hospitals Barnet and Chase Farm Hospital Trust 0 10 20 30 40 50 60 70 80 90 2005/06 2006/07 2007/08 Year Number of MRSA infections Actual No. Target Figure 1 Graph showing number of MRSA infections in Barnet and Chase Farm Hospitals compared to their target number. Barnet and Chase Farm Hospitals Year Target Actual MRSA 05/06 75 79 MRSA 06/07 56 62 MRSA 07/08 38 53 Figure 2 Table showing number of MRSA infections in Barnet and Chase Farm Hospitals compared to their target number. Although the actual number of MRSA infections are a little higher than the target set, the rate of infection is decreasing.
Royal Free Hospital Trust 0 20 40 60 80 100 2005/6 2006/7 2007/8 Year Number of MRSA infections Actual Target Figure 3 Graph showing number of MRSA infections in the Royal Free Hospital compared to their target number. RFH Year Target Actual MRSA 05/06 78 93 MRSA 06/07 58 75 MRSA 07/08 39 30 Figure 4 Table showing number of MRSA infections in the Royal Free Hospital compared to their target number. The rate of infections have been decreasing each year and in 2007/08 the rate of MRSA infections fell below the target set. Royal National Orthopaedic Hospital 0 0.5 1 1.5 2 2.5 3 3.5 2005/6 2006/7 2007/8 Year Number of MRSA infections Actual Target
Figure 5 Graph showing number of MRSA infections in the Royal National Orthopaedic Hospital compared to their target number. (Target numbers for years 2005/6 and 2006/7 have not been provided) RNOH Year Target Actual MRSA 05/06 3 MRSA 06/07 2 MRSA 07/08 0 Figure 6 Table showing number of MRSA infections in the Royal National Orthopaedic Hospital compared to the target number. The number of infections at the Royal Orthopaedic Hospital have been low and have been declining every year to no infections in 2007/08. Indeed it is true to say that all three hospital trusts have shown a decline in the number of MRSA infections.

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MRSA

  • 1. Methicillin Resistant Staphylococcus Aureus (MRSA) Healthcare Commission (HCC) Assessing Hospital Trusts on cleanliness standards The Healthcare Commission (HCC) is the independent watchdog for healthcare in England. HCC assess and report on the quality and safety of services provided by the NHS and the independent healthcare sector. One of the core standards which is assessed by HCC is infection control1 What is MRSA? S.aureus is just one of a family of staphylococcal bacteria. Their normal home is on human skin. This is generally harmless on the skin, however, the bacteria can cause significant infections if it enters wounds on medical devices such as artificial hip joints or heart valves, or when staff use intravenous catheters to access the bloodstream. This is especially so for severely ill patients such as those in intensive care units or those undergoing cancer chemotherapy. Moreover, Staphylococcus aureus is a very common cause of bacterial infections such as boils, carbuncles, infected wounds, deep abscesses and bloodstream infection (or bacteraemia). Types of infections Staphylococcus aureus, including those that are MRSA, cause a wide range of infections from asymptomatic colonisation, where the MRSA is doing no damage but is still capable of causing clinical infections, to fatal septicaemia, which is the most severe form of blood stream infection. Wound infections S.aureus / MRSA is the commonest cause of wound infection - either after accidental injury or surgery. The symptoms are a red, inflamed wound with yellow pus. The wound may break open or it may fail to heal and can cause a wound abscess to develop. Superficial ulcers Pressure ulcers, varicose ulcers and diabetic ulcers are all due to poor blood supply and superficial skin damage, these are often sites of MRSA infection. Intravenous line infections 1 Core Standard 4a: Healthcare organisations keep patients, staff and visitors safe by having systems to ensure that the risk of healthcare acquired infection to patients is reduced, with particular emphasis on high standards of hygiene and cleanliness, achieving year on year reductions in Methicillin-Resistant Staphylococcus Aureus (MRSA).
  • 2. MRSA may infect the entry site of an intravenous line causing local inflammation with pus. MRSA can enter the blood stream through the intravenous line and cause a bacteraemia, which is a blood stream infection. Deep abscesses If MRSA spreads from a local site into the blood stream it can infect various sites in the body such as the lungs, kidneys, bones, liver, and spleen. This can then cause one or more deep abscesses which are at a distant from the original site. The abscesses are often painful and the patient will have a high fever, a high white cell count in the blood and signs of inflammation near the infection. The patient will be very unwell and may have rigors (shivers) and low blood pressure (shock). Over a period of time, the body will enter a catabolic state with breakdown of tissue, loss of weight and failure of essential organs. This is usually linked with an associated septicaemia. Lung infections MRSA / S.aureus is a rare cause of lung infection except in Intensive Care Units. There, the patient is on a ventilator with a tube in the trachea, bypassing the defences of the nose and throat. MRSA can gain entry to the lungs via the tube and cause pneumonia which may be fatal. Bacteraemia / Septicaemia MRSA / S.aureus can enter the normally sterile blood stream either from a local site of infection such as a wound, ulcer, and abscess or via an intravenous catheter. Bacteraemia describes the presence of MRSA / S.aureus in the blood. Septicaemia can follow and is the clinical term for a severe illness caused by the bacteria in the blood stream. The symptoms are not specific to MRSA and can be the same for other bacteria that cause septicaemia. The usual symptoms can include high fever; raised white cell count; rigors (shaking); disturbance of blood clotting with a tendency to bleed and failure of vital organs. This is the kind of MRSA infection that has the highest death rate. All MRSA bacteraemia are reported and treated as serious incidents so that hospitals can learn from each incident and prevent re-occurrence.
  • 3. MRSA Infections in Barnet Hospitals The following graphs show the incidence of MRSA and how this compares with their targets in Barnet Hospitals Barnet and Chase Farm Hospital Trust 0 10 20 30 40 50 60 70 80 90 2005/06 2006/07 2007/08 Year Number of MRSA infections Actual No. Target Figure 1 Graph showing number of MRSA infections in Barnet and Chase Farm Hospitals compared to their target number. Barnet and Chase Farm Hospitals Year Target Actual MRSA 05/06 75 79 MRSA 06/07 56 62 MRSA 07/08 38 53 Figure 2 Table showing number of MRSA infections in Barnet and Chase Farm Hospitals compared to their target number. Although the actual number of MRSA infections are a little higher than the target set, the rate of infection is decreasing.
  • 4. Royal Free Hospital Trust 0 20 40 60 80 100 2005/6 2006/7 2007/8 Year Number of MRSA infections Actual Target Figure 3 Graph showing number of MRSA infections in the Royal Free Hospital compared to their target number. RFH Year Target Actual MRSA 05/06 78 93 MRSA 06/07 58 75 MRSA 07/08 39 30 Figure 4 Table showing number of MRSA infections in the Royal Free Hospital compared to their target number. The rate of infections have been decreasing each year and in 2007/08 the rate of MRSA infections fell below the target set. Royal National Orthopaedic Hospital 0 0.5 1 1.5 2 2.5 3 3.5 2005/6 2006/7 2007/8 Year Number of MRSA infections Actual Target
  • 5. Figure 5 Graph showing number of MRSA infections in the Royal National Orthopaedic Hospital compared to their target number. (Target numbers for years 2005/6 and 2006/7 have not been provided) RNOH Year Target Actual MRSA 05/06 3 MRSA 06/07 2 MRSA 07/08 0 Figure 6 Table showing number of MRSA infections in the Royal National Orthopaedic Hospital compared to the target number. The number of infections at the Royal Orthopaedic Hospital have been low and have been declining every year to no infections in 2007/08. Indeed it is true to say that all three hospital trusts have shown a decline in the number of MRSA infections.