Rapid Responses to:
|
|
Rapid Responses: Rapid Responses published:
-
![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Lethal bug
- Ann C Dey (3 September 2004)
-
MRSA & PHLEBOTOMY
- Frank J Conroy (6 September 2004)
-
The tabloid fixation on hospital superbugs
- Ruth T Wollacott (24 September 2004)
-
Preventing the spread of MRSA...
- David P Mather (26 October 2004)
|
|
|||
|
Ann C Dey, GP Principal East Street Medical Centre, Littlehampton, West Sussex BN17 6AW
Send response to journal:
|
So, this is why I've had several patients telling me that they don't want an operation or admission to hospital, because of 'that MRSA bug'. Perhaps it'll reduce waiting lists?! Competing interests: None declared |
|||
|
|
|||
|
Frank J Conroy, SHO Plastic Surgery Pinderfields Hospital, Wakefield, WF2 4DG
Send response to journal:
|
EDITOR - The spread of MRSA has been wholly apportioned by the mass media to poor handwashing techniques by doctors and nurses. Whilst handwashing techniques must be improved, there are other quite blatant modes of transmission which are swept aside. Every healthcare professional will be aware of the prevalance of MRSA in the community, yet the media never consider that the relatives and friends of patients may well be a significant factor in the spread of MRSA in the hopsital setting. However, after observing phlebotomists at work I have come to realise a far more obvious mode of transmission....the tourniquet. No junior doctor would be without the phlebotomist, who make the busy houseman's working life so much easier. They graciously attend all the wards in the hospital and thanklessly take blood. In doing this however, they may well be giving MRSA the helping hand it needs. The same tourniquet is used on all the patients on all the wards throughout the hospital, no doubt ensuring a healthy spread of MRSA throughout. To overcome this risk of transmission the tourniquet must be diposed of after each use. Whilst during my training I was always taught not to use a glove as a tourniquet for fear of leaving it on the patient. However, the glove does provide a cheap, easy accessable and most importantly disposable tourniquet which may well help cut down the transmission rates of MRSA in hospitals. Whilst this seems quite a simple idea, I am sure it will be simple techniques that will help reduce transmission rates of MRSA nationwide. Competing interests: None declared |
|||
|
|
|||
|
Ruth T Wollacott, Full time mother and part time history undergraduate 295 Osborne Road, Hornchurch, Essex, RM11 1HW
Send response to journal:
|
I have just read the review by Peter Wilson in the BMJ dated 4 September regarding the current media coverage of MRSA; the article cited in The New York Times was written about my son and Mr. Wilson is quite correct - my son has a very sordid story and the responsibility must fall directly onto those who have control of the budget. Ultimately this is the British government, although some responsibility must lie with NHS managers whose role surely is to advise the government as to the best methods of running an efficient NHS. I believe it unlikely there will be any disagreement that the measures Mr. Wilson outlines should be implemented without delay - staffing levels must rise and hospitals kept clean whatever their condition. Old, cramped hospitals are obviously harder to clean and more provision in the way of staff, time and materials has to be made to ensure that the clinical excellence exhibited by the medical staff is not scuppered by a lack of basic cleaning. However, no member of the public has any control over the decisions made in NHS management other than through the ballot box, which is a very long and circuitous route and, as is currently being evidenced, no guarantee that the public's wishes will come to fruition. The British public is clamouring for the changes Mr. Wilson suggests and believe that by voting in a government pledged to improve the NHS they have both exhibited that desire and, through taxes, have already paid for them to be introduced. They can do nothing more than continually agitate for change and I suspect that tabloid headlines have become a last resort in the face of continued professional reluctance to admit the extent of the problem, either in reducing the numbers of infection or the devastation that MRSA can wreak on one's life once contracted, even after one has recovered from such a frightening illness itself. I think Mr. Wilson's question asking why MRSA has only just attracted so much attention, despite being a constant problem in the UK for several years has the same answer. I attended a discussion on MRSA infection at the Dana Centre last week and was quite perturbed at the attitude exhibited by some (medical) members of the panel; a diatribe regarding the over-prescription of antibiotics over the last forty years; an attempt made to suggest that there is no correlation between the rising incidence of HAI with the perceived lowering of standards in the general cleaning and hygiene of hospital premises (despite evidence to the contrary from Denmark, Holland and some hospitals in the UK), and a suggestion that increased vigilance by patients themselves would enhance the cleanliness and hygiene of both hospital premises and staff. All these suggestions fall well outside the remit of any patient to implement and the pervasive implication from some areas of the medical profession that the public should share the burden of blame is a cynical attempt to deflect attention from those who have abrogated their responsibility. People are frightened. They now realise that MRSA can strike anyone – it is neither age nor clinically selective. My son was 19 when he contracted MRSA; he was fit and healthy, had a physical job and played sport at competition level. Following two successful operations to repair a severed artery and dislocated knee caused in an accident, he was given a very good prognosis. A week or so later he contracted MRSA. Sixteen months later - after many invasive surgical procedures, several weeks extremely ill in isolation and on toxic intravenous drugs, the removal of the pins holding his knee together causing the initial successful repair work to be negated, a further two attempts at reconstruction each causing further compromise of the integrity of the knee, constant pain and frustration - he is substantially crippled, cannot work, finds it difficult to walk more than a few hundred yards, can engage in no sporting activities - what is his future? One-third of the population being colonised with MRSA is a very different scenario to being infected by MRSA and the implication that those at most risk are elderly, long-term hospitalised or immune-suppressed is disingenuous. I had no concerns regarding HAI when my son was admitted last May – I considered him to be one of the least at-risk patients in the hospital due to his age, general state of health and level of physical fitness. My main concern at the time was the possibility of him dying or losing his leg due to a severed artery and the need to find a vascular surgeon on a Bank Holiday Sunday evening who could repair the damage immediately; the choice of hospital was never a factor. Hospitals should always be chosen for the clinical excellence of the incumbent medical staff and there should be absolutely no question of one hospital being cleaner than another; every hospital should meet the highest standards of hygiene at all times. Of course the tabloid press are having a field day with this, but the climate of fear which they are whipping up is not unfounded, or even unreasonable. It may well generate increased newspaper sales but this must increase the chance that the weight of informed public opinion will force both NHS managers and the government to take notice. There are many health scares which can be avoided e.g. smoking, drug taking, obesity - these are all risks which can be minimised by the individual. However, being taken by emergency ambulance to hospital following an accident is a scenario everyone can imagine and something which it is hard to guard against. Whilst the NAO report may be more objective and more useful to microbiologists at the front line, my son and the rest of our family has been very much at the front line since last June, firstly fighting MRSA and now trying to rebuild a future from a life very damaged forever by the legacy of MRSA; the extent of that damage has yet to be revealed. The vast majority of the British public see a simple general equation, based possibly not on objective reports, but rather more on an obvious fact than on sensational stories: more cleaners=cleaner environment=less infection; this model works well in all areas of normal life, there is no reason to suppose it will not have the desired effect in hospitals. Until this has been proved not to be the case I suspect there will continue to be similar stories across the front pages of the popular press. Yours sincerely
Competing interests: None declared |
|||
|
|
|||
|
David P Mather, SHO Plastic Surgery Pinderfields, Wakefield WF2 4DG
Send response to journal:
|
Editor-The MRSA debate will run in the tabloids (1) until the readership become desensitized to NHS horror stories. I have found the recent articles in the BMJ by Frank Conroy and Peter Wilson come as no surprise but they could act as a useful starting point in what I believe should be the first step towards fighting the 'super bug'. They serve to highlight that nearly everybody has been blamed for spreading the infection, from domestics to surgeons and visitors to phlebotomists, yet the blame has not found affinity with any particular group; an unusual occurrence when the mud starts flying in a hospital environment. Whereas everybody has the ability to aid the spread of MRSA, how many people actually understand what it is? Our hospital microbiologists show incredible patience when faced with questions daily from doctors involving very basic principles. Perhaps they are aware how little the health care professionals around them understand the goings on down the microscope. If some doctors struggle after 5 years study and many subsequent years of anecdotal experience, what chance have our colleagues with differently focused training. I would like to see the basic principles of bacteriology shared amongst hospital personnel, so they understand the difference between ideas such as colonisation and infection and the factors that control them. Why not teach these ideas as part of the screening program suggested by Nicholas Akerman? 1 Wilson P. The tabloid fixation on superbugs BMJ 2004;329:578. Competing interests: None declared |
|||