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MRSA

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MRSA Action UK was founded 10 years ago by a group of people who had life changing experiences or lost a loved one through contracting MRSA. Healthcare Arena spoke to Derek Butler, the elected Chair of the MRSA Action UK Board to find out more, he began: “We are all volunteers who run the group in our spare time and we have been campaigning to reduce healthcare-associated infections in the UK, make hospitals safer for patients so that loved ones can feel confident that everything that can be done, will be done.”

Derek firmly believes on the focus on prevention, he continued: “When it comes to reducing MRSA, the only weapons we have here and now are hospital cleanliness and handwashing. The development of new antimicrobials and the proper usage of antibiotics is necessary for the future but educating people as to why they must adhere to cleanliness now is key. This is a far more powerful tool and it will importantly preserve the stock of antibiotics that we have for a longer. No resistance has ever built up to prevention.”

Discussing the thorny topic of antibiotic over-prescription, Derek said: “I think we need to be careful not to knock the medical profession too much, we understand that doctors can be pressurised into giving antibiotics to patients, especially if they have a young child. Doctors shouldn’t be made to look like the pariahs of antimicrobial resistance: they are not the problem.”

The problem is that we need to get smarter at how we tackle the bacteria, give the doctors the tools to diagnose, recognise and treat the difference between a bacterial and viral infection. We think that new technology like rapid testing and point of care diagnostics will help GPs with appropriate prescribing of antibiotics.”

He continued: ”We also need to look at how we use antibiotics in the general environment – in animal husbandry, farming, food products, and in pharmaceuticals. Antimicrobials are now being put into plastics and fabrics, so I think we need to step back on usage of antibiotics and antimicrobials. They should only be used as a last resort. We will always need to develop new antimicrobials but also look at the stock we have, and incentivise their development for future use.”

While Infections rates of bacteraemias (blood-borne infections) have decreased by 80-90%, different types of infections (such as those in catheters wounds, skin and surgical sites) are poorly documented, and it is believed that these have not dropped as much. Derek commented: “There are still too many incidences of people contracting MRSA. What we are seeing is a drop in MRSA numbers in hospitals but not in the community, staff now say that new incidences of MRSA are being brought into hospitals and these account for about 70% of all infections.”

Explaining how previous campaigns have been carried out, he continued: “They have been hospital-focussed, but nothing has been done in the community and unless this is tackled all round, we are going to see numbers in hospitals plateau or worse– increase. In fact this has happened, albeit by a very small amount but it is a worrying trend,” adding “In the community the same approach should be taken as in the hospitals”.

Describing a successful pilot carried out in Northumberland, 2008 Derek said: “they used to go out to community healthcare facilities, teaching staff the importance of hand hygiene, and in these areas the infection rates in the community plummet rapidly.”

A key issue is that care staff in often do not receive the same training as those in hospitals, domestics. “Regardless of whether the care is in-house or outsourced, the training should be the same: in other high-risk industries, standards are the same and health and safety law states that the responsibility lies with companies who do the outsourcing.”

With this back-to-basics approach, Derek thinks we can learn from: “I believe that there should be an information and education campaign on hand hygiene nationally, as with the successful clean your hands campaign back in the early 2000s.”

MRSA Action also works together with companies to promote innovative products and technology for safer hospitals and healthcare settings. Commenting on ABLiS™ – Antimicrobial Basin and Liner System Derek said, “A very simple effective product, and sometimes the most simple ideas are the best. This is brilliant, a product like this can have a massive impact and it’s not costly.”

 

If you would like to comment on any of the issues raised by this article, particularly from your own experience or insight, Healthcare-Arena would welcome your views.

 

Links

MRSA Action UK Website

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Antimicrobial Research Collaborative (ARC) recommends CRE screening as a priority for admissions to high-risk specialities

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The Gram-negative bacterial family of Enterobacteriaceae, includes the species Klebsiella, Enterobacter, and Escherichia. These bacteria can cause opportunistic wound infections, gastroenteritis, pneumonia and septicaemia, particularly in hospital patients, including post-operative patients. Carbapenem-resistant Enterobacteriaceae (CRE) is now a serious concern for the NHS (1).

In 2009, reports first emerged from the USA that these new hospital-acquired, antibiotic-resistant bacteria, had caused death in hospital patients. A prediction was made at this time that CRE could be even harder to eradicate than methicillin-resistant Staphylococcus aureus (MRSA) or antibiotic-resistant Clostridium difficile.

Following reports of cases of CRE in more than a dozen hospitals in England and Scotland in 2009, the then Health Protection Agency (HPA) (now Public Health England) issued a warning about what it called, ‘a notable public health risk’(1). Initially, CRE was thought to be imported from patients having had surgery in India and CRE was considered to be a consequence of the increasing number of UK patients travelling abroad for surgery each year (> 100,000 in 2013) (2).

In 2015, a joint collaboration between Imperial College Healthcare NHS Trust, Imperial College Academic Health Sciences Centre (AHSC) and Imperial College London has created a new multidisciplinary research group, the Antimicrobial Research Collaborative (ARC) (3,4). The aim of the ARC is to translate research findings into new infection prevention strategies. This initiative will have an important role in addressing the problem of antimicrobial resistance (AMR).

As part of the ARC collaboration, in April 2015 researchers lead by Professor Alison Holmes, Director of the National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU), Imperial College London, published their review of current CRE screening strategies in the Journal of Infection(5,6). Among the findings of this study, they noted that admissions to high-risk specialties were likely to have higher CRE prevalence rates and that the higher prevalence of CRE resulted in higher detection rates and lower false-positivity rates (6). These researchers have recommended that CRE screening should be prioritised for hospital admissions to high-risk specialties (6).

The CRE strains are resistant to all the standard antibiotics now used in the NHS. Furthermore, some of these resistant bacteria have been shown to survive in hospital environments, such as table surfaces and door handles.

In May 2015, a publication by Weber and colleagues in the US, in the journal Infection Control & Hospital Epidemiology (ICHE) (published online in Feb 2015), reported that CRE-infected patients contaminated the environmental surfaces of hospital rooms in 8.4% of cases, but at low levels (7). Three species of CRE, Enterobacter, Klebsiella, and Escherichia, survived poorly, with 15% survival after 24 hours and 0% survival after 72 hours (7).

The survival of enteric organisms, such as CRE, is likely to be less than the survival of MRSA on hospital surfaces, due to differences in the structure of the bacterial cell capsule. The ICHE study shows that the levels of contamination and survival are high enough to be important in terms of CRE transmission (7).

In conclusion, carbapenem-resistant Enterobacteriaceae (CRE) are an important group of infections for the new multidisciplinary antimicrobial resistance (AMR) teams to target. Despite their reported limited growth and survival on hospital surfaces, the increasing number of reported cases supports the view that now is not the time to be complacent about hospital infection control.

If you would like to comment on any of the issues raised by this article, particularly from your own experience or insight, Healthcare-Arena would welcome your views.

References

(1) Public Health England. https://www.gov.uk/government/organisations/public-health-england Accessed June 16, 2015

(2) Office for National Statistics, Travel Tends 2013. http://www.ons.gov.uk/ons/dcp171776_361237.pdf Accessed June 16, 2015

(3) Imperial College Healthcare NHS Trust. http://www.imperial.nhs.uk Accessed June 16, 2015

(4) The Antimicrobial Research Collaborative (ARC), Imperial College, London. http://www.imperial.ac.uk/arc Accessed June 16, 2015

(5) The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London. http://www1.imperial.ac.uk/hpruantimicrobialresistance/ Accessed June 16, 2015

(6) Venanzio V, Gharbi M, Moore LS, Robotham J, Davies F, Brannigan E, Galletly T, Holmes AH. Screening suspected cases for carbapenemase-producing Enterobacteriaceae, inclusion criteria and demand. J Inf 2015;pii:S0163-4453(15)00197-8. http://www.ncbi.nlm.nih.gov/pubmed/26070742 Accessed June 16, 2015

(7) Weber DJ, Rutala WA, Kanamori H, Gergen MF, Sickbert-Bennett EE. Carbapenem-resistant Enterobacteriaceae: frequency of hospital room contamination and survival on various inoculated surfaces. Infect Control Hosp Epidemiol. 2015;36(5):590-3. http://www.ncbi.nlm.nih.gov/pubmed/25661968 Accessed June 16, 2015

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