Volume 188 - Issue 12
Methicillin-resistant Staphylococcus aureus (MRSA): “missing the wood for the trees”
Author: Peter J Collignon
Med J Aust 2008; 188 (12): 733-734. || doi: 10.5694/j.1326-5377.2008.tb01865.x
Published online: 16 June 2008
Published online: 16 June 2008
In reply: I heartily endorse Chan’s comments. To control infections in our hospitals, we desperately need not only a change in governance, but also a change in attitude. Chief executives of all hospitals, as well as all clinicians (nurses and doctors), need to take personal responsibility for serious infections that occur frequently in our hospitals. To do so, they also need to know how often these infections occur. We need robust and transparent measures — for example, data on health care-associated Staphylococcus aureus bloodstream infections, including methicillin-resistant S. aureus (MRSA),1 and deep-seated prosthetic joint infections.
In recent years, faced with rising numbers of health care-associated infections, especially MRSA infections, the United Kingdom embraced necessary changes in governance. These included the promotion and use of seven key actions,2 with active surveillance and investigation being the first on the list. One of these mandatory surveillance measures was of all bloodstream infections caused by S. aureus (including MRSA)2,3 and the investigation of all episodes caused by MRSA with a “root-cause analysis”.2,4 There are early indications that the changes have successfully reduced the number of MRSA infections: from a peak of 3955 episodes of MRSA bloodstream infection occurring between October 2003 and March 2004, the number had fallen by over 40% to 2376 episodes in the period April 2007 to September 2007.3
Prevention and control of health care-associated infections must be a core part of clinical governance and patient safety programs in all hospitals. Chief executives and all clinical directors need to be aware of the numerous factors that must be given careful attention in order to reduce health care-associated infections. More importantly, they need to ensure that all appropriate steps are taken to prevent infection. This includes basic issues such as making sure that surfaces in clinical areas are adequately cleaned5 and that hand hygiene protocols are complied with — not just some of the time, but all of the time.
References
- Collignon PJ, Wilkinson IJ, Gilbert GL, et al. Health care-associated Staphylococcus aureus bloodstream infections: a clinical quality indicator for all hospitals. Med J Aust 2006; 184: 404-406.
- Chief Medical Officer, UK. Winning ways: working together to reduce healthcare associated infection in England. London: Department of Health, 2003. http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4064689.pdf (accessed Mar 2008).
- Health Protection Agency, UK. Quarterly reporting results for Clostridium difficile infections and MRSA bacteraemia, January 2008. http://www.hpa.org.uk/infections/topics_az/hai/Mandatory_Results.htm (accessed Mar 2008).
- Department of Health, UK. Essential steps to safe, clean care. London: National Health Service, 2007. http://www.clean-safe-care.nhs.uk/toolfiles/88_82131-COI-Essential%20Steps%20Working%20together.pdf (accessed Mar 2008).
- Dancer SJ. Importance of the environment in methicillin-resistant Staphylococcus aureus acquisition: the case for hospital cleaning. Lancet Infect Dis 2008; 8: 101-113. CBBIFEED