Brian Edwards CBE
Emeritus Professor of Healthcare Development
University of Sheffield
Up to 5,000 patients may be dying in hospitals each year in England as a consequence of contracting an infection whilst in hospital, with the principal culprit being MRSA (methicillin-resistant Staphylococcus aureus). Other European countries are faced with similar problems, although not on the same scale. In 2002, a review by the European Antimicrobial Resistance Surveillance System of the proportion of S aureus bacteraemia isolates resistant to methicillin showed important differences between countries (see Table 1).
Such important variations usually point to data collection problems, but, on this occasion, the difference between countries has been observed by professionals on the ground. Although the problem is predominantly found in the hospital setting, patients can also present with the condition in nursing homes and general practices. The causes for these high rates are complex, but most certainly include excessive and inappropriate use of antibiotics, inadequate hospital cleaning practices, the degree of patient movement within the hospital and between hospitals, and poor professional practice, with handwashing between patient contacts remaining crucial. Another underlying cause is high bed-occupancy, which allows little time for regular cleaning and puts staff under serious pressure. Apart from endangering patients, these high rates of infection have major economic consequences. In England, the cost to the NHS has been estimated to be Euro 1.7 billion, and infection rates are so high that they recently prompted a report by the government auditors, who described the current position as shameful (although a few hospitals have managed to get rates down to low levels).
As a consequence, the Department of Health has now produced a plan to reduce infection rates. New investments will be targeted at employing more specialist infection control staff, tightening up cleaning standards, launching a “clean your hands” campaign and encouraging patients to challenge staff about whether they have indeed washed their hands since they treated or examined their last patient. There will also be a checklist for nurses and patient groups to use for quality inspections. The compulsory reporting systems will remain in place, and, from April 2005, all hospitals will have target reductions to meet. The results will be made public, which is bound to impact on the reputation and business viability of the hospitals that continue to have high rates. This kind of action should reduce infection rates.
On the other hand, countries with low rates will need to remain vigilant. The inappropriate use of antibiotics has been highlighted as a danger to patients, and it is time that governments, the pharmaceutical industry and the health professions took this issue more seriously. Antibiotics should be available only on prescription, and pharmacists should be very careful in recommending their use.