Wanna be a Superbug?

This week news broke of a serious outbreak of the superbug Clostridium difficile at Ennis General Hospital last year. A damning report published by the HSE, listed a litany of problems at the hospital. The hospital has since taken appropriate action to bring the situation under control but the response from the HSE is less than encouraging.

The extent of the problem in Ennis came to light when routine laboratory surveillance showed up higher levels of infection at the hospital than would be expected. The review, conducted by two assistant national directors with the HSE, found that in total 46 elderly female patients became infected with this superbug within the first 6 months of 2007 and of these 21 had died by the end of the year. Clostridium difficile was not listed in any of the cases as a primary cause of death though it was listed as a contributory factor in 13 of the deaths. The report published by the HSE yesterday concluded that the contributing factors included overcrowding, poor hygiene, high bed occupancy rate, faulty equipment and staff shortages. In all, it made 15 recommendations in relation to improvements which should be made at the hospital. It also recommended that a national reference laboratory be established to improve control of this superbug. Ennis General Hospital has already implemented changes and levels of this dangerous bug are now very low at the hospital.

The HSE’s response to this report was “The HSE will ensure that learning from this specific incident is applied nationally and on that basis will be holding a briefing session with hospital and other appropriate healthcare managers in coming weeks“.

Meanwhile, last Tuesday I read in this week’s edition of Healthplus, published by the Irish Times that “The Health Service Executive (HSE) West has sought to allay concerns about the impact of current financial cutbacks on laboratory testing for MRSA. Restrictions on testing for the MRSA superbug have been implemented as part of State-wide HSE stringencies since September last“.

So at the same time as alarming rates of the superbug, Clostridium difficile were coming to the fore in Ennis, the HSE implemented cutbacks which have directly affected laboratory staffing levels and caused “service restrictions“. This week’s report clearly recommended that laboratory services should be increased and improved and yet we hear that the HSE continues to restrict services in this area. The cutbacks introduced last September have also had a knock-on effect on the problems of overcrowding, poor hygiene, bed occupancy rate, supply of equipment and staff recruitment in our hospitals – all the factors listed in the Ennis report as contributing to cross infection.

You don’t have to be a rocket scientist to work out that we have an infection control crisis in the making. The cutbacks across the country are giving superbugs free rein to march. The failure of hospital management and senior health officials to appreciate this real and growing threat, is putting lives at risk. I rest my case.

19 Responses to Wanna be a Superbug?

  1. Grannymar says:

    A heart attack becomes more inviting every day! I hope when my turn comes, I just keel over and fall off my perch.

  2. Bendy Girl says:

    That’s ridiculous in its stupidity. Still, I should know better than to expect anything less from a government agency! BG

  3. Baino says:

    Your HSE seems to contradict itself at every turn! I can forgive crowded hospitals, even staff shortages given the lousy pay that nursing staff receive but poor hygeine? That’s unforgivable in a medical establishment. It seems these days the best way to become ill is to go to hospital . . it’s like allowing your kid to play with the box of toys in a doctor’s office . . I always thought that a terrific way to transmit germs and infection.

    On the super bug thing . . I also worry about the random prescription of antibiotics in children . . this certainly helps build resistance which is why these ‘super bugs’ begin to take hold in the first place. Already my son is ‘immune’ to the effects of one broad spectrum antibiotic.

    If it wasn’t so serious, I’d have laughed at the cartoon!

  4. steph says:

    I’m back! Thanks for your comments.

    GM – please don’t pop your clogs just yet – there’s still lots more important blogging to be done ;-)

    BG – you’re right, there is no joined-up thinking coming from government agencies.

    Baino – there is growing public disquiet about the level of hygiene in our hospitals. Progress in this area has been terribly slow thanks to the cutbacks and a very casual attitude from senior health officials, to the risks involved.

    Over-prescription of antibiotics is well-known as a major contributing factor to the spread of MRSA and I agree, it is worrying when you consider that our children belong to the generation most exposed to antibiotics. As regards immunity – as far as I’m aware, our levels of immunity are constantly changing, as is the resistance of the superbugs to antibiotics. When I had the MRSA infection, it was resistant to almost every antibiotic available (scary stuff!) whereas now when I get a routine infection, swabs show improved antibiotic sensitivities.

  5. Knipex says:

    When you compare the UK system and attitude to HCAI’s and the Irish system side by side the difference is amazing.

    Two weeks ago there was a problem with C.diff in Tyrone county hospital. They had 5 confirmed cases in a week from two wards.

    What did they do ?
    They cohort-ed all infected patients in a 6 bed room (they have a bigger problem with lack of isolation facilities that we do.)
    They informed all visitors to the two wards in question.
    Stopped admitting people to the wards in question.
    They moved out patients that could be moved and monitored them all for diohrrea. They emptied and 10 bed bay and closed it off and issued a press release letting the community know there was a problem and asking them to refrain from visiting patients in these wards and re-emphasised the need for hand hygiene entering and leaving the wards.

    They then cleaned the empty ward and brought in a specialist decontamination company (from Limerick) to decontaminate the empty ward and all side rooms. (They contacted the Rapid Review Panel and the UK department of health to find out what technologies were approved for use and what was recognised best practice)

    Then they transferred all patients into the 10 bed bay and closed off the rest of the two wards and decontaminated every inch including equipment. It took 4 days and then they issued another press release telling the public they had no new cases, the steps they had implemented and the fact that the two wards were fully decontaminated and reopened and that no one need be worried about being admitted to these two wards.

    All open and above board, a logical thought through plan following best practice. The went to the rapid review panel and looked at the technologies that were approved and implemented them.

    Compare that to what happens in Ireland..

    What happened in Ennis happened 12 months ago and they only tell us about it now ?

  6. Steph says:

    Cheers! Knipex

    I think Irish healthcare suffers from a bad case of “Ah, sure it’ll do” syndrome!

    It’s interesting to hear that Tyrone called in experts from Limerick. I wonder did Ennis call in any specialists in decontamination or did they just give the “oul’ lobby a wash down, Sunshine”?

  7. Knipex says:

    Steph

    To the best of my knowledge there was no decontamination carried out in Ennis except by traditional deep clean techniques. (bleach and a cloth).

    I can not be 100% sure of this but I do know for sure that no decontamination was carried using an independently approved technology. Mainly because there is only one and thats the one that was used in Tyrone.

    In fairness to Ennis they were running at well over 100% occupancy levels at the time and could not vacate wards or (even rooms) to allow for decontamination.

  8. Dr Thunder says:

    “The report published by the HSE yesterday concluded that the contributing factors included overcrowding, poor hygiene, high bed occupancy rate, faulty equipment and staff shortages. In all, it made 15 recommendations in relation to improvements which should be made at the hospital. It also recommended that a national reference laboratory be established to improve control of this superbug. ”

    “Ennis General Hospital has already implemented changes and levels of this dangerous bug are now very low at the hospital.”

    I bet the reccomendations, and the changes made don’t exactly tee up with each other, though! I wonder what they’ve done about overcrwding and bed occupancy? I don’t know, but I’d guess it’s the square root of sweet FA!

    Dr Thunder
    http://www.twoweeksonatrolley.blogspot.com

  9. Steph says:

    In response to the recommendation made to establish a national reference laboratory, “an HSE spokeswoman said the establishment of such a laboratory would be considered as part of an ongoing review of State laboratories”, according to the Irish Times (12/04/08).

    In other words, the advice will be ignored and the decision will be put on the back boiler until the next crisis arises.

  10. Roy says:

    Who is really to blame for superbugs?
    is it the overuse of anti-biotics
    is it down to a simple lack of cleanliness?
    Can the problem ever really be solved?
    Dr thunder says;
    poor hygiene, high bed occupancy rate, faulty equipment and staff shortages
    poor hygiene on who’s part, patients? staff? visitors? all three?
    high bed occupancy! they’re damned if they do, damned if they don’t
    Faulty equipment , from what i gather all relevant equipment has the necessary service contracts from suppliers
    Staff shortages? wrong staff in the wrong places more likely!

  11. Steph says:

    Cheers! Roy

    In answer to your question, the superbugs are thriving because of a combination of all of the above factors. I would add poor infrastructure of our public hospitals to the pile. They were not designed with infection control in mind so regardless of how clean they are kept, as long as sick people are hoarded together in overcrowded spaces, the superbugs will thrive. If adequate funding was provided, plenty could be done to reduce the spread of infection but of course, the health cutbacks have put paid to that. Better hand hygiene has been shown to reduce levels of infection – it costs nothing but time and commitment (which is why the HSE homed in on the idea) and it’s something everyone (staff, patients & visitors alike) can do to play a part in stopping the spread of infection.

    Here are some thoughts I had the on this subject last year:

    http://biopsy.wordpress.com/2007/11/15/mrsa-whos-to-blame/

  12. Knipex says:

    Roy

    Super-bugs came about because of the incorrect \ overuse of antibiotics. Patients themselves are as much to blame as doctors for this.

    They are here now and we are never going to get rid of them but the use of antibiotics has to be carefully monitored to ensure that they don’t become resistant to the few remaining effective ones.

    We are never going to get rid of HCAI’s. Never. They have always been with us and always will be. What we can do is minimise them. Its not rocket science to do this and the techniques are well known.

    Antibiotic stewardship.
    Screening of incoming patients,
    Proper isolation.
    Single rooms no more nightingale wards.
    Hand hygiene.
    Environmental hygiene.
    Adequate microbiologists in staff.

    The problems are that our existing hospital infrastructure has not been designed for this. They are old buildings, difficult to clean, lack of isolation facilities. poor toilet facilities.
    Microbiology went out of fashion as a career choice so microbiologists are not exactly a dime a dozen.
    Lack of lab facilities do not allow for the screening of every patient.

    To get it right we need to rebuild all out hospitals, invest heavily in training and education, build and equip labs, train more infection control nurses and microbiologists.

    All this requires time and vast sums of money.

    All we can do at the moment is try to do that best with what we have.

    It is worth remembering that the levels of HCAI’s in Ireland are comparatively good and much lower than the UK.

  13. Steph says:

    Thanks for your help! Knipex

    You’ve outlined the problems really well and brought new perspective to the debate. There can be no doubt that the more we all discuss this problem, the more likely a way forward will be found out of the morass that presently exists.

    Have you any thoughts you’d like to add on the measures implemented in Holland to successfully keep MRSA out of the hospitals?

  14. Knipex says:

    Steph I actually spoke to a Consultant Microbiologist for Holland who was in Ireland to look at our health service.

    He admitted to me that their system just would not work over here.

    In Holland the levels of MRSA are so low that when they screen everyone entering hospital they can easily isolate those infected or even colonised.

    In Ireland HCAI’s are so prevelant especially in the residental care units and other hospitals where the vast majority of admissions come from, that even if we did screen then what would we do with them???

    Before we can implement their system we need to get our levels way down and to do that will take time.

    The reason Holland is so far ahead is due to their antibiotic policy not only now but historically and the fact that have been monitoring infections for so much longer than us.

  15. Zebedee says:

    Why does it take Ireland so long to catch up with what is already accomplished in other countries, we re-invent the wheel. Cdiff outbreaks in Canada, the USA in 2004 and in Europe and the UK over the last three years are well known. A report from 2005/2006 on the MWHB website recommended Cdiff be made notifiable three years ago. It demanded that reference lab too. It warned about the new virulent disease. It’s from the Public Health Department run by one of the Assistant National Directors who wrote the Ennis report. New HSE guidelines are coming next month but it’s a little late now!

  16. roy says:

    Now YOU can get *infected!
    visit the Science exhibition on the corner of westland Row/Pearse Street and they’ll infect you with ebola virus on the way in!

    The folks in the cab say it’s GREAT!

    (*virtual infection)

  17. Steph says:

    Roy – Thanks for reminding me!

    I heard a radio interview about this exhibition and would like to get to see it. I’ll put up a post about it shortly.

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