Trusts own up to service deficiencies

And this is actually good news. The Healthcare Commission today have published the compliance declarations of NHS Trusts in England and a large number are being open and honest about the current state of play. Athough this has been presented in the media as yet another set of failures, the fact that Trusts are openly acknowledging non-compliance means that robust action plans are being prepared that can be monitored and progress demonstrated. I would be more worried about organisations that state compliance when they are not as recognition and acknowledgement of problems is the first stage of remedying them. Patients should feel reassured that their local hospitals are being open and honest on this issue.

To me it’s a bit like choosing where to eat on an evening out. I would actually choose to eat in an establishment that has recently been prosecuted for failing a food standards inspection as if they are open you could be absolutely guarantee that standards are now being met through the inspection process and you may not be able to say this about every eatery in town.

Of course, this is the first stage in this process as these declarations have yet to be ratified by the Healthcare Commission through cross-checking and it will be interesting to see how many organisations have overstated their position, for examples some may have declared compliance with reductions in MRSA when having overshot the target by some distance when the final figures are known

Wipes in the Dock – Guilty or not guilty?

The BBC website has reported on a paper presented in the USA by scientists from the Welsh School of Pharmacy that looks at the possibility of the mis-use of wipes being a possible vector for MRSA. I suppose this is possible, but as usual, if items such as these are used correctly then the risks should be minimal. Staff who have had the apporopriate training and who are motivated to implement what they’ve been taught will reduce the risk of this occurring. Papers such as these are useful in demonstrating the risks to those who can become blase about good practice and it is good to see that the BBC sought comments from Tracey Cooper from the Infection Prevention Society.

Pigs raise their ugly heads.. again

The first reported cases of the ST398 strain prevalent in dutch swine have been recorded in adults in Scotland reports The Daily Mail. Formerly The Soil Association have reported on this in 2007 and produced a report that makes for interesting reading. The Mail amongst others reports that these cases in humans in Scotland are not related to contact with pigs (well not living ones anyway) and it will be interesting from an epidemiological angle to determine where this strain was acquired from. Until now cases in humans have normally been related to contact with livestock. There is at least one report of a hospital cluster of colonsation in staff with this strain, which is non-typable and commonly resistant to Tetracycline (Oxytetracycine is commonly used in pigs in Holland).

Could the food chain be a vehicle? High standards of food hygiene should be adequate to reduce the risk of transmission from meat to a minmal level and as long as hand washing takes place after handling raw meat and thorough cooking takes place then there should be no problem. As ever, high standards of hygiene are our protection from disease.

Watch out, Cleaner’s about: Another ‘undercover expose’

Yet again another Hospital has fallen to a secret camera concealed about the person of an agency cleaner. BBC Wales will broadcast the story tonight at 7.30pm tonight. The report will highlight the following: No training, no CRB checks, no time to clean etc.

So, a completely new set of findings then.. I know that on the face of it this will look dreadful, but I do wonder just how much footage was shot in order to make the final version. It would be nice to know so that a balanced view could be made.

Still, as they say, all publicity is good publicity; especially in the battle to reduce HCAI

ONS publish death rates for MRSA and C. difficile

The Office for National Statistics has published death rates for each NHS organisation in England and Wales, along with total deaths for each. The headlines, as usual, do not match the story. Take the Grauniad for example: “Superbug hospitals named and shamed”. I wonder if the headline writers ever read the article before putting pen to paper. The problems with this headline are many.

• The data relates to deaths where MRSA or C. difficile are mentioned and are not necessarily the primary cause of death
• Deaths related to these organisms where they are not mentioned on the death certificate are not counted
• The data relates to where the death was recorded
• The data does not relate to where the infection was acquired
• Most of the deaths related to people over 85 years of age who had multiple courses of antibiotics for other medical conditions

All preventable deaths from these important investigations should be thoroughly investigated in order to look for opportunties to improve practice and protect the vulnerable. Unfortunately the completion of death certificates was not particularly god at the time of the collection of these statistics. Hopefully the guidance produced by the Chief Medical Officer in 2007 will lead to better data on which firmer conclusions can be drawn.

R4 covers ‘Superbugs’

In case you missed it at 7.20 this morning the Radio 4 ‘Today’ programme has looked at the ‘Superbug’ problem in a very sensible manner. No surprises for guessing who one of the contributors was but worth listening to one of the contributors digging himself expertly out of a hole. If the links stops working, the programme is available on the R4 Today website for the next seven days

MRSA ‘cure’ heralded in the media however..

The media have been exercised by stories of a cure for MRSA over the weekend. On further scrutiny this turns out to be a nasal gel for carriage. Useful I’m sure but will it save 1600 lives annually (so reports the Record). Other reports are more guarded with an extremely sensible response from Derek Butler from MRSA Action UK. Yes, a new treatment for MRSA colonisation of the nose would be very welcome.

A cure for MRSA? No

Scottish MRSA litigation proceeds to trial

The BBC have reported that the attempt by lawyers acting on behalf of the Greater Glasgow Health Board have failed in their bid to have a claim for healthcare-acquired MRSA thrown out prior to the full hearing stage. The case seems to centre on claims of poor hand hygiene and failure of hand hygiene facilities and supplies (Times article). It will be very interesting to follow this case (if and) when it reaches trial to see what the implications for the Health Services in the UK are.

Things seem to be moving in this way over the water in Ireland also, with a healthcare worker who contracted MRSA whilst undergoing treatment being awarded a six-figure out-of-court settlement.

Media learn to spell new organism

Reports of an impossible to treat ‘new’ infection have been circulating in the media. The new organism? Take a bow Stenotrophomonas maltophlia and welcome to the ‘Superbug club’. Scourge of ice-machines and other wet places, ths organism has never been accorded the honour of being abbreviated (until now) and is now being dubbed ‘Steno’ in some sections of the media. Reports in the time-honoured non-anxiety promoting style talk of a death rate of 30% but there is little hard evidence of this.

The source of all of this interest? Scientists at the wellcome institute have sequenced the genome. Very important I agree but turned yet again into a horror story for patients.

RCN vote to oust private cleaners

The BBC report that the RCN have voted overwhelmingly in a motion calling for the end of private contractors in hospital cleaning. My view? I have to confess that I have only limited experience of private contractors and it was not a positive one. Locally employed staff, responsible to the hospital and working as colleagues alongside the rest of the healthcare team makes perfect sense to me. At the end of the day the staff involved in cleaning hospitals are the most poorly paid and are frequently undervalued for the vital work that they undertake and promoting pride in their work and recognising this provides job satisfaction that is repaid over and over again.

Making everyone feel part of the team, sharing success (and failure) is part of the process where everyone feels a shared responsibility for the condition of the wards and departments where vulnerable patients are cared for. Personal accountability is the key to raising standards. I am glad that the RCN also recognised in the debate that nurses MUST take some responsibility for cleaning and monitoring and do wonder if there is this sense of responsibility and accountability where cleaning is outsourced and becomes the problem solely of the company providing the service.

In my experience cleaning staff are rightly proud of the service that they provide and frequently complain, not about conditions or hard work, but about the fact that they are unable to do the job to the level that they would wish to (for variuos reasons).

We all have a responsibility for cleanliness and we should never lose sight of it. Ultimately we all work in our local hospitals; where our loved ones may be cared for and where we may well end up ourselves at some time. All patients are someone’s relative and we should deliver no less a standard of care and cleanliness than we should hope and expect for ourselves and our families. Next time you’re walking down a hospital corridor and see a bit of litter why not pick it up instead of leaving it for somone else to do. You’ll be pleasantly surprised as to how good it makes you feel!

Glass half full or half empty?

The media it seems cannot make up their minds about the latest HCAI figures published today. Yes, the figures for MRSA bacteraemia in the last quarter of 2008 are up on the previous month. The BBC describe this as ’stalled’, whilst others describe this as the figures ‘On the Up again‘ and The Telegraph (!) runs a story saying the battle is being won. The facts? Yes, up by…. 0.6% over the previous quarter but in reality a 30% fall on the same period in the previous year (along with reports of C. difficile which are also down).

Any preventable case is a cause for concern but people should realise just how much hard work has been going on at the coalface in order to reduce avoidable infections and there is still work to be done. This is not the time to undermine the value of the achievements to date by manipulating the news into yet another negative story that will onlt serve to demoralise hard-pressed staff and cause anxiety for those due to be admitted to hospitals. There can be no doubt that hospitals are considerably safer places to be than they were a few years ago and it would be motivating if the media were to recogise it and put the credit where it is due.

Hmm, well that didn’t get much airtime

Monitor seem to have woken up to the fact that some foundation trusts are er, underperforming when it comes to the MRSA target. Well about time too if I may say so, even if their press release acknowledging this got as much coverage in the media as Gillingham’s recent wonderful win over Luton.

Trusts wanting to achieve foundation status are required to hit the MRSA Trajectory, yet it seems for some who have already achieved this state of ‘excellence’ that gross failure of the target isn’t enough to put FT status at risk. Hardly an equitable situation. Seven FT’s have already been summoned to the headmaster for a good talking to and it is interesting to see the the excuses that the rest of the NHS used to trot out when the targets were first set now being recycled.

The bottom line is that the MRSA target is in sight and healthcare professionals in the NHS deserve huge credit for reducing HCAIs at a rate never documented before. Now, if only Monitor had spoken up (however quietly) a year or so ago..

How clean is your house?

Well at midnight the big cleanup is officially over.

Yes as it happens I do think it was worthwhile. I know the science is poor and it wasn’t going to reduce MRSA bacteraemias (which it wouldn’t have anyway as the vast majority are device-related) but it may just have an impact on C. diff because it’s shown just how poor the standard of equipment is and how uncleanable it is. Anyway with the NHS making a huge profit.. er, I mean surplus, why not spend some of it on cleaning. Mind you there has been just a small amount of ‘box-ticking’. Anyone who thinks that clinical areas can be deep cleaned whilst patients are still being nursed in the area clearly has no concept of what a deep clean really entails. If a job’s worth doing..

FOI – Alright for some

I see that MPs have launched a bid to stop the publication of details of their expenses (story here).  As most Infection Prevention and Control Practitioners in the country stave off yet another time-wasting FoI request from an MP on a fishing trip for an infection-related story I do hope that ‘what goes around, comes around’ happens eventually.

First attempt at an Infection Prevention advert for staff

C’ est difficile – bloomin’ right it is..

NHS Trusts in England are currently attempting to get to grips with the new target setting process for C. difficile. The interim targets being set so far are er.. interesting in so much as some medium acute NHS Trusts appear to have higher targets than some major tertiary referral teaching hospitals. The crux seems to be the apportioning of cases to being ‘hospital acquired’ or not based upon some form of criteria that is not yet in the public domain as regards the science underpinning it. To that matter, much of the science surrounding C. difficile is somewhat murky to say the least.

• Incubation period – unknown
• Infective dose – unknown
• Carriage rates in hospital inpatients on admission – unknown
• Strains circulating in hospitals on a real-time basis – unknown
• Time to become toxin-positive after onset of infection – unknown
• Infections caused by strains that do not test positive for toxin – unknown
• Where a patient originally acquired the organism that subsequently caused symptoms after antibiotics prescribed – unknown

And these are only the things that we know that we don’t know; as yet there will also be many unknown unknowns (not that I ever thought I’d ever quote Donald Rumsfeld, but he had a point).

I’m certain that this will mean that Hospital staff will be under extreme pressure to extract a specimen from patients within 48 hrs of admission in an attempt to demonstrate that the infection did not come from the hospital. Another wrinkle is that the day of admission is day one (as for the MRSA target), so a patient admitted at 11.55 pm has the first five minutes of the admission counted as day one and the next 24 hrs as day two, meaning that a patient could only be in an organisation for 24 hrs and 10 mins, produce a liquid stool and this will count as a hospital-acquired infection. Given that some authorities quote periods of 3 months after antibiotic therapy before diarrhoea may start this is, to say the least, unscientific!!

MRSA present in 11% of Dutch Swine

Just in case you’re not an avid reader of pigprogress.net, a report shows that a study carried out by the risk department of the Dutch Food and Consumer Product Safety Authority (VWA) revealed that 11% of meat products in the retail sector is contaminated with MRSA. You can read the story here. Clearly there are no single-occupancy stys in Holland, unlike the hospitals. There is a well-documented ’seek and destroy’ policy for MRSA in healthcare, so I wonder what the policy for pigs will be – “destroy” is after all what happens to them anyway.. and I wouldn’t want to forego my sunday morning bacon butties!