MRSA found in UK poultry

The first case of MRSA in poultry in the UK has been found in turkeys and chickens on a farm in East Anglia says the Department of Health (DH).MRSA found in UK poultryA spokesman said that two thirds of the turkeys on the farm, which hasn’t been named, were found to be infected.

It is thought that hundreds of turkeys have already been sold to local retail outlets and farm gate sales.

The spokesman said the strain of the disease found in the poultry – Livestock-Associated (LA) MRSA – “rarely caused disease in humans” and if it did would involved a mild skin infection which cleared up quickly.

LA-MRSA is different to the MRSA that causes the healthcare associated infections seen in people.

It can potentially pass from animals to humans through direct contact or through dust in animal housing, meaning poultry workers are at risk.

But LA-MRSA rarely causes disease in people and in most cases the bacteria clear within 24 hours.

Appropriate handling and cooking of raw meat should eliminate any risk of transmission to people.

Steve Wearne, Director of Policy at the Food Standards Agency, said: “Any risk of contracting MRSA through meat from animals with these bacteria is very low when usual good hygiene and thorough cooking practices are observed. All poultry should be handled hygienically and cooked thoroughly to destroy any bacteria that may be present.”

Prof Angela Kearns of Public Health England said: “There are many different strains of MRSA that cause illness in people but this is not one of the strains that we are overly concerned about given the very low number of clinical infections that have been seen in people.”

In the UK, since 1999, there have been published reports that MRSA has been isolated from dogs, cats and from a rabbit and a horse.

Other countries have also reported cases in cattle and poultry.

Prof Peter Borriello, Chief Executive of the Veterinary Medicines Directorate, said: “LA-MRSA has been identified in livestock in a number of countries and is not considered to represent a significant risk to animal health and welfare.”

Doctors’ tie ban resulted in scruffy health professionals

A health professional has criticised “scruffy doctors” and called for a return to ties and white coats.
Doctors' tie ban resulted in scruffy health professionalsStephanie Dancer, a microbiologist at Hairmyres Hospital in East Kilbride, said patients complained they did not know who the doctor was.

In 2008, the Scottish government dropped the white coat and banned ties in a bid to cut infection rates.

However, Ms Dancer said the role of the uniform in transmitting bacteria had been exaggerated.

There is no evidence that the white coat is a vehicle for the spread of infection, she said, whereas “hand-touch contact, airborne delivery, environmental reservoirs, and human carriage are all implicated in transmission”.

She added that informal dress could project an image of poor personal hygiene and imply declining standards of cleanliness.

Ms Dancer also claimed it eroded the image of doctors as responsible and competent.

The consultant warned that easy access to antibiotics was eroding the importance of basic hygiene over the past half century.

“Given that cleanliness is no longer a matter of life or death, it is no wonder our junior doctors dress the way they do,” she said.  “Before the antibiotics run out, we need to revisit the hygiene values of the past”.

The white coat was first introduced in the 19th Century in part to prevent cross-contamination.

However, 100 years later they fell out of favour with Labour’s nanny state. In 2007, national NHS guidance advised against wearing long-sleeves and ties during clinical work.

The Scottish government introduced a new NHS uniform in 2008, which included tunics in four shades of blue for clinical staff and tunics in green for support staff.

The uniforms were brought in to help tackle healthcare associated infections such as MRSA and C.difficile.

DNA code of MRSA superbug cracked by scientists

The DNA code of the superbug MRSA has been cracked by scientists so that their future spread can be halted more quickly.DNA code of MRSA superbug cracked by scientistsA new device can identify specific bacterial strains from their genetic codes so experts can target the transmission path of the infection and cut it off.

In an early test of the technology, researchers halted an outbreak of the MRSA superbug in a special care baby unit at the Rosie Hospital in Cambridge.

It is believed to be the first time DNA sequencing has been used to contain an infectious disease outbreak at a hospital.

The scientists are now developing the concept into a simple system that can be used routinely by hospital staff who are not genetics experts.

In future, it could be used to combat many kinds of infection outbreak, and also help doctors decide the best way of treating patients.

Professor Sharon Peacock, from Cambridge University, who led the research team, told a news briefing in London: ”What we’re working towards is effectively a ‘black box’. Information on the genome sequence goes into the system and is interpreted, and what comes out the other end is a report to the health care worker.

”It could, for example, determine the species of the bacterium; it could determine antibiotic susceptibility, and it could provide information about what genes are present that are often associated with poor outcomes in patients.

”It will give information about how related that organism is to other organisms within the same setting, giving an indication of the capability of transmission from one patient to another.”

A report on how the baby unit outbreak was brought under control appears in the latest issue of the journal The Lancet Infectious Diseases.

The scientists used a technique called rapid whole genome sequencing, which maps an organism’s entire genetic code, to analyse MRSA bacteria taken from 12 babies.

MRSA (methicillin resistant Staphylococcus aureus) is an antibiotic resistant form of a common skin bug that can cause potentially deadly wound infections in hospitals.

Standard procedures had not been able to show whether a genuine outbreak had occurred, or whether the babies had all coincidentally been exposed to MRSA.

The team was quickly able to confirm that 10 babies were part of an MRSA outbreak involving a previously unknown strain of the bug.

Measures were introduced to clear MRSA from carriers and deep-clean wards, but two months later a new infection case was identified in the baby unit.

DNA sequencing showed it was caused by the same strain identified earlier, carried to the ward by one of 154 screened health care workers.

Co-author Dr Julian Parkhill, head of pathogen genomics at the Wellcome Trust Sanger Institute in Hinxton, Cambridgeshire, said: ”The staff member was decolonised and went back to work, and we believe this brought the outbreak to a close.”

He said he expected the cost of whole genome sequencing of bacteria to fall from around £100 per sample to £50, and ultimately just ”a few pounds” in the near future.

”People are talking about the thousand dollar human genome,” he added. ”If you can do the human genome for a thousand dollars you can do a bacterial genome for one dollar.”

The MRSA outbreak at the Rosie Hospital, part of Cambridge University Hospitals NHS Foundation Trust, was estimated to have cost the NHS around £10,000. This was double the cost of the DNA sequencing, said the researchers.


Hand hygiene campaign cut hospital superbug infections

The campaign to improve hand hygiene in hospitals in England and Wales is contributing to a significant fall in the rates of superbug infections, according to a report.Hand hygiene campaign cut hospital superbug infectionsThe study published on the BMJ website showed the amount of soap and hand gel being used tripled during the campaign.

At the same time, levels of MRSA and C. difficile infections in hospitals fell.

The government has since dropped the campaign, but said its ambition was to “wipe out” such infections.

Hospital superbugs were once a real fear for many patients. In response the Clean Your Hands campaign, funded by the Department of Health, was introduced in all hospitals by June 2005.

Alcohol gels were put by bedsides, posters reminded staff to wash their hands and there were regular checks to ensure hands were kept clean.

By 2008, the total amount of soap and alcohol gel being purchased by hospitals trebled, going from 22ml per patient per day to 60ml per patient per day.

Rates of MRSA more than halved in the same time period and C. diff infections fell by more than 40%.

One of the report’s authors, Dr Sheldon Stone from the Royal Free University College London Medical School, estimated that around 10,000 lives were saved because of the campaign.

He told the BBC: “It’s been a real British success story, we’ve gone from being the dirty man of Europe to being world leaders.

“What we need to do is keep up the momentum and stay at the forefront of world hand hygiene.”

A spokesman from the Department of Health said: “The Clean Your Hands campaign was successful in its aim to highlight the importance of good hand hygiene practice across the NHS. We know this has been successful.

“The challenge now is to ensure the NHS embeds the good practice highlighted in the campaign to achieve our ambition to wipe out avoidable healthcare-associated infection.

“We know real progress has been made in this area as MRSA bloodstream infections have dropped by 41% and C. difficile by 30% across the NHS in England since 2009/10.”


Record number of patients catch infections in hospitals

The number of patients who contracted life threatening infections in NHS hospitals has almost doubled in two years to a record level, official figures have shown.Record number of patients catch infections in hospitalsRecorded cases of patients with a “nosocomial condition” – any infection acquired in hospital or a medical environment – also rose by more than a third last year compared with the year before.

A large proportion of the patients involved were aged over 75, the figures from the NHS Information Centre show. Illnesses related to such infections led to average stays in hospital last year of 31.1 days.

Experts blamed poor hygiene for the dramatic rise in infections, including superbugs MRSA and Clostridium difficile (C. diff) as well as norovirus and E.coli.

But the Department of Health dismissed the “misleading” figures, published online, saying that officials have “got better and better at tackling hospital infections”.

According to the new figures, supplied by NHS hospitals, the number of patients found by consultants to have hospital acquired infections rose last year reached a record 42,712.

That figure increased from the 31,447 recorded in the previous year and almost double the 22,448 documented in 2008/09.

Last year’s figures were the highest levels recorded in the 13 years in which the records have been publicly available. In 1998/99 there were just 335 such cases. The Centre did not provide a breakdown of illnesses.

It came as the Health Protection Agency said that there were 46 suspected outbreaks of norovirus in hospitals over the past two weeks, with more than half leading to ward closures or admissions restrictions.

The agency said the levels were within seasonal norms.

Commenting on the overall infection levels Joyce Robins, co-director of Patient Concern, said the figures were a “terrifying prospect for vulnerable elderly people who think they are going into hospital to get better”.

“It contrasts sharply with the happy propaganda that has been telling us that infection rates had dropped sharply,” she said.

A DoH spokesman said: “The NHS has got better and better at tackling hospital infections, demonstrated by the record lows we have seen this year.

“Because we are not complacent, we have introduced mandatory reporting of more hospital infections. That means that we have shone a light on the problems previously swept under the carpet.  But patients should be confident that the measures we have taken will continue the downward trend in hospital infections.”

Norovirus bug outbreak at 35 hospitals closes dozens of wards

Health officials have issued a warning about the serious threat posed by the norovirus bug after an outbreak has seen cases jump by 20 per cent on this time last year.Norovirus bug outbreak at 35 hospitals closes dozens of wardsThe winter diarrhoea and vomiting bug has affected 35 hospitals, with hundreds of beds unavailable after 27 wards were shut in the past two weeks to isolate infected patients and deep cleaned.

Overall confirmed individual cases across the country from July to mid-December are 19 per cent higher than during the same period last year.

Norovirus is extremely contagious and can be lethal to the elderly, very young or very sick patients.

People who have been ill are being asked not to visit friends and relatives in hospital until they are well.

Medical bosses at hospitals across the country are working to prevent the condition spreading and to reopen wards that were closed yesterday.

Nationally data from the Health Protection Agency released last week shows that norovirus rates remain below the level expected for this time of year, possibly reflecting the mild weather until now.

The HPA declares norovirus season has started when 4.8 per cent of calls to NHS Direct are about vomiting. Last week there were 4.2 per cent of calls about vomiting.

The first sign of Norovirus is usually a sudden sick feeling followed by forceful vomiting and watery diarrhoea. Other symptoms include a raised temperature, headaches, stomach cramps and aching limbs.

The data showed that last week the North East and South West were the worst affected.

Three hospitals reported that 124 beds are unavailable as a result of the ward closures. It is thought that the true number across all eight hospitals will be more than 200.

Wards were also closed to new patients at Montagu Hospital in South Yorkshire while 82 beds were closed on two wards at Northwick Park in Harrow, north London.

Croydon Health Services said it had one ward closed to new admissions.

Two wards were also closed at Warwick Hospital and the Richard Wells Ward was shut at Bedford hospital to contain a bout of gastroenteritis.

Director of nursing and patient services at Bedford hospital, Eiri Jones, warned visitors not to sit on hospital beds and not to visit at all if they had been ill in the preceding 72 hours.

Queens Hospital in Burton had one ward temporarily closed after a number of cases of diarrhoea and vomiting while the Countess of Chester Hospital had visiting restrictions in place at four wards to contain the outbreak.

A 14-bed ward at the University Hospital Southampton Trust was closed and County Durham and Darlington said it had seen isolated cases but had not had to close any wards.

Visitors to Northern Devon hospitals were warned only close relatives should visit patients and Mid Essex Hospital Trust said it had closed wards last weekend because of a similar outbreak.

The Royal College of GPs say the virus has not been a major problem so far this year – although outbreaks can occur very quickly, as the complaint is extremely infectious.

A statement from the Health Protection Agency said: “Norovirus is highly contagious and can be transmitted by contact with an infected person; by consuming contaminated food or water or by contact with contaminated surfaces or objects. The virus spreads rapidly in closed environments such as hospitals, schools, nursing and residential homes.

“Anyone who thinks they may have norovirus should not to go to their doctor’s surgery or A&E as this could spread the illness to vulnerable people and health care workers.”

Europe losing superbugs battle

The emergence of antibiotic resistant infections has reached unprecedented levels and now outstrips our ability to fight it with existing drugs, European health experts are warning.
Europe losing superbugs battleEach year in the EU over 25,000 people die of bacterial infections that are able to outsmart even the newest antibiotics.

The World Health Organization says the situation has reached a critical point.

A united push to make new drugs is urgently needed, it says.

Without a concerted effort, people could be dealing with the “nightmare scenario” of worldwide spread of untreatable infections, says the WHO.

One example is the New Delhi or NDM-1 superbug recently found in UK patients. They have brought the infection back with them from countries like India and Pakistan, where they had visited for medical treatment and cosmetic surgery.

The Cardiff University researchers, who made the discovery last August, now say bacteria with this new genetic resistance to antibiotics have contaminated New Delhi’s drinking water supply, meaning millions of people there could be carriers.

Dr Timothy Walsh and his team collected 171 swabs of seepage water and 50 public tap water samples from sites within a 12km radius of central New Delhi between September and October 2010.

The NDM-1 gene was found in two of the 50 drinking-water samples and 51 of 171 seepage samples.

Worryingly, the gene had spread to bacteria that cause dysentery and cholera, which can be easily passed from person to person via sewage-contaminated drinking water.

“Oral-faecal transmission of bacteria is a problem worldwide, but its potential risk varies with the standards of sanitation.

“In India, this transmission represents a serious problem… 650 million citizens do not have access to a flush toilet and even more probably do not have access to clean water,” the researchers warn in the journal Lancet Infectious Diseases.

The scientists are calling for urgent action by health authorities worldwide to tackle the new strains and prevent their global spread.

Zsuzsanna Jakab, WHO regional director for Europe, said: “Antibiotics are a precious discovery, but we take them for granted, overuse and misuse them: there are now superbugs that do not respond to any drugs.

“Given the growth of travel and trade in Europe and across the world, people should be aware that until all countries tackle this, no country alone can be safe.”

The UK’s Health Protection Agency said it was monitoring the spread of NDM-1 closely.

“The first case of a bacterial infection with this resistance was identified in January 2008. Monitoring of this resistance began in 2009 as more cases were identified.”

So far, there have been around 70 cases of the infection recorded in the UK.

The HPA insists that the risk of infection to travellers to the Indian subcontinent who are not treated in hospital is minimal.

“If members of the public are travelling for surgery overseas they should satisfy themselves that appropriate infection control measures are in place,” says the HPA.


MRSA Action UK’s fears for government’s continued failings over hygiene

MRSA Action UK’s dismay at the government’s continued failings to inform the public of the need to protect themselves from Swine Flu and other infectious illnesses that have become a modern day plague.
MRSA Action UK's fears for government's continued failings over hygieneWith H1N1 (Swine Flu), norovirus and the continuing threat from MRSA and Clostridium difficile in the community setting MRSA Action UK is dismayed that their calls for a public information campaign on both hand and respiratory hygiene have not been forthcoming.

Whilst there has been considerable efforts put into preventing avoidable infections in hospitals, the public are still largely unaware of the simple actions that can be taken to reduce the burden of avoidable infections in the wider community.

Resistant pathogens continue to concern many in the field of microbiology, but not all healthcare professionals are in tune with the need to inform their patients on the sensible use of antibiotics. Posters in surgeries are few and far between, workplaces, supermarket notice boards, schools and public transport could all help spread the word.

There are some NHS Hospital Trusts and Strategic Health Authorities that have taken the initiative to raise awareness, but with cuts in budgets for many this has been a lower priority, despite the fact that preventing infections is far more cost effective than trying to manage the consequences of contracting them in the first place, which can often be fatal.

The Swine Flu epidemic has served to heighten the need for information and more needs to be done to raise awareness not only of the need for those at higher risk to come forward for vaccination, but also to take the necessary precautions to help prevent and fight infections like the Swine Flu.

With cases of flu in England and Wales soaring by 45% in a week, Swine Flu reaching epidemic proportions in under-fives and 39 dead from flu, 36 from the H1N1 virus, it’s time for the government to put promised resources into a public information campaign.

The previous administration was criticised by the present Health Secretary Andrew Lansley for making promises it didn’t keep, the Labour government stepped down the resources that were earmarked for raising awareness by curtailing the “cleanyourhands” campaign and ignored the research findings that they themselves commissioned proving the need for a public information campaign. We had hoped the new administration would heed our warnings, but to date little has changed as the campaign has not come to fruition.

By Derek Butler Chair MRSA Action UK

Andrew Lansley- an open, transparent NHS is a safer National Health Service

The health secretary Andrew Lansley explains why Dr Foster’s Hospital Guide should be welcomed by patients and NHS professionals.
Andrew Lansley- an open, transparent NHS is a safer National Health ServiceIn the first speech I delivered as health secretary, I made one thing perfectly clear: we need a cultural shift in the NHS: from a culture responsive mainly to orders from the top down to one responsive to patients, in which patient safety is put first.

A key driver in this is the provision of meaningful and easily accessible information. An open, transparent NHS is a safer NHS. Dr Foster’s Hospital Guide, published today, is a welcome source of information about standards in healthcare services, which patients and purchasers of healthcare services can use.

In particular, the guide highlights high levels of “adverse medical events”, the widespread under-reporting of incidents and too many hospitals with death rates higher than one would expect.

Safe care saves lives and saves money. Adverse events like high levels of infection, blood clots or falls in hospital, emergency readmissions and pressure sores cost the NHS billions of pounds every year. There is a serious human cost too, with patients ending up injured, or even dead. Most are avoidable with the right care.

So what are we doing about it? For a start, the NHS consists of many highly skilled, dedicated and motivated people. We will free them from central control while holding them to account for the quality of care they deliver. Soon, GPs will be responsible for designing and paying for local health services, working with their colleagues across the NHS to get the best results for their patients.

We will shine a bright light on NHS performance. A new culture of openness and transparency will transform patient care. Everyone – patients, the public and other clinicians – will be able to see just how well a particular organisation, team or even an individual is performing. This will create a huge incentive for ever higher levels of quality and patient safety.

We have already published hospital infection data for MRSA and C-difficile online, updated weekly for all to see. And we are planning to publish regular data on other potentially fatal infections too. We are also changing the way we collect and publish mortality statistics so that they act as an early trigger for unsafe care.

In the coming years, we will add significantly to this, making it much easier for patients and their doctors to choose the best and safest care. Our plan to deliver a payment system linked to the result of treatments will encourage hospitals to improve the quality of care they deliver for patients – like our 30-day readmission tariff – and should help drive up even higher the standards of care in hospitals.

And we will focus on outcomes: reducing avoidable deaths, continually cutting infections, treating patients safely and successfully and then getting them back home. This already happens in heart care where publishing data on outcomes has been critical to taking our results well above those elsewhere in Europe. We want to see this happen across the board.

The NHS deals with nearly a million patients a day. No one can guarantee that nothing will ever go wrong. But we can eliminate the culture of blame and secrecy that can compound the initial mistake and stops lessons being learned.

I never want anyone working in the NHS to be afraid of coming forward when they believe patient safety is compromised. We will strengthen the whistleblowing rights of staff and place a duty on their employer to support and investigate their concerns.

I want the NHS to give all patients care that compares with the very best in the world. To help it achieve this, a new range of quality standards – designed by the professions themselves and monitored by the independent Care Quality Commission – will set out what safe, high-quality care looks like. But the standards will not dictate how this is to be achieved. This government will never undermine the clinical judgment of health professionals.

Where the NHS embraces a culture of transparency, of learning from its mistakes and constantly striving for higher performance, it is a world-beater.

There are real centres of excellence – the challenge now is to achieve that excellence across the whole of the health service.

The interview was carried at:

Payout for hospital chief after 90 superbug deaths after DoH bungle

A senior judge has delivered a stinging rebuke to the Department of Health over its treatment of a former head of an NHS trust that experienced the worst superbug outbreak in memory.
Payout for hospital chief after 90 superbug deaths after DoH bungleLord Justice Sedley gave his ruling as the Court of Appeal awarded more than £190,000 in damages to Rose Gibb, former chief executive of the Maidstone and Tunbridge Wells NHS Trust in Kent, where outbreaks of clostridium difficile from 2004 to 2006 infected more than 1,100 patients and led directly to 90 deaths.

Ms Gibb went to court after the Department of Health withheld a six-figure severance payment she had agreed in return for her resignation days before a report into the outbreak was published by the Healthcare Commission.

The judge said the trust had offered to compensate Ms Gibb, who was paid £150,000 a year, so it could “sacrifice on the altar of public relations a senior official who had done nothing wrong”. Its decision was one that “the Department [of Health] does not appear to have cavilled at,” he added.

But when the department later disallowed most of the payment, worth £250,000, it triggered the court action by Ms Gibb.

Lord Sedley said: “The effect of unwarranted departmental interference has been to trap the trust between a rock and a hard place and to expose it, in its attempt to escape, to heavy legal costs.” He added: “It seems that the making of a public sacrifice to deflect press and public obloquy, which is what happened to the appellant, remains an accepted expedient of public administration.”

The Healthcare Commission inquiry into the outbreak, published in October 2007, was highly critical of the trust’s leadership but pinned much of the blame on the Trust’s board – all of whom resigned following its publication.

The Commission’s report said the trust should review its leadership and the trust ordered its legal advisers to report on allegations against Ms Gibb. But no adverse findings were discovered and a decision was made not to remove her by the trust’s Remuneration Committee.

That decision was reversed at a meeting of the committee in September 2007, when it was decided to pay off Ms Gibb before publication of the Healthcare Commission report in October. It was agreed that she would receive £75,000 in lieu of notice and £175,000 compensation.

But the trust rescinded the agreement after being ordered by the director-general of NHS Finance, Performance and Operations to withhold the £175,000 compensation payment, which has since increased to £190,000 with interest.

The Court of Appeal yesterday ordered the trust to pay Ms Gibb the full amount of the compensation plus the costs of the court hearings.

Lord Sedley concluded: “Perhaps those responsible will now reflect that, since such blame as the report allocated was subsequently accepted by the trust’s board – all of whom resigned following publication of the report – there had been no good reason to dismiss the CEO; and that all this money, both compensation and costs, could have been spent on improving hygiene and patient care in the trust’s hospitals.”

Patients and relatives affected by the superbug reacted angrily. Former Bucks Fizz singer Cheryl Baker, whose mother-in-law Doreen Ford died at Maidstone Hospital in 2008 aged 77 after contracting clostridium difficile, called on Ms Gibb to give the money to the families whose loved ones died.