British Hospitals Struggle to Limit 'Superbug' Infections

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http://www.nytimes.com/2004/08/14/international/europe/14superbug.html?th

 

August 14, 2004

 

British Hospitals Struggle to Limit 'Superbug'

Infections

 

By LIZETTE ALVAREZ

 

LONDON - When James Wollacott badly wrenched his knee

while jumping on a trampoline in the back garden of

his house, the healthy, athletic 20-year-old imagined

a quick operation and a swift recuperation.

 

Instead, he spent three months in the hospital last

year, bedridden and gravely ill, battling high fevers

and a merciless staph infection. The infection was

M.R.S.A., short for methicillin-resistant

staphylococcus aureus, known as the " superbug,'' and

Mr. Wollacott picked it up when doctors inserted in

his kneecap four titanium pins.

 

More than a year after his accident, Mr. Wollacott,

who lives in Essex, still has trouble walking, mostly

because his knee failed to set and heal properly from

the infection, and he faces long-term arthritis. " You

just don't expect it, " he said. " You don't expect

going into a hospital and coming out worse. "

 

Britain has one of the worst rates of

hospital-acquired M.R.S.A. bloodstream infections in

Europe, second only to Greece, and the problem is

getting worse. The National Audit Office, a government

watchdog organization, announced this month that there

had been an 8 percent increase in the number of all

staphylococcus aureus, or staph, infections in the

bloodstream, to 19,311 in 2004 from 17,933 in 2001. Of

those, 40 percent were resistant to the antibiotic

methicillin.

 

But that reveals only a slice of the problem because

the Department of Health, which began to keep figures

on the infections in 2001, does not track the

existence of staph infections outside the bloodstream,

in wounds or in the urinary tract.

 

One in 10 patients contracts a staph infection while

staying in England's hospitals, which rank among the

oldest and most crowded in Western Europe. Because

superbugs multiply easily in unhygienic surroundings,

dirty hospital wards and unclean hands contribute to

their spread from patient to patient.

 

While estimates remain sketchy, mostly because the

cause of death is seldom narrowed to hospital-acquired

infections, the National Audit Office stood by its

assertion, first made in 2000, that the infections

result in at least 5,000 deaths a year.

 

Staph infection rates in the United States are also

increasing, said Dan Jernigan, a medical

epidemiologist at the Centers for Disease Control and

Prevention. An estimated 300,000 patients a year are

in the hospital with staph infections, and a third of

those patients have M.R.S.A., a rate that has steadily

increased in the past 30 years.

 

Edward Leigh, a conservative member of Parliament and

the chairman of the Committee on Public Accounts, said

there had been an " appalling lack of progress " in

tackling the infections. " The picture is bleak, " he

said. " It is a matter of shame that our M.R.S.A.

infection rate is among the worst in Europe. "

 

Prime Minister Tony Blair, while not as dire in his

choice of words, conceded that it was a " serious

problem. "

 

Responding to the increase in infections, John Reid,

the health secretary, announced plans this month to

try to curb the infection rates, including flying in

experts, installing hot lines by patients' bedsides so

they can alert the cleaning staff if something is

dirty, improving supervision of the cleaning staff and

ensuring that hospitals publish and display their

infection rates.

 

He also advised patients to ask nurses and doctors to

wash their hands before touching them, a suggestion

that was ridiculed by patients' rights groups that say

people in hospitals are often too sick and vulnerable

to make such demands.

 

M.R.S.A., a type of bacteria, is abundant in everyday

life. Most people carry it on their skin, and

typically it causes no harm. It is only when it enters

the body, either through wounds or punctures from

intravenous drips, for example, that problems can

occur. It can cause skin infections, sepsis and toxic

shock.

 

Often, exposure to a superbug results in only minor

problems. But at times, particularly in the elderly

and people with compromised immune systems, it can be

fatal.

 

Most staphylococcus infections can be treated with

antibiotics, but bacteria are constantly evolving and

becoming immune to these drugs, many of which have

been overused by the general population. For years,

the infections were treated with methicillin. Now, a

few stubborn infections must be treated with

vancomycin, the last drug in the arsenal to combat

staph infections.

 

With Britons keen on learning more about the dangers

of infection, newspapers around the country have been

clamoring to find victims and to publish their sordid

stories.

 

Leslie Ash, a well-known television star here who

appears on the BBC show " Men Behaving Badly, " has been

fodder for newspapers since she landed in the hospital

in April with a broken rib and a punctured lung.

 

Ms. Ash was treated and sent home but then forced to

return to the hospital almost immediately when

M.S.S.A., or methicillin-sensitive staphylococcus

aureus, attacked her body. The television star, who is

still in the hospital, can barely walk and is

seriously ill. For a time she was almost entirely

paralyzed.

 

In Britain, staph infections have taken root for

several reasons. A number of hospitals were built

decades ago and are not designed to isolate infected

patients; few have single and double rooms. Instead,

wards of six or eight people are common, and there are

frequently not enough wash basins. The government is

also under pressure to prune long waiting lists for

elective procedures, a factor that has aggravated

crowding and increased workloads.

 

" I think from the patient's point of view, it

increases anxiety, " said Pat Troop, the chief

executive for the Health Protection Agency, a

government organization that focuses on public health

protection. " People go into a hospital and they are

anxious anyway. You can't stop these infections

totally. There will always be a level of infection,

but the aim is to keep it at a minimum. "

 

Claire Rayner, the 73-year-old head of the Patients'

Association and a prominent member of the community,

said she had spent a lifetime vouching for Britain's

National Health Service, the government agency in

charge of medical care. But no more, she said.

 

Mrs. Rayner, a former nurse, is so worried about the

spread of infections that she opted not to send her

husband to the hospital after he fell and got a gash

in his brow.

 

" The average wait can be up to six or seven hours, "

Mrs. Rayner said. " I'm not letting a man with an open

wound sit in a ward with a room full of people, full

of I-don't-know-what bugs. "

 

Mrs. Rayner caught a minor case of M.R.S.A. three

years ago, when she was in the hospital for an

operation on her knee. She has been in several

hospitals for a variety of reasons since then, and

says she is appalled by the filth and the hygiene

practices. In one case, she watched dirt and dust pile

up in the corner of a ward. Nurses and assistants did

not always wash their hands. She had to call for a

basin when she needed to vomit, and then the nurse ran

off and left her alone.

 

Some hospitals do a better job than others. The

problem is rare among England's handful of private

hospitals, although those facilities seldom see the

most vulnerable patients.

 

And while most Britons rely on government-financed

National Health Service hospitals, a growing number,

like Mrs. Rayner, are choosing to spend their own

money on private care.

 

" It sounds awful complaining like this because in lots

of way they were good, " Mrs. Rayner said. " But I've

stopped using the N.H.S. Our hospitals are going

downhill. "

 

Alison Langley, a spokeswoman for the Department of

Health, said the agency was determined to do more to

combat the infections. In the meantime, there is no

need to panic, she said.

 

" I'm not sure how to reassure people, " Ms. Langley

said. " But M.R.S.A. is not a death sentence. "