Beating Healthcare-Associated Infections

By the Health Protection Agency

You’ve read all the papers with their screaming headlines about ‘superbug rampages wards’ and ‘hospitals on alert over superbug battles’. No one wants to go into hospital but sometimes we all have to. So what can you do to protect you and your family when a hospital visit or stay is necessary? In this article the Health Protection Agency gives you the basic facts about two bacteria which are often responsible for healthcare associated infections, MRSA and C-difficile, and outlines some of the ways in which you as a patient can take steps to prevent picking up an infection.

A bit of Perspective…

Recent years have seen an increase in the awareness of healthcare-associated infections (HCAIs), in particular those caused by antibiotic-resistant ‘superbugs’. The problem with the term ‘superbug’ is that scientifically or medically it doesn’t really mean anything at all. However it is a ‘catch-all’ phase that has been used to describe variously (and not necessarily correctly) bugs with more virulence, which cause infection more readily, cause more severe infection, or are difficult to treat.

HCAIs are infections that are passed person to person as a result of healthcare procedures, in hospital and other healthcare settings. A wide variety of bacteria and other micro-organisms can cause HCAIs, leading to an extensive range of different conditions.

Hospitalisation or interventions for the purposes of healthcare have always been associated with a risk of infection. There are number of factors that contribute to this risk:

• Underlying illnesses in a patient receiving treatment, for conditions such as cancer, diabetes, heart disease, can make patients more vulnerable to infection and mean their immune systems find it harder to fight infection. Treatments to manage the patient's illness and which may enable them to survive and prolong life, may leave them more vulnerable to infection.
• Invasive procedures such as surgery, renal dialysis, intravenous therapy, and artificial ventilation provide opportunities for bacteria and other micro-organisms to enter the body and cause infection.
• The use of antibiotics to treat one infection can render the patient susceptible to other bacteria, which may cause harm, for example, Clostridium difficile. The widespread use of antibiotics to treat infection, particularly in hospitalised patients, encourages antibiotic-resistant bacteria to emerge. This occurs naturally as part of the bacterial fight for survival. This may occur even when the right antibiotics are used, in the correct dose, for the correct duration. These resistant infections may be more difficult to treat.
• Caring for many patients together in hospitals provides opportunities for bugs to spread between patients. The greatest risk of infection is associated with hospital patients because of the severity of their illness and type of invasive procedures they undergo. However, increasingly complex care is now provided in clinics or the patient's own home and these are also associated with risks of infection.

Not all HCAI can be prevented. Advances in healthcare have meant that many more people now survive serious disease, but infection may be one of the many risks associated with their treatment. Therefore the risk of infection has to be balanced against the need for, and benefits from, the treatment.

The truth about MRSA

MRSA stands for Methicillin Resistant Staphylococcus aureus. Methicillin, the ‘M’ bit, is an antibiotic which is very similar to that used normally to treat Staphylococcus aureus infections (flucloxacillin). Staphylococcus (‘S’) aureus (‘A’)is a common germ that is found on the skin and in the nostrils of about a third of all healthy people. Most of the time, Staphylococcus aureus lives harmlessly on the skin and does not cause a problem. However, skin breaks (cuts, surgery) can allow the bacteria to get into the body, where they may cause localised infections, such as boils or abscesses, or more generalised infection, such as blood poisoning.

There are many different types of Staphylococcus aureus (SA), but it is the types that are resistant (‘R’) to methicillin which cause most concern to patients at the moment.

MRSA can behave just like strains of Staphylococcus aureus which are sensitive to common antibiotics – for instance, they may cause no harm at all, or mild localised infections or severe, potentially life-threatening infections.

MRSA is not normally a threat to healthy people, including the elderly, pregnant women, children, babies or those coming into hospital for elective procedures. It is much more likely to affect people who have certain long-term health problems, particularly people who have chronic skin conditions or open wounds.

The difference from C. difficile

Like MRSA, Clostridium difficile (C difficile) is a bacterium which can cause HCAI and is also sometimes referred to as a ‘superbug’. However, these are completely different bacteria, unrelated to MRSA. They have different habitats and different risk factors. The concern about MRSA largely relates to the difficulty in treating infections with an organism which is resistant to common antibiotics. C. difficile is present in the gut of up to 3% of healthy adults and 66% of infants and normally only causes problems when certain antibiotics disturb the balance of the ‘good’ bacteria in the gut.

Prof Peter Borriello, Director for the Centre of Infections for the Health Protection Agency explains, “You can drink a whole glass full with millions of C. difficile germs. So long as you are healthy, this won’t cause any problems at all and they won’t contract infection with C. difficile. But in hospital environments, where many patients are on antibiotics which can upset the healthy, friendly bacteria in the gut, problems can start”.

C. difficile can survive in the environment for a long time – on any surface, piece of equipment, furniture or furnishing. Vulnerable people (for instance, those on certain antibiotics) can become infected simply by touching contaminated surfaces and then touching their mouths. This is why hygiene and regular cleaning is so important on hospital wards. Patients who are exposed to C. difficile may suffer no ill effects if they have normal, healthy gut flora. However, those whose gut flora has been disturbed may develop infection, ranging from mild to severe diarrhoea with serious inflammation of the bowel.

Clostridium difficile can also be spread from person to person by poor hygiene, for instance by failing to wash your hands properly after going to the toilet and before handling food.

What YOU can do about MRSA and C. difficile

The Royal College of Nursing has devised the following check list for people about to go in to hospital.

You can help yourself and other patients by:

• always washing and drying your hands after visiting the toilet and before you eat
• not touching or fiddling with your wound or any device that is in your arm/leg/bladder or other body cavity - for example a drip or catheter
• keeping the space around you tidy and uncluttered so that the cleaning staff can access all surfaces to remove dust easily – your visitors or relatives could help you to do this
• telling your nurse, the matron, or clinical leader, if you spot any dirt or dust on the ward
• washing and drying your hands before and after helping other patients
• showering as frequently as you are able
• reminding staff about hand washing if they forget (they may use alcohol hand rub nearby as this efficiently cleans hands as an alternative) - don’t worry they won’t be offended
• asking your visitors to wash and dry their hands thoroughly before and after entering the ward/home and not to sit on your bed or use the patients’ toilets
• not sharing possessions or equipment with other patients unless it has been cleaned.
• asking your relatives and friends not to visit in large groups.