Swine Flu Return May Cause Rise in MRSA, Warns Influential Expert Group
As NHS hospitals face an even tougher winter than usual managing the rise in demand for beds alongside the second wave of swine flu, an influential group of doctors, scientists and patient representatives has called for the early discharge of appropriate MRSA patients to prevent a rise in MRSA infection rates.
The MRSA Working Group, together with National Concern for Healthcare Infection (NCHI) and the Patients Association, has written to all NHS hospitals reminding them to review their policy for the early discharge of MRSA patients.
The expert group urges hospitals not to let increasing pressure on staff and rising bed occupancy rates reverse the good work they have done to date to reduce MRSA rates. Research has shown that when a hospital's bed occupancy rate exceeds 90%, MRSA rates can be as much as 40% above average (1).
The NHS is also preparing for higher than normal levels of staff sickness at the height of the pandemic. Reduced staffing levels and reliance on temporary staff can contribute to increased levels of healthcare-associated infections (HCAIs) (1).
Dr Matthew Dryden, Consultant Microbiologist at the Royal Hampshire County Hospital and General Secretary of the British Society of Antimicrobial Chemotherapy, said, "The NHS has been working really hard to plan for swine flu and ensure there will be enough hospital beds available for patients who need to be admitted. What we don't want to see is an increase in infections such as MRSA, which have been linked to high bed occupancy rates. A way to get around this is to support patients with infections to get out of hospital earlier with outpatient and home care and good antibiotic stewardship."
The letter to hospitals outlines methods to help ensure sufficient critical care beds are available this winter through identifying MRSA patients and discharging them early as supported by Department of Health recommendations (2). Studies have shown that providing IV treatment at home (3) or switching eligible patients to oral antibiotics could free-up scarce hospital beds by enabling patients who are well enough to do so to go home earlier (4).
"When faced with a difficult winter, it is vital that hospitals ensure sufficient beds are available. Treating patients with infections such as MRSA at home can help by reducing their length of stay in hospital, freeing up much needed beds and easing pressure on staff and resources. It also helps to improve a patient's quality of life," Dr Dryden continued.
Katherine Murphy of The Patients Association, who co-signed the letter, commented: "There is a real risk that swine flu patients may block isolation beds resulting in patients with healthcare infections such as MRSA being treated on general wards. This coupled with a highly pressured and reduced workforce, could increase the risk of infections such as MRSA spreading to other vulnerable patients and throughout the hospital."
"Where possible and when it is clinically prudent, patients who have been infected or colonised with infections such as MRSA should be treated in the safety and comfort of their own homes," added Neil Manser, Corporate Executive of the NCHI. "Only then can we be sure we are doing our best to effectively contain the spread of infectious diseases such as MRSA and prevent further infection of hospital patients during any winter bed crisis period."
1. Department of Health. Hospital organisation, specialty mix and MRSA. 2007.
2. Department of Health. Pandemic Flu: A national framework for responding to an influenza panic. 2007.
3. Pfizer, MRSA separating fact from fiction, January 2008.
4. Desai M, Franklin BD, Holmes AH, Trust S, Richards M, Jacklin A, Bamford KB. A new approach to treatment of resistant gram-positive infections: potential impact of targeted IV to oral switch on length of stay. BMC Infect Dis. 2006;6:94.
Adapted from materials provided by Medical News TODAY