Tuesday, November 28, 2006

Lewisham Hospital does belatedly well on MRSA: Are there lessons for us all?
A recent story has pointed out that Lewisham Hospital is winning the battle against the MRSA bug. The last three months have been infection-free, and this has resulted in the Government urging all NHS trusts to follow Lewisham’s successful programme. Great news! But has it been too late? And what does it say about embracing good practice from elsewhere?

A stringent screening programme of all adult emergency and non-emergency admissions for the bug began in October 2004. This has been complemented with extensive hand washing terminals throughout the hospital. In June 2005, a Healthcare Commission survey showed that Lewisham was the fourth-worst hospital in the country for MRSA so this is a major improvement. Yet could it have been better? And sooner? Between April 2001 and September last year, more than 220 people caught the infection while being treated at Lewisham. So there were cases of MRSA despite the screening programme being in place! And what became of Lewisham’s successful hydrogen peroxide trial in 2004? Developed in 1818 by Louis Jacques Thénard, hydrogen peroxide has been used by hospitals, in varying degrees, for decades, even before the arrival of the NHS in 1948: Retired nurse Cissie Ridings recalled using it for Ottorrhoea (discharge from the ear) in the War years. Ears were swabbed with hydrogen peroxide daily and if the solution bubbled, pus was present. Then the ears were mopped out with saline. One chief downside with it is that it can be corrosive especially in concentrated doses. It can destroy good tissue as well as areas of infection particularly where open wounds are being treated. In 2004, Lewisham Hospital took part in a trial where Dalek-like machines emitted peroxide as vapour. The company supplying the technology was Bioquell and they played a major role in the hospital’s MRSA `Search and Destroy’ policy. In one example, Bioquell points out that ten patients had MRSA in one surgical ward of twenty beds. A survey revealed that 35.7% of 28 surfaces and 27.7% of 18 air samples had the bug. The ward was emptied and cleaned with bleach for four days yet 16% of 65 surfaces still had MRSA. Bioquell were called in to decontaminate the ward using its peroxide-based Room Bio-Decontamination Service (RBDS). No adjacent areas experienced any leakage of peroxide vapour. The clean up allowed the ward to be occupied immediately afterwards, and RBDS was used in two other wards. But there are forms of hospital-associated infection that hydrogen peroxide reportedly struggles against: Bleach is apparently better than peroxide for some bacteria like Clostridium difficile, the biggest cause of hospital-acquired diarrhoea. Yet bleach could not shift the ward-based MRSA at Lewisham. But perhaps the biggest obstacle to ridding hospitals of infection is not choosing the right disinfectant: It is State bureaucracy. In December 2004, the Department of Health’s Rapid Review Panel lauded Bioquell in trial assessments in the fight against MRSA. However, one year later this newspaper reported that the same Ministry said more trials were needed before it could be rolled out to hospitals as standard practice. In fact, the Ministry went as far as to blame Bioquell for not making the business case to use them!

It seems to me that the State stands in the way of health care. Lewisham Hospital could have had an even better MRSA record but for the delay of Government in supporting the standard use of peroxide in combating MRSA. But there is another element to this argument. There is a major health sector today that literally caters to the public and has the hygiene problem licked. It’s the food industry. Not only are high standards of cleanliness rigorously imposed on workers, who must wear sterilised uniforms daily, but also visitors to plants. Malcolm Kane, is a food scientist with quarter of a century experience in managing food-related infection. He says: “Even a brief visit requires you to cover your head, take your shoes off on one side of a bench, swing your feet over to the other side and put them straight into a pair of freshly sterilised boots.” Professor Hugh Pennington, president of the Society for General Microbiology and a leading expert on hospital acquired infections, has stated that “the food industry certainly provides a model that could work in hospitals; what’s needed is more authority to push it”. Isn’t there a better way of rolling out technology, like Bioquell’s, which costs £100,000 a year to run per hospital yet can save lives as well as millions of pounds in MRSA claims? And would we all be prepared to support the fight against MRSA by volunteering ourselves to be `hygienically-cleared’ when we visit the hospital? Would Government support such an idea? I know I would, wouldn’t you?