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MRSA - Medical disaster on the horizon?

The control of hospital-acquired infections, including MRSA, should be a priority for both the present Minister for Health and Children, Mary Harney, TD, and the Health Service Executive (HSE). An appalling vista of strife and tribulation which will inevitably culminate in unnecessary litigation is materialising on the horizon.

The dearth of response by the Cabinet to put in place an effective strategic plan to meet and address the issues of relevance, in terms of reducing the incidence of MRSA infection, is nothing short of disgraceful.

Over the past ten years, the failure of the State to learn from the mistakes of the past as each and every medical catastrophe materialises is shocking. Policies to combat medical catastrophes, such as MRSA infection, should commence at ministerial level. They should be introduced and implemented throughout the healthcare system, from the CEO to all hospital personnel, in order for such policies to be effective.

Through my practice in health law and medical negligence, I have had both the privilege and misfortune to address the consequences of medical malpractice, health catastrophes and government inadvertence on a daily basis. At first hand, I have seen the effects of Hepatitis C infected Anti-D immunoglobulin, Hepatitis C and HIV infected blood products, institutional abuse, unlawful caesarean hysterectomies and many other medical misadventure scenarios. The cost in human suffering, emotional upset and loss of quality of health is more significant than any financial cost. Yet again, I see another Irish medical disaster materialising on the horizon.

At the present time, persons facing admission to hospital are more concerned about the prospect of MRSA infection than any surgical procedure which they may undergo. There are many strategies that should be introduced for the purposes of controlling, reducing, and possibly eliminating MRSA from the hospital environment. One must question whether the neglect, omission, or inability to introduce such policies is motivated by inappropriate factors. Certainly, it cannot be countenanced that the failure to introduce such policies is motivated by lack of financial funding.

More effective MRSA policies would reduce infection and clarify responsibility for infection. These policies, if introduced, would also have the effect of assisting in the establishment of a valid MRSA litigation claim against the State. The neglect to introduce effective policies such as MRSA testing upon admission to hospital, in effect, results in the burden of proof being extremely difficult to establish for any potential plaintiff who has developed MRSA except by breach of Statutory Duty. An MRSA infection is potentially catastrophic and can result in death, paralysis, further infection from flesh eating bugs and other equally horrific consequences.

In addition, a culture of inadvertence, including concealment has developed. Patients are not informed in a timely manner, and in some cases not at all, of their MRSA infection. There appears to be a reticence on the part of medical professionals to disclose details associated with these MRSA type infections, which should have been avoided.

Each potential patient in a hospital should carefully consider a proposed MRSA Charter including:

1. Ensuring that MRSA testing occurs on date of admission or shortly thereafter. If an MRSA type problem materialises at a later date, this will assist in establishing whether it is a hospital-acquired infection.
2. Insisting upon your entitlement to a hospital bed. Don't accept being placed on a trolley or in a corridor as this puts you at greater risk of contracting MRSA.
3. Drawing the attention of the relevant authorities if the hospital environment is unclean to the naked eye.
4. Ensuring that each and every medical or healthcare professional who comes into contact with you wears gloves or alternatively washes their hands. Hospitals have provided sufficient hand-cleaning facilities, but, unfortunately I must indicate that, from personal knowledge and experience these facilities are on occasion disregarded.
5. Checking the MRSA statistics in respect of the hospital to which you are being admitted for the purposes of being satisfied that the risk of MRSA infection is minimised in that hospital.
6. Postponing elective surgery if the risk of contracting MRSA is high in the hospital that you are being admitted to.
7. Obtaining a single room with private toilet facilities, if at all possible, as this will similarly minimise the risk of infection and transmission. In Scandinavian countries, single hospital rooms have significantly contributed towards the reduction of MRSA infection.

Regretfully, Irish hospitals are endemic with MRSA infection. In Scandinavian countries the risk of MRSA infection is less than 1 percent. Both the Minister for Health and Children and the HSE should learn from the way in which healthcare personnel from these countries achieve such good infection control results. In short, it appears to be a matter of cost and making choices in terms of your healthcare budget as to whether MRSA can be almost eliminated from a healthcare setting.

Hospitals should ensure that healthcare professionals who are treating MRSA infected patients only treat such patients. In addition, single rooms or isolation facilities should be available for MRSA infected patients. Hospitals should screen patients on admission in order to isolate them if there is a potential risk to other patients. There should also be sufficient personnel employed to implement the infection control procedures.

In the Netherlands, where MRSA infection rates are as low as in Scandinavian countries, there are strict hospital policies. Any patient who tests positive for MRSA or any other hospital-acquired infection is immediately isolated. The healthcare professionals who are caring for such patients wear aprons, masks and gloves, and the air pressure in the allocated single rooms can be lowered to reduce the risk of the spread of infection. A patient who is not in isolation and is unexpectedly found to have acquired MRSA is immediately isolated. In addition, all healthcare workers who have been in contact with infected patients are tested for MRSA. Any healthcare professional that tests positive for MRSA is kept away from patients until that person has cleared the MRSA infection. Also, there is a policy of restrictive antibiotic usage in these hospitals. All of the foregoing has had the effect of reducing and almost eliminating the incidence of MRSA infection.

In Ireland, the situation is radically different. Despite reassurances from the Minister for Health and Children and the Health Service Executive, progress towards addressing the valid concerns amongst members of the public and patients about antibiotic resistance has been extremely slow. Some five years after the launch of the SARI report (Strategy for the Control of Antimicrobial Resistance in Ireland), national levels of MRSA remain unacceptably high and, in the case of certain pathogens, have significantly increased. Whilst people continue to suffer and die, a proper and effective strategic plan is still awaited.

Shamefully, Ireland is one of the few countries in Europe without a national system for appropriate surveillance of healthcare associated infections. An urgent response is required in order to ring fence appropriate financial and healthcare resources at both national and local levels for the development and implementation of a strategic development plan to fight MRSA infection.

In addition, key appointments are required for the purposes of addressing the deficit in hospital personnel. Similarly, additional budget allocations are required to address the lack of appropriate hospital facilities. The State's response has been to the effect that there is nothing that we can do to eliminate MRSA infections. Instead, they have taken adopted a wait and see approach! Yet other countries have almost eliminated MRSA infections by implementing a proactive strategy. Is the dearth of response by the Minister for Health and Children, the HSE and the hospitals the result of being incapable, unwilling or inept in reducing and almost eliminating MRSA infection? Traditionally, our citizens have ignored the political sins of the past, including financial irregularities, resulting in limited political fallout. The personal consequences for all Irish citizens are so significant that such procrastination, inadvertence and lack of progress should not be condoned when a Government puts the safety of vulnerable hospital patients at risk. Now is the time for action to eliminate MRSA.

Raymond Bradley,

Managing Partner of Malcomson Law Solicitors

Published in the Irish Medical News on Monday, 02 April, 2007.

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Further information re. MRSA

Case Study: MRSA

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