Last week I outlined a grim situation that developed in the United Kingdom through the late 90’s and early 00’s. With the emergence of antibiotic resistant bacterial strains in UK hospitals, infections and deaths related to the bacteria MRSA were rising dramatically. Mostly because I didn’t want to write a novel in one post, I left off with a bit of a cliffhanger relating to what’s happened to UK MRSA trends since 2006/2007. To finish this story we have to understand not only what happened, but also why.
For a bit of background, the healthcare system in the UK consists of both public and private facilities/resources. The National Health Service (NHS) is a taxpayer funded public healthcare system operated by the UK Department of Health. This organization has a clear and long-standing mandate to deliver high quality healthcare on a need (NOT paying ability!) basis. The vast majority of healthcare in the UK is currently delivered through the NHS.
In the early part of this decade, in response to rising infection rates and increasing negative media coverage surrounding MRSA, the UK government began mandating aggressive national initiatives across all NHS Trusts. The CleanYourHands® campaign was established to ensure that NHS staff perform hand hygiene in an adequate and consistent manner.1 In addition, mandatory screening of all patients entering NHS hospitals for MRSA carriage was instituted,2 with many hospitals actually going one step further to adopt targeted MRSA decolonization strategies as standard of care. With these practices, a broad target was declared – the reduction of MRSA infections by half from 2004 to 2008.
So what effect, if any, did these interventions have on UK MRSA rates? The graph below, taken from a 2009 report by the UK Health Protection Agency, shows the 58% decrease in MRSA bacteremias between 2004 and 2008, expressed per 10,000 occupied bed-days.3 Furthermore, the overall proportion of surgical site infections attributed to MRSA has decreased from >25% to less than 20% in the same general timeframe.3 In 2009, the UK Office for National Statistics reported a 37% decrease in mentions of MRSA on death certificates from 2008.4 Bottom line – with aggressive and country-wide interventions, the NHS was able to significantly impact the threat of MRSA within its walls. Of course there’s still room for continuous improvement, as there remain roughly 3000 reported cases of MRSA infection annually in the UK.5
So, aside from feeling empathy for our English neighbors, why are we North Americans interested in this whole story? Well that answer is easy. I’m here to tell you that without active intervention by the government and/or healthcare profession the prevalence of MRSA is not going anywhere but up in our backyard. Furthermore, MRSA is just the tip of the iceberg. Strains of pathogenic bacteria have already emerged that are resistant to all known antibiotics, including the “last line” medicines that doctors withhold only for the most serious cases. We may not yet have experienced the same magnitude of problem as the UK and other European countries have, but this is likely due more to differences in population density than anything else. Even more disturbing, it can be argued that we’re already in the midst of a major problem, but our powers that be are slow to acknowledge the issues for fear of lack of adequate resources/solutions to deal with it. No doubt that the US and Canada enjoy some of the most advanced technologies and healthcare resources in the world, but in the case of infection control unfortunately Europe has adopted much more progressive views so far. Hey, look at it on the brightside……at least we have a model to look to when we start to realize things are gettin’ REAL bad….
2 UK Department of Health: MRSA Screening – Operational Guidance 2, published December 31, 2008
3 UK Health Protection Agency Report: “Trends in Rates of Healthcare Associated Infection in England 2004-2008”, June 2009.
4 UK Office for National Statistics: http://www.statistics.gov.uk/cci/nugget.asp?id=1067