I’m pretty sure I have Clostridium difficile, AKA c dif. I’m thinking Zeke has it, too. I’ve been reading up on people and dogs with it. We are miserable

Why do we always get the sickest for nights, weekends and holidays?

Health care-associated infections are on everyone’s mind these days and the costs related to HAIs continue to rise, adding $28 billion to $33 billion in unnecessary health care costs every year. To help combat these costs and dangerous patient care HHS Secretary Kathleen Sebelius recently announced the award of $17 million to fund projects to fight HAIs.

“When patients go to the hospital, they expect to get better, not worse,” Secretary Sebelius said. “Eliminating infections is critical to making care safer for patients and to improving the overall quality and safety of the health care system. We know that it can be done, and this new initiative will help us reach our goal.”

$8 million of the $17 million will fund a national expansion of the Keystone Project, a project started by Johns Hopkins University and the Michigan Health & Hospital Association to implement a “comprehensive unit-based safety program”. Within the first 18 months the program was successful in reducing the rate of central-line blood stream infections, CLA-BSIs, in more than 100 Michigan intensive care units, saving 1,500 lives and $200 million in healthcare facility costs.

The Keystone program involves:

• Utilizing a checklist of evidence-based safety practices;
• Staff training and other tools that can be implemented in hospital units for preventing infections;
• Standard and consistent measurement of infection rates; and
• Tools to improve teamwork among doctors, nurses and hospital leaders.

With additional funding from AHRQ and a private foundation, the Keystone Project is now operating in all 50 states, Puerto Rico and the District of Columbia. The new funding will expand the effort to more hospitals, and settings in addition to ICUs, and broaden the focus to address other types of infections.

For more information and a complete list of the funding: http://www.ahrq.gov/qual/haify09.htm.

Envision Inc.’s Related Video Training programs:

“Preventing Central Line-Associated Bloodstream Infections” (CLA-BSI), http://www.envisioninc.net/index.php/programs/details/preventing_central_line_associated_bloodstream_infections_cla_bsi/

This program is in line with the recommendations, interventions and evidence-based practices promoted in the Keystone Project and is an excellent tool for those facilities following this initiative.

Presented in association with the AVA (Association for Vascular Access), this 15-minute training program includes an in-depth Study Guide, Post Test and Tools: Nursing Checklist for Central Venous Catheter Insertion, and the AVA’s SAVE that Line Poster and Reference Card.

Featuring renowned infectious disease expert Dennis Maki, MD, the program also comes with a Bonus Track Video with additional educational information. The training video features the latest evidence-based practice from the CDC and HICPAC / SHEA / IDSA / APIC recommendations for preventing central line-associated bloodstream infections.

“Infection Control 8-Minute Solution: MRSA”, http://www.envisioninc.net/index.php/programs/details/infection_control_8_minute_solution_series_mrsa/

“Clostridium difficile: A Growing Threat”, http://www.envisioninc.net/index.php/programs/details/clostridium_difficile_a_growing_threat/

Source: Clean, Safe Care

Follow this link for fulltext

Date of publication: 9^th September 2009

Publication type: Best practice

In a nutshell: A Root Cause Analysis (RCA) is an essential activity to undertake following the diagnosis of a health care associated infection.   Clean, Safe Care has developed a toolkit for implementing a clearly defined process for undertaking a RCA, in order to identify areas that require improvement and minimise the chance of recurrence.   The toolkit includes data gathering tools, training materials, case studies and checklists.

Clostridium Difficile Deaths [Scotland] – report from the General Register Office for Scotland – 7 August 2009
Last Updated 7 August 2009

“This section presents information on the numbers of deaths for which Clostridium difficile was mentioned on the death certificate.

Why these figures must be used with caution

In its “Report on Review of Clostridium difficile Associated Disease (CDAD) cases and Mortality in all Acute Hospitals in Scotland …” (published on 7 August 2008), Health Protection Scotland (HPS) wrote that:

“… four NHS boards undertook detailed case note reviews …. [and] … found marked discrepancies between the General Register Office for Scotland (GROS) data and the actual cause of death.”  “

… continues on the website

Clostridium difficile is a potentially deadly bacteria associated with diseases ranging from severe diarrhea to colitis and sepsis. Clostridium difficile, often called C. difficile or “C. diff,” is a bacterium that can cause symptoms ranging from diarrhea to life-threatening inflammation of the colon.

Illness from C. difficile most commonly affects older adults in hospitals or in long term care facilities and typically occurs after use of antibiotic medications.

Symptoms: For mild to moderate disease, watery diarrhea three or more times a day for two or more days; mild abdominal cramping and tenderness. For severe disease, watery diarrhea 10 to 15 times a day, severe abdominal cramping and pain, fever, blood or pus in the stool, nausea, dehydration, loss of appetite and weight loss.

Causes: The bacteria is passed in feces and spread to food, surfaces and objects. The majority of cases occur in health-care settings.

Risk factors: Taking antibiotics; being 65 or older; being hospitalized recently; living in a nursing home; having a serious underlying illness or weakened immune system; having recent abdominal surgery or a gastrointestinal procedure; having a colon disease.

Treatment: Certain antibiotics, usually metronidazole or vancomycin; probiotics to restore a healthy balance to the intestinal tract; removal of the diseased portion of the colon in severe cases.Sources: Mayo Foundation for Medical Education and Research; Association for Professionals in Infection Control and Epidemiology

Lessons learned from NHS QIS visits to NHS Orkney, NHS Highland and NHS Grampian following C.difficile incidents

About these reports

“Each NHS board report contains specific findings. Together they identify:

* a need for a fresh look at implementing healthcare associated infection (HAI) guidance
* a need for greater clarity within Health Boards on internal working systems and practices on HAI prevention
* a need within Health Boards for improved monitoring systems, antibiotic prescribing, and collaborative working across Scotland in relation to HAI. “

About the visits

“We have recently undertaken ‘shared learning’ visits to three NHS boards following Clostridium difficile (C.difficile) outbreaks.

These visits were carried out at the request of the Scottish Government Health Department (SGHD).  Below is a link to the NHS Board specific reports from each of these visits along with an overview report which draws together the key themes and learning points from the visits along with potential solutions for addressing the challenges we face.”

* Lessons Learned Overview Report (PDF, 205K)

* NHS Orkney – Clinical Governance Diagnostic Review (PDF, 231K)

* NHS Grampian – Infection Prevention and Control: Improving through Learning (PDF, 226K)

* NHS Highland – Infection Prevention and Control: Improving through Learning (PDF, 207K)

Source: Clean, Safe Care
For fulltext link here 
Year of publication: 2009
Publication type: Case study
In a nutshell:  The project aims to improve PCT board assurance in infection prevention and control (IPC) and to keep the trust board informed with an ‘at-a-glance’ view of the present position with regards to MRSA, Clostridium Difficile and other infections. The dashboard captures in one place all relevant assurance data from providers (including internal, ie PCT providers) about their performance regarding infection control.  The dashboard is also intended to provide information as an ‘early warning’ indicator to identify future trouble spots.
Length of publication: Series of 4 PDFs

Source: Oxoid
Follow this link for fulltext
Date of publication: 2009
Publication type: News item

In a nutshell: The infection control team at the Heart of England NHS Foundation Trust has been awarded the 2008/2009 Oxoid Infection Control Team of the Year Awards.  Significant cuts in MRSA and Clostridium Difficile rates impressed the judges as well as innovations including the provision of training in aseptic technique combined with blood culture packs designed to reduce contaminated cultures.

Length of publication: Web page
Acknowledgement: Nursing Times

Source: NHS Purchasing and Supply Agency, Centre for Evidence Based Purchasing

For fulltext link here

Publication type: Report

In a nutshell: Report evaluating different Clostridium Difficile toxin detection assays.

Length of publication: 36 pages

Some important notes: This is report CEP08054 in the CEP catalogue.

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Source: Clean, Safe Care

For fulltext link here

Year of publication: 2009

Publication type:  Case study

In a nutshell: Case study outlining a range of activities undertaken at Wirral to reduce Clostridium Difficile infection (CDI) through various activities relating to the four Ps of Health Care Associated Infection (HCAI): people, performance, policies and practice.  CDI cases have been reduced by 35% in the hospital and community setting.

Length of publication: 8 pages

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From Internal Medicine 2009, the annual meeting of the American College of Physicians in Philadelphia

Alcohol-based hand sanitizer gels have revolutionized our concept of cleanliness over the past decade or so.

courtesy of Flickr user cag2012

Upscale public toilets sport gel dispensors  on the wall. My daughter’s summer camp a couple of years ago placed a few huge pump bottles at the entrances to their dining hall. Mini vials of the stuff, sitting in large baskets, became a popular freebie in the exhibit hall at many medical meetings, the small plastic bottles often coming in a clip-on sleeve so health-care providers could dangle them from their white coats. Just in the past year or two I began noticing wall-mounted gel squirters in the hallways at my local hospital that seemed placed every 10 or 20 yards.

That same decade has seen a “precipitous” rise in the  incidence of Clostridium difficle associated disease (CDAD), a potentially deadly, hospital acquired infection in the U.S. and many other countries, said Dr. Dennis G. Maki,  an infectious diseases physician at the University of Wisconsin in Madison.  Today, it’s estimated that more than 300,000 cases of CDAD occur in the U.S. annually, more than the number caused by methicillin-resistant Staphylococcus aureus, he said. Compounding the problem is a “super-virulent” strain of C. difficile that began to spread in the early 2000s, with a mortality rate of 10%-15% and resistance to metronidazole, one of the only two antibiotics that were effective against the bacterium (the other is vancomycin).

Dr. Dennis G. Maki/photo Mitchel Zoler

Hospital-acquired C. difficile and CDAD is “one of the most important emerging infectious diseases,” despite being first identified as a human disease only about 25 years ago, Dr. Maki said. Hospitals are “greenhouses” for it, with C. difficule spores covering all their surfaces.

What might explain the spike in CDAD in the 21st century? The super-virulent strains, more older patients (the most susceptible age group), and broader use of antibiotics that set the stage for C. difficule overgrowth probably have all played a role. But Dr. Maki hypothesized that heavy responsibility lies with another culprit: alcohol-based hand sanitizers.

A smear of hand sanitizer will not inactivate C. difficile spores (actually hardly anything will aside from bleach). Primarily for this reason, when Dr. Maki makes rounds in his hospital he cleans his hands between patients by scrubbing with some chlorhexidine and running water (he says plain soap also works). The physicial act of hand scrubbing under water will mechanically drop the number of spores carried on the hands. “I do not use alcohol-containing hand rubs,” he said.

Sanitizer gel seems so handy, so effective, and it does work at eliminating many hand-borne pathogens. But here’s another example where bacteria trump human ingenuity.

—Mitchel Zoler (on Twitter @mitchelzoler)

I had an infection in my head recently which recurred repeatedly despite treatment with antibiotics. An antibiotic called Suprax finally knocked the infection into submission. Unfortunately, it also knocked the lining of my large intestine into submission. Since finishing the antibiotic just over three weeks ago, I have suffered from intermittent colitis. For those who don’t know what the symptoms of colitis are, I’ll spare you the details. Suffice to say, I’ve spent a lot of time in the bathroom in the last few weeks.

Diarrhoea is a common side-effect of antibiotic treatment. When I consulted my GP with worsening symptoms a week after stopping the Suprax, he suspected that I may have developed an infection known as Clostridium difficile. This highly contagious bacterial infection of the bowel can occur following antibiotic treatment but laboratory tests last week ruled it out. Or so we thought.

I was given medication to quell the increasing nausea but over the Easter weekend, the pain in my intestines worsened and I was forced to seek medical help again. This time the hospital came back saying that the antibiotic-associated colitis must be urgently treated. There are two antibiotics used to treat C. Diff and associated infections, called Flagyl and Vancomycin.  I had a severe reaction to Flagyl many years ago and as I am considered high-risk because of a previous history of pseudomembranous colitis, I have been prescribed the drug of “last resort”, Vancomycin.

Vancomycin is normally given intravenously for the treatment of serious, life-threatening infections such as MRSA but it can also be used to treat colitis. When taken orally, the drug does not cross through the intestinal lining and remains in the intestines. As this is exactly where it’s needed at the moment, it is the drug of choice. Fingers crossed please!

In the meantime, tests results have suggested that chronic osteomyelitis is recurring in the bone around my eye. I am presently awaiting an appointment to return to the specialist unit in the UK, for assessment. The bugs go marching on.

__________

Earlier this year, Harold and Freda Mitchell of Como, Miss., both came down with a serious stomach bug. At first, doctors did not know what was wrong, but the gastrointestinal symptoms became so severe that Mrs. Mitchell, 66, was hospitalized for two weeks. Her husband, a manufacturing supervisor, missed 20 days of work.

A local doctor who had worked in a Veterans Affairs hospital recognized the signs of Clostridium difficile, a contagious and potentially deadly bacterium. Although the illness is difficult to track, health officials estimate that in the United States the bacteria cause 350,000 infections each year in hospitals alone, with tens of thousands more occurring in nursing homes. While the majority of cases are found in health care settings, 20 percent or more may occur in the community. The illness kills an estimated 15,000 to 20,000 people annually.

“It’s been the worst thing I’ve ever tried to get through in my life,” said Mrs. Mitchell, who remains weakened by the ordeal. “I really did think I was going to die.”

What is so frightening about C. difficile is that it is often spurred by antibiotics. The drugs wipe out the targeted illness, like a urinary tract or upper respiratory infection, but they also kill off large portions of the healthy bacteria that normally live in the digestive tract. If a person comes into contact with C. difficile, or already has it, the disruption to the beneficial bacteria creates an opportunity for the harmful bacteria to flourish.

The public health community has been sounding the alarm for years about the overuse of antibiotics and the emergence of “superbugs” — bacteria that have developed immunity to a wide number of antibiotics. But the C. difficile problem shows that the threat is not generalized or hypothetical, but immediate and personal.

“One of the things that we counsel consumers about is to make sure that an antibiotic is really necessary,” said Dr. Dale N. Gerding, an infectious disease specialist at the Stritch School of Medicine at Loyola University in Chicago. “There are many good reasons for taking an antibiotic, but an illness like sinusitis or bronchitis winds up being treated with antibiotics even though it will go away by itself anyway.”

Even appropriate use of antibiotics can put a person at risk. Dr. Gerding said his own adult son came down with a C. difficile infection after taking antibiotics for tonsillitis.

The typical treatment for C. difficile is another course of antibiotics, typically the drug vancomycin. But the situation can quickly turn tragic. The Centers for Disease Control and Prevention has reported on several cases of pregnant and postpartum women who developed life-threatening C. difficile infections after being treated for minor infections. In some instances, a C. difficile infection can be treated only by emergency surgery to remove the patient’s colon. Doctors say many patients report that they continue to suffer from regular bouts of diarrhea even after the infection is gone. About 20 percent of patients with the infection suffer a relapse, and C. difficile support groups have emerged on the Internet.

In the case of the Mitchell family, Mr. Mitchell had been taking antibiotics for another health problem, and the treatment apparently led to his C. difficile infection. Mrs. Mitchell probably contracted the illness from her husband. The spores from C. difficile are hardy, and contaminated surfaces must be scrubbed down with bleach to eradicate the germ. Doctors say Mrs. Mitchell’s illness is unusual because most people are protected by their own bacterial flora and wouldn’t be vulnerable to C. difficile if they had not been taking antibiotics, even after close exposure. The risk of contracting C. difficile outside the health care setting remains low, at about 7 cases per 100,000 people, studies show.

C. difficile is not a new illness, but it appears to be spreading at an alarming rate. The rate of C. difficile infection among hospital patients doubled from 2001 to 2005, according to an April 2008 report from the C.D.C. The rise in C. difficile cases around the world is linked with the growing use of all antibiotics, particularly a class of drugs called fluoroquinolones, which came into widespread use around 2001. The use of acid-suppressing drugs, including proton pump inhibitors like Prilosec, also may be a risk factor, although studies have been contradictory.

In addition to becoming more common, C. difficile is also becoming more deadly. Several years ago, the mortality rate from a C. difficile infection was around 1 to 2 percent. But today, various studies estimate that the death rate is 6 percent. The reason is that a hypervirulent strain has emerged that emits higher levels of toxins than earlier strains.

Many patients are far more familiar with another superbug, methicillin-resistant Staphylococcus aureus, or MRSA, which can cause a severe and potentially deadly skin infection. MRSA started off primarily as a hospital-based infection but has become increasingly common in the community.

Hospitals may become more motivated to control C. difficile if the Centers for Medicare and Medicaid Services decides to withhold reimbursement for cases of hospital-acquired C. difficile infections. The system already withholds reimbursement for certain other preventable hospital infections.

In addition to careful use of antibiotics, patients and hospital visitors should always be vigilant about hand washing, and visitors should not sit on a patient’s hospital bed or use a patient’s restroom if it can be avoided. Patients should always report severe diarrhea symptoms to a doctor, particularly if they have taken antibiotics recently.

“Up until about 2002, this was a very mild disorder and very few people ever died from it,” said Dr. Perry Hookman, a gastroenterologist and associate professor of medicine at the Miller School of Medicine at the University of Miami. “But in the past few years the bugs have become hypervirulent, more severe and now it’s a global threat.”

__________

Full article and photo: http://www.nytimes.com/2009/04/14/health/14well.html?hpw

Clostridium difficile infection: how to deal with the problem

This guidance outlines newer evidence and approaches to delivering good infection control and environmental hygiene and updates the 1994 DH/PHLS guidance(Department of Health – publications)   15 January 2009

See also the June 2009 report from NHS Health Quality in Scotland looking at the Lessons learned from NHS QIS visits to NHS Orkney, NHS Highland and NHS Grampian following C.difficile incidents

Source: Department of Health

For fulltext link here

For Abstract link here

Year of publication: 2009

Publication type: Practice Guidelines

In a nutshell: Guidance  outlining newer evidence and approaches to delivering good infection control and environmental hygiene. This documents updates the 1994 DH/PHLS guidance (Clostridium difficile infection: Prevention and management)

Length of Publication: 140 page pdf document

Acknowledgement: DH Website

Source: University College London Hospitals NHS Foundation Trust

For fulltext link here

Year of publication: 2009

Publication type: Case Study

In a nutshell: A pilot hand hygiene campaign funded by the Department of Health was launched at University College Hospital on Tuesday 24 February.   The campaign aims to to engage, excite and motivate people to improve hand hygiene and to change their attitudes and behaviour.  The campaign uses new technology and communication strategies such as viral messaging, holograms, laser displays and a specially commissioned song for YouTube.

Length of publication: 1 web page

Source: Department of Health

For fulltext link here

Year of publication: 2008

Publication type: Best Practice

In a nutshell: A compendium designed to identify areas of good practice arising from the national deep clean initiative and become a basis for sharing learning across organisations.

Length of publication: 29 page report

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Acknowledgement: New Documents Bulletin

Source: Clean, Safe Care

For fulltext link here

Year of publication: 2009

Publication type: Case study

In a nutshell: This case study examines the planning and development of a 12 bedded cohort isolation facility on Broadwater Unit, Worthing Hospital, designed to combat the spread of Clostridium difficile (C.difficile) within the Trust. Caring for all affected patients in one place allowed a co-ordinated approach to the medical treatment and nursing care of patients.

Length of publication: 4 page PDF document

I’m home, I got released today.  Happy.  Showered, brushed teeth, resting.

Final diagnosis for Angela & myself: Viral Gastroenteritis (Stomach Flu), possible Foodborne Illness

Still trying to figure out what ECTP means, but isolation cart and getting told I better not use any bathroom other than the portable toilet that got stuck in my ER room was pretty clear.  Pictures are from when the hospital was suspicious and testing me for C. Diff.  Oh jeeze I just read they got whole quarantine wards for patients for C. Diff in the UK.

“

In my long hours spent in the “Throne Room” over the past month, contemplating the party Clostridium difficile, aka C. diff, was throwing in my intestines, and the complete lack of a party that my life had become, I wrote the following:

An Ode to Clostridium difficile

Oh, C. difficile, say it ain’t so,
It’s playtime, sleep time, but you make me go….
Despoiled and ravaged by your little meek toxin
I huddle under 7 blankets, 2 comforters, a dog, socks n’
Shake and chatter and moan hoping it’ll pass
Then hop and run to the bathroom (in case it’s not gas)
The sounds how lovely, the hue how green
And the aroma, how scintillating, with a bouquet of Dead Rat ’19?
Fans on, doors closed with towels jammed below
Still wakes you from a dead sleep, in time to go “Oh…”
The food, how white and……..white
Bread, rice, bread, n’er mind, it’s all just sh&*e.
Wave upon wave reach to form a tsunami
Of cramping and clutching and “Oh f*&# me.”
And still.  Just lay still.  No shakie.  Still.
No touchie. No movie.  No drinkie.  Still.
“But Oh here she comes, up from the bed, it’s neck and neck, she rounds
The corner, clears the table, another corner, Oh!  She takes to the ground
Who will make it first? The bathroom or the piles?
Now she’s crawling and yes! She makes the tiles!
Very key, very key as they’re much easier to clean
It’s a close race, but wait, the anus is clenching, now that’s just mean
She grimaces through it, down with the pants, dignity is out the window
Just in time, it sounds like a doozy, it’s boiling up and “Thar’ she blows!”
Yes C. diff I love you so, let me count the ways
33 doses of flagyl and vancomycin 4 times a day for 14 days.
My love (and ass) so burns
My God I hope you never return.

If that poem was not too much information for you, the following is some further information on the bacterium, along with some informative websites.  Future blog topics will vary depending on my health, politics, and my boredom, but I welcome any reader’s suggestions.  Thanks to Julidoc, one of the upcoming topics will be the socialization of medicine.  Now, back to the wonders of C. diff

For the past month, I have had the joy of  Clostridium difficile a.k.a “C. diff”.  A bacterium, C. diff, resides in the intestines of many individuals and is generally harmless. We usually think of our immune systems as being a bunch of white blood cells that act as bouncers and assassins, holding sickness at bay.  In truth, our immune system is much more complex.  The acidity of our stomach prevents many bacteria from entering any further into our gut and in our gut we have good bacteria that help us to digest our food, take up all available real estate and secrete various chemicals that prevent the bad bacteria from taking hold.  If for some reason this good bacteria is killed, say through taking antibiotics, bad bacteria like C. diff move in and multiply before a “For Rent” sign can even be posted.

Antibiotics are not the only way C. diff can be acquired.  It is not uncommon for long-term residents of hospitals and nursing facilities to acquire it, as well as people who have some defect in their immune system, the immunocompromised.  Traditionally a disease of hospitals and the ill, C. diff has now found its way into the community.  For unknown reasons reports of community-acquired C. diff are on the rise.  No risk factors, people just get it.  I’m one of the lucky few.

So here are the symptoms (Warning: I advise against reading this next part if eating or attempting to establish a romantic mood….though if you’re looking for romance tips, this is the wrong blog):

• diarrhea, profuse diarrhea, explosive at times
• classically the diarrhea is green and very foul smelling (foul enough to wake my husband up from a dead sleep)
• abdominal cramping
• nausea
• loss of appetite

and if it is severe enough:

• blood or pus in stool
• dehydration
• worsening abdominal pain

Clostridium difficile is not an illness to wait out to see if it improves.  Severe diarrhea combined with nausea can result in severe dehydration and electrolyte imbalance.   Progressing down the spectrum of badness, the infection can worsen to the point of inflaming your entire large intestine, a condition called colitis.  Even worse, and luckily rarer, a hole, or perforation, in your large intestine can develop, releasing the contents of your gut into your abdominal cavity.  As you can imagine this is not a good thing and requires immediate medical attention.

This brief rundown on C. diff is meant to be informative but by no means replace an evaluation by a physician.   If you are concerned that you may have C. diff, please contact your physician immediately or go to the ER.  C. diff is easily diagnosed through symptoms and stool cultures and can be treated with antibiotics.  I can also vouch that after 2-3 weeks of diarrhea, receiving a couple liters of fluid will make you feel worlds better.

For more informative on Clostridium difficile the following are excellent websites:

• Mayo Clinic – http://www.mayoclinic.com/health/c-difficile/DS00736
• Centers for Disease Control and Prevention – http://www.cdc.gov/NCIDOD/DHQP/id_Cdiff.html
• eMedicine from WebMD – http://emedicine.medscape.com/article/186458-overview

Cheers,

Patient Z, MD

Ireland is one of only three countries in Europe where antibiotic prescribing outside of hospitals, is on the rise. Antibiotics are frequently taken for viral colds and flu, when in fact they are only effective against bacterial infections. The more frequently antibiotics are used, the more resistant forms of bacteria become to them. The HSE recently launched a national education programme to change prescribing patterns in a bid to curb the use of antibiotics. The level of superbugs like MRSA and C. difficile in our hospitals would fall if antibiotic use was reduced. However, there’s another side to the superbug problem in our hospitals which I believe, has been overlooked.

When I developed serious symptoms of infection some years ago, it took three days for a nasal swab report to come through from the laboratory. In the meantime, I was treated in a ward shared with four other patients, two of whom were recovering from surgery. When my positive MRSA status emerged, I was quickly moved out of the ward and into isolation. You have to wonder at how many patients were cross-infected as a result of this delay in diagnosis. Multiply this by the huge number of MRSA cases passing through our hospitals each year and you get some idea of the scale of cross-infection.

The sad fact is that there is a Rapid MRSA test available which gives same-day results but it appears that the HSE restriction on budgets has ruled out it’s use in Irish hospitals. This decision is short-sighted as rapid MRSA identification can help hospitals make cost savings.

“The 3M BacLite Rapid MRSA test allows fast, affordable screening of patients for MRSA. It also has the potential to improve patient outcomes and decrease treatment costs. Rapidly identifying MRSA colonised patients provides hospitals with another tool to assist in pro-actively managing health care associated infections (HCAI).”

If I’d been rapidly screened, the result would have been available in hours, not days thereby enabling infection control teams to act quickly. My MRSA infection was hospital acquired (HCAI) following surgery and resulted in six weeks of expensive in-patient treatment. The infection recurred a year later and since then I have frequently been screened for MRSA as an out-patient. I always have to wait 2-3 days for a result and as far as I know, a similar delay still applies for in-patient screening.  I’d be very interested to hear if anyone knows different?

Everyone has a role to play in stopping hospital infection, patients and their families included.  However, if the HSE seriously wants to reduce MRSA figures and make reductions in their budgets, then it should address the problem of delayed identification. The rapid MRSA test would ultimately lead to huge cost savings for hospitals and more importantly, save lives.

Clostridium difficile infection: how to deal with the problem outlines newer evidence and approaches to delivering good infection control and environmental hygiene and updates the 1994 DH/PHLS guidance (Clostridium difficile infection: Prevention and management).