Beating the Bugs That Cause Infection ; In Association With the NHS Busting Bugs Including MRSA and

Jan 28, 04:27 PM

IT'S the beginning of another busy day for workers in the lab at Newcastle's Freeman Hospital and already hundreds of specimens are arriving to be scrutinised under the microscope.

In the last year these lab workers have taken on an essential role in the hospital's bid to bring down the number of patients carrying bacteria which could turn into potentially dangerous antibiotic-resistant infections.

Now they analyse swabs from 400 patients every day from the Freeman, Newcastle General and the Royal Victoria Infirmary as part of a massive screening programme by the Newcastle Hospitals NHS Foundation Trust to detect MRSA before it is given a chance to spread.

Their speedy analysing means hospital staff can be informed within 24 hours if one of their patients is carrying MRSA bacteria, and a test for Clostridium difficile can be returned in just a few hours.

It gives nurses and doctors on the wards the chance to treat the patient immediately with disinfectant washes, creams and sprays for MRSA, or a course of antibiotics for patients with Clostridium difficile.

"We screen a lot of patients who have come into hospital and of course the lab gets very busy," explained senior biomedical scientist Jennifer Wright.

"It's just a constant stream of samples for us and we've even extended the hours of the lab so we can get everyone done. At the moment we're screening around 80% of our admissions, which is a massive task.

Human bodies are covered in bacteria but many of us could be carrying MRSA in our noses, groins or throat, or Clostridium difficile in our bowels, without even knowing it.

They become problematic when the disease takes hold causing symptoms which could be devastating for a hospital patient who is already vulnerable.

"We use a rapid testing method and we can run that test as often as is practical now because we've opened our labs six days a week," said Prof Kate Gould, consultant microbiologist and director of infection prevention and control at the Freeman.

"In this lab we've got a long history of research and development relating to a range of diagnostic tests for MRSA and C-diff. We worked with local universities to invent new tests and new ways of detecting bacteria.

"When I took over as head of infection control I wanted to improve the way our policy was delivered across the trust. So we put together this system and it's working really well."

Once the swabs are taken, they are whisked to the Freeman's labs and the bacteria are grown on a jelly in an incubator overnight.

If the MRSA bacteria is present then it shows up as green spots in the petri dish.

Lab workers will then update a patient's records and the infection control team are informed so staff on the ward can start treatment.

The quickest they have been able to get MRSA results back has been 18 hours and for C-diff the time is just five hours.

And once the results are back the infection control team swings into action, visiting the patient and ward staff to advise what can be done to get rid of the infection.

When their risk assessment is over and treatment has been decided, the ward staff then take over.

"We actually start treatment straight away regardless of the time of day," said Sally Ridley, matron for urology at the Freeman.

"For MRSA we will give the patient a mouth spray, nose cream, body wash and shampoo which they have to use for at least five days.

"Patients are not screened routinely for C-diff but if they have diarrhoea a sample will be sent to the lab to be tested. If it's positive then a course of antibiotics is prescribed after a consultation with the microbiology department to see which would be best suited to the patient."

Clostridium difficile is particularly nasty, causing diarrhoea, and as soon as patients at the Freeman start to get this symptom they are treated in a cubicle rather than a ward - even if it is not actually C-diff.

Once the C-diff or other diarrhoeacausing infection has been treated and the patient has been symptom-free for 48 hours, they are moved on to a ward.

There has been a sharp rise in the number of C-diff cases in the past couple of years in Newcastle's three hospitals. From April to June 2006 there were 162 cases in patients aged between two and 65, but by April to June 2007 the number had risen to 263.

But experts believe they are now on track to bring infection rates down and also reassure patients and hospital visitors that the Freeman is clean and safe.

"We've got locally agreed targets for the number of cases we have and at the moment we are well within them," explained Prof Gould.

"But we don't want to be overly confident."

Most importantly people - staff and hospital visitors - are getting the message about infection control, and the trust's policy is even reassuring those who are facing a stay at the Freeman.

"Everyone is quite positive about the screening and they realise this is the best way to prevent it," said ward one sister at the Freeman, Judith Heckles.

"Patients are actually keen to see what we're doing about MRSA and C-diff and having this policy in place shows them we're taking it all very seriously.

"That's particularly important among the patients we see in urology who are coming in and out of hospital regularly for surgery and checks."

"Everyone works very much as a team across the organisation," added nurse Sally Ridley.

"Infection control is everyone's business now, from the senior management to the ward staff."

New rules for staff and visitors are already helping to prevent infections from spreading. Patients can only have a limited number of visitors at one time and sitting on a hospital bed is banned.

Staff are asked not to wear any jewellery below the elbow as this can hinder hand washing.

And monthly hand washing audits make sure every medic is scrubbing down in between handling patients.

The trust also wants to educate medics about how the correct use of medication, in particular antibiotics, can also prevent the spread of infections.

"I work on the wards and review antibiotic use," explained antimicrobial pharmacist Matthew Lowery. "The bottom line with these drugs is use of them will cause resistance.

"The important thing is to use the narrowest spectrum of antibiotics and for a short period of time.

"We'll never be able to entirely get rid of infections but we can slow their progression."

Patients are actually keen to see what we're doing about MRSA and C-diff and having this policy in place shows them we're taking it all very seriously."

(c) 2008 Evening Chronicle - Newcastle-upon-Tyne. Provided by ProQuest Information and Learning. All rights Reserved. Beating the Bugs That Cause Infection ; In Association With the NHS Busting Bugs Including MRSA and
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