Tuesday, July 17, 2007

One in ten Scottish hospital patients 'suffering infection'

ALMOST one in ten patients in Scottish hospitals is suffering from an infection such as MRSA, a survey suggested yesterday. The new study - thought to be the most comprehensive ever carried out in Europe - found 9.5 per cent of people in acute hospitals had a healthcare associated infection (HAI). And the cost of such infections to the NHS is thought to be at least 183 million pounds a year.

Experts and campaigners last night said that HAIs continued to be a problem because of poor hygiene in hospitals and a lack of isolation facilities. Professor Hugh Pennington, Scotland's leading microbiologist, said more attention was also needed to ensure that only patients who needed antibiotics were receiving them to help tackle drug resistance.

Nicola Sturgeon, the Scottish health secretary, yesterday pledged to step up efforts to combat HAIs in light of the latest figures, which give the most accurate picture yet of the issue. This includes the possibility of introducing an MRSA screening programme for those going into hospital.

The new report, by Health Protection Scotland, suggested the rate of HAIs is higher in Scotland than the rest of the UK. A study by the Hospital Infection Society from February to May 2006 found that 8.2 per cent of patients in England had an HAI, 6.3 per cent in Wales and 5.4 per cent in Northern Ireland. Over the same three-month period, the rate in Scotland was 9 per cent. But experts said the differences in rates were most likely due to the more comprehensive nature of the Scottish survey, which covered every acute hospital and a sample of community hospitals.

The HPS report involved teams going into every acute hospital - 45 in total - and a sample of 22 community hospitals between October 2005 and October 2006. There they counted the number of inpatients over the age of 16 with an HAI who were in hospital on the day of the visit. In total, they found 1,103 patients in acute hospitals had an HAI - amounting to 9.5 per cent of all these patients. Of these, 126 had more than one infection. In the sample of non-acute hospitals, they found 157 patients with an HAI, of which seven had more than one. Taken across the country as a whole, this could mean more than 1,800 patients in hospital have an infection at one time.

The report found that Clostridium difficile was the most common bug among infections where researchers had identified the organism, accounting for 17.6 per cent of cases. This was followed by MRSA (methicillin-resistant Staphylococcus aureus) at 17.2 per cent and MSSA (methicillin-sensitive Staphylococcus aureus) at 8.9 per cent.

The hospital with the highest HAI rate in Scotland was Stobhill Hospital in Glasgow at 18.3 per cent, followed by Falkirk Royal Infirmary at 17.2 per cent. But the reason for the higher rates may be that these hospitals were surveyed during winter, when infections are more common. Older hospitals have sometimes been blamed for rising rates of infection. But yesterday's figures showed that this was not necessarily the case. The flagship Edinburgh Royal Infirmary, which opened in 2003, had an HAI rate of 11.6 per cent, compared with 6.8 per cent at the much older Southern General Hospital in Glasgow.

Rates also depend on the type of patients treated, with older people more vulnerable. And hospitals also have to deal with patients and their visitors bringing infections in.

Dr Jacqui Reilly, from HPS, said HAIs clearly had an impact on costs to the NHS, adding: "Patients with an HAI stay in hospital 70 per cent longer than those without an HAI." And she said if infections were cut by 30 per cent, the NHS could save 55 million pounds a year. Ms Sturgeon said this money could pay for an extra 8,000 patients to be treated. She added: "It is not good enough that 9.5 per cent of patients in Scottish acute hospitals have some form of HAI. The 183 million cost to the NHS, together with the human cost of HAI is also unacceptable."

Prof Pennington said the key to tackling HAIs was to continue with measures already in place, but to do them better. He added: "At the moment we are just about holding our own, but cases of MRSA are not going down and C difficile is going up. We need to continue to implement policies to control antibiotic prescribing, which contributes to resistance. "The cleaning and hand hygiene must also be a key focus. I am also in favour of screening, but it would need to consider what we do with patients who are carrying the bugs." Prof Pennington said Scotland and the UK in general did not have enough isolation facilities to care for patients with an infection, and added that there was evidence of more virulent strains of infections spreading.

Moya Stevenson, of campaign group MRSA Action UK, said it wanted to see screening for MRSA in hospitals. She added: "Bed occupancy rates have to be reduced within our hospitals and this will reduce quite significantly those rates of infections." Willie Duffy, from health union Unison, said that the quality of cleaning in hospitals had declined since the introduction of competitive tendering of hospital cleaning in the 1980s and the continuing outsourcing of cleaning at PFI hospitals. He added: "It is no coincidence the lowest levels of HAI in the UK are found where there are the lowest levels of contracting out - in Wales."



For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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