MRSA battle hindered by conditions

OVERSTRETCHED conditions at Ipswich Hospital are compromising the fight against MRSA, a senior doctor admitted today.Dr Philip Jones, the consultant microbiologist responsible for leading the investigation into the death of Woodbridge baby Luke Day, said: "MRSA is a much bigger problem in the rest of the hospital than it is on the maternity unit.

OVERSTRETCHED conditions at Ipswich Hospital are compromising the fight against MRSA, a senior doctor admitted today.

Dr Philip Jones, the consultant microbiologist responsible for leading the investigation into the death of Woodbridge baby Luke Day, said: "MRSA is a much bigger problem in the rest of the hospital than it is on the maternity unit.

"I think the pressures on the hospital, because it is running at such a high bed occupancy, are making it very difficult for us to do everything possible to limit MRSA."

Ideally, hospitals should have around 85per cent of their beds occupied at any one time. At Ipswich 98pc of beds are full.

Dr Jones admits these conditions make the fight against MRSA harder.

He said: "It's very important that we can place patients properly in the hospital and control movement from one area to another but, with the hospital being as full as it is, what we can not always do is segregate patients who have MRSA from other patients."

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One of the main concerns being raised since the news of Luke's death has been the issue of handwashing.

Many of those who have contacted The Evening Star have said they have been in hospital or had relatives in hospital and have not seen nurses or other staff washing their hands.

Annie Newton, senior infection control nurse, stressed that the hospital does everything possible to ensure staff are washing their hands but said: "It is inevitable that there are going to be times when staff should be washing their hands and haven't. This goes back to the issue of having enough staff.

"The important thing is that they have the time to do things, but when the turnover in the ward is very high, when you are striving to get people through the system, then these time issues become very strained and stretched.

"People have to have the time to do things properly and sometimes we don't always have that time."

Dr Jones admits that MRSA is never going to disappear from wards completely but is confident, however, that it can be brought under control.

He said: "We can improve the situation but we are never going to eradicate it because it is a very successful organism. It may die away gradually over some decades but for the forseeable future we are going to have MRSA.

"What we have to do is prevent people getting infections from MRSA. People will acquire it and they will carry it but what we have to do it prevent them getting infections and that's difficult when people are carrying it.

"This requires a lot of effort, resources, money and staff and I think the government is now recognising that there is no one simple solution to MRSA."

HOSPITAL staff have today admitted they may never know exactly how two-day-old Luke Day contracted MRSA.

The investigation into his death has now come to an end with no firm conclusions. But doctors said lessons have been learnt from it and revealed MRSA screening could be introduced to the maternity department within the next few weeks.

Dr Jones, who led the inquiries, said: "It is very difficult because there are many things we do not know. We want to know, we want to provide the answers, and it's very difficult when we can't."

Luke Day died at Ipswich Hospital on February 3. His death was particularly puzzling for doctors because it happened so quickly – just 36 hours after he was born.

Mrs Newton said: "The speed at which this happened is what has puzzled us. There is usually some warning or a period of illness where you can administer treatment, but Luke showed absolutely no signs of illness."

Samples of the bacteria found in Luke's blood were sent to MRSA specialists in a London laboratory for further testing.

Dr Jones said: "We wanted to know if there was anything different about this particular strain but the specialists' reports show that they have not found any especially virulent factors. It is not an unusual strain of MRSA.

"The bacteria will continue to be examined even further by specialists in this field."

Dr Jones said he is confident the hospital has done everything it could.

"We've looked in to all the circumstances and investigated it properly. We have not found any breakdown in procedures or any problems with the care of Luke or his mum.

"We feel very frustrated that we have not found an answer but I am confident we've done all we could."

He said he felt everybody had learned from the incident and thought it could lead to changes in a number of areas.

He said: "The standards of care on the maternity unit are extremely high and always have been, but this will obviously make people even more aware of MRSA than ever before.

"Generally the prevalence of MRSA is much lower on the maternity unit than in other areas of the hospital but we are in talks at the moment about introducing MRSA screening on the maternity unit and, while the finer details have not yet been worked out, this will happen."

It is thought screening could be carried out on mothers who have had to have previous hospital admissions or come from other hospitals, and would also be carried out on some babies after birth.

Do you think screening in the maternity unit is a good idea? Write to Your Letters, Evening Star, 30 Lower Brook Street, Ipswich, IP4 1AN or send us an e-mail to eveningstarletters@eveningstar.co.uk

The Investigation:

As soon as Luke died, investigations began. Blood samples were taken from him during resuscitation attempts and rushed off to the laboratory, meanwhile staff were meeting to determine the exact chain of events in the hours leading to his death.

Mrs Newton said: "As soon as we knew there had been a death of an infant our investigations started. This was well before we knew his death was due to MRSA."

Dr Jones added:"The first thing we did was get all the facts together.

"One of the very first things we did was look at the patients notes. We went through all the procedures that had happened to Luke's mum during the admission and the birth so we understood all the events leading to his death.

"We spoke to all the midwives and everyone in maternity. All the staff involved came together to ensure we had the complete picture."

It was then up to Dr Jones' team in the microbiology lab to carry out a series of complex tests on the samples taken from Luke to detect MRSA.

This involves placing the blood in a special machine which is kept at body temperature, providing the optimal conditions for any organisms to grow. Once these are grown, various tests are carried out to determine whether the bacteria found are resistant to different drugs. The whole process took around two days. The team carry out between 12-14,000 MRSA tests on swabs every year and this number is rising.

Dr Jones said: "Once we knew that we had an MRSA organism we began a very thorough inspection of the environment and took lots of swabs.

"We swabbed all the equipment in the room where Luke was born and the room where he and his mum were moved to. This included the bed, the cot and all the other equipment used."

None of the swabs tested positive for MRSA.

More than 60 staff were also swabbed during the investigation and all of their swabs proved negative too.

When the hospital had exhausted all avenues, samples of the MRSA bacteria were then sent to specialists in London to determine how virulent this particular strain of the bug was.

While all specific investigations in to Luke's death have now been concluded Mrs Newton said: "We do have an ongoing MRSA system in the hospital which we will continue and enhance."

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