FAQ - Should I be worried about MRSA?
MRSA stands for Methicillin Resistant Staphylococcus Aureus. It means the strain of staphylococcus [a common wound-infecting bacterium] being cultured is resistant or immune to the antibiotic methicillin. Methicillin is an antibiotic that is no longer used in clinical practice but is related to the penicillin group; and thus resistance to methicillin infers resistance to other penicillin derivatives.
MRSA is therefore a description of antibiotic resistance, not necessarily directly relating to virulence or potential destructive capability. Some MRSA strains are of low virulence, and will be easily controlled by using antibiotics from other classes besides the penicillins. The problem is that MRSA often means the organism is resistant to other antibiotic classes as well, and maybe particularly aggressive or difficult to control in the clinical setting. Staphylococcus Aureus is very common outside of hospitals, and most of these 'wild' strains will still be sensitive to methicillin (and therefore the penicillin group). MRSA is largely a product of antibiotic use (or over-use} in hospitals and other healthcare institutions. The prevalence of MRSA is therefore a crude measure of how effective infection control measures may be in any particular clinical setting. This is why MRSA rates are used as an indicator of the 'quality' of such measures. MRSA rates will only be reliable if dependable surveillance and reporting systems exist!
MRSA is not the only nasty bug around. There are some equally nasty organisms such as VRE (Vancomycin Resistant Enterococcus) and Clostridium Difficile.
All micro-organisms are a particular problem for the weak, elderly or otherwise immuno-compromised. Intensive care units (ITUs) are thus an example of where resistant organisms are common, lethal and difficult to control.
Whilst hand washing and other basic hygiene methods help to control the spread of micro-organisms, they are NOT enough on their own. Isolation and exclusion methods are probably even more important, but for these tactics to work properly, money must be spent on extra beds and dedicated staff. Occasionally, it may be necessary to close whole wards or suspend elective surgery until an outbreak is contained. These steps are not always popular with hospital administrators who may have volume or financial targets to meet!
In the past, we have largely coped by developing new antibiotics, thus keeping one step ahead of the microbes. This is however a self-defeating exercise as new, multiple resistant 'superbugs' emerge.
It is increasingly being realised that antibiotic use must be restricted, and their indiscriminate use in the past is partly to blame for the problems we are seeing now.
MRSA (and other infection) rates will be very low in any institution where routine pre-operative testing is taking place (before patients are admitted) and where mostly 'clean' elective or planned surgery is taking place. In this respect, most UK private hospitals will fulfil these criteria. NHS units that mix Elective and Trauma or Emergency work; particularly if the latter has a high proportion of elderly patients, will struggle to keep infection rates low. Wherever possible, Mr Bloomfield believes that Trauma or Emergency work should be physically and geographically separated from Elective surgery and he was instrumental in promoting such a concept whilst he was still Clinical Director of Trauma and Orthopaedic services at Ashford & St Peter's NHS Trust.
In summary, you should not worry if you are having surgery in most UK private hospitals, but in NHS institutions, try to pick one that has a clear policy of excluding Trauma or Emergency work from the ward where you will be admitted. In all cases ask whether there is a policy of pre-operative testing for MRSA. Take a bath or shower a few hours before your surgery: this may be most practical to do before you leave home as there is not always the time or the available facilities when you get to hospital!
