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Are we really beating MRSA?

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MRSA infection rates have been halved, exceeding the national target and the expectations of many. Steve Ford and Clare Lomas review this achievement and consider the next steps.

The Department of Health announced last week that the NHS in England had met its four-year national target for reducing cases of MRSA (NT News, 23 September, p2).

The target, set by former health secretary John Reid in November 2004, called for a halving of the number of MRSA infections – based on the quarterly average for that year of 1,925 – by the end of March 2008.

This meant the NHS would have needed to reduce the number of cases to fewer than 963. In fact there were 836 MRSA cases reported in England during the three months between April and June 2008, according to the Health Protection Agency’s latest figures – a 57% reduction.

The fact that the target was not only met but exceeded contrasts with doubts – even within the Department of Health itself – of whether it was attainable.

An internal memo from Liz Woodeson, DH director of health protection, warned another former health secretary, Patricia Hewitt, in October 2006 that the target was likely to be missed.

‘Although the numbers are coming down, we are not on course to meet that target and there is some doubt over whether it is in fact achievable,’ Ms Woodeson wrote.

This is not the only political controversy to have dogged the MRSA target debate. There have been claims and counterclaims over the deadline itself and, therefore, whether or not the target was actually achieved.

The government has stated that success on meeting the end of March target would be measured by looking at the data for the following quarter, running from April to June.

But shadow health secretary Andrew Lansley has consistently argued that ministers changed the deadline in order to make
it easier to meet and that the target should have been measured against the number of cases recorded in the January to March quarter.

The exact measurement period was not set when Mr Reid originally announced the target. It was only formally agreed and made public by ministers in February 2007.

But the government insists that it was always working on the assumption of judging the target on the April to June quarter.

‘At no point have we changed how we are measuring the target,’ junior health minister Ann Keen said at the start of this month in answer to a question from Mr Lansley.

However, irrespective of the target’s deadline, the fact remains that the MRSA rate has been halved – news that has been welcomed across the board.

The government has been quick to highlight the apparent success of its Deep Clean and other initiatives such as its new uniforms policy. But it was also vocal in its praise for nurses and other staff.

‘This tremendous achievement is down to you, the staff of the NHS, and I wanted to write to thank you on behalf of everyone who relies on the NHS for your efforts over the course of the last year,’ said prime minister Gordon Brown in a letter addressed to all NHS staff.

However, notes of caution were also sounded amid the celebrations. Anna Walker, chief executive of the Healthcare Commission, which is currently inspecting all acute trusts on how they measure up to the government’s hygiene code, said: ‘It is important to remember that our work still shows variations in the performance of trusts.’

She added: ‘We should also remember that MRSA is only one of a number of infections that pose a risk to the safety of patients. Trusts must therefore never be complacent or take their eye off what is happening with other infections.’

Indeed, new threats are emerging such as Panton-Valentine Leukocidin-positive Staphylococcus aureus – a virulent form of staphylococcus that has become a major problem in the US and is spreading across Europe. The number of cases reported in England and Wales tripled from 224 in 2005 to 1,361 in 2007 (NT News, 23 September, p7).

Perhaps more pressing is the situation with Clostridium difficile, though there are mixed messages depending on which set of statistics are quoted.

The latest HPA figures, published in July, show there were 10,586 cases reported in England among patients aged 65 years and over between January and March 2008, a 6% increase from the 9,993 in the previous quarter. However, comparison of these figures with the same quarter in the previous year shows a 32% reduction from 15,644 cases.

The 6% rise represents an expected seasonal increase and C. difficile rates are ‘coming down at a reasonable rate’, according to

Martin Kiernan, nurse consultant for the prevention and control of infection at Southport and Ormskirk NHS Trust, and newly appointed president of the Infection Prevention Society.

‘The recognition that commonly used invasive devices, such as peripheral IV cannulas, are responsible for a significant number of infections has had a significant impact on infection rates,’ he said.

Undoubtedly, the meeting of the MRSA target represents a major achievement for the NHS, which has often been criticised for its record in infection control.

‘The next challenge for the NHS will be to ensure that the downward trend continues and that we move to a position of zero tolerance,’ said Peter Borriello, director of the HPA’s centre for infections.

MRSA figures for the present quarter are due to be published in December.

Nursing teams will need support to continue a ‘sustained attack’ against the infection if a lull in effort is to be avoided in the aftermath of meeting the target, RCN general secretary Peter Carter has suggested.

‘This means further investment in training for key nursing positions such as ward managers and infection prevention and control nurses working across the NHS,’ he said.

Mr Kiernan agreed. ‘We need to keep our eye on the ball and continue to move forward if we are to sustain the changes and continue to improve,’ he said.

He added: ‘Infection has been reduced at a rate previously unthought of by many healthcare professionals and opens the window to show what’s possible.’

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