Trying to get control of healthcare associated infections (HCAIs) is like trying to expel the air from an inflatable mattress. You press down hard in one area, only to find another air bubble pops up again somewhere else.
After a sustained programme of hand hygiene measures, which saw purchases of soap and hand gel treble, there was a marked fall in the prevalence of HCAIs in the UK in 2011 – down to 6.4% from 8.2% in 2006. Over the period of the ‘cleanyourhands’ campaign rates of MRSA were halved and C.difficile infections in hospitals fell by more than 40%, resulting in an estimated 10,000 lives saved.
But celebrations are premature. MRSA and C.diff may be in decline, but other infections – notably the coliforms, including Salmonella and E.coli – have risen. And 12% of these infections were resistant to cephalosporins.
Unlike MRSA, patients cannot be screened for coliform bacteria as they are present in everyone; normally they are not a problem, but they can cause life-threatening infections in the elderly, the very young, or the very sick.
Another obstacle to controlling HCAIs has been raised by a team of researchers at Edinburgh University. Using the genetic code of MRSA as a tag, they tracked the spread of the superbug and found that large city hospitals act as a breeding hub for the bacteria, which are then transferred along with the patients to smaller, local healthcare facilities.
Hand hygiene and decontamination measures are only the start. It will take even more rigorous hygiene measures not only to continue reducing existing infections but also to prevent new ones becoming entrenched.