The most important lesson in the report yesterday by the Commons Public Accounts Committee into “superbugs” is that we do not know enough about them. MPs on the committee admit that a “fog of ignorance” surrounds the issue of hospital-acquired infections, such that its own estimate of a cost of £1 billion a year to the NHS is rough and ready at best. This is partly because of the paucity of information collected by the Government. So sparse is it that estimates of hundreds of thousands of annual UK infections are extrapolated from figures collected in America. There is a lack of concrete knowledge about the cause and extent of superbugs.
Staphylococcus aureus is a common type of bacterium carried on the skin or in the nose by around a third of the population. It does little harm unless it breaks through the skin, which happens frequently in hospital via surgical wounds. The sicker, weaker and more immunosuppressed the patients, the more likely they are to succumb to the infection. As the NHS learns to treat and keep alive patients in more vulnerable states — older, younger, sicker — so the risk to them of falling victim to hospital acquired infections increases.
The most notorious bug, MRSA — methycillin-resistant Staphylococcus aureus — is used as an acronoym for 17 different forms of the bacterium that are variously resistant to methycillin and/or many other antibiotics. There were just 51 recorded deaths from MRSA in British hospitals in 1993, rising to 955 in 2003. Nobody knows how much of that increase is accounted for by more accurate reporting and the demand on hospitals to “come clean” about it. Many patients died in the past from post-operative complications which today would be marked down as “MRSA”.
“I mean”, asked the Conservatives in the election campaign, “how hard is it to keep a hospital clean?” The point is valid, even though the bugs are commonplace and hard to control. They may lurk on a dirty floor or lavatory seat (although how they would then enter an open wound is questionable), but they may also be harboured in a television remote-control handset, the flowers sent by a relative, the hands of that relative or your nose. One hospital trust with high MRSA rates conveniently estimates that 40 per cent of infected patients contract bugs outside the hospital after surgery, and then return to wards for treatment.
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What, then, can be done? Many doctors fail to clean their hands between patients. They should, as must nurses, because there is every chance that it may do some good and it cannot do any harm. Isolating patients in single rooms, and running hospitals at less than absolute capacity, would also mean a reduced chance of passing infections between patients. The NHS runs at far higher capacity — near 100 per cent — than health services in other developed nations. It is what makes it efficient and infuriating. The Government must look for and provide more accurate information — the ignorance allows hospitals to duck responsibility, and unnecessary fears to prevail.