Hospital Acquired Infections a Look into MRSA Infections

Hospital Acquired Infections a Look into MRSA Infections and the Occurrence of MRSA Bacteraemia in Different Regions of England. Phoebe Martin

What are Hospital Acquired Infections? - ‘Infections acquired in hospital by a patient who was admitted for a reason other than that infection’ - Fungal, bacterial, viral or parasitic organisms http: //1. bp. blogspot. com/_PB 5 -El 7 se 4 s/Rw 3 tj. QWGJI/AAAAEO 8/Zrd. No. Pn 9 Tm. I/s 400/mrsacart. j pg - Most common complication and a main cause of preventable injury and death http: //www. life. umd. edu/classroom/bsci 424/Images/Pathogen. I mages/Four. Quadrant. Streak. Plate. jpg

Prevalence of HAIs in Hospitals Worldwide - 1/20 of all healthcare patients in the USA - 2002 – 1. 7 million patients acquired HAIs, resulting in approximately 99, 000 deaths - Annual national healthcare costs increase by $4. 5 billion - Acquisition most common in ICU – 30% of all ICU patients acquire an HAI - In Europe: Switzerland – 11. 6% The Netherlands – 6. 9% http: //1. bp. blogspot. com/F 8 da. OPNBUT 4/T 2 PEGH_p. EUI/AAAAAEo/SN 5 b. GFe 2 m 1 w/s 1 600/hospital_ward__beds. jpg

Prevalence of HAIs in the UK - Rates vary within the UK - HIS reported 8. 2% rate in English hospitals Site of infection Prevalence (%) Gastrointestinal system 22 Urinary tract 19. 7 Pneumonia 13. 9 Surgical site 13. 8 Skin and soft tissue 10. 5 Primary bloodstream 6. 8 Lower respiratory tract 6 Eyes, ENT or Mouth 2. 9 Systemic 1. 2 Bone & Joint 1. 2 Cardiovascular system 1. 1 Reproductive tract 0. 6 Central Nervous system 0. 3 Country Prevalence (%) England 8. 19 Wales 6. 35 Scotland 9. 5 Northern Ireland 5. 43 - The most common types of infection in England are GIs (22%) and UTIs (19. 7%)

Most Prevalent Causative Pathogens - Escherichia coli Streptococcus pneumoniae Influenza virus A Staphylococcus aureus Clostridium difficile Norovirus Pseudomonas aeruginosa http: //upload. wikimedia. org/wikipedia/commons/2/2 d/Escherichia_coli. jpg https: //upload. wikimedia. org/wikipedia/commons/2 0/Streptococcus_pneumoniae. jpg http: //upload. wikimedia. org/wikipedia/commons/2/2 d/Pseudomo nas_aeruginosa_Gram. jpg

Methods of Prevention - ‘Modern Matrons’ (2000) - ‘The Deep Clean’ (2007 -2008) http: //blog. al. com/montgomery/2012/04/6_teena gers_hospitalized_after. html - ‘The Healthcare Associated Infections Technology Programme including the Rapid Review Panel’ (2008) - ‘MRSA screening‘ (2009) - ‘Cleanyourhands campaign’ (ongoing) http: //www. microphage. com/product/screening. Mrsa. US. cfm

Methicillin Resistant Staphylococcus aureus - MRSA - Non-motile, aerobic, gram-positive cocci - 30% of people are asymptomatic carriers - Infection occurs upon microorganism entering the blood stream http: //www. mrsaresources. com/

Methicillin Resistant Staphylococcus aureus - MRSA - Transmitted endogenously and exogenously http: //image. made-inchina. com/43 f 34 j 00 a. Zut. Vj. Rd. HDbo/Endotracheal-Tube. With-Suction-Catheter. jpg - Microorganism infection involves host defence evading mechanisms including https: //upload. wikimedia. org/wikipedia/commons/e/e 4/St aphylococcus_aureus_biofilm_01. jpg

MRSA - Antibiotic resistance - Resistance of S. aureus to antibiotics has occurred in prominent waves - Horizontal gene transfer, chromosomal mutations or antibiotic selection result in resistance to antibiotics - Vancomyin - slower rate of bacterial clearance and lower rate of clinical response than -lactam antibiotics

Rates of MRSA infections in England - 35% reduction in cases from 2009 -2010 Financial Year Total MRSA Bacteraemia Rate per 100, 000 population April 2008 - March 2935 5. 7 2009 April 2009 - March 1898 3. 7 2010 - 42% reduction observed between the years of 2003 -04 (7, 700 cases) and 2007 -08, (4, 450 cases)

Regional Differences in MRSA Rates -Highest number of cases was in London -Lowest number of cases was in South Central and the North East Region Yorkshire and The Humber North West London South Central East of England East Midlands South West South East North East West Midlands Number of Hospitals 19 26 31 8 15 14 17 13 10 18 Total number of MRSA bateraemia cases 70 89 95 20 34 31 36 27 20 33 Average Number of Cases per Hospital 3. 68 3. 42 3. 06 2. 5 2. 27 2. 21 2. 12 2. 08 2 1. 83 - Highest average number of infections per hospital in Yorkshire and the Humber -Lowest average number of infections per hospital in the West Midlands

Demographics by region Life expectancy (years) Region Yorkshire and The Humber Rate of MRSA per Population density hospital (million) (people /km 2) Males Females GDHI (£) Gross Population Weekly 65+ years Earnings (£) (%) 3. 68 5. 3 344 77. 7 81. 8 13, 600 466 17 North West 3. 42 6. 9 490 77 81. 1 14, 200 460 17 London 3. 06 7. 8 4, 978 79 83. 3 20, 000 610 11 East of England 2. 27 5. 8 305 79. 6 83. 2 16, 400 529 18 East Midlands 2. 21 4. 5 287 78. 4 82. 4 14, 300 472 17 South West 2. 12 5. 3 221 79. 5 83. 5 15, 700 473 20 South East 2. 08 8. 5 447 79. 7 83. 5 17, 600 554 17 North East 2 2. 6 300 77. 2 81. 2 13, 300 451 17 1. 83 5. 5 420 77. 9 82. 2 14, 000 471 17 West Midlands *GDHI - Gross Disposable Household Income

Influence of Regional Population and Population Density on MRSA Rates Life expectancy (years) Region Yorkshire and The Humber Rate of MRSA per Population density hospital (million) (people /km 2) Males Females GDHI (£) Gross Population Weekly 65+ years Earnings (£) (%) 3. 68 5. 3 344 77. 7 81. 8 13, 600 466 17 North West 3. 42 6. 9 490 77 81. 1 14, 200 460 17 London 3. 06 7. 8 4, 978 79 83. 3 20, 000 610 11 East of England 2. 27 5. 8 305 79. 6 83. 2 16, 400 529 18 East Midlands 2. 21 4. 5 287 78. 4 82. 4 14, 300 472 17 South West 2. 12 5. 3 221 79. 5 83. 5 15, 700 473 20 South East 2. 08 8. 5 447 79. 7 83. 5 17, 600 554 17 North East 2 2. 6 300 77. 2 81. 2 13, 300 451 17 1. 83 5. 5 420 77. 9 82. 2 14, 000 471 17 West Midlands *GDHI - Gross Disposable Household Income

Influence of Life Expectancy on MRSA Rates Life expectancy (years) Region Yorkshire and The Humber Rate of MRSA per Population density hospital (million) (people /km 2) Males Females GDHI (£) Gross Population Weekly 65+ years Earnings (£) (%) 3. 68 5. 3 344 77. 7 81. 8 13, 600 466 17 North West 3. 42 6. 9 490 77 81. 1 14, 200 460 17 London 3. 06 7. 8 4, 978 79 83. 3 20, 000 610 11 East of England 2. 27 5. 8 305 79. 6 83. 2 16, 400 529 18 East Midlands 2. 21 4. 5 287 78. 4 82. 4 14, 300 472 17 South West 2. 12 5. 3 221 79. 5 83. 5 15, 700 473 20 South East 2. 08 8. 5 447 79. 7 83. 5 17, 600 554 17 North East 2 2. 6 300 77. 2 81. 2 13, 300 451 17 1. 83 5. 5 420 77. 9 82. 2 14, 000 471 17 West Midlands *GDHI - Gross Disposable Household Income

Influence of Regional Average Earnings on MRSA Rates Life expectancy (years) Region Yorkshire and The Humber Rate of MRSA per Population density hospital (million) (people /km 2) Males Females GDHI (£) Gross Population Weekly 65+ years Earnings (£) (%) 3. 68 5. 3 344 77. 7 81. 8 13, 600 466 17 North West 3. 42 6. 9 490 77 81. 1 14, 200 460 17 London 3. 06 7. 8 4, 978 79 83. 3 20, 000 610 11 East of England 2. 27 5. 8 305 79. 6 83. 2 16, 400 529 18 East Midlands 2. 21 4. 5 287 78. 4 82. 4 14, 300 472 17 South West 2. 12 5. 3 221 79. 5 83. 5 15, 700 473 20 South East 2. 08 8. 5 447 79. 7 83. 5 17, 600 554 17 North East 2 2. 6 300 77. 2 81. 2 13, 300 451 17 1. 83 5. 5 420 77. 9 82. 2 14, 000 471 17 West Midlands *GDHI - Gross Disposable Household Income

Influence of Age on MRSA Rates Life expectancy (years) Region Yorkshire and The Humber Rate of MRSA per Population density hospital (million) (people /km 2) Males Females GDHI (£) Gross Population Weekly 65+ years Earnings (£) (%) 3. 68 5. 3 344 77. 7 81. 8 13, 600 466 17 North West 3. 42 6. 9 490 77 81. 1 14, 200 460 17 London 3. 06 7. 8 4, 978 79 83. 3 20, 000 610 11 East of England 2. 27 5. 8 305 79. 6 83. 2 16, 400 529 18 East Midlands 2. 21 4. 5 287 78. 4 82. 4 14, 300 472 17 South West 2. 12 5. 3 221 79. 5 83. 5 15, 700 473 20 South East 2. 08 8. 5 447 79. 7 83. 5 17, 600 554 17 North East 2 2. 6 300 77. 2 81. 2 13, 300 451 17 1. 83 5. 5 420 77. 9 82. 2 14, 000 471 17 West Midlands *GDHI - Gross Disposable Household Income

Comparison between hospitals with high rates MRSA bacteraemia and those with low rates Population Number of cases of MRSA Hospital bacteraemia * Region Yorkshire St James University and the Hospital 11 Humber Royal London Hospital 10 London East of Addensbrooke’s Hospital 9 England Manchester Royal Infirmary 9 North West Scarborough General Hospital Royal Marsden Hospital Watford General Hospital Christie Hospital * from 25/09/2011 to 11/11/2012 1 1 Yorkshire and the Humber London East of England North West City Number of Beds Rate of % 65+ MRSA per City bed Population years old % male % female Leeds London 1157 652 105. 18 65. 2 751, 500 8, 173, 900 14. 6 11. 1 48. 3 49. 3 51. 7 50. 7 Cambridge 1180 131. 11 123, 900 11. 7 50. 8 49. 2 Manchester 800 88. 89 503, 100 9. 4 50. 2 49. 8 Scarborough London 552 109 108, 800 8, 173, 900 23. 3 11. 1 48. 3 49. 3 51. 7 50. 7 Watford Manchester 499 174 90, 300 503, 100 12. 4 9. 4 49. 6 50. 2 50. 4 49. 8

Influence of Size of Hospitals on MRSA Rates Population Number of cases of MRSA Hospital bacteraemia * Region Yorkshire St James University and the Hospital 11 Humber Royal London Hospital 10 London East of Addensbrooke’s Hospital 9 England Manchester Royal Infirmary 9 North West Scarborough General Hospital Royal Marsden Hospital Watford General Hospital Christie Hospital * from 25/09/2011 to 11/11/2012 1 1 Yorkshire and the Humber London East of England North West City Number of Beds Rate of % 65+ MRSA per City bed Population years old % male % female Leeds London 1157 652 105. 18 65. 2 751, 500 8, 173, 900 14. 6 11. 1 48. 3 49. 3 51. 7 50. 7 Cambridge 1180 131. 11 123, 900 11. 7 50. 8 49. 2 Manchester 800 88. 89 503, 100 9. 4 50. 2 49. 8 Scarborough London 552 109 108, 800 8, 173, 900 23. 3 11. 1 48. 3 49. 3 51. 7 50. 7 Watford Manchester 499 174 90, 300 503, 100 12. 4 9. 4 49. 6 50. 2 50. 4 49. 8

Influence of Gender on MRSA Rates Population Number of cases of MRSA Hospital bacteraemia * Region Yorkshire St James University and the Hospital 11 Humber Royal London Hospital 10 London East of Addensbrooke’s Hospital 9 England Manchester Royal Infirmary 9 North West Scarborough General Hospital Royal Marsden Hospital Watford General Hospital Christie Hospital * from 25/09/2011 to 11/11/2012 1 1 Yorkshire and the Humber London East of England North West City Number of Beds Rate of % 65+ MRSA per City bed Population years old % male % female Leeds London 1157 652 105. 18 65. 2 751, 500 8, 173, 900 14. 6 11. 1 48. 3 49. 3 51. 7 50. 7 Cambridge 1180 131. 11 123, 900 11. 7 50. 8 49. 2 Manchester 800 88. 89 503, 100 9. 4 50. 2 49. 8 Scarborough London 552 109 108, 800 8, 173, 900 23. 3 11. 1 48. 3 49. 3 51. 7 50. 7 Watford Manchester 499 174 90, 300 503, 100 12. 4 9. 4 49. 6 50. 2 50. 4 49. 8

Conclusions - Many contributing factors for rates of MRSA - Hospital size - Further research: - Specialisation of trusts - Staff to patient ratio - Prevention methods and techniques within individual hospitals