A MHRA warning indicated that without regular changing of filters in Ventilators the MRSA virus was being spread around the hospital environment. In this regard, would the use of an anti-viral filter on electric and pipeline suction equipment help combat the spread of MRSA?

Probably not, because the worst contamination is on the outside of the equipment; and on the curtains; and on the staff uniforms; and on the doctor's hands !

The issue about filters on patient ventilators came about because they found the MRSA bug in the dust inside some ventilators in ICU - on the PCBs etc - and realised that the cooling fan filter hadn't been changed for months and was also heavily contaminated. Filters in the breathing circuit have to be changed or sterilized between every patient anyway.

Thanks Roy. Appreciate your comments. Look forward to the views of others.

Just a slight correction, MRSA is bacterial. Normally our bodies can fight most viruses naturally but with bacterial infections we need the help of antibiotics. MRSA is resistant to most antibiotics so there lies the problem. MRSA is spread by contact therefore if equipment is brought to the workshop without proper decontamination there is a risk to ebme staff. Ensuring that all equipment is accompanied by proper decontamination status documentation is important, although this does not take into account people who complete the form without actually cleaning the equipment!

Bioman, you are correct, MRSA is a bacteria, it is also, as Roy points out, carried very effectively in "dust". It is impossible to decontaminate Medical Equipment 100% . So I was always advised to follow standard hygiene practices. I.e.. wear gloves, wash your hand thoroughly etc. and trust nothing to chance. I would also suggest all staff have a visit from your trust’s infection control. I have found these bods very helpful in the past.
More than can be said for the countless number of quacks that can be found in the Canteen at lunch still donning their theatre gowns.

LIII

Thanks Louis, I was just correcting Keith's view that MRSA was viral. I wasn't correcting Roy's comment re dust. My bit about contact was merely providing an example of how easily the EBME guys could be exposed to MRSA outside of a clinical area i.e. in the workshop the dust aspect just reinforces it. I should have gone one further and stated the importance of a proper hand washing policy. Our Trust is trying to clampdown on the wearing of scrubs and gowns outside of clinical areas as I suspect mosts hospitals are.

Interestly MRSA was a problem when I joined the NHS 10 years ago and has only really hit the media in last few years. I suspect in the early years hospitals kept quiet in the hope it would sort itself out, I wonder whether the government would have injected the money to tackle it had the press not made it a major news item?

Thanks for the correction guys.

I agree Bioman, Going by experience though, Have you ever seen the reaction of the "Theatre Gods" when they are asked to remove their babe magnet attire? Hell haff no fury my friend, hell haff no fury indeed.

LIII

P.S. I am under the impression that the original cause of MRSA is a bi-product of GP's giving out various "Mycins" like sweets, and patients not completing their full course of treatment. On a further note ...how many trusts use +ve room pressure and does it assist in the overall control of infection. We are looking at various systems now. Info on Cost, Problems etc are most welcome.

LIII

Dear Brothers,

In my humble opinion the current MRSA “outbreak” has much to do with overcrowding within hospital wards, lack of simple ventilation, and poor hygiene by hospital staff (you’d think they’d know better, would you not?).

For our own part, I urge you all to insist that only “decontaminated” (ie, clean) equipment is allowed into your workshops, and to follow the advice of Dr. Semmelweis and wash your hands, wash your hands, and then wash your hands!

Remember, however, that the great Dr. Semmelweis was so hounded and ridiculed for beseeching his fellow surgeons to wash their hands after autopsies, before performing surgery, or when delivering a baby, that he ended up in an asylum for the insane!

Hi Louis, Can the Theatre Gods queue in the Canteen, in their Blues/Greens for Bacon Butties in your neck of the woods then ???

Bioman , i also have been in the nhs ten years and are amazzed how the routine scrubbing and ward closures no longer appear to happen as they used to. I understand it will not stop MRSA , but it would not make it or any problem worse (apart from cash flow).

Why are our hospitals not designed en-suite like mainland europe. Is it any wonder we have one of the highest rates in europe. If you've ever been unfortunate enough to be admitted into hospital im sure you know what i mean.

MRSA is not the only transmitted illness curently on the rise. The old war-time favorite of scabbies is coming back, as i found out recently, it is very common in elderly medicine and not particulary pleasant.

Tracy

Don't forget TB ! That's been on the up for several years and a BBC programme some time ago blamed the increase squarely on overcrowding.

I can't remember the figure, but a very high percentage of people are carrying the MRSA bug around on their skin - or up their noses - and suffer no ill effects, untill they have surgery. An even higher percentage of us are carrying the non-resistant form, which apparently dissapears after a few days / weeks.

A few months ago I was asked by two nurses if the plastic aprons, gloves, masks and caps they were wearing were suitable protection from a confirmed MRSA carrying patient who was coming into their department for a scan. I said that I thought it was OK - except that they still had their uniforms on underneath.

They hit me ! !

Hi Tracy

I had almost forgotten about routine ward closures where nurses and cleaners worked hand in hand to scrub the walls, surfaces and equipment. I seem to remember our Infection Control Team also insisted on Estates painting the walls after they had been scrubed clean. I suppose in those days cleaning staff were under the control of Trusts and not contractors who are hell bent on employing staff on as little as possible and trying to get them to clean more areas than is humanly possible.

Roy - i did know about this as my father is a community dialysis patient and is regularly swabbed. MRSA affects more than just hospitalised patients.

Bioman - i also remeber waiting for the swabs of the walls to come back clean, before the area could be used again. Staff were also reguarly swabbed. Has anyone out there ever been tested?

Hi Tracy, Whilst a Biomed in the Sultanate of Oman in 1990, we were all tested by swabs in the mouth and ears.This was after all the cleaning,painting etc and petri dishes left out to check the cleaned areas.We were all found negative and the source was never traced.The ITU re-opened after all the precautions described.
Have a Good Weekend. Tony.

Tony unfortunatly it is true
Whilst in the UK the trust I was employed at had their first real outbreak in 97, all hell broke lose. Even the local Infection Control bod arrested us all and took our palm prints for analysis. I think they are too relaxed now. Typical hey. From one extreme to the other.

LIII

Hi Louis, Too true my dear chap too true.!!
However as another Dear Friend Geoff Hannis reports earlier in the thread, good old soap and water is all that is needed to remove the bacteria from the skin !!
Perhaps the Manufacturers of Vancomycin are keeping quite on that one !!
Mah, Salamah. Tony

Meanwhile the Battle of the Bugs continues as the little blighters doggedly continue on their remorseless march to conquer the world. Speaking of which, what can our overseas correspondents report regarding this issue? Surely it's not a phenomenon restricted only to British NHS hospitals?

Long Live Low-Life, indeed!

Wow - talk about continuing a long lost thread. 3 years have passed since the last posting. :]

Is this you recycling Geoff? lol

If something is old is it not an indication that it has earned the right to survive, John? Just look at me. Still going strong (in spite of all those bacteria)! Ha, ha.

The thread may be three years old, but the problem has obviously not gone away! Words fail me on this one, so I'll leave you to reflect upon it, and draw your own conclusions.

As long as the human race tries to fight against nature, the problem (of bacterial infection) will never be over. As for conquering the world, it was theirs to begin with.

The problem lies with human arrogance. Just because humans are, the self-proclaimed “pinnacle” of evolution, it does not follow that we have the divine right to survive. If you look at any extinction event, bacteria always survive, partly due to their sheer numbers, but also due to their diversity and adaptability. They reproduce so quickly, and allow genetic mutants to “take their chances”, that they are always able to adapt to new conditions – how do you think that life became so diverse in the first place? So, if you look at it from the perspective of survivability, are humans or bacteria the pinnacle of evolution?

We have to learn to live with nature as we have done for thousands of years, not fight against it.

You get my vote, BSM. "Adapt and survive" is the secret of life. My crystal ball shows the ultimate battle to be between the machines and the bugs. Man, in all his frailty, will have disappeared by then I should imagine (or, perhaps reduced to the subservient role of tending the machines - a trend that I started myself over thirty years ago, come to think of it)! But meanwhile, Long Live Low-Life, as I like to say!

My point in placing the link about that poor young bloke was to alert people to the plight of a wounded hero falling victim to not only MRSA, but c.diff as well in the same hospital. Don't know about you guys, but I find that outrageous! Not to mention unforgivable.

Bring back the old style Matron and stop the practice of Hot Bedding!!!!!!

And while we're at it, let's get rid of the clipboards, and bring back the Florence Nightingale ethos. Surely leaving patients to lie in their own mess is never acceptable.

And ... return to visiting times, and restrict the number of visitors at any one time. I've seen places where it looks like the whole street turns up! It overwhelms the ward, let alone the patient!

How To Give Your Patient A Hospital Aquired Infection.
1.Put on clean uniform.
2.On entry to ward, notice Hand Hygiene poster and use alcohol gel provided. (so far so good?)
3.On entry to patients bed area, notice sign saying STOP! Have YOU DECONTAMINATED YOUR HANDS? Duly clean your hands again with the alcogel provided. (this is easy).
4.You may want to don a pair of gloves just to be absolutely sure.
5.Witness domestic staff busily going about their job with sheer dedication to keeping the ward spotless.(Can't get much better than this!)
6.Attach dirty Syringe pump to patient thus also contaminating hands.
7. Attach dirty ECG electrodes to patient. (they look clean but i wonder what that minute trace of black stuff is right inside each clip?)
8. Follow above procedure for several days.
9. Wonder why patient has caught a HAI.
10. Notice Hand Hygiene posters everywhere and the media coverage of hand hygiene.
11. Moral? Dirty Medical Devices have prolonged direct contact with patients and without clean equipment it is pointless following hand hygiene procedures.
So wheres all the posters & media coverage relating to devices?

You forgot the manky BP cuff Topper!

This is Methicillin-Resistant Staphylococcus Aureus, whilst this is Clostridium Difficile. Two entirely different beasts, as you can see.

Outside of the path lab, the only stinking bits of medical equipment I have ever come across have been commodes, bed-pan washers and the odd suction pump that has been "left to ferment", as it were.

For MRSA it is essential that an alcohol gel is used on the hands. For C.Dificile it is necessary to wash the hands with soap and water!!! Go figure?!!!!

How about a weak bleach dip that will kill the little bugs. Also may clean some of the manky equipment.

I recommend raising any infected items temperature to about 2000 degrees C for approximately 12 hours that usually does it.

That may have an environmental impact.

...like melting the walls of the cssd building

Part of the problem is that there are just too many bio-systems bustling around in modern hospitals. What are all those people doing? Take a look at those wonderful old photographs that sometimes adorn corridor walls, and you'll see spacious, polished, wards (usually with the windows open), and just a couple of nurses posing stiffly for the camera. The patients are also there, of course!

It's not so much the kit that spreads the bugs about, it's all those people! Is it just me, or has anyone one else noticed how much the wards stink these days? If it's not "you-know-what", it's the stench of food. The wards are always stuffy, over-heated, and without adequate ventilation. And, as I say, over-crowded. The first thing I always find myself doing is getting some windows open, just so I can breathe! I stay only as long as it takes to sort out the task at hand, and then bug-out (yes, pun intended).

These days, I don't even stop to chat with the elderly patients, as I used to. Take my advice, Mates, and keep out of the wards as far as possible!

You're not the only one to notice the stink of the wards! All appear to smell the same! I remember the mingled smell of toast and bed-pans in the mornings!!!

It's worth remembering that the average length of in-patient hospital stays has come down from 45 days in 1948 to about 2 days now so there is not a lot of time to clean up between patients! I don't envy our nursing friends their jobs.

I once read of someone in the USA having a cochlear implant operation and paying $115,000 dollars for three nights stay alone ( not including the operation and bits and pieces either!! ) What do our American friends do, burn the furniture in between patients???

That reminds me Geoff the problem isn't just with the NHS, there was a local story here that this happened in a BUPA hospital. Although if it had been a NHS hospital the news story would probably have been an national story and given more enthusis!

All I can smell here is the odor of floor cleaner, a very strong sweat, sickly smell, I take it there's a reason that NHS cleaner doesn't come in pine fresh?

You're spot on about the smell of toast, Jon! It seems that British hospitals couldn't manage without it.

Fair comment about private hospitals Chris. I make no distinction myself. Military hospitals used to be the best (in terms of cleanliness, and general good order), but they're a thing of the past in UK now (sadly, in my view).

As a Field Engineer mobile across the whole southern cluster I get to go in and out of many hospitals week in and week out. Having taken an interest in Infection Control during my MSc, I go out of my way to take note of how many people entering an leaving hospital at the same time as me use the alcohol gel provided at almost every entrance. I'm sure it will come as no surprise to many that almost no one uses it. It has been pointed out earlier in the thread that Hospitals seem inundated by oodles of visitors at all times of the day, and it seems to me that almost none of them seem to be taking responsibilty for their own infection control. As long as this public intransigence prevails I fear the organised fight against HAI from within the Healthcare Communinty is doomed for the outset.

Sheep need to be led, Snowler (or, perhaps, dipped would be more appropriate in this case)!

Perhaps sprayed? Does anybody remember the Dr Who episode when they were visiting the Face of Bo and they got showered in the lift!

During the summer holidays, the hospital employed (at £7 per hour) a group of university students to stand in the entrance and offer alcohol gel to everyone (including staff) coming in or out of the premises.
Surprise, surprise, the infection rate fell and MRSA cases were zero in August.

To my unfashionable, and no doubt old fashioned, way of thinking, it all boils down to discipline, pure and simple. The trouble is, that once highly-regarded characteristic is now totally absent in modern British Society. Or, put in a slightly different way, we get what we deserve!

Well said Geoff, I totally agree. Respect (for the rules, regulations and demarcation zones) is also lacking these days.

I have thought for a while that Trusts would be well advised to employ some Infection Control "Concierges" who encourage (!) all visitors to use alcohol gels etc etc as they enter and leave the building. It must be more cost effective to do this and enjoy the benefits than lose the funds to bedblocking MRSA patients with all the attendant nursing care and resources they swallow up.

I have another gripe too! How many times have you been growled at by the beautiful people in theatres for daring to venture into their ivory tower for a split second without wearing a gown etc, only to see the same oink an hour later in the Spar Shop with the very same gown and mules and very nice "Disney" bandana on that he was wearing in their "sterile bubble" ? I just don't get it. And nurses doing their weekly shop on the way home from work in the uniform they have been wearing all day, shovelling sh*t and the like in? It can't just be me who can see where it is all going wrong surely? The media go nuts over HAI and the public are becoming scared of going into hsopitals yet no one seems to even take an interest in the most basic and yet effective methods of IC. Bewildered am I.

Talking about uniforms I hear there is a trial about to start in some UK hospitals where the staff are to be given uniforms woven with silver. Seemingly bacteria including MRSA and C dificile cant survive on silver, so it will be interesting to see if this makes a difference. Maybe this silver lining should also be incorporated into things like BP cuffs, SpO2 probes, ECG cables ect. The link below gives some other info on this silver lining.

http://www.robprince.net/MRSA/forum-products.asp?action=replys&forumID=8919

Is this the same lining as that currently fitted as standard to the cirrus, cumulus and stratus range?

Meanwhile (some years later) the fight continues.

It is always nice when stuff is well designed. Does anyone (from the hospitals mentioned in the piece, perhaps) have any information for us about this?

I notice that "saving money" comes into the equation (or so they say). So that's all the boxes ticked, then.

Whilst I'm on here I may as well reiterate my own suggestions:- turn down the heating by two or three degrees (at least), open the flippin' windows, and get some air into the place.

And then, get rid of all the dust and fluff (and who knows what else) that's laying (or blowing) around ... and if it's "hidden" (inside equipment, for example), then get some proper PM organised.

And, lastly, be a bit more discerning about who gets let onto the Wards, and the grot they bring in with them. Restrict the number of "visitors" cluttered around bedsides, have them remove their outdoor clothing (and get them to wear overshoes), and watch as they wash their grubby pawls before entering. Also (if necessary) check what's in their bags - both before and after visiting!

In a word, manage the situation.

But there again, none of of those suggestions would ever be taken up. Why not? Well, they can't be any good as they don't cost mega-amounts of tax-payers' money!