NEWCASTLE UPON TYNE HOSPITALS NHS TRUST
MRSA and other antibiotic-resistant organisms
1. Introduction
The problem of antibiotic-resistant bacteria has been identified as a serious and increasing
problem for hospitals in the UK. There are many such organisms, but at present the betterknown are meticillin-resistant Staph. aureus (MRSA), glycopeptide-resistant enterococci
(GRE) and extended-spectrum beta-lactamase producing Gram-negative bacilli (ESBLproducers). Hospitals elsewhere in the UK have also reported outbreaks of infection due to
other organisms, such as Acinetobacter, but these have not presented a major problem in
Newcastle thus far. In addition, Clostridium difficile infection, although not considered to be
a multi-resistant organism in quite the same way, is often grouped with the above
organisms as the preventive and control measures are very similar.
This paper shows the current state of these organisms in the Newcastle Trust and
discusses the control measures which have been adopted by the Trust.
2. MRSA
2.1 Current status
The Trust saw its first outbreaks of MRSA infection in 1995, and since then the organism
has become common in our patients, as it has in every other acute hospital in England and
Wales. It has spread to all areas, but is much more common in some than others, notably
general medicine, care of the elderly, and to a lesser extent general surgery. Some
specialist units, such as renal medicine and critical care, also have a higher rate of MRSA.
The organism is very rare in child health and obstetrics.
In 2001 the Department of Health commenced a national surveillance programme to
monitor the rate of MRSA in hospitals by collecting data about one specific infection,
MRSA bacteraemia (the presence of MRSA in the bloodstream). The table below shows
the rate of MRSA bacteraemia per 1000 bed-days for the four years to March 2005, plus
the six months from April to September 2006 (the last date for which validated figures are
currently available).
Table 1. MRSA rates per 1000 bed-days, April 2001 to September 2005
2001-2002
2002-2003
2003-2004
2004-2005
Trust rate
0.17
National
0.23
average
rate*
* for all 45 specialist Trusts
0.14
0.23
0.18
0.23
0.17
0.21
April to
September
2005
0.11
0.21
In comparison to other similar Trusts – the Trust is classed as a ‘specialist’ Trust due to
the nature of its work – we have a relatively low MRSA rate. In fact, the six months from
April to September 2005 showed that our rate was the third lowest in all of the 45 specialist
Trusts in England.
2.2 Prevention and control measures
We have a number of measures in place designed to prevent and reduce the rate of
MRSA infection. These include:
 the presence of a well-established and very active infection control team on each
hospital site
 a comprehensive policy for the control of MRSA, which has been in place for
several years
 all new staff are screened and where necessary treated for MRSA
 patients from groups known to be at high risk of MRSA are screened on
admission, and those found to be MRSA-positive are isolated to prevent crossinfection
 a policy for the active reduction of the MRSA rate, which was put in place early in
2005
 extensive promotion of hand washing and the use of alcohol hand gel (this is
probably the single most important method of preventing the spread of resistant
bacteria)
 the Trust places considerable importance on general cleanliness and hygiene
and has achieved good results in various inspections carried out with regard to
cleanliness
 a detailed policy for minimising the use of antibiotics which promote resistant
organisms
The latest available figures indicate that we have achieved a 30% reduction in the rate of
MRSA in the past 15 months. It should also be remembered that a significant proportion of
patients with MRSA do not acquire the organism in the Trust. Other places of possible
acquisition include nursing/care homes, other hospitals in the UK, and hospitals abroad.
Due to the specialist nature of the Trust’s work, many patients are transferred to us from
other hospitals, sometimes bringing resistant organisms with them.
3. Other resistant organisms
GRE is an uncommon organism in UK hospitals at present, unlike the USA, for example,
where it is very common. In 2003-2004, the national surveillance scheme showed that the
Trust had just two cases, one of the lowest rates of all specialist hospitals. A separate
policy exists for the control of GRE should it occur.
The infection control teams have noted with some concern the increase over the past two
years of ESBL-producing organisms which are very antibiotic-resistant. No national
surveillance scheme currently exists for these organisms but we are developing our own
surveillance system. Data from elsewhere in the UK indicates that the community, rather
than hospitals, is the source of many of these bacteria, for reasons that are not clear.
4. Clostridium difficile infection
This infection has attracted considerable attention recently. There is a national surveillance
scheme which shows that in 2004 the Trust had a C. difficile infection rate of 1.37 cases
per 1000 bed-days, compared to a national average of 1.71. This lower rate is due partly
to the measures outlined for the control of MRSA, and partly due to other measures such
as the isolation of patients with C. difficile infection and the development of antibiotic
policies intended specifically to minimise the risk of this condition.
5. Conclusions
Whilst we are not complacent about the rate of infection due to resistant organisms in the
Trust, and there is certainly room for improvement, we believe that data from the national
surveillance schemes indicate that the measures we are taking to prevent and reduce
infection with resistant bacteria are having an effect. For the future we need to improve on
these measures and to ensure that good standards of hygiene, and particularly of hand
hygiene, are maintained.
Dr. Steve Pedler
Director of Infection Prevention and Control
28 March 2006