Phoebe Martin
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Hospital Acquired Infections a Look into MRSA Infections and the Occurrence of MRSA Bacteraemia in Different Regions of England. Phoebe Martin
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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’ - PowerPoint PPT Presentation
Transcript of Phoebe Martin
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://www.life.umd.edu/classroom/bsci424/Images/PathogenImages/FourQuadrantStreakPlate.jpg
http://1.bp.blogspot.com/_PB5-El7se4s/Rw3tj-QWGJI/AAAAAAAAEO8/ZrdNoPn9TmI/s400/mrsacart.jpg
- Most common complication and a main cause of preventable injury and death
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/-F8daOPNBUT4/T2PEGH_pEUI/AAAAAAAAAEo/SN5bGFe2m1w/s1600/hospital_ward__beds.jpg
Prevalence of HAIs in the UK
- Rates vary within the UK
- HIS reported 8.2% ratein English hospitals
- The most common types of infection in England are GIs
(22%) and UTIs (19.7%)
Country Prevalence (%)
England 8.19
Wales 6.35
Scotland 9.5
Northern Ireland 5.43
Site of infection Prevalence (%)Gastrointestinal system 22Urinary tract 19.7Pneumonia 13.9Surgical site 13.8Skin and soft tissue 10.5Primary bloodstream 6.8Lower respiratory tract 6Eyes, ENT or Mouth 2.9Systemic 1.2Bone & Joint 1.2Cardiovascular system 1.1Reproductive tract 0.6Central Nervous system 0.3
Most Prevalent Causative Pathogens
- Escherichia coli - Streptococcus pneumoniae- Influenza virus A - Staphylococcus aureus - Clostridium difficile - Norovirus - Pseudomonas aeruginosa
http://upload.wikimedia.org/wikipedia/commons/2/2d/Escherichia_coli.jpg
https://upload.wikimedia.org/wikipedia/commons/2/20/Streptococcus_pneumoniae.jpg
http://upload.wikimedia.org/wikipedia/commons/2/2d/Pseudomonas_aeruginosa_Gram.jpg
Methods of Prevention
- ‘Modern Matrons’ (2000)
- ‘The Deep Clean’ (2007-2008)
- ‘The Healthcare Associated Infections Technology Programme including the Rapid Review Panel’ (2008)
- ‘MRSA screening‘ (2009)
- ‘Cleanyourhands campaign’ (ongoing)
http://blog.al.com/montgomery/2012/04/6_teenagers_hospitalized_after.html
http://www.microphage.com/product/screeningMrsaUS.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
- Microorganism infection involves host defence evadingmechanisms including
http://image.made-in-china.com/43f34j00aZutVjRdHDbo/Endotracheal-Tube-With-Suction-Catheter.jpg
https://upload.wikimedia.org/wikipedia/commons/e/e4/Staphylococcus_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
- 42% reduction observed between the years of 2003-04 (7,700 cases) and 2007-08, (4,450 cases)
Financial Year Total MRSA Bacteraemia Rate per 100,000 populationApril 2008 - March
2009 2935 5.7April 2009 - March
2010 1898 3.7
Regional Differences in MRSA Rates
RegionNumber of Hospitals
Total number of MRSA bateraemia cases
Average Number of Cases per Hospital
Yorkshire and The Humber 19 70 3.68North West 26 89 3.42London 31 95 3.06South Central 8 20 2.5East of England 15 34 2.27East Midlands 14 31 2.21South West 17 36 2.12South East 13 27 2.08North East 10 20 2West Midlands 18 33 1.83
-Highest number of cases was in London-Lowest number of cases was in South Central and the North East
- 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
Rate of MRSA per hospital
Population (million)
Population density (people /km2) Males Females GDHI (£)
Gross Weekly Earnings (£)
Population 65+ years (%)
Yorkshire and The Humber 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
West Midlands 1.83 5.5 420 77.9 82.2 14,000 471 17
*GDHI - Gross Disposable Household Income
Influence of Regional Population and Population Density on MRSA Rates
Life expectancy
(years)
Region
Rate of MRSA per hospital
Population (million)
Population density (people /km2) Males Females GDHI (£)
Gross Weekly Earnings (£)
Population 65+ years (%)
Yorkshire and The Humber 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
West Midlands 1.83 5.5 420 77.9 82.2 14,000 471 17
*GDHI - Gross Disposable Household Income
Influence of Life Expectancy on MRSA Rates
Life expectancy
(years)
Region
Rate of MRSA per hospital
Population (million)
Population density (people /km2) Males Females GDHI (£)
Gross Weekly Earnings (£)
Population 65+ years (%)
Yorkshire and The Humber 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
West Midlands 1.83 5.5 420 77.9 82.2 14,000 471 17
*GDHI - Gross Disposable Household Income
Influence of Regional Average Earnings on MRSA Rates
Life expectancy
(years)
Region
Rate of MRSA per hospital
Population (million)
Population density (people /km2) Males Females GDHI (£)
Gross Weekly Earnings (£)
Population 65+ years (%)
Yorkshire and The Humber 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
West Midlands 1.83 5.5 420 77.9 82.2 14,000 471 17
*GDHI - Gross Disposable Household Income
Influence of Age on MRSA Rates
Life expectancy
(years)
Region
Rate of MRSA per hospital
Population (million)
Population density (people /km2) Males Females GDHI (£)
Gross Weekly Earnings (£)
Population 65+ years (%)
Yorkshire and The Humber 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
West Midlands 1.83 5.5 420 77.9 82.2 14,000 471 17
*GDHI - Gross Disposable Household Income
Comparison between hospitals with high rates MRSA bacteraemia and those
with low rates Population
Hospital
Number of cases of MRSA bacteraemia * Region City
Number of Beds
Rate of MRSA per bed
City Population
% 65+ years old % male % female
St James University Hospital 11
Yorkshire and the Humber Leeds 1157 105.18 751,500 14.6 48.3 51.7
Royal London Hospital 10 London London 652 65.2 8,173,900 11.1 49.3 50.7
Addensbrooke’s Hospital 9East of England Cambridge 1180 131.11 123,900 11.7 50.8 49.2
Manchester Royal Infirmary 9 North West Manchester 800 88.89 503,100 9.4 50.2 49.8
Scarborough General Hospital 1
Yorkshire and the Humber
Scarborough 552 552 108,800 23.3 48.3 51.7
Royal Marsden Hospital 1 London London 109 109 8,173,900 11.1 49.3 50.7Watford General Hospital 1
East of England Watford 499 499 90,300 12.4 49.6 50.4
Christie Hospital 1 North West Manchester 174 174 503,100 9.4 50.2 49.8* from 25/09/2011 to 11/11/2012
Influence of Size of Hospitals on MRSA Rates
Population
Hospital
Number of cases of MRSA bacteraemia * Region City
Number of Beds
Rate of MRSA per bed
City Population
% 65+ years old % male % female
St James University Hospital 11
Yorkshire and the Humber Leeds 1157 105.18 751,500 14.6 48.3 51.7
Royal London Hospital 10 London London 652 65.2 8,173,900 11.1 49.3 50.7
Addensbrooke’s Hospital 9East of England Cambridge 1180 131.11 123,900 11.7 50.8 49.2
Manchester Royal Infirmary 9 North West Manchester 800 88.89 503,100 9.4 50.2 49.8
Scarborough General Hospital 1
Yorkshire and the Humber
Scarborough 552 552 108,800 23.3 48.3 51.7
Royal Marsden Hospital 1 London London 109 109 8,173,900 11.1 49.3 50.7Watford General Hospital 1
East of England Watford 499 499 90,300 12.4 49.6 50.4
Christie Hospital 1 North West Manchester 174 174 503,100 9.4 50.2 49.8* from 25/09/2011 to 11/11/2012
Influence of Gender on MRSA Rates
Population
Hospital
Number of cases of MRSA bacteraemia * Region City
Number of Beds
Rate of MRSA per bed
City Population
% 65+ years old % male % female
St James University Hospital 11
Yorkshire and the Humber Leeds 1157 105.18 751,500 14.6 48.3 51.7
Royal London Hospital 10 London London 652 65.2 8,173,900 11.1 49.3 50.7
Addensbrooke’s Hospital 9East of England Cambridge 1180 131.11 123,900 11.7 50.8 49.2
Manchester Royal Infirmary 9 North West Manchester 800 88.89 503,100 9.4 50.2 49.8
Scarborough General Hospital 1
Yorkshire and the Humber
Scarborough 552 552 108,800 23.3 48.3 51.7
Royal Marsden Hospital 1 London London 109 109 8,173,900 11.1 49.3 50.7Watford General Hospital 1
East of England Watford 499 499 90,300 12.4 49.6 50.4
Christie Hospital 1 North West Manchester 174 174 503,100 9.4 50.2 49.8* from 25/09/2011 to 11/11/2012
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
