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Comment is free: A bug's life A bug's life
MRSA stories sound alarming, but we live with these bacteria all the time. They thrive in hospitals because the population is vulnerable.
Sarah Boseley
December 18, 2006 03:50 PM
Hospitals are dangerous places. People die there - and not always from the condition that brought them in. The chances of dying in hospital because one of the staff made a mistake in your treatment is
one in 300. That's 33,000 times higher than your chances of dying in a plane crash.
Any number of things could go wrong. The more complex medical care becomes, the more room there is for a human error - although some still surprise in their simplicity, such as the surgeons who
removed a pensioner's only healthy kidney because they held an X-ray the wrong way round. But very much more likely is a drug overdose. There are 40,000 mistakes relating to medication in hospital each year - and 2,000 of them cause moderate to serious harm to patients.
Now
we hear that two people, one a nurse and one a patient, have died in hospital of a particularly unpleasant variant of the so-called superbug, MRSA. It's highly alarming for two reasons: first, this bug, a variant of MHRA which produces a white blood cell-killing toxin called PVL, has not been identified in UK hospitals before; and second, some of the patients affected, including the nurse, are young. The ordinary sort of MRSA was linked to 1,168 hospital deaths in 2004, a rise of a quarter on the year before, but the infection is usually a contributing factor to, not the sole cause of, death. Those in hospital who suffer are usually old or particularly vulnerable because of a damaged immune system. MRSA is often doing what pneumonia used to do in the days when it was tagged "the old man's friend".
But nobody should be precipitated into death by a bug picked up on the ward - whether an old man with MRSA or a young nurse with PVL-producing MRSA. Infections can be prevented. Hospitals have been goaded by the department of health into major programmes of infection-reduction. Hand-washing is the single most important thing doctors, nurses and other staff and visitors can do. These bugs are transferred from one person to another on the skin.
But what tends to be forgotten is that they turn up in hospitals because, first of all, they live among us in the community. Bacteria were here before we were and they are unbelievably resilient. We have fought them since the invention of penicillin with what appeared to be an ever-larger and more powerful arsenal of antibiotics. They have simply mutated and developed new modes of attack of their own. So, where we once had staphylococcus aureus, we now have MRSA - a variant of staph aureus that is resistant to methycillin, the antibiotic normally used against it (penicillin long ago became useless).
Thus we have a thriving population of potentially deadly and damaging bacteria out there, and a captive audience of vulnerable people in our hospitals. Even the latest lethal arrival, PVL-producing MRSA, does its deadly work only if it can pass the barrier of our skin. The young nurse was carrying it unharmed until she had an operation. That's when it was able to enter her bloodstream.
It's hard to imagine how we can stamp out the threat from bacteria that are around us all the time. Washing hospital floors may make patients and visitors feel happier and safer, but the bugs walk in and out with us.
I don't mean to minimise the importance of hospitals doing all they can to protect the sick and the frail - absolutely they must, and staff who do not wash their hands are putting patients in danger. But we should stop thinking of hospitals as places of safety. They are not and never have been, and probably never will be. The best anybody can do is to try to minimise the risk.
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