STATISTICS show that hospital-acquired methicillin resistant Staphylococcus aureus (MRSA) has fallen from three per 1,000 patients in 2002 to 2.2 patients in 2007 at public hospitals in Singapore.
These figures have been dragged down by the brilliant performance of the National University Hospital, where infections have been almost halved from four to 2.1 per 1,000 patients in that five-year period.
But what the figures don’t show is that the hospital has changed the way it counts MRSA infections.
Instead of reporting all cases, it started reporting only “new” cases. Nothing wrong with that, as the hospital wanted to know how many patients had actually caught the bug while in hospital.
A patient who has been colonised – that means the patient has the bug on his skin or in the nose, but is not sick with it – is regarded as having brought the bug in with him.
Should he undergo surgery, for example, and the bug then gets into his blood stream or organs, and he then gets infected, he is not counted as having hospital-acquired MRSA.
But because of this practice, NUH numbers which stayed at four or more per 1,000 patients from 2002-2004, started falling in 2005.
This raises the question of how much MRSA rates in public hospitals have really fallen by. And how these patients became colonised with the drug resistant bug in the first place.
Since MRSA is largely found within hospital walls, it would be reasonable to assume that the vast majority got it in hospital.
But over the years, these bugs have been leaking out into the community. How do these bugs get out? Is that another area that needs to be plugged?
A recent article on MRSA published by infectious diseases experts here claims that each of Singapore’s three largest hospitals sees “almost one death, six to nine new clinical infections and up to 60 new individuals colonised per week.”
Those are not small numbers.
Hospital-acquired MRSA infections are not a uniquely Singapore problem. It is seen all around the world. Only a handful of countries have succeeded in keeping numbers of infections low – at high cost and with all hospitals working in unison.
While there is no need for hospitals here to berate themselves, it is also not something Singapore should remain complacent about.
Other countries have shown that with the will to stamp it out and the resources to do so, it can be done. It is certainly something worth doing, since it will save much unecessary suffering and deaths.
But no single hospital can do it alone. Singapore is a small country and patients move from one hospital to another. Hospital workers, some of whom may carry MRSA, also move, bringing the bugs along with them.
As Tan Tock Seng’s Professor Chng Hiok Hee so rightly pointed out, patients and their visitors too help to spread the bug. All it takes is one weak link.
So while doctors, nurses and other healthcare workers need to be more stringent in hand hygiene – contaminated hands are the single biggest cause of MRSA transmission say experts – patients and their visitors too need to ensure that they do not spread the bug.
This could well be the reason patients in subsidised wards are at higher risk of catching the bug. All it takes is for one helpful patient going to the aid of another – putting a pillow straight, offering a cup of water – to spread the bug.
Public education is needed to teach people that hospitals are not clean places and that they must take care.
Scenes of children running around a ward during visiting hours are all too common. They do not know the danger they are putting themselves in.
Since the stories on hospital-acquired MRSA appeared in The Straits Times, many patients have called to share their experiences of how they caught unknown infections, not necessarily MRSA, in hospital.
One man complained that the patient in the next bed kept sneezing. One woman actually called from a hospital ward to say a patient placed in an isolation ward was walking around, and the nurses weren’t stopping her.
As people become aware of the dangers of infection spreading, they will take greater precautions and this could help break the chain of transmission.
Hospitals now have alcohol rubs in all wards and at every bed, making keeping hands clean easy. Some even have them in the lobby and along corridors.
But these rubs are of no use if they are not used. Even among people who use them, not all use them correctly, often missing the back of hands, the wrist or the webbing between fingers.
While most hospital staff do use the rubs, few patients or visitors do. It’s time they did, if only to protect themselves.
What is needed is public education, so that visitors and patients do not become the weak link in the fight against infection.