MRSA: the making of a ‘superbug’

Another day, another shot fired in Britain’s ‘war against MRSA’. This time it was health secretary Patricia Hewitt saying that NHS managers could be subject to criminal prosecution if they fail to improve hospital hygiene.

MRSA has barely been out of the headlines in recent months. It was at the forefront of the parties’ campaigns in the General Election, with Tory leader Michael Howard making action on MRSA one of his five pledges. New ways of tackling the problem are always being mooted, from bringing back the ward ‘matron’ to asking hospital visitors to swab up. The stories of people injured or killed by the infection give the impression that this is a ‘killer bug’, which could strike any one of us, anytime. You might think, from all this, that MRSA is one of the biggest problems facing Britain today. It isn’t.

Staphylococcus aureus is a bacterium found in the noses of around 20 to 30 per cent of healthy people. MRSA is a strain of Staphylococcus aureus that is resistant to antibiotics, but in most cases it remains on the surface of the skin without causing health difficulties. Infection is rare, and is more likely if a patient is old, weak or has just had surgery.

MRSA contracted in hospitals is responsible for about 1,000 deaths per year. Every accidental death in hospital is one too many, and a tragedy for those concerned. But to put this in perspective: each year there are over 11million admissions to hospital (1); of these, around 300,000 will pick up an infection. So even for the hospitalised, the risk of dying of MRSA is small. And we have to consider, too, that more patients are having invasive procedures, such as surgery, which tend to cause complications. As Dr Stephen Barrett from Imperial College London said: ‘We have just got far more patients in hospital who are sick and have had more things done to them than happened in the past, and if it wasn’t MRSA they would probably have picked up something else anyway.’ (2)

MRSA is merely one of many practical problems facing a cash-strapped and chaotic NHS. It isn’t even the biggest source of infection – some 4,000 deaths per year are caused by other infections. ‘We hear that MRSA…is the sole problem – it is not’, said Dr Tony Howard, Wales’ leading specialist on MRSA. ‘On the spectrum of killer bugs, it is a fairly medium player…. Most infections that arise in hospitals arise from organisms present in our own bodies.’ (3) Deaths from MRSA have increased substantially over recent years, from only a handful of cases back in 1993, but experts believe that at least some of this increase is due to increased reporting (4).

The debate about MRSA has little to do with finding ways to tackle this practical problem. Instead, it seems that MRSA has become a metaphor for a host of social anxieties. MRSA is presented as the result of our slovenliness, of nurses not taking care to wash their hands, of floors left dirty and patients uncared for. There is an idea that we are all responsible, and should all do our bit – by swabbing up if we visit friends and relatives in hospital, and being on the lookout for poor hygiene. Yet improving poor personal hygiene isn’t the sole solution to MRSA infection. Experts estimate that only about 15 per cent of cases would be prevented by methods such as isolating infected patients and nurses washing their hands regularly (5).

There is a perception that MRSA is a uniquely British problem – it becomes an emblem of national decline, especially because it occurs in the NHS, ‘jewel in the crown’ of the British welfare state. In fact, UK infection rates are comparable with other European countries. The calls for the return of ‘matron’, to keep wards in line and impose discipline, are particularly ineffective. It’s almost a plea for somebody with a bit of character to impose standards on us feckless lot.

The idea is that MRSA could be anywhere, and could strike anybody down at any moment. We are warned about all the possible sources of infection, from sandwiches brought in by visitors to the keyboards used in hospitals. These concerns have led food scientists to recommend that hospitals adopt the hygiene procedures used in food factories, where ‘even a brief visit requires you to cover your head, take your shoes off on one side of a bench, swing your feet over to the other side and put them straight into a pair of freshly sterilised boots’ (6). Reports detail how this or that happy mum and tot fell ill, or how recently a healthy young British soldier died after going into hospital for a cut to his leg. The subtext here is that, ‘It could happen to you…’.

The panic about MRSA is also driven by a mistrust of public authorities. Some claim there is a ‘cover up’ taking place, implying that the true scale of the problem is being hidden. After the sad death of baby Luke Day, his family accused the hospital of trying to hide the fact that MRSA was one of the causes of his death. Another woman challenged prime minister Tony Blair on TV, claiming that she wasn’t told about being infected with MRSA after her caesarean section: ‘They covered it up. And when we asked them, they still denied it.’ (7) MRSA web forums speculate on the ‘true number’ of infections. But this belongs to the realm of conspiracy theories: whatever the specifics of individual cases, it’s extremely unlikely that doctors are falsifying the death stats to cover up MRSA.

It is in this context that we should see the government’s new tough measures to make hospital managers carry the can for hospital hygiene. Threatening NHS managers with the dock is intended to indicate that the government is getting a grip. But these gestures are unlikely to make any headway in tackling either the disease of MRSA, or the spectrum of concerns surrounding it.

(1) See hospital episode statistics on the DoH website

(2) http://news.bbc.co.uk/1/hi/health/4402089.stm, BBC News, 8 April 2005

(3) Expert slams MRSA ‘myth’, ICWales, 20 May 2005

(4) See MRSA deaths on National Statistics online

(5) http://news.bbc.co.uk/1/hi/health/4402089.stm, BBC News, 8 April 2005

(6) Culture, not MRSA, is the real NHS bug, The Times, 13 May 2005

(7) MRSA cover-up claim put to Blair, BBC News, 30 March 2005