Methicillin Resistant Staphylococcus Aureus (MRSA) is a type of staph bacteria that is resistant to certain antibiotics. MRSA can cause infections in wounds, ulcers, intravenous lines, lungs, and the bloodstream. The Healthcare Commission assesses UK hospitals on infection control standards including MRSA rates. Data on three London hospitals from 2005-2008 shows declining MRSA infection numbers, with rates dropping below targets over time at two hospitals and reaching zero at one hospital by 2007-2008.

1. Methicillin Resistant Staphylococcus Aureus (MRSA)
Healthcare Commission (HCC) – Assessing Hospital Trusts on cleanliness
standards
The Healthcare Commission (HCC) is the independent watchdog for
healthcare in England. HCC assess and report on the quality and safety of
services provided by the NHS and the independent healthcare sector. One of
the core standards which is assessed by HCC is infection control1
What is MRSA?
S.aureus is just one of a family of staphylococcal bacteria. Their normal home
is on human skin. This is generally harmless on the skin, however, the
bacteria can cause significant infections if it enters wounds on medical
devices such as artificial hip joints or heart valves, or when staff use
intravenous catheters to access the bloodstream. This is especially so for
severely ill patients such as those in intensive care units or those undergoing
cancer chemotherapy. Moreover, Staphylococcus aureus is a very common
cause of bacterial infections such as boils, carbuncles, infected wounds, deep
abscesses and bloodstream infection (or bacteraemia).
Types of infections
Staphylococcus aureus, including those that are MRSA, cause a wide range
of infections from asymptomatic colonisation, where the MRSA is doing no
damage but is still capable of causing clinical infections, to fatal septicaemia,
which is the most severe form of blood stream infection.
Wound infections
S.aureus / MRSA is the commonest cause of wound infection - either after
accidental injury or surgery. The symptoms are a red, inflamed wound with
yellow pus. The wound may break open or it may fail to heal and can cause a
wound abscess to develop.
Superficial ulcers
Pressure ulcers, varicose ulcers and diabetic ulcers are all due to poor blood
supply and superficial skin damage, these are often sites of MRSA infection.
Intravenous line infections
1 Core Standard 4a:
“Healthcare organisations keep patients, staff and visitors safe by having systems to ensure
that the risk of healthcare acquired infection to patients is reduced, with particular emphasis
on high standards of hygiene and cleanliness, achieving year on year reductions in
Methicillin-Resistant Staphylococcus Aureus (MRSA).”

2. MRSA may infect the entry site of an intravenous line causing local
inflammation with pus. MRSA can enter the blood stream through the
intravenous line and cause a bacteraemia, which is a blood stream infection.
Deep abscesses
If MRSA spreads from a local site into the blood stream it can infect various
sites in the body such as the lungs, kidneys, bones, liver, and spleen. This
can then cause one or more deep abscesses which are at a distant from the
original site. The abscesses are often painful and the patient will have a high
fever, a high white cell count in the blood and signs of inflammation near the
infection. The patient will be very unwell and may have rigors (shivers) and
low blood pressure (shock). Over a period of time, the body will enter a
catabolic state with breakdown of tissue, loss of weight and failure of essential
organs. This is usually linked with an associated septicaemia.
Lung infections
MRSA / S.aureus is a rare cause of lung infection except in Intensive Care
Units. There, the patient is on a ventilator with a tube in the trachea,
bypassing the defences of the nose and throat. MRSA can gain entry to the
lungs via the tube and cause pneumonia which may be fatal.
Bacteraemia / Septicaemia
MRSA / S.aureus can enter the normally sterile blood stream either from a
local site of infection such as a wound, ulcer, and abscess or via an
intravenous catheter. Bacteraemia describes the presence of MRSA /
S.aureus in the blood. Septicaemia can follow and is the clinical term for a
severe illness caused by the bacteria in the blood stream. The symptoms are
not specific to MRSA and can be the same for other bacteria that cause
septicaemia. The usual symptoms can include high fever; raised white cell
count; rigors (shaking); disturbance of blood clotting with a tendency to bleed
and failure of vital organs. This is the kind of MRSA infection that has the
highest death rate. All MRSA bacteraemia are reported and treated as
serious incidents so that hospitals can learn from each incident and prevent
re-occurrence.

3. MRSA Infections in Barnet Hospitals
The following graphs show the incidence of MRSA and how this compares
with their targets in Barnet Hospitals
Barnet and Chase Farm Hospital Trust
0
10
20
30
40
50
60
70
80
90
2005/06 2006/07 2007/08
Year
Number
of
MRSA
infections
Actual No.
Target
Figure 1 Graph showing number of MRSA infections in Barnet and Chase
Farm Hospitals compared to their target number.
Barnet and
Chase Farm
Hospitals
Year Target Actual
MRSA 05/06 75 79
MRSA 06/07 56 62
MRSA 07/08 38 53
Figure 2 Table showing number of MRSA infections in Barnet and Chase
Farm Hospitals compared to their target number.
Although the actual number of MRSA infections are a little higher than the
target set,
the rate of infection is decreasing.

4. Royal Free Hospital Trust
0
20
40
60
80
100
2005/6 2006/7 2007/8
Year
Number
of
MRSA
infections Actual
Target
Figure 3 Graph showing number of MRSA infections in the Royal Free
Hospital compared to their target number.
RFH Year Target Actual
MRSA 05/06 78 93
MRSA 06/07 58 75
MRSA 07/08 39 30
Figure 4 Table showing number of MRSA infections in the Royal Free
Hospital compared to their target number.
The rate of infections have been decreasing each year and in 2007/08 the
rate of MRSA infections fell below the target set.
Royal National Orthopaedic Hospital
0
0.5
1
1.5
2
2.5
3
3.5
2005/6 2006/7 2007/8
Year
Number
of
MRSA
infections
Actual
Target

5. Figure 5 Graph showing number of MRSA infections in the Royal National
Orthopaedic Hospital compared to their target number. (Target numbers for
years 2005/6 and 2006/7 have not been provided)
RNOH Year Target Actual
MRSA 05/06 3
MRSA 06/07 2
MRSA 07/08 0
Figure 6 Table showing number of MRSA infections in the Royal National
Orthopaedic Hospital compared to the target number.
The number of infections at the Royal Orthopaedic Hospital have been low
and have been declining every year to no infections in 2007/08. Indeed it is
true to say that all three hospital trusts have shown a decline in the number of
MRSA infections.