Thursday, May 12, 2005

MRSA in Gibraltar - No need for alarm, says Britto

MRSA cases in Gibraltar

Health minister Ernest Britto has given an unequivocal commitment to review hospital referrals should evidence show a dramatic rise in the number of local MRSA cases contracted during treatment in any specific foreign medical facility.

He cautioned, however, that numerous factors had to be taken into account when interpreting MRSA statistics, adding that reaching firm conclusions was both difficult and potentially misleading.

MRSA refers to a type of bacteria that has become resistant to the most commonly used antibiotics.

Dubbed the ‘hospital Superbug’ by the sensationalist media, it has been the object of wide public attention and is often perceived as a virulent threat that carries severe consequences for sufferers.

But in an interview with the Chronicle, both the minister and Dr David McCutcheon, chief executive of the Gibraltar Health Authority [GHA], stressed that the problem had to be understood within its proper context and that there should be no cause for public alarm.

MRSA hit the local headlines again last week after the government provided details to the House of Assembly of the number of cases treated in St Bernard’s Hospital between 1996 and 2004.

According to that information, the hospital treated 117 MRSA cases during that time, of which 40 were acquired in health facilities abroad, 18 locally and the balance “elsewhere.” In one case, MRSA was a contributing factor in the death of a patient.

Given that most cases are contracted outside Gibraltar, concerns have been voiced that if any particular hospital stands out in terms of the number of local people treated there and coming back with MRSA, then patients should no longer be sent there.

Mr Britto, who is also chairman of the GHA, declined to give a detailed breakdown of the numbers of MRSA cases contracted in specific hospitals in the UK and Spain.

“The main reason is because it is not a precise science and we may be pointing fingers at a hospital which we should not be actually pointing [at],” he said.
“Secondly, we may also be creating concerns in our patients which are not necessarily justified.”

“We have confidence that the hospitals we are dealing with are all hospitals which are doing their best to counter MRSA and we’re obviously keeping an eye [on it] to make sure that we don’t suddenly get one hospital that spikes. At the end of the day, if there is a hospital that is giving us cause for concern, [GHA] management would be the ones taking the immediate steps to stop sending people there,” he concluded.

Hospitals Abroad

Although the minister declined to provide a detailed breakdown of the number of MRSA cases acquired in specific hospitals, the information has in fact been publicly available in the GHA’s annual reports since 2000.

From those reports, it is possible to glean that of the 23 cases of MRSA contracted in foreign hospitals between 2000 and 2003, 16 of those were acquired during treatment in St Mary’s in the UK.

Of the total 65 cases of MRSA reported in Gibraltar during that four-year period, 21 were acquired locally. While that figure appears to be at odds with the information provided by the government during the recent session of the House of Assembly, it also includes cases within the community and not necessarily treated at St Bernard’s Hospital. They could, for example, refer to cases within the community, or in other public local healthcare facilities.

That last fact sharply illustrates one of the problems with MRSA statistics. While they can provide healthcare professionals with an idea of trends, they can also easily prove deceptive.

For a start, the number of cases in any particular hospital has to be seen within the overall number of patients treated in that hospital and the rate of bed occupation.

The more patients a hospital treats, the higher the number of potential MRSA cases.
Not only that but each department within that hospital will have different rates of MRSA infection that may be better or worse than the overall figure.

In the UK, levels of MRSA are assessed as a ratio calculated on the basis of the number of cases per 1000 bed days. In broad terms, recent figures from the UK Department of Health suggest the numbers are dropping.

In Gibraltar, the number of MRSA cases reported annually is low in relation to the UK, but the comparisons are virtually meaningless unless the figures are analysed in depth.

Controlling Risks

Looking at the broader picture may be useful, but the focus in Gibraltar is on the detail.

“It’s very small numbers, so we track them in actual cases,” Dr McCutcheon said. “The issue is that each individual case is tracked. So if there’s a case, it’s reported to the infection control committee of the hospital and they review the circumstances around that case.”

Both Mr Britto and Dr McCutcheon stressed that MRSA had to be seen within the wider context of “hospital acquired illnesses”, adding that management systems had been put in place – and were constantly under review – to ensure the risks were minimised as far as possible.

Ultimately, infection control is about strict hygiene procedures, not just for hospital staff but for visitors too.

“There’s no sense of alarm or panic,” Mr Britto said of MRSA in Gibraltar.

“But it’s a source for concern because it’s [about] infection control and we need to be aware of it and we need to be on top of it.”

Related Links:

A simple guide to MRSA


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