News from NICE: Renewed vigilance of handwashing

infectionNHS must renew hygiene efforts to tackle ‘unacceptable and avoidable’ infection rates

Healthcare professionals should wash their hands before and after seeing every patient to help prevent the spread of infections such as MRSA and C difficile in the NHS. One in 16 people being treated on the NHS picks up an infection. As a result, more NHS resources are consumed and the affected patients are at increased risk.

See the latest NICE quality standard which contains six statements designed to reduce infection rates, including a statement recommending that patients should be looked after by healthcare workers who always clean their hands thoroughly, both immediately before and immediately after contact or care.


BMJ Best Practice: MRSA

Extract from BMJ Best Practice

“This month’s topic is MRSA, one of BMJ BP’s most recently updated topics and an important cause of infection in both healthy people in the community and in people in healthcare facilities.

The prevalence of MRSA infection is increasing globally. MRSA is an important cause of infection in both healthy people in the community and in healthcare institutions, but the two presentations and therapies differ.

Children and younger adults are more commonly afflicted with community-acquired MRSA, while hospital-acquired MRSA is more common in older age groups. It is also important to distinguish MRSA colonisation from infection.

Read the brief summary of MRSA below and click the links to refresh your knowledge of its prevention, diagnosis, and treatment.

You can also review the available evidence on MRSA and find further reading here.


Haider, S., Wright, D: BMJ Case Report 2013

Panton-Valentine leukocidin Staphylococcus causing fatal necrotising pneumonia in a young boy 
Shahzad Haider, David Wright
Department of Paediatrics, Macclesfield District General Hospital, Macclesfield, UK
Panton-Valentine leukocidin (PVL) toxin producing strains of Staphylococcus aureus are known to cause skin and soft tissue infection. They can also cause necrotising pneumonia in otherwise healthy individuals. Here we report a case of severe, necrotising, haemorrhagic pneumonia in a 12-year-old boy who presented with a four-day history of a sore throat and fever. During his admission he deteriorated and needed full ventilatory support but despite all efforts he died. Postmortem examination lung swabs confirmed the presence of PVL-associated S aureus. There is a need to improve awareness of this disease among medical practitioners as early diagnosis and appropriate management can save lives.
Click here for the full article – requires Athens account

Healthcare Associated Infection (HCAI) Surveillance computer system


A new web based Healthcare Associated Infection (HCAI) Surveillance computer system is being developed which will replace the existing MESS system used to collect the patient level mandatory surveillance data on MRSA, MSSA and E. coli bloodstream infections, and C.difficile infections. Expected to go live in April 2013, the new computer system will be faster and have new features which will give users improved facilities to input and manipulate the data more easily. It will also allow users to produce customised tabulated and graphical reports of local, regional and national HCAI data.

Read more of this letter at dh_134577.pdf (application/pdf).

Health Protection Report | Infection Reports | Healthcare Associated Infections

Last updated 15 June 2012 Volume 6, No 24 (PDF file, xxx kB) 

Trends in mandatory Staphylococcus aureus (MRSA and MSSA) and E. coli bacteraemia, andClostridium difficile infection data for England up to January-March 2012

The eleventh publication of the quarterly epidemiological commentary describes recent trends for mandatory surveillance of  (MRSA) and Clostridium difficile infections (CDI) reported by NHS acute Trust hospitals in England up to March 2012 [1,2]. The publication also contains analyses of the first 15 months of meticillin-sensitive Staphylococcus aureus (MSSA) bacteraemia data and a summary of the first 10 months of Escherichia coli bacteraemia surveillance (June 2011 to March 2012). This is the second quarterly epidemiological commentary to include mandatory surveillance data on E. coli bacteraemia.

The complete epidemiological commentary with additional information on the rates of MRSA, MSSA and E. coli bacteraemia, and CDI, is available on the HPA website [3].


MRSA bacteraemia

The total count of MRSA bacteraemia during the previous 10 years is shown in figure 1, and is divided into Trust apportioned episodes (this category includes patients presumed to have been infected while admitted to the Trust*) and non-Trust apportioned episodes (‘all other episodes’).

  • in 2011 there were 1,185 MRSA bacteraemia reports made. This is an 83.7% reduction compared to the number of reports in 2002 (7,274) (figure 1);
  • there were 504 Trust apportioned reports in 2011; representing an 83.7% reduction compared to 2006 (6,776 reports);
  • there were 681 non-Trust apportioned reports (all other reports) in 2011 compared to 2,244 in 2006 representing a 69.7% reduction in non-Trust apportioned reports compared to 2006 (figure 1).
  • there were 262 MRSA bacteraemia reports in the quarter January-March 2012 of which 118 and 144 were Trust apportioned and non-Trust apportioned, respectively. This represents an 86.4% decrease in reports relative to the baseline of 1,925 quarterly reports in financial year 2003/04.

Figure 1. Overview of MRSA bacteraemia reports, 2002 to 2011

MSSA bacteraemia

  • there were a total of 10,903 reports between January 2011 and March 2012. 3,569 of these reports were Trust apportioned ¥ and 7,334 were non-Trust apportioned (all other reports). An overview of reports by month is presented in figure 2.
  • there were 2,157 MSSA bacteraemia reports in the quarter January-March 2012 of which 33.3% and 66.7% were Trust apportioned and non-Trust apportioned, respectively.
  • Figure 2. Monthly counts of Trust apportioned and all other reports of MSSA bacteraemia, January 2011 to March 2012

E. coli bacteraemia

  • of all bacteraemia covered by mandatory surveillance, E. coli is currently the most common bacteraemia with monthly reports being about 28-fold and 4-fold higher than those for MRSA and MSSA bacteraemia, respectively.
  • there were a total of 26,619 E. coli bacteraemia reports between June 2011 and March 2012 (table 1). E. coli bacteraemia data is not currently being apportioned.

Clostridium difficile infection

in 2011 there were 19,130 CDI reports made. This is a 53.0% reduction compared to the number of reports in 2008 (40,705 [figure 3]);

  • there were 8,418 Trust apportioned † reports in 2011 representing a 64.0% reduction in Trust apportioned reports compared to 2008 (23,085 reports [figure 3]).
  • in 2011 there were 10,712 non-Trust apportioned (all other reports) CDI reports made, representing a 39.2% reduction from the number reported in 2008 (17,620). In 2010 the ratio of non-Trust apportioned reports to Trust apportioned reports was approximately 1:1 whilst in 2011 the ratio had increased to 1.3.
  • data for the most recent quarter (January-March 2012) showed a total of 3,708 reports, which corresponds to a 73.3% reduction on the baseline year’s quarterly average (13,875 reports for financial year 2007/08). Of the 3,708 reports, 1,610 (43.4%) were Trust apportioned while 2,098 (56.6%) were non-Trust apportioned.

Non-Trust apportioned reports (“all other reports”): These include all reports that are NOT apportioned to an acute Trust. The two categories are mutually exclusive.

The next commentary will be published in September 2012.

via Health Protection Report | Infection Reports | Healthcare Associated Infections.