METHICILLIN RESISTANT Staphy-lococcus aureus (MRSA) is just one of the many bacteria that can cause infections in hospitalised patients. MRSA was first identified in 1961 in the United Kingdom. During the 1980s, outbreaks of MRSA were noted in some London hospitals, but it was during the 1990s that an exponential rise in levels of MRSA was seen across the UK. It is difficult to identify the causative factors for this increase, but epidemic strains of MRSA became evident, which appeared to spread rapidly and easily amongst hospitalised patients. At this time, national guidelines for the control of MRSA existed and were largely based upon a “search and destroy” approach, as is seen in many other European countries today. Despite this stringent approach large outbreaks still occurred and infections with MRSA are of concern even today.

Winning Ways, the recently published strategy for prevention of healthcare as-associated infections, crystallises much of what was already known to be key measures needed to prevent transmission of MRSA and other infections. However, applying these measures in practice can be challenging. It is well established that hand-washing is a vital measure in the prevention of MRSA. Nevertheless, staff fail to carry out this practice for many reasons, including lack of time, lack of resources or lack of a culture that recognises the importance of this basic but essential activity. In a busy healthcare environment, hand-washing is an activity that can lapse. Staff cannot take the time to carry out procedures correctly, corners are cut, and clinical activities are delegated to junior staff – all of which place patients at increased risk of infection. We must allow them time in their day to wash their hands and we must provide them with the appropriate re-sources to do this.

It is very difficult for healthcare staff to meet often conflicting needs of patients, demands of the service and stringent healthcare performance targets. To meet targets for trolley waits in the Accident and Emergency Department, patients can be admitted to any ward where there is a spare bed and then transferred to the ward they should ideally have been placed on at a later date. Moving patients from one ward to another during their stay creates an environment for transmitting MRSA easily and rapidly around a hospital. It is vital that hospitals are allowed sufficient bed capacity, enabling patients to be admitted to the most appropriate ward area from the outset.

Cleanliness of the hospital environment has often been blamed for MRSA infections. Whilst the “dirt” itself is not likely to be directly responsible for MRSA infections, lack of general cleanliness does not motivate staff to adopt high standards. It is imperative that cleaning services are seen as an important part of an infection prevention service, resources allocated appropriately and cleaning staff recognised for the important role they play in preventing infections. Providing a good environment facilitates good cleaning, and therefore it is vital that hospital facilities are maintained in good order and built to specifications that make them easy to clean.

Infection control nurses and doctors play a vital role in modern healthcare and to facilitate this, in many trusts in-vestment in this service has occurred. There is still room for improvement. Whereas the United States and Canada have recommendations and standards for the number of infection control nurses a healthcare facility should have, this is not the case in the UK. Infection control teams manage a programme of infection prevention measures from education to collecting information on numbers of infections, to reassuring concerned relatives of MRSA patients. Appropriate staffing for these teams is essential if they are to ensure staff carrying out direct patient care have the knowledge, resources and ability to prevent the spread of MRSA and other infections. Whilst the appointment of the new directors of infection prevention and control is a positive move, it is the infection control teams that carry out the day-to-day infection prevention activities. They must be given the authority and support needed to fulfil their roles effectively.

There is no time for complacency in the fight against MRSA and antibiotic resistance. If swift action is not taken, there is the real threat of a return to the days when infections were untreatable. Many of the actions in Winning Ways have already been applied within healthcare trusts, but we now need to apply all the action areas effectively and consistently. We must ensure trusts have the resources to apply good infection control practice and they must be monitored effectively to ensure good performance. The evolutionary process of bacteria and viruses makes the increasing threat of resistance to treatment inevitable. In this constant battle to beat MRSA and other infections we must refocus on basic and essential infection prevention measures and provide a climate that facilitates these good practices.