ICUs struggle to cope with superbug

JUST four out of 33 intensive care units (ICUs) in hospitals around the country were successfully able to isolate patients with MRSA, a new survey has found.

Prevalence of the anti-biotic resistant superbug was highest in ICUs catering for the most seriously ill patients.

Carried out by the Health Protection Surveillance Centre the survey found:

* four ICUs did not have any single rooms;

* more than one-third fall below the recommendation of one single bed to every four ICU beds as per national MRSA guidelines;

* while all single rooms are equipped with hand sinks, only 45% have anterooms for health staff;

* there is wide variation in the types of screening sites tested. While 20 ICUs screen nasally, less than half (48%) screen the nasal, groin, wound and medical device sites as recommended by national guidelines.

The overall prevalence of MRSA in ICUs catering for both high-dependency patients and patients requiring intensive care increased from 7.1% in 2008 to 8.2% in 2010.

For units catering for the most critically ill patients, prevalence decreased from 11.4% in 2001 to 9.3% in 2010, but was still higher than ICUs catering for less seriously ill patients.

The report found a number of factors contributed to the small number of ICUs capable of isolating all MRSA patients. These included lack of isolation room availability, the use of isolation rooms for other reasons, such as infectious tuberculosis, or insufficient staff to care for a patient in an isolation room.

The report said ICUs with more at-risk patients were prone to higher rates of MRSA acquisition for reasons including more staff-to-patient contact, higher use of medical devices and more selective pressures induced by antibiotic therapy.

On the upside, the majority of ICUs (almost 90%) show a proportion of MRSA acquisition of less than 1.5%; all 21 ICUs that responded to a questionnaire on ICU care had an annual infection control plan; all used hand-free waste bins; all had alcohol rub for staff beside each ICU bed and a hand hygiene education programme; all used gloves and aprons when in contact with an MRSA patient and all changed bed curtains after discharge of the patient.

However, less than 40% routinely cleaned the unit with detergent and disinfectant.

The report warned that effective control of the superbug in hospitals hinges on early detection and isolation of the patient — but the diagnosis of MRSA can take 48 hours or longer.

Lack of isolation rooms is another issue, and both delayed diagnosis and access to isolation needed to be improved to minimise ICU transmission of the superbug, the report said.

The HSE said the number of MRSA cases diagnosed nationally has almost halved in the last five years.

The latest figures show that 304 cases were confirmed last year.

The Irish Patients Association (IPA) said that while it welcomed the downward trend in MRSA prevalence rates, it remained a challenge in the healthcare system.

Chairman Stephen Mc-Mahon said: “We still need constant vigilance to ensure patients are protected from a superbug that can cause serious injury and even death.”