Hospital Acquired Infections a Look into MRSA Infections and the Occurrence of MRSA Bacteraemia in Different Regions of England. Phoebe Martin

What are Hospital Acquired Infections? -‘Infections acquired in hospital by a patient who was admitted for a reason other than that infection’ -Fungal, bacterial, viral or parasitic organisms mages/FourQuadrantStreakPlate.jpg QWGJI/AAAAAAAAEO8/ZrdNoPn9TmI/s400/mrsacart.j pg - Most common complication and a main cause of preventable injury and death

Prevalence of HAIs in Hospitals Worldwide - 1/20 of all healthcare patients in the USA – 1.7 million patients acquired HAIs, resulting in approximately 99,000 deaths - Annual national healthcare costs increase by $4.5 billion - Acquisition most common in ICU – 30% of all ICU patients acquire an HAI - In Europe: Switzerland – 11.6% The Netherlands – 6.9% F8daOPNBUT4/T2PEGH_pEUI/AAAAAAAAAEo/SN5bGFe2m1w/s1 600/hospital_ward__beds.jpg

Prevalence of HAIs in the UK - Rates vary within the UK - HIS reported 8.2% rate in English hospitals - The most common types of infection in England are GIs (22%) and UTIs (19.7%) CountryPrevalence (%) England8.19 Wales6.35 Scotland9.5 Northern Ireland5.43 Site of infectionPrevalence (%) Gastrointestinal system22 Urinary tract19.7 Pneumonia13.9 Surgical site13.8 Skin and soft tissue10.5 Primary bloodstream6.8 Lower respiratory tract6 Eyes, ENT or Mouth2.9 Systemic1.2 Bone & Joint1.2 Cardiovascular system1.1 Reproductive tract0.6 Central Nervous system0.3

Most Prevalent Causative Pathogens -Escherichia coli -Streptococcus pneumoniae -Influenza virus A -Staphylococcus aureus -Clostridium difficile -Norovirus -Pseudomonas aeruginosa d/Escherichia_coli.jpg 0/Streptococcus_pneumoniae.jpg nas_aeruginosa_Gram.jpg

Methods of Prevention -‘Modern Matrons’ (2000) -‘The Deep Clean’ ( ) -‘The Healthcare Associated Infections Technology Programme including the Rapid Review Panel’ (2008) - ‘MRSA screening‘ (2009) - ‘Cleanyourhands campaign’ (ongoing) gers_hospitalized_after.html

Methicillin Resistant Staphylococcus aureus - MRSA -Non-motile, aerobic, gram-positive cocci -30% of people are asymptomatic carriers -Infection occurs upon microorganism entering the blood stream

Methicillin Resistant Staphylococcus aureus - MRSA -Transmitted endogenously and exogenously -Microorganism infection involves host defence evading mechanisms including china.com/43f34j00aZutVjRdHDbo/Endotracheal-Tube- With-Suction-Catheter.jpg taphylococcus_aureus_biofilm_01.jpg

MRSA - Antibiotic resistance -Resistance of S.aureus to antibiotics has occurred in prominent waves -Horizontal gene transfer, chromosomal mutations or antibiotic selection result in resistance to antibiotics -Vancomyin - slower rate of bacterial clearance and lower rate of clinical response than  -lactam antibiotics

Rates of MRSA infections in England -35% reduction in cases from % reduction observed between the years of (7,700 cases) and , (4,450 cases) Financial YearTotal MRSA BacteraemiaRate per 100,000 population April March April March

Regional Differences in MRSA Rates Region Number of Hospitals Total number of MRSA bateraemia cases Average Number of Cases per Hospital Yorkshire and The Humber North West London South Central East of England East Midlands South West South East North East West Midlands Highest number of cases was in London -Lowest number of cases was in South Central and the North East - Highest average number of infections per hospital in Yorkshire and the Humber -Lowest average number of infections per hospital in the West Midlands

Demographics by region Life expectancy (years) Region Rate of MRSA per hospital Population (million) Population density (people /km 2 )MalesFemalesGDHI (£) Gross Weekly Earnings (£) Population 65+ years (%) Yorkshire and The Humber , North West , London , , East of England , East Midlands , South West , South East , North East , West Midlands , *GDHI - Gross Disposable Household Income

Influence of Regional Population and Population Density on MRSA Rates Life expectancy (years) Region Rate of MRSA per hospital Population (million) Population density (people /km 2 )MalesFemalesGDHI (£) Gross Weekly Earnings (£) Population 65+ years (%) Yorkshire and The Humber , North West , London , , East of England , East Midlands , South West , South East , North East , West Midlands , *GDHI - Gross Disposable Household Income

Influence of Life Expectancy on MRSA Rates Life expectancy (years) Region Rate of MRSA per hospital Population (million) Population density (people /km 2 )MalesFemalesGDHI (£) Gross Weekly Earnings (£) Population 65+ years (%) Yorkshire and The Humber , North West , London , , East of England , East Midlands , South West , South East , North East , West Midlands , *GDHI - Gross Disposable Household Income

Influence of Regional Average Earnings on MRSA Rates Life expectancy (years) Region Rate of MRSA per hospital Population (million) Population density (people /km 2 )MalesFemalesGDHI (£) Gross Weekly Earnings (£) Population 65+ years (%) Yorkshire and The Humber , North West , London , , East of England , East Midlands , South West , South East , North East , West Midlands , *GDHI - Gross Disposable Household Income

Influence of Age on MRSA Rates Life expectancy (years) Region Rate of MRSA per hospital Population (million) Population density (people /km 2 )MalesFemalesGDHI (£) Gross Weekly Earnings (£) Population 65+ years (%) Yorkshire and The Humber , North West , London , , East of England , East Midlands , South West , South East , North East , West Midlands , *GDHI - Gross Disposable Household Income

Comparison between hospitals with high rates MRSA bacteraemia and those with low rates Population Hospital Number of cases of MRSA bacteraemia *RegionCity Number of Beds Rate of MRSA per bed City Population % 65+ years old% male% female St James University Hospital11 Yorkshire and the HumberLeeds , Royal London Hospital10London ,173, Addensbrooke’s Hospital9 East of EnglandCambridge , Manchester Royal Infirmary9North WestManchester , Scarborough General Hospital1 Yorkshire and the HumberScarborough , Royal Marsden Hospital1London 109 8,173, Watford General Hospital1 East of EnglandWatford499 90, Christie Hospital1North WestManchester , * from 25/09/2011 to 11/11/2012

Influence of Size of Hospitals on MRSA Rates Population Hospital Number of cases of MRSA bacteraemia *RegionCity Number of Beds Rate of MRSA per bed City Population % 65+ years old% male% female St James University Hospital11 Yorkshire and the HumberLeeds , Royal London Hospital10London ,173, Addensbrooke’s Hospital9 East of EnglandCambridge , Manchester Royal Infirmary9North WestManchester , Scarborough General Hospital1 Yorkshire and the HumberScarborough , Royal Marsden Hospital1London 109 8,173, Watford General Hospital1 East of EnglandWatford499 90, Christie Hospital1North WestManchester , * from 25/09/2011 to 11/11/2012

Influence of Gender on MRSA Rates Population Hospital Number of cases of MRSA bacteraemia *RegionCity Number of Beds Rate of MRSA per bed City Population % 65+ years old% male% female St James University Hospital11 Yorkshire and the HumberLeeds , Royal London Hospital10London ,173, Addensbrooke’s Hospital9 East of EnglandCambridge , Manchester Royal Infirmary9North WestManchester , Scarborough General Hospital1 Yorkshire and the HumberScarborough , Royal Marsden Hospital1London 109 8,173, Watford General Hospital1 East of EnglandWatford499 90, Christie Hospital1North WestManchester , * from 25/09/2011 to 11/11/2012

Conclusions -Many contributing factors for rates of MRSA -Hospital size -Further research: -Specialisation of trusts -Staff to patient ratio -Prevention methods and techniques within individual hospitals