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

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Presentation on theme: "Hospital Acquired Infections a Look into MRSA Infections and the Occurrence of MRSA Bacteraemia in Different Regions of England. Phoebe Martin."— Presentation transcript:

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

2 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 http://www.life.umd.edu/classroom/bsci424/Images/PathogenI mages/FourQuadrantStreakPlate.jpg http://1.bp.blogspot.com/_PB5-El7se4s/Rw3tj- QWGJI/AAAAAAAAEO8/ZrdNoPn9TmI/s400/mrsacart.j pg - Most common complication and a main cause of preventable injury and death

3 Prevalence of HAIs in Hospitals Worldwide - 1/20 of all healthcare patients in the USA - 2002 – 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% http://1.bp.blogspot.com/- F8daOPNBUT4/T2PEGH_pEUI/AAAAAAAAAEo/SN5bGFe2m1w/s1 600/hospital_ward__beds.jpg

4 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

5 Most Prevalent Causative Pathogens -Escherichia coli -Streptococcus pneumoniae -Influenza virus A -Staphylococcus aureus -Clostridium difficile -Norovirus -Pseudomonas aeruginosa http://upload.wikimedia.org/wikipedia/commons/2/2 d/Escherichia_coli.jpg https://upload.wikimedia.org/wikipedia/commons/2/2 0/Streptococcus_pneumoniae.jpg http://upload.wikimedia.org/wikipedia/commons/2/2d/Pseudomo nas_aeruginosa_Gram.jpg

6 Methods of Prevention -‘Modern Matrons’ (2000) -‘The Deep Clean’ (2007-2008) -‘The Healthcare Associated Infections Technology Programme including the Rapid Review Panel’ (2008) - ‘MRSA screening‘ (2009) - ‘Cleanyourhands campaign’ (ongoing) http://blog.al.com/montgomery/2012/04/6_teena gers_hospitalized_after.html http://www.microphage.com/product/screeningMrsaUS.cfm

7 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 http://www.mrsaresources.com/

8 Methicillin Resistant Staphylococcus aureus - MRSA -Transmitted endogenously and exogenously -Microorganism infection involves host defence evading mechanisms including http://image.made-in- china.com/43f34j00aZutVjRdHDbo/Endotracheal-Tube- With-Suction-Catheter.jpg https://upload.wikimedia.org/wikipedia/commons/e/e4/S taphylococcus_aureus_biofilm_01.jpg

9 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

10 Rates of MRSA infections in England -35% reduction in cases from 2009-2010 -42% reduction observed between the years of 2003-04 (7,700 cases) and 2007-08, (4,450 cases) Financial YearTotal MRSA BacteraemiaRate per 100,000 population April 2008 - March 2009 29355.7 April 2009 - March 2010 18983.7

11 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 19703.68 North West 26893.42 London 31953.06 South Central 8202.5 East of England 15342.27 East Midlands 14312.21 South West 17362.12 South East 13272.08 North East 10202 West Midlands 18331.83 -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

12 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 Humber3.685.334477.781.813,60046617 North West3.426.94907781.114,20046017 London3.067.84,9787983.320,00061011 East of England2.275.830579.683.216,40052918 East Midlands2.214.528778.482.414,30047217 South West2.125.322179.583.515,70047320 South East2.088.544779.783.517,60055417 North East22.630077.281.213,30045117 West Midlands1.835.542077.982.214,00047117 *GDHI - Gross Disposable Household Income

13 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 Humber3.685.334477.781.813,60046617 North West3.426.94907781.114,20046017 London3.067.84,9787983.320,00061011 East of England2.275.830579.683.216,40052918 East Midlands2.214.528778.482.414,30047217 South West2.125.322179.583.515,70047320 South East2.088.544779.783.517,60055417 North East22.630077.281.213,30045117 West Midlands1.835.542077.982.214,00047117 *GDHI - Gross Disposable Household Income

14 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 Humber3.685.334477.781.813,60046617 North West3.426.94907781.114,20046017 London3.067.84,9787983.320,00061011 East of England2.275.830579.683.216,40052918 East Midlands2.214.528778.482.414,30047217 South West2.125.322179.583.515,70047320 South East2.088.544779.783.517,60055417 North East22.630077.281.213,30045117 West Midlands1.835.542077.982.214,00047117 *GDHI - Gross Disposable Household Income

15 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 Humber3.685.334477.781.813,60046617 North West3.426.94907781.114,20046017 London3.067.84,9787983.320,00061011 East of England2.275.830579.683.216,40052918 East Midlands2.214.528778.482.414,30047217 South West2.125.322179.583.515,70047320 South East2.088.544779.783.517,60055417 North East22.630077.281.213,30045117 West Midlands1.835.542077.982.214,00047117 *GDHI - Gross Disposable Household Income

16 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 Humber3.685.334477.781.813,60046617 North West3.426.94907781.114,20046017 London3.067.84,9787983.320,00061011 East of England2.275.830579.683.216,40052918 East Midlands2.214.528778.482.414,30047217 South West2.125.322179.583.515,70047320 South East2.088.544779.783.517,60055417 North East22.630077.281.213,30045117 West Midlands1.835.542077.982.214,00047117 *GDHI - Gross Disposable Household Income

17 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 HumberLeeds1157105.18751,50014.648.351.7 Royal London Hospital10London 65265.28,173,90011.149.350.7 Addensbrooke’s Hospital9 East of EnglandCambridge1180131.11123,90011.750.849.2 Manchester Royal Infirmary9North WestManchester80088.89503,1009.450.249.8 Scarborough General Hospital1 Yorkshire and the HumberScarborough552 108,80023.348.351.7 Royal Marsden Hospital1London 109 8,173,90011.149.350.7 Watford General Hospital1 East of EnglandWatford499 90,30012.449.650.4 Christie Hospital1North WestManchester174 503,1009.450.249.8 * from 25/09/2011 to 11/11/2012

18 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 HumberLeeds1157105.18751,50014.648.351.7 Royal London Hospital10London 65265.28,173,90011.149.350.7 Addensbrooke’s Hospital9 East of EnglandCambridge1180131.11123,90011.750.849.2 Manchester Royal Infirmary9North WestManchester80088.89503,1009.450.249.8 Scarborough General Hospital1 Yorkshire and the HumberScarborough552 108,80023.348.351.7 Royal Marsden Hospital1London 109 8,173,90011.149.350.7 Watford General Hospital1 East of EnglandWatford499 90,30012.449.650.4 Christie Hospital1North WestManchester174 503,1009.450.249.8 * from 25/09/2011 to 11/11/2012

19 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 HumberLeeds1157105.18751,50014.648.351.7 Royal London Hospital10London 65265.28,173,90011.149.350.7 Addensbrooke’s Hospital9 East of EnglandCambridge1180131.11123,90011.750.849.2 Manchester Royal Infirmary9North WestManchester80088.89503,1009.450.249.8 Scarborough General Hospital1 Yorkshire and the HumberScarborough552 108,80023.348.351.7 Royal Marsden Hospital1London 109 8,173,90011.149.350.7 Watford General Hospital1 East of EnglandWatford499 90,30012.449.650.4 Christie Hospital1North WestManchester174 503,1009.450.249.8 * from 25/09/2011 to 11/11/2012

20 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

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