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  #21  
Old 11-30-2006, 08:39 AM
Alastair Alastair is offline
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MRSA superbug claims may surge
By Nick Triggle
Health reporter, BBC News



MRSA is linked to over 1,000 deaths a year in the UK
A flood of MRSA compensation claims could finally be realised as lawyers turn to workplace safety legislation to pursue hospitals.
To date it has been hard to pin the blame on the NHS, as it is never known exactly when a person becomes infected.

But recent successes have prompted a rethink in how lawyers tackle cases, with many making use of laws governing the control of hazardous substances.

A government MRSA adviser said it was right that the NHS was held to account.

I have seen people who have lost limbs and had their lives devastated by MRSA, it will be a good thing if they start getting some recompense for that

Professor Hugh Pennington,
University of Aberdeen


'I wanted the NHS to take responsibility'

Susan MacQueen, head of infection control at London's Great Ormond Street Hospital and a member of the government's Specialist Advisory Committee on Antimicrobial Resistance, said: "I think this presents the best route for people to pursue the NHS.

"They have traditionally been very hard to proceed with, but lawyers seem to have come up with a way of moving forward with them."

She acknowledged hospitals were concerned it could lead to many more claims, but added: "It will help patients hold the NHS to account and that will help improve our performance in infection control so it is also a good thing."

MRSA is cited on the death certificates of more than 1,000 people every year, with thousands more left severely ill or disabled by the infection.

But lawyers have found it hard to win cases as clinical negligence claims require causation to be established which is next to impossible with MRSA because of a lack of proof over exactly where, when and how the infection was contracted.

Cases that have reached court tend to be about the treatment a patient received once they got MRSA rather than over catching MRSA.

There have only been a handful of settlements - seven involving hospital-acquired infections in England from April 2002 to March 2006 - and no admission of responsibility for causing MRSA has been made.

Disputes

However, solicitors now believe the tide may be changing after they started adopting a different approach.

Instead of relying solely on the traditional clinical negligence argument, they have started pursuing the NHS by using legislation more common to industrial disputes.

Control of Substances Harmful to Health (COSHH) requires employers to control exposure to hazardous substances to prevent ill health.

Lawyers have argued MRSA comes under such a definition and if it applies to staff it should also apply to patients in hospitals.

The first breakthrough was in July 2005 when Kitty Cope, a pensioner from Bridgend in Wales, won compensation when she got MRSA after having a hip replacement.

WHAT IS COSHH?
The 2002 regulations require employers to control exposure to substances which can put people's health at risk
It defines these substances as those used at work, such as paint, generated at work, such as fumes, and naturally occurring, such as dust
However, most importantly for the MRSA claims, it also involves biological agents such as bacteria and other micro-organisms

The hospital involved settled out of court, but admitted it had not followed its guidelines on infection control.

Since then there are believed to have been several other settlements where COSHH has been used - there are no clear figures as they have all been settled out of court.

Recently, the family of Lincolnshire pensioner Joan Staples won an out of court settlement after she died following a hip replacement operation. COSHH was cited, although the hospital trust involved never admitted it was applicable.

Leading solicitors firms including Irwin Mitchell, Anthony Collins and Hugh James confirmed to the BBC they were now handling dozens of MRSA cases where COSHH was being used in the legal challenge.

Phil Barnes, the solicitor who handled the Cope case, said: "The advantage with COSHH is that it places the burden on the defendant to prove they are meeting the requirements.

"I know solicitors across the county are beginning to look at this as a way of pursuing claims.

"What we need now is for one to reach court to set a precedent, but at the moment the NHS seems to be picking off the strongest cases to settle them before it gets that far."

The NHS Litigation Authority, which handles legal challenges for hospitals in England, refused to comment on the issue.

Anne-Louise Ferguson, managing solicitor at Welsh Health Legal Services, which represents Welsh hospitals, said: "It is an interesting proposition whether MRSA, which many people carry with them in the community, can be classed as a hazardous substance.

"But I think from the trusts' point of view, they are looking at the cases and not wanting to set a precedent."

Tony Field, chairman of the MRSA Support victims group, said: "I think this has got the NHS really worried. We should see many more successful claims in the future."

The Department of Health refused to comment on whether it thought MRSA claims should be covered by COSHH.

But a spokeswoman added: "There will be cases where healthcare was negligent and it is reasonable that claims might be made in these cases."
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  #22  
Old 12-18-2006, 08:33 AM
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Harrison Harrison is offline
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The sad stories continue.
_________________________________________

MRSA strain kills two in hospital
A strain of MRSA that has never previously caused deaths in hospitals has killed two people, according to the Health Protection Agency (HPA).

After a healthcare worker died in September, it emerged that a form of Panton-Valentine Leukocidin (PVL) MRSA had also claimed a patient's life.

The strain attacks white blood cells and sufferers cannot fight infection.

Nine others also contracted the strain in the outbreak at University Hospital of North Staffordshire, Stoke-on-Trent.

Of these, only one was a patient.

This outbreak is the first time transmission and deaths due to this strain are known to have occurred in a healthcare setting in England and Wales
Health Protection Agency

In a statement the hospital said: "With the exception of one infection it is not clear at this stage whether transmission has occurred within the hospital or, as is more common, in the community which it serves.

"The hospital is continuing to take advice from the Health Protection Agency on management of the outbreak."

Hospital-associated strains of MRSA normally affect more elderly hospitalised patients.

But the PVL strain is unusual because it can affect young and otherwise healthy people.

Other strains

In the outbreak in Staffordshire, the first person - Case A - who died was a healthcare worker who developed MRSA, and was being treated as a patient at the hospital.

The second fatality was a patient being who was being treated on the ward where Case A had worked.

The HPA said there have been other cases of this particular strain of PVL MRSA in England and Wales - but these have been in the community, not hospitals.

Thirteen cases were recorded in the community in 2005. All were skin and soft-tissue infections.

There have also been five deaths linked to PVL MRSA in the UK over the last two years - but these were other strains of the bug.

Marine Richard Campbell-Smith, 18, cut a leg in training and died after becoming infected with a form of PVL in 2004.

A 28-year-old woman also died from a form of the infection after picking up the bug in her local gym.

'First time'

In a statement, the HPA said: "PVL-producing strains of MRSA have been seen in the UK before - however, the small numbers of cases reported have usually been in the community rather than a hospital setting.

"This outbreak is the first time transmission and deaths due to this strain are known to have occurred in a healthcare setting in England and Wales."

The agency identified those affected as being "among individuals in a hospital and their close household contacts in the West Midlands".

The agency only covers England and Wales.

Dr Angela Kearns, an MRSA expert with the HPA, said: "When people contract PVL-producing strains of MRSA, they usually experience a skin infection such as a boil or abscess.

"Most infections can be treated successfully with everyday antibiotics but occasionally a more severe infection may occur.

"The HPA is advising the hospital on outbreak control measures, and will continue to monitor MRSA infection nationally."

The PVL toxin is carried by less than 2% of the bacteria responsible for MRSA.

Although, it normally causes pus-producing skin infections, such as abscesses or boils, it can trigger more severe invasive infections such as septic arthritis, blood poisoning or a form of pneumonia.

Shadow health secretary, Andrew Lansley, said: "Over the last nine years there have been far too many cases where the government has allowed MRSA to become endemic.

"The inevitable result has been an evolving process leading to increased resistance to antibiotics.

"It is time for us to take on the threat of new and more dangerous bacteria."

Story from BBC NEWS:
http://news.bbc.co.uk/go/pr/fr/-/2/h...th/6188801.stm
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  #23  
Old 02-07-2007, 07:22 AM
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Harrison Harrison is offline
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I understand that some patients are being screened for MRSA in advance of their surgery. A q-tip swab of the inner nose is tested for staph (et al?) and if positive, the patient is prescribed antibiotics for five days.

I find it interesting that this practice is spotty, being offered in a handful of hospitals across the country.

Ahem, standards, anyone?!
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  #24  
Old 02-07-2007, 09:19 AM
Justin Justin is offline
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Harrison,

I don't think more antibiotics is the answer--far from it. EVERYONE has staph in their nose, and a good percentage of those are methicillin resistant. This is not to say that staph is not an opportunistic pathogen that thrives in immunocompromised patients. However, if you have an infection (ie immunocomprosmised) they won't put you on an OR table.

It comes down to simple things like hand washing and not wearing neck ties (which can harbor MRSA and lead to nosocomial infections--this is especially true for physicians in the hospital).

With all of our antibacterial soaps, etc. has made us TOO clean, which has resulted in highly resistance strains of pathogens to antibiotics/antivirals.

One easy step in the right direction: quit using antibacterial soap.

Justin
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  #25  
Old 02-08-2007, 07:28 AM
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I am neither endorsing nor critiquing the solution to staph. Rather, I am complaining about the lack of standards for carrying out ANY solution nationwide.

But since you brought it up, I will quibble with your statement:

“…However, if you have an infection (i.e. immuno-compromised) they won't put you on an OR table…”

I can tell you for a fact, that many patients had procedures while having low-grade, systemic (bacterial) infections. E.g., pre-op blood checks simply do not check for mycoplasmic (cell-wall deficient bacteria) infections.

In addition, I find it interesting that there are also disparities between manufacturer’s disqualification criteria on this. More on this later in another topic.
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  #26  
Old 02-08-2007, 07:52 AM
Justin Justin is offline
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I just don't have the time these days to have "all inclusive" posts that cover all the bases on a given subject--too much real life going on around me.

Quote:
I can tell you for a fact, that many patients had procedures while having low-grade, systemic (bacterial) infections. E.g., pre-op blood checks simply do not check for mycoplasmic (cell-wall deficient bacteria) infections.
I'll chime out of these posts and leave them to the experts with substantiated facts.
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  #27  
Old 02-09-2007, 05:32 PM
SeanTheFireman SeanTheFireman is offline
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Last week when I went for my pre-admission testing at NE Baptist I was screened for MRSA, they did this by using a q-tip and getting a culture in my nose, and sent me home with a prescription for Mupirocin 2% and I was told to only fill the prescription if they call me with a positive result. I got a call the next day that I was positive for MRSA and was to use the Mupirocin twice a day for 5 days. (The Mupirocin 2% comes in a tube and you need to apply in your nose with a q-tip).
At first I was a little nervous about this but after doing alot of research on the issue and talking with my Dr today at my last appointment before surgery I feel alot better about it. My Dr said that the only thing that it really changes is the antibiotic that they will give me during surgery.
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  #28  
Old 03-21-2007, 08:54 PM
Ginny Ginny is offline
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Hi. I'm new to this and have been trying to post this for awhile now. I really need your help for myself and my husband. But first as a nurse, I wanted to comment on the MRSA discussion. It is widespread and has been increasing for awhile. I saw it my first day of nursing school clinicals and now, 12 years later, it's practically commonplace. The government has started initatives for hospitals to help stop the spread in the community & the hospital. Yes, they are TRYING to flag patients that have MRSA or have a history of MRSA. It's good to be up-front about whether you've had it in the past, because that gives the doc a head start in picking out what antibiotic may work better for you.

Here are some things I've learned over the years.

1. Good hand washing now consists of vigorous scrubbing for 30 seconds with soap and water, at the webs between the fingers, the back of the hand as well as the front, and under the nails. Antibacterial soaps, etc can potentially increase your risk for MRSA. If you just do a quick wash, then there's not enough exposure to kill the germ but just enough to make the germ change it's makeup and become resistant.

2. Long fingernails and artificial nails have the potential to harbor MRSA, etc.
3. Bedlinens and clothing of a MRSA patient should be washed separately from others in the household. (There's even a dryer that can sterilize clothes now.)

4. Diluted bleach kills the MRSA. I personally use quarter strength. Another nurse uses half strength. Every so often, I wipe down the door knobs and other areas, throughout the house.

5. A little dirt is ok, we can't live in a sterile bubble, we aren't sterile people, staph & strep and other nasty little germs just live on people. A few dust-bunnies in the house with a little germ can actually help build your immune system. Once you have the antibodies for it, you are better prepared if that dust-bunnies' brother or sister come to visit.

6. Vancomycin (iv) helps kill MRSA, BUT...VRE is an old germ that has gotten a face-lift and is vancomycin resistant. Zyvox is the new antibiotic for VRE and it's the only one I know of currently available to treat VRE. However, one infectious disease doc has found a case of a Zyvox resistant germ. How do you treat THAT? Some people are encouraging people & docs to go with the Zyvox orally (pill) to treat instead of iv, because it would be cheaper than a long hospital-stay. But the risk there is that it won't be as well regulated and more resistance will develop. Our little country hospital trys to monitor the use of vanc and zyvox to make sure that the docs are prescribing it appropriately. They do this because of past national over-use of antibiotics and because these antibiotics can be toxic with strong, dangerous side effects.

7. Silver in a wound dressing because of it's antibacterial properties is being strongly encouraged through pharmacuetical companies, etc, but I recently have "heard" of studies where they found resistance to the silver (even though people said there'd never be resistance because its a metal and you'd have to change the periodic table.....?)

8. As for c-diff, its major diarrhea and you run the risk of getting it from antibiotics doing to0 good of a job and killing off the good bacteria in the gut. Then it gets spread from one person to another by not performing good handwashing or by getting the germs on your clothing. According to our infectious disease nurse, the alcohol-based hand sanitizers don't kill the c-diff. Hep, it kills 99.9%, except for c-diff. So, you gotta grab the soap and scrub.

9. Recently, the Norwalk (winter-vomiting disease) virus has been showing its power. After the vomiting & diarrhea are gone, you are still contagious for 2-3 days afterward, so someone else needs to do the cooking for the family at that time. Grab the diluted bleach and wipe down the bathroom. For the elderly and immunocompromised, I have heard it being compared to Parvo in dogs. So, when a nursing home puts themselves on quarentine, they mean it (NO MATTER HOW POLITELY THEY MAY SAY).

10. There is now resistant yeast infections too...

11. Last bit of info, there is necrotizing fasciitis out there (it's commonly refered to as that "flesh eating" disease. It starts out on the skin, (usually the groin areas), red & painful, can start weeping/leaking clear to clear yellow fluid, odor is possible, and it is extremely painful. IF any generalized painful redness starts turning purple-black, get to the emergency room IMMEDIATELY.

Well, that's what I've learned. I'm not perfect. I'm not certified in a specialty. I just vowed when I became a nurse to be a patient advocate no matter what. And I just wanted to shared what I've learned over the years.

Thank you & I'll be in touch about the back pain.

-Ginny
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  #29  
Old 03-22-2007, 07:25 AM
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Harrison Harrison is offline
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Wow, very interesting and helpful, Ginny, thanks for sharing your insights.

See you soon on another channel!!
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  #30  
Old 03-23-2007, 10:08 AM
Anita Anita is offline
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Hello Everyone,

Dr. B and I met at a business meeting in a "highly acclaimed" heart surgery center in the USA in January where we observed an aneurysm repair of the brain. We were meeting the surgeon afterwards and were given a tour.

We were both astounded at the clutter, total disarray and overall uncleanliness in the OR theater and were equally shocked when we were asked to step into a carpeted hallway afterwards to remove our bodysuits, hats and booties, a hallway used by the general public entering for same day surgeries.

We, of course, automatically balked at this and removed our protective garments inside the OR area hallway first, washed our hands with the antiseptic pump, having NOT transported anything with our feet or hands, while our guides, (doctors) stared at us like we were children behaving funny.

Dr. B later told me the conditions we saw are common for him to see stateside, (as he is in the USA on a monthly basis), and would NOT be
permitted in Germany or Austria. Period.

After attending over 200 hundred sugeries here where the theaters are used for many types of surgeries, including childbirth, and all are as immaculate, uncluttered and scrubbed as much as possible between each case, I am most reluctant to have ANY type of surgical procedure stateside.

I am equally as dumbfounded and angered when patients are warned off from having surgery in Europe by their own physcians, because,(this is what is told to many, many patients from every corner of the USA) and I quote, "Are you crazy?, Lord knows what kind of infection you'll come back with if you have surgery in Germany, AND you can forget about "Me" handling your post-op problems here in the USA." end quote.

Dr. Bertagnoli's post-op infection rate? "0%".

Be very wary of advice given based on ignorance and fear.

Just my two cents worth based on actual real time experience.

Anita Peludat
International Patient Coordinator
Dr. Rudolf Bertagnoli
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