Madam, - With regard to the comments attributed to me in your HEALTHplus supplement of October 21st, and subsequent correspondence, may I say that while the report generally reflects my views there is one point of clarification?
I believe that staphylococcus aureus is very widespread in the community. Variants of staphylococcus aureus that are resistant to meticillin (MRSA) are much less common in the community. When I use the term "screening for MRSA" I refer to testing people with no clinical signs of infection to see if they have MRSA on their body.
If you are in good general health it is very unlikely that staphylococcus aureus (including MRSA) on your body will do great harm.
In that setting I do not see the value of doing the test. Testing people with clinical signs of infection can be useful but in that situation it is important to test for all relevant bacteria, not just MRSA. This is important because the ordinary staphylococcus aureus that is sensitive to meticillin (MSSA) can also be associated with serious infection.
Dr Graham refers to stigma attached to steps taken within hospitals for identifying patients who carry certain antibiotic-resistant bacteria and providing care for those patients separately from others.
These steps are not motivated by a desire to attach stigma. The measures are upsetting for some patients and for some families and I agree that these measures should be taken with the greatest possible sensitivity and respect for privacy. However, the measures are essential during the time that people spend in acute hospitals in order to reduce the risk of transfer of antibiotic-resistant bacteria.
Similar measures are not needed in the community, where the immediate goal should be a reasonable standard of infection control in the care of all patients. When I spoke at the meeting of general practitioners my take-home message was to focus on patients' general health, be sparing in the use of antibiotics, and to wash hands (after all patients); then there is no need to send screening swabs for MRSA.
The difference between an infection, such as pneumonia, and a type of bacteria, such as MRSA, is certainly one that I emphasise. It is important to measure the occurrence of hospital infection whether the infection is associated with MRSA or MSSA or any other microorganism. This focus on the patient and the infection rather that on specific types of bacteria seems consistent with the aims of Stop Infection Now.
With respect to the issue of providing information on hospital infection I can say that colleagues of mine in professional societies such as the Irish Society of Clinical Microbiologists and Infection Control Nurses' Association have been working for decades to control hospital infection, to share information and to advocate higher standards.
If infection-control professionals had their way, Irish society and the Irish healthcare system would have shown more initiative and commitment in dealing with these issues much earlier.
I also welcome the important role of public advocacy groups and patients in this area. I am afraid that in these times of reduced public spending some difference of opinion or emphasis between me and campaigning groups such as Stop Infection Now may well be the least of our challenges. - Yours, etc,
MARTIN CORMICAN,
Professor of Bacteriology,
Medical School,
NUI Galway.