Sir, Your table of methicillin-resistant Staphylococcus aureus (MRSA) rates in hospitals (March 8; see also letter, March 4) makes odd reading to an insider unless it is understood that the figures do not refer to total infection rates but to the number of cases of infections serious enough to get into the blood.

The overall colonisation of patients is far higher. Stopping patients from developing bacteraemia is one thing (and not to be disparaged) but it is far more important to develop ways of stopping the spread of skin contamination, and I fear that this latter is actually a worsening problem.

On my unit we have, for over three years, operated a strict policy of exclusion or isolation if transfer is unavoidable. Together with a strict treatment policy, this has kept the prevalence of MRSA to very low levels — all the more remarkable because patients with chronic neurological diseases are a high-risk group. Protocols such as these are unachievable on general wards if staff numbers are low and where pressures on acute beds result in frequent moves of patients between wards.

I doubt there is a hospital in the country that would not heave a sigh of relief if it could open another ward or two. It is generally reckoned that a bed occupancy above 85 per cent is unmanageable and becomes unsafe; most hospitals are running occupancy rates considerably above this, as is my own. The Government must understand that we cannot churn sick patients through the system any faster and must expand the NHS bed complement.

Yours faithfully,
ANDREW BAMJI,
(Director, Elmstead Rehabilitation Unit),
Queen Mary’s Hospital,
Frognal Avenue, Sidcup DA14 6LT.
March 8.

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