Earlier this year, Dermot Graham, a father of two, was admitted to Waterford Regional hospital for treatment. During his 10-week stay he acquired the superbug MRSA and never returned home.
His widow Teresa blames a basic lack of hygiene for the hospital-acquired, antibiotic-resistant infection, which is endemic in Irish hospitals.
“It was shocking,” said Graham, whose husband died on October 24. “I was amazed by the atrocious standards of cleaning within the hospital.”
On one occasion, she noticed dried blood and faeces on the rim of a toilet, and decided to test the hospital’s hygiene standards.
“I thought to myself, ‘I’ll leave this dirty toilet alone and see how long it lasts’,” she said. It went unnoticed for two days.
When the toilet became re-contaminated with patient’s blood, vomit, urine and faeces, it was three days before it was cleaned. Notices claiming the area was disinfected five times a day were signed and posted on the hospital walls.
“I was a coward,” she said. “I waited until Dermot died before speaking out because I was afraid that I would cause difficulties. I was afraid to complain loudly in case I caused any unpleasantness between myself and the staff, and for my husband.”
The Grahams knew a lot about hygiene. They ran a pub that served meals and had completed a diploma in food hygiene, receiving regular training about the risks of cross-contamination and the importance of infection control. Their premises were regularly inspected, and they knew of other traders whose businesses had been closed for failing to comply with basic hygiene requirements.
“If you go into premises to use a toilet or to eat and they are dirty, you can walk away, you can leave in disgust, you can have it closed down,” said Graham. “But we don’t have that choice with our hospitals. Why aren’t they subject to the same scrutiny? “My husband was going to die anyway, I accept that. But the MRSA hastened his death and added greatly to the pain and discomfort he suffered. You shouldn’t be going into hospital afraid that you will catch something.”
John Devane, a solicitor, contracted MRSA at St John’s hospital in Limerick three years ago. Last week he was reluctant to attend the birth of his daughter amid fears — shared by some medical staff — that he would expose his girlfriend and baby to the bug.
“I’m terrified to even hold my own child in case I infect her. What sort of life is that?” said Devane, who is still on sick leave with MRSA-related complications and is suing the hospital and the state for medical negligence.
He represents more than 30 people who contracted the superbug in public hospitals, and believes hospital managers bear corporate responsibility for the state and cleanliness of their institutions.
“I’m out of work at least three months a year with constant illnesses,” he said. “It is a nightmare. We were made sick by the system. You go into hospital to get better, not to contract a life-threatening illness.”
So are Irish hospitals really making patients sicker? And are doctors and their dirty hands, as one expert committee has concluded, potentially the biggest threat to public health in Ireland?
ABOUT 10,000 Irish patients contract MRSA each year. Most carry the bacteria, which resides in the skin and in the nose of about a third of healthy individuals, without coming to any harm. But 3,000 patients develop the more serious and potentially lethal MRSA infection during visits to hospitals. Last year an estimated 240 people died from the most severe strain of the superbug, which occurs when the infection enters the bloodstream, and is fatal in 50% of cases.
MRSA — methicillin-resistant staphylococcus aureus — is shorthand for any strain of staphylococcus, a family of common bacteria that is resistant to some over-used antibiotics. The infection breeds almost exclusively in hospitals, and targets their vulnerable populations.
Old, sick and weak patients who live in large acute hospital settings are examined daily by doctors and nurses who have touched a multitide of patients, often without washing their hands. The very places people go to be treated thus become a breeding ground for infections they would not have picked up if they were treated at home. Experts conservatively estimate that one in 10 Irish patients will pick up an infection in hospital.
Last week, St Vincent’s in Dublin had to close its doors as management struggled to control an outbreak of the winter vomiting bug. More than a third of patients were infected with the small round-structured virus (SRSV). Hundreds of medical staff have also been affected and are on sick leave, exacerbating an already severe staffing shortage.
Victims of SRSV suffer vomiting, diarrhoea, abdominal pain and fever for three days. It is a resistant microbe spread through the air and by personal contact.
“It is so easy to catch,” said an A&E staff member at St Vincent’s. “We have no isolation facilities, and the wards are closed because of the bug, so patients have to sleep here.
“We have one toilet in A&E. It is in the sluice room where bedpans are emptied, and only a shower curtain separates the sluice and toilet. Patients wash and brush their teeth in that stench. We treat them side by side on trolleys in cubicles, with a flimsy curtain separating them from someone 2ft away suffering with chronic diarrhoea.”
The bugs doing the rounds of Irish hospitals are costing the government €200m each year. They include toxin-variant clostridium difficile diarrhoea (CDD), a bacterium carried in the stool, which can survive up to 70 days outside the body. CDD is widespread in the Mater hospital, Dublin, where it claimed the lives of six people last year.
The Mater will be Ireland’s designated “nerve centre” in the event of outbreaks of flu, smallpox, ebola and Sars, all of which can be spread through human contact.
Once they get into a hospital, superbugs spread rapidly. The primary route of transmission is dirty hands, clothing and equipment. Frequent and thorough hand washing is crucial; a single contaminated door handle can infect the first 14 people who touch it.
But a recent study in Ireland found that almost half of doctors do not wash their hands between patient examinations. Of those who did, less than half used disinfectant. Less than one in 10 cleaned their stethoscopes once a day, and almost two-thirds wore the same unwashed white coat for a week or more.
SRSV and hospital superbugs thrive in unsanitary, overcrowded conditions, as Irene O’Donovan discovered when attending the A&E department with her mother, Kathleen Byrne, at the Mater.
Byrne, 72, spent four days marooned on a trolley, during which she suffered a series of suspected mini strokes. It was two days before staff removed another patient’s vomit from the floor beside her, by which time she and her daughter — along with other patients and visitors — had contracted the winter vomiting bug.
“It knocks you for six,” said O’Donovan. “I spent 48 hours locked in the bathroom, violently ill and isolated from my family in case they too got infected.”
The winter vomiting bug, although uncomfortable for its victims, is cyclical and shortlived. MRSA is deadly and has the potential to reach “catastrophic proportions” within our hospitals, according to a 2001 government report.
There are no official figures available for MRSA deaths in Ireland, but at No 3 in the European MRSA league, Ireland boasts one of the highest infection rates in the world.
The country’s infection control shortcomings are well established. Last year, at the height of global concerns about Sars, a Chinese woman suspected of carrying the virus roamed the streets for several hours after absconding from a hostel where she was supposedly being monitored by doctors.
THE solution is not as simple as doctors washing their hands. The first step is finding out just how serious the problem is. Irish hospitals, which record their MRSA rates, refuse to publish statistics.
Mary Harney, the minister for health, who admitted in the Dail that it was “extraordinary” that the main cause of bugs was the failure of medical personnel to observe basic hygiene rules, has nevertheless refused to force hospitals to disclose individual figures.
This is in contrast to Britain, where alarming MRSA figures prompted the introduction of league tables comparing each hospital’s infection rates and trends.
More than 5,000 people died in Britain last year from hospital infections, compelling John Reid, the secretary for health, to issue an unprecedented plea to the international community to help curb the spread of the bug.
“People are entitled to know the rates of hospital infections,” said Martin Cormican, president of the Irish Society of Clinical Microbiologists (ISCM). A consultant microbiologist, he works at University College hospital, Galway, one of two of Ireland’s 36 acute hospitals that have published MRSA rates.
“It doesn’t necessarily have to be a league table, but the public are entitled to know the risks,” he said.
Once that is established, the next move will be to get doctors to clean up their act. “We need dedicated, fully resourced infection control infrastructures in every hospital if we are to fight these infections,” said Cormican. “That means adequate isolation facilities, dedicated infection control managers, nurses and clinical staff backed up by scientific teams of laboratory staff and microbiologists.”
If Irish hospitals are not cleaned, experts have warned that the consquences could be dire. Earlier this year, the ICSM warned Micheal Martin, Harney’s predecessor, that “basic deficiencies will create major difficulties in the event that Ireland should become involved in a major infectious disease crisis such as Sars, pandemic influenza or a bioterrorism event”.
In the wake of 9/11 and the Sars crisis, a planning committee was appointed to examine Ireland’s ability to cope with a terrorist or public health emergency. The committee is about to tell the government that hospitals potentially pose the biggest threat to the country’s public health.
It will say that if a widely anticipated European flu pandemic hits, unhygienic doctors will contribute to the spread of the virus. Unless hospital hygiene improves soon, Ireland will simply be unable to cope with the outbreak.
THE DEADLY SUPERBUGS
MRSA: Methicillin-resistant staphylococcus aureus is Ireland’s leading hospital superbug. The bacterium often enters the body through surgical wounds, and can result in blood poisoning or pneumonia.
An estimated 240 patients died last year from the most severe form. The main cause of its spread is poor hygiene in hospitals.
SRSV: Small round- structured virus, or winter vomiting bug. It is spread through the air and by personal contact. Symptoms include severe vomiting, diarrhoea, and fever.
CDD: Clostridium difficile diarrhoea, is carried in the stool. It can survive up to 70 days outside the body. Transferred by contact with infected patients. Claimed six lives in the Mater hospital last year.
VRE: Vancomycin-resistant enterococci is found in faeces and can cause urinary-tract infections. Common only in long-stay patients, those on certain antibiotics, and those fed by nasogastric tubes.
