AS a doctor who has worked in Britain and Holland, Hajo Grundmann could not have a better insight on why the two countries are so far apart in the battle against the superbug MRSA.

While Holland, along with Norway, has emerged as the nation with the lowest rate of MRSA in Europe, Britain has one of the highest, together with Cyprus, Malta and Portugal.

In Norway and Holland less than 1% of all bloodstream infections are drug resistant, while in Britain the figure is 44%. Figures compiled by the European Antimicrobial Resistance Surveillance System, which Grundmann coordinates, show that Britain has higher rates of the superbug than all comparable European countries, including Germany, France and Spain.

Grundmann, a consultant microbiologist, said the differing levels of cleanliness between Britain and Holland were apparent to anyone entering the hospitals. “In Dutch hospitals, you are struck by their modernity and the design of the wards. This translates into the ability to isolate patients in single rooms and there is certainly greater availability of beds,” he said.

“Levels of cleanliness in Britain are on the low side when compared to other European standards. Cleanliness explains only a proportion of the transmission of MRSA but it is important because it is a marker for diligence and commitment and shows that staff are taking their work seriously.”

Grundmann said overcrowded British hospitals were a big contributor to infection. British hospitals have fewer single rooms and so isolating all infected patients is impossible. As a result, patients with MRSA need to be cared for on communal wards and risk passing on the bug.

He said the proximity of beds, the high percentage of beds occupied at any given time and the rapid turnover of patients fuelled the high rates of MRSA in British hospitals.

“The drive to bring down the waiting lists by increasing the number of interventions and reducing the average length of stay is not helpful. This imposes a lot of work on an already overburdened system and staff and this always results shortcuts in hygiene,” he said.

The inability to isolate patients due to lack of space and pressure to have wards open to keep waiting times down contrasts starkly with the drastic action taken to control MRSA outbreaks in Holland.

Grundmann recalls an outbreak in a large Dutch hospital in 2003, affecting 28 patients. Managers reacted by closing two wards, including an intensive care unit, and spent €2m (£1.3m) screening all staff and patients. Staff found to be carrying MRSA were sent home.

Ironically, the process of screening patients for MRSA and isolating those found to be carrying the bug, a technique known as “search and destroy”, was devised in Britain. But, in the mid1990s when the MRSA rates began to soar, managers found it impossible to isolate all infected patients – there simply was not enough space.

The latest MRSA bloodstream infection figures, released last week, show that there were 3,391 cases in England from April to September 2006, down 5% from the same period in 2005.

However, the figures appear to have reached a plateau, with the rate of decline being too slow to meet the target set in November 2004 by John Reid, the then health secretary, of a 50% reduction in MRSA cases before April 2008.

The number of deaths from MRSA in England and Wales has increased from about 50 in 1993 to 1,170 in 2004. The youngest victim was two-day-old Luke Day, who died at Ipswich hospital in 2005 after contracting MRSA.

Sheldon Stone, a consultant in healthcare of the elderly at the Royal Free hospital in north London, said Britain needed to set up special isolation wards where all the patients with MRSA are treated. Failing this, he said, special nurses should be designated to look after only MRSA victims, to prevent the bug being transmitted to other patients.

The Department of Health said many NHS trusts had been successful in bringing down the rates of MRSA, especially by encouraging staff to wash their hands. Additional reporting: Nicola Smith and Marcus Oscarsson

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