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Hospital Overcrowding Linked to MRSA

Overcrowding in specialist hospitals across England could be responsible for increasing rates of MRSA infection, according to research from a University of Ulster team published today (Thursday) in the British Journal of Nursing.

The researchers found that three quarters of English hospitals exceed the recommended 82% bed occupancy rate – with a third of trusts having occupancy rates of 87% or greater. This could mean that there is too little time between one patient being discharged and another being admitted to properly disinfect the bed and surrounding area.

In a continuation of their research into the relationship between rates of MRSA infection and bed occupancy in Northern Ireland, first published in the prestigious Journal of Hospital Infection in November 2005, the researchers have now found that the same relationship may exist in specialist hospitals across England. High levels of occupancy are an indicator of overcrowding.

The original research found a relationship between high rates of bed occupancy and high levels of MRSA in Northern Ireland. In a study published in the British Journal of Nursing today the authors, nursing lecturer Brian Cunningham, Professor of Health Research, George Kernohan, and researcher Thomas Rush, report similar findings in England for 35 specialist hospitals, where data could be matched for all variables.

The House of Commons Public Accounts Committee and other governmental bodies have repeatedly drawn attention to the fact that high levels of bed occupancy is not consistent with good infection control and bed management practices. The researchers found that three-quarters of English hospitals exceed the recommended 82% bed occupancy with a third of Trusts having occupancy of 87% or even greater.

Based on their research from the Northern Ireland studies the researchers estimate that the turnover interval in some medical units could be similar to that in NI trusts, which was estimated at 72 minutes. During this period one patient is discharged, the bed space and bed itself are disinfected, and a new patient is admitted. The minimum time for cleaning the bed alone to an acceptable level could take as long as 75 minutes.

The authors said: “The Healthcare Commission's annual staff survey (2006) based on replies from 209,000 employees in 570 NHS trusts in England reported that one in four said trusts did not do enough to promote the importance of hand-cleaning to staff, patients and visitors and nearly 40% of NHS staff do not have constant access to the hot water, soap, paper towels and alcohol rubs needed to prevent the spread of hospital infection.

“Trusts which fail to give such attention to this basic preventative measures are also unlikely to comply with the high standards required to disinfect beds and bed spaces and, as we have suggested, the time available for cleaning because of short turnover interval and high occupancy rates may be insufficient to prepare for safe admissions of patients.”

The researchers commented on a recent statement by Dr Gill Morgan, chief executive of the NHS Confederation, who said: "More patients are being treated faster and more effectively than ever before by the NHS (...) The number of actual beds has steadily reduced, yet the amount of care the service is able to deliver has dramatically increased." She said also that the health service could do with fewer hospital beds.

Researcher Brian Cunningham said that such statements, usually made by managers and not by clinicians, showed a cultural clash between clinicians and managers. He said that there is a limit to how many patients can be treated safely in hospitals. High levels of occupancy result in limited time for hand-washing, ward cleaning between admission and discharge, overworked and stressed staff, and constant bed crises.

The authors concluded: “The rise in the incidence of MRSA rates may be a symptom of a systems failure in the central and local management of the NHS.”

David Young | alfa
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