What we know
What information do we have about the Eastern Board area?
What is the result of this on our health locally?
Policies
What is happening in the Eastern Board area?

In recent years there has been considerable concern about the frequency of infections acquired by patients while they are in hospital. This is despite improved methods of sterilisation of equipment and wider adoption of aseptic techniques. The factors involved in this include:

	The emergence of resistant strains of organisms, partly due to the increased used of antibiotics;
	The increased survival of patients with life threatening illnesses who are more susceptible to infection;
	The wider use and complexity of surgical procedures;
	The advent of modern therapies, such as immunosuppressive drugs, which lower resistance to infection.

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The Communicable Disease Surveillance Centre Northern Ireland records instances of Methicillin-resistant Staphylococcus Aureus (MRSA). Between April 2004 and March 2005, there were 242 patient episodes recorded of MRSA Bacteraemia in Northern Ireland, 143 of which were in hospitals in the Eastern Board area. It is important to note, however, that there is a concentration of hospital Trusts in the Eastern Board area, many of which provide regional services.  This illustrates a reduction of 21% in Northern Ireland and from the same period in 2003/04

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Urinary and wound infections, that are especially likely to develop when a patient is in hospital, tend to be endogenous (i.e. a break in the patient’s natural body defences causes the patient’s own normal bacterial flora to induce infection). Hospital acquired infections often increase the length of stay in hospital with economic implications for the individual and the health service.

One infection which has caused increased concern recently is Methicillin-resistant Staphylococcus Aureus (MRSA). The main problem with MRSA in the hospital setting is that staff or patients who carry the bacteria represent a risk to other patients. Staphylococcus aureus is a skin commensal which is carried by about 30% of the population. All staphylococci, including MRSA, are easily spread by direct contact and persist in the environment. Where patients are being constantly moved between wards and from nursing homes into hospital MRSA can spread very quickly. The primary problem in hospital is therefore one of cross infection. MRSA can cause deep-seated wound infections that prove very difficult to treat. Hospital outbreaks of MRSA can be difficult to control. Effective control measures include identifying and treating carriers, isolating those with infection and strict adherence to stringent hygiene policies in hospitals including rigorous environmental cleaning.

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