A nurse and a patient have died from a deadly new strain of MRSA after a superbug outbreak at a hospital.
The Health Protection Agency said three other nurses in the West Midlands hospital were among eight people who contracted the new, more lethal strain of MRSA, four of whom have infections including boils and abscesses. Two have died.
It is the first time that the toxic strain of the superbug, known as PVL-producing MRSA, has caused infection and deaths in a hospital, the agency said. The outbreak has alarmed public health officials who say it could pose risks for staff as well as patients. The toxic PVL strain has previously been detected only in small outbreaks among healthy children and young people. It attacks the white blood cells, destroys tissue and can cause boils up to 3 inches (10cms) across.
If it became established in hospitals, where people are sicker, have lowered immunity and may have open wounds, it could pose a much more serious threat. Ordinary hospital-associated MRSA preys on older, sicker patients and does not normally affect nurses and other staff.
The Health Protection Agency put out a warning to the NHS at the weekend in its weekly Communicable Disease Report. It said patients with boils and abscesses should be tested for the new strain and the results sent to the Centre for Infections in Colindale, north London.
In a statement, the agency said: "This outbreak is the first time transmission and deaths due to this strain are known to have occurred in a healthcare setting in England and Wales. The HPA is advising the hospital on outbreak control measures and will continue to monitor MRSA infection rates nationally."
But a spokesman added: "There is no indication that [the PVL strain] is widespread or gaining a foothold in hospitals. It certainly would be of concern if it became established."
The lethal nature of the new strain of MRSA was demonstrated two years ago when a physically fit young soldier became infected after grazing his leg while out running on Woodbury Common, Devon. Richard Campbell, 18, a Royal Marine recruit, rapidly developed swelling in both legs, became unable to walk and died two days later. A 28-year-old woman also died after picking up the bug in her local gym.
MRSA is carried on the skin of one in three healthy people and can be transmitted by skin-to-skin contact. The bugs do not usually cause problems in those with healthy immune systems, but the PVL strain is more toxic.
It can enter the body through a scratch or pimple and can develop into necrotising fasciitis, the so-called "flesh-eating bug", which caused a nationwide panic when a cluster of cases struck in Gloucester in the early 1990s. In rare cases, it spreads to the lungs, causing pneumonia and death. There were 13 cases of skin infections caused by the strain reported in 2005 in England and Wales.
The HPA said the nurse died in September and had been well before developing blood poisoning and pneumonia after an operation at the hospital, which has not been named.
The source of the outbreak is thought to have been a patient who died on the same ward several months earlier. Investigations revealed the nurse had been infected with the PVL strain of MRSA and another nurse on the same ward who had a history of abscesses was also infected. It is likely the nurse who died was carrying the bug on her skin and it became a lethal infection when she had the operation.
Further tests revealed that the toxic strain had also been transmitted to two nurses working on a neighbouring ward, one of whom had had a persistent eyelid infection for four months. It was also transmitted to two of the nurses' flatmates.
Evidence from the US shows that occurrence of the PVL strain has soared since 1998, when the first cluster was identified in North Dakota. Researchers in San Francisco studying the PVL strain collected 6,000 cases in a year; they had expected 200.
The Communicable Disease Report says there have been 12 reports worldwide of the PVL strains of MRSA transmitted in hospitals. "This change in the epidemiology of MRSA demands increased vigilance among healthcare personnel," it says.
Angela Kearns, an MRSA expert at the HPA, said: "When people contract PVL-producing strains of MRSA, they usually experience a skin infection such as a boil or abscess. Most infections can be treated with everyday antibiotics but occasionally a more severe infection will occur."
The PVL strain of Staphylococcus aureus was identified in the 1930s and accounted for 60 per cent of all staph infections before 1960. It was almost eliminated by antibiotic methicillin in 1961, but has resurged, linked to the growth of MRSA.
Cleaning up their acts
Government guidelines urge doctors and nurses to wash their hands thoroughly between each patient. But a recent study by researchers from the University of Hertfordshire showed that 88 per cent of staff failed to wash properly, even when dealing with infected patients. A separate study said efforts to tackle infection rates by improving the cleanliness of wards were failing because of poor hygiene.
The British Medical Association has suggested doing away with superfluous items of clothing such as ties may help. The Brighton and Sussex Hospital Trust - which has one of the highest rates of infections - recently told staff to avoid wearing ties and jewellery.
Victim was a 'super-fit' marine recruit
By Andrew Johnson
Richard Campbell-Smith was just four weeks from completing his training as a Royal Marine when he scratched himself on a gorse bush during a week-long training exercise in October 2004.
The 18-year-old recruit, described as "super-fit", contracted the common bacterial bug staphylococcus, which usually produces a small amount of pus in a graze.
But he was soon finding it hard to walk and was admitted to the medical centre in Lympstone, Devon. Two days later he collapsed by his bed and was taken to hospital. He died there from what doctors said was heart and respiratory failure.
The common bacteria had produced the deadly toxin Panton Valentine Leukocidin (PVL), which is linked to MRSA. It had spread rapidly, causing his major organs to fail. A post-mortem showed he died of cardiac and respiratory failure, but traces of PVL were also found.
At his inquest, it was suggested the bacteria had entered his blood through blisters on his feet and cuts to his legs, suffered during the rigorous military exercise. The PVL killed white blood cells, leaving him unable to fight the original infection, no matter what treatment was given.
His grandmother, Edwina Fooks, 74, of Bournemouth, who had looked after him since his parents died, said: "He called me and said the training and been hard that week and it had been pouring with rain and freezing cold. He said he was very, very cold and his hip hurt and he couldn't walk. I was worried because he never feels the cold. It was so unusual for him to be unwell."
Other cases have been reported in America, France and Australia.