What does MRSA mean to me as a doctor working in the field of infection? On a purely practical level it means daily close liaison with a team of highly skilled infection control nurses who struggle to keep new cases isolated in an inadequate number of single rooms. It means teaching medical students how to wash their hands correctly. It means giving advice to doctors, whose skills lie elsewhere than the treatment of infectious diseases, in managing patients who have contracted deep-seated or life-threatening infections with the bacterium. It means helping the staff administer the potentially toxic antibiotics for MRSA without poisoning the patient by monitoring antibiotic levels in the blood.
I hope you won't be surprised to learn that hospitals take MRSA (and other antibiotic resistant bugs) very seriously indeed, and did so long before the Government suddenly began to take an interest in a problem which has been around since the Sixties. Believe it or not, we prefer not to have patients die unnecessarily - MRSA in the bloodstream has a similar proportional mortality to smallpox. In my hospital that means careful monitoring of the rates of infection, scrutinising every new scrap of evidence that might reduce the number of cases, and thinking up ways to shame colleagues into washing their hands. My department has also developed a new ultra-rapid means of detecting the bacterium using genetic fingerprinting. It can give results in hours rather than the conventional two to three days. It is a measure of the hospital's commitment to the problem that this won us the trust's annual research prize.
Our trust has recently appointed a new specialist pharmacist in antibiotics whose job it will be to check that our remaining precious antibiotic drugs are not being squandered or even making things worse. Many believe that the problem was caused by inappropriate prescribing in the first place - not least within agriculture, where potent antibiotics have been indiscriminately used as growth-promoters. You might think that the genie is well and truly out of the bottle on that score, but there is some scope for hope here. Related antibiotics called cephalosporins seem to be particularly effective in making MRSA pop up like dragons' teeth. Some think that restricting prescriptions of these drugs might help contain the problem.
It seems plain as day to the public that the problem is dirty wards. Getting the cleaning done properly by those who are paid to supervise it might surely help? Such clear solutions are often muddied by contracts struck with private contractors. Some of these have managed to negotiate astonishing long-term private finance initiative deals that leave them with almost no culpability - and also pay pitiful wages. Personally if I were a director of one of these companies I would have trouble sleeping at night.
What MRSA means in the immediate future is finding ways of reducing our number of serious blood infections by 60 per cent, following the kind of autocratic diktat that characterises the present government. I know how to do this; in fact I could reduce hospital MRSA infection by 100 per cent at one single stroke.
Close the hospital.
The writer is a consultant in infectious diseases and works in a London teaching hospital