Tuesday, 21 April 2009

MRSA - understanding good statistics

The current flurry of improved MRSA statistics coming from British Health Service Trusts needs a degree of informed interpretation.

Most knowledgeable commentators have some doubts about the NHS statistics being totally free from the malign influence of "targets."

If you pay over the odds for sick animals, the market delivers sick animals in huge numbers, we know that from the Foot and Mouth outbreak in 2001.

If you pay over the odds for NHS Chief Executives to produce reductions in MRSA, you get statistics that show an improvement.

The greed-driven economy is easy to predict. It produces whatever you pay for, especially if the pay is generous and the payee ruthlessly inadequate and focused on benefiting personally from good results.

That aside, there are perfectly respectable, but still more ominous,reasons why the MRSA figures often show a genuine improvement and probably will continue to do so for some months.

This at a time when the real situation on the ground may well deteriorate further.

NHS MRSA screening has almost reached its objective of universal screening for all elective surgery. The gradual introduction over past months would bring an improvement in the statistics. Enough money has been spent upon it.

Screening NHS style detects about 70 percent of carriers who can be sent home to "clean up" or in emergency situations given a degree of isolation and attention until they are clear.
This, taken together with good ward cleaning, washing hands etc, should and will reduce the rates of MRSA.

Good so far! Well Done NHS.

What are you going to do about the 30 percent missed of human carriers by the nasal swabs?

BUT the statistics of HA - Hospital Acquired - MRSA were always overstated and over the years the writer has staunchly defended the NHS from being blamed for CA - Community Acquired- MRSA. They were carrying the can for incoming patients bringing MRSA into the hospital and spreading it about undetected.

So the situation in the hospital sector may well improve, for a while whilst the situation in the community deteriorates sharply. We can be lulled into believing all is well, when the opposite is the case. All over the world, the attention is shifting dramatically to risks beyond the hospital walls. Eventually MRSA will wash back into the wards from outside.

The European Continental system of "Search and Destroy" with its more reliable testing centred on the obvious risk patients of veterinarians, pig and pork industry patients, will always give better real results, both within the hospitals and outside in the community.

The Continentals have few problems in their hospitals and a clear vision of the problems on the farms and in the meat factories.

Britain, Ireland (with a single exception), Canada and now the United States have chosen a system that may well give some false confidence for a few short months and delay the necessary measures been taken way beyond the hospital doors.

The situation is serious and time is not on our side.