Superbug Scare: Staphylococcus Aureus and Clostridium Difficile - Essay Example

While journalists may be accurate as sources of information on concrete events, they do not serve as sources of education in areas of safety and quality in health services1 particularly on preventing infections by Staphylococcus Aureus and Clostridium Difficile. Therefore, if ever the journalists have created scare stories about these superbugs, it does not deflect from the true nature of these bugs. This implies that making decisions about them should not rest on education given by journalists but on microbiologists or persons trained in the sciences of these bugs. Methcillin-resistant Staphylococcus Aureus (MRSA) and Clostridium Difficile have both been dubbed as superbugs one after the other, but differ in their media exposure. Issues on the first have been reported to be blown out of proportion2 while the importance of the second had not caught much public awareness.3 In terms of public safety, however, attempts to inform or educate the public underscore all the more the need to evaluate sources of information and education before they are believed, in light of the public scare that media have created about them. Staphylococcus Aureus (MRSA) MRSA has been reported by media as a potentially killer ‘superbug’ which common antibiotics have not stemmed. For the 10 year period from 1995 through 2005 of newspaper coverage of MRSA that researchers4 analyzed, MRSA reporting came around with the notion of you-or-me to blame. Guardian5 summarized the MRSA hospital superbug story thus- A bloke with no microbiology qualifications in unaccredited garden shed “laboratory” finds MRSA on swabs given to him by undercover tabloid journalists for their “dirty hospital scandal” stories, but proper labs cannot find MRSA in the same places that this “leading MRSA expert Dr Chris Malyszewicz” (with his unaccredited American correspondence course PhD) has, and proper microbiologists have very good reasons for believing that the methods of this “expert” (who incidentally sells a range of anti-MRSA products) could not distinguish between harmless skin bacteria and MRSA6 It is noted that the blame centered on why it spreads – the lack of cleanliness in hospitals – and not on its origin.7 As a result, the National Health Service is seen as mismanaged. Nevertheless, in the Hansard files8 it is the credibility of source that is put into question: the tabloid, Evening Standard, covering the story, including the “expert” who is considered as the source of the tests - Lord Warner replied: “I entirely agree with you about the laboratory concerned and the uncritical acceptance of its results by some parts of the media. ‘The main source of this misleading information in the media is Chemsol which is run by a person who is not qualified in microbiology. He is not a member of a recognised professional body and his so-called laboratory does not meet UK accreditation standards. The methods used in this laboratory do not distinguish between harmless bacteria found on the skin and the potentially harmful MRSA.’” 9 This being the case, the message suffers equally the same as the messenger from credibility: the so-called tests of the non-expert as well as the reporting of media. The more damaging effect, however, is that despite this lack of credibility, findings of the non-expert had been published far and wide, resulting in unneeded anxiety for the community and the hospitals involved.10 In the House of Lords, Lord Warner of the DOH was speaking. The Minister of State, Department of Health said that laboratories must be accredited before making microbiological investigations; and tests must be done along approved procedures and standards. Further, the results should be subject to both internal and external quality assurance tests. Despite questionable methods, these MRSA test results were given wide publicity in the media. As an effect, NHS resources were wasted in having to counter the unnecessary public concern that ensued.11 Clostridium difficile Meanwhile, Clostridium difficile, represented as the CD superbug by tabloids, is considered the usual cause of diarrhea. C. difficile associated disease (CDAD) occurs when beneficial bacteria that protects the gut from harmful infection are killed by antibiotic treatment.12 In an epidemic in Quebec in the year 2005,13 it was reported that a new hypervirulent strain of CDAD was causing outbreaks not only in North America but also in Europe in the last 10 years. It is not something new, therefore, since for about 30 years, it has been recognized as the cause of antibiotic-associated diarrhoea, to the serious diarrhea, to the life-threatening type. CDAD is a common disease in UK that for patients above 65 alone, in 2006, there were reported 51,690 cases, 30 times increase those reported 10 years ago. This means that the number of reported C. difficile cases is now thrice those for the notorious MRSA pathogen.14 No considerable government funding is allocated for basic research on hospital superbugs, though.15 Meanwhile, CDAD outbreaks have been consistently growing since the 1990s, going up levels higher than the more popular MRSA.16 Recent studies also reported in the Postgraduate Medical Journal (PMJ)17 of a hypervirulent strain of Clostridium difficile in Canada, the USA and later in England, the Netherlands and Belgium, bringing attention to this organism as the latest “superbug.” Conclusion The domain of educating the public on these superbugs does not belong to journalists or simply writers but to trained microbiologists and related scientists. Medical science has to be based on fact and not on accurate representation of events. Staphylococcus Aureus and Clostridium Difficile are at best emerging infectious diseases (EIDs) that all the more scientific mindset of experts is a must. Though there had been justified earlier complaints about media reporting by journalists who clearly were not medical practitioners nor microbiologists, there are the reports of credible representatives of medical science. Mayo Clinic Proceedings,18 for example said that intense media attention on superbugs began from a recent write-up in the Journal of the American Medical Association (JAMA). It stated estimates of MRSA yearly infections in the United States. Accordingly, there were 19,000 fatal MRSA infections in 2005. The word “staph” in media then increased 10 times in the next 2 weeks after that. Two years before this, tabloids were blamed as making an unnecessary public scare,19 but of late, medical literature have suggested that the transmission and control of these bugs lie in hygiene practices of the health care professionals. All told, the spread of MRSA and other drug-resistant organisms can be limited by infection control measures. These include hand hygiene and the use of clean personal protective equipment including gowns and gloves in hospitals.20 Despite the public scare created, it is not after all difficult to prevent infection of these bugs. End Notes 1. Walker, Christine F. and Struan W. Jacobs. The role of the print media in informing the community about safety in public hospitals in Victoria, Australia: the case of ‘golden staph.’ International Journal for Quality in Health Care 2005 17(2):167-172; doi:10.1093/intqhc/mzi019. Retrieved March 23, 2008, from http://intqhc.oxfordjournals.org/cgi/content/abstract/17/2/167 2. Goldacre, Ben. How many microbiologists does it take to change a tabloid story? The Guardian. Saturday November 19, 2005. Printed in Bad Science. Retrieved March 25, 2008, from http://www.badscience.net/?p=187 3. Wren, Brendan W. Clostridium difficile comes of age. Future Microbiology. October 2006, Vol. 1, No. 3, Pages 243-245. (doi:10.2217/17460913.1.3.243). Retrieved March 25, 2008, from http://www.futuremedicine.com/doi/full/10.2217/17460913.1.3.243?cookieSet=1 4. Washer, Peter and Helene Joffe. The “hospital superbug”: Social representations of MRSA. Social Science & Medicine. Vol. 63, Issue 8, October 2006, Pages 2141-2152. doi:10.1016/j.socscimed.2006.05.018. Retrieved March 21, 2008 from    http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6VBF-4K716FJ-2&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=5f7bd4a03ad2369095a4e6e1a4cec718. 5. Goldacre (2005) 6. Goldacre (2005) 7. Washer, Peter and Joffe (2006) 8. Goldacre (2005) 9. Response 21. Goldacre, 2005: Minister hits out at misleading information on MRSA. By Anthony Looch, PA Lords Staff. 10. Lord Warner, Hansard Files, in Goldacre (2005) 11. Responses to Goldacre, Ben. 30 Nov 2005: Column 210, Number 23 post, full transcript from Hansard. 12. Wren, Brendan W. Clostridium difficile comes of age. Future Microbiology. October 2006, Vol. 1, No. 3, Pages 243-245. (doi:10.2217/17460913.1.3.243). Retrieved March 25, 2008, from http://www.futuremedicine.com/doi/full/10.2217/17460913.1.3.243?cookieSet=1 13. Pepin‌ J, N Saheb, and Coulombe MA et al.: Emergence of fluoroquinolones as the predominant risk factor for Clostridium difficile-associated diarrhea: a cohort study during an epidemic in Quebec. Clin. Infect. Dis. 41(9), 1254–1260 (2005). [CrossRef] [Medline]  14. Wren (2006) 15. Bacteria not welcome at the MRC? [Editorial]. Nat. Rev. Microbiol. 4(1), 2 (2006). Nat. Rev. Microbiol, 2006 16. Poxton, Ian R. Clostridium difficile – new challenges for hypervirulent strains. Oxoid. Culture. March 2006. Vol. 27. No. 1. ISSN 0965-0989. Retrieved March 23, 2008, from http://www.oxoid.com/culture/27-1.pdf. [Poxton is a professor of microbial infection and immunity of U]. 17. Cookson, Barry. Hypervirulent strains of Clostridium difficile. Postgraduate Medical Journal 2007;83:291-295; doi:10.1136/pgmj.2006.056143. Retrieved March 22, 2008, from http://pmj.bmj.com/cgi/content/full/83/979/291 [Dr Barry Cookson is from the Centre for Infections, Health Protection Agency, 61 Colindale Avenue, London, NW9 5HT, UK]. 18. Sampathkumar, Priya. Methicillin-Resistant Staphylococcus aureus: The Latest Health Scare. Editorial. Mayo Clin Proc. 2007; 82:1463-1467. Mayo Foundation for Medical Education and Research. Retrieved March 25, 2008, from http://www.mayoclinicproceedings.com/inside.asp?AID=4545&UID= [Dr. Sampathkumar is from the Division of Infectious Diseases, Mayo Clinic, Rochester, MN] 19. Goldacre (2005) 20. Sampathkumar (2007) Read More