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WSWS : News & Analysis : Australia & South Pacific
VRE outbreak at major West Australian hospital
By Celeste Ferguson
16 January 2002
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Royal Perth Hospital, Western Australia�s oldest teaching hospital,
was forced to close one of its intensive care units last October in
the wake of Australia�s worst outbreak of the antibiotic- resistant
�superbug� known as VRE (Vancomycin Resistant Enterococci).
Within weeks, patients at other Perth hospitals were also infected.
The hospitals affected included Swan District, which services outer
suburban and rural areas around Perth, and Bentley, in the southern
suburbs, where a number of elderly patients who had been transferred
from Royal Perth (RPH) tested positive for the disease. Infections
also occurred at RPH�s Shenton Health Campus, which cares for
patients undergoing rehabilitation. Many of those affected had been
transported to the main RPH campus for day treatment.
To date, over 140 cases of VRE have been identified statewide, although no deaths have
been reported. A Health Department spokesman David Smith said most cases arose from
RPH and that more than 1,000 people may have come
into contact with carriers of VRE. According to recent media reports, no new cases
have been detected at RPH for several weeks. It is troubling, however, that the
screening of people in the community and other medical fac
ilities who may have had contact with VRE at RPH continues to find new carriers.
VRE is of particular concern because it is resistant to the antibiotic vancomycin, one
of the strongest antibiotics available. A relatively harmless bacteria when found, as
is common, in the human gut, enterococci can bec
ome fatal if it travels into the bloodstream. There is no known cure�patients can only
be stabilised in the hope that their own immune systems eventually prevail.
Outbreaks of VRE first occurred in Europe in the mid-1980s. Cases then began to appear
in America, Canada and Japan. The first Australian case was detected in 1994 at Austin
Hospital, Victoria. In 1996, several cases were
diagnosed in hospitals in Sydney, Brisbane, Perth, Melbourne and Newcastle.
Many medical experts say VRE has developed due to the overuse or incorrect use of
antibiotics that has, over time, made enterococci resistant. Antibiotics attack a
bacterial infection. There is always the chance that with
in the population of bacteria, some members will continue to grow in the presence of
the antibiotic. Those germs that are not killed, then, are free to multiply without
competition from the sensitive strains. Microbiologi
sts argue that the more antibiotics we use, the more we contribute to this pool of
resistant germs. Eventually these strains build up and an outbreak of antibiotic
resistant disease can take hold.
Hospitals, and particularly intensive care units are veritable breeding grounds for
resistant germs, as this is where the heaviest and most concentrated use of
antibiotics takes place. When this is combined with patients
who have compromised immune systems and intravenous tubes that allow easy bacterial
entrance to the bloodstream, the chances of contracting VRE are higher. Under these
conditions, a very strict hygiene regime is critical.
In an attempt to play down concerns and reassure patients and the public, West
Australian Health Department acting chief officer Dorothy Jones issued a statement in
October saying that WA hospitals were as safe as other A
ustralian hospitals. �Antibiotic resistance is a fact of modern health care.
Unfortunately in busy teaching hospitals where you have a lot of people with complex
illnesses you tend to see these things from time to time,�
she said.
Jones and other officials have yet to explain how the outbreak occurred, however.
A breakdown in hygiene protocols may well have contributed. Miscellaneous Workers
Union spokesman David Kelly pointed to the privatisation of cleaning services at RPH.
Kelly said private contractors were used to clean non
-ward areas, while staff cleaning the wards were also engaged in catering and orderly
services. Kelly said staff who are required to do several jobs at once might be
playing a part in the spread of the VRE.
�When non-ward cleaning was privatised the standards went down the toilet. From our
point of view the jury is still out on the effectiveness of multi-skilled workers who
are cleaning the wards because the reports to us ar
e that they are run off their feet.�
To date, RPH management has not commented publicly on the question of private
cleaners, yet it has decided to restore in-house cleaning.
Some health professionals have raised wider concerns. In November, RPH emergency
department head Ron Hirsch said staff shortages, particularly of nurses, had led to
some workers having to shortcut hand-washing procedures
due to lack of time and access to sinks. �Busy emergency department staff are often
quite unable to comply with the hospital infection control guidelines which have been
specifically designed to prevent such outbreaks ...
such as gaining access to wash basins to perform the simple but vitally important
functions of hand washing after patient contact.�
Industrial action by WA nurses over the past year has served to highlight the crisis
in staffing levels, wages and conditions as well as aging equipment�the legacy of a
protracted running down of the public health system
by state and federal governments, Labor and Liberal alike.
In last year's state elections, deep going opposition to public health cuts was a
factor in the defeat of the Liberals and the return of Labor under Premier Geoff
Gallop. In Gallop�s first budget last September, however,
public hospitals received between $85 and $120 million less than required to maintain
basic services.
Late last month, in an attempt to placate angry health professionals and the public,
the Labor government promised another $70 million. Gallop was forced to acknowledge
that some of the �extra money is needed to fight the
antibiotic VRE germ that swept Royal Perth Hospital�.
National prevention strategies are also being hampered by a lack of funds.
Professor Turnbridge, a Microbiology and Infectious Diseases Director at North
Adelaide�s Womens and Childrens Hospital said the federal government had agreed last
year that an expert advisory committee would examine the
problem of antibiotic resistant germs but the committee was yet to receive any money
for critical aspects such as the surveillance of VRE.
�The absence of a national notification system for resistant bacteria such as VRE ...
meant there was no official data. This makes monitoring difficult. There is general
agreement there should be a laboratory in each stat
e that acts as one network,� Turnbridge said.
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