Editorial. Hospital hygiene sweeps resistance under the carpet. Lancet Infect Dis 2004 12. Web site: http://infection.thelancet.com/journal/journal.isa.

The authors of this unsigned editorial were not amused when John Reid, the minister of health for England and Wales, charged the National Health Service hospitals with reducing by half the number of methicillin-resistant Staphylococcus aureus (MRSA) infections by 2008. MRSA is estimated to kill about 5,000 people per year in the two countries. Statistics compiled by the Health Protection Agency show that the annual number of MRSA bacteremias in England and Wales rose from 7,250 to 7,647 between April 2001 and March 2004.

However, the National Audit office says that because the data are incomplete, the true number of MRSA infections may be much higher. This uncertainty over the scale of the problem led the Liberal Democratic party’s spokesman on health, Paul Burstow, to comment in response to the government’s target: "Halving a problem, when you don’t really know the scale of the problem, is an extraordinary feat."

Of course, England and Wales are not alone in suffering the plague of MRSA; the frequency of isolation of MRSA among all S. aureus is around 70% in Japan and South Korea, and 40% in the United States, Ireland, Greece, Italy, Malta, and Portugal. But compared with the Netherlands and Scandinavia, where rates remain below 1%, the increase in frequency of isolation of MRSA from 3% in 1992 to 43% in 2002 is shocking. Rates seem to have plateaued just above 40% since 2000, although whether this is the result of the UK-wide Antimicrobial Resistance Strategy and Action Plan the government released in that year is anyone’s guess. Common sense and the experience of countries with low rates of MRSA suggest that standards of hospital hygiene, particularly staff hand hygiene, do make a difference; and government actions to improve hygiene are to be welcomed. The government plan says little about better isolation facilities for patients with MRSA, however, (and certainly not in the time scale for improvement demanded).

"We believe that the MRSA action plan misses the point — or at best, skips lightly over the point — in its failure to emphasize the far greater issue of growing antibiotic resistance in general," the editorial stated. "Governments worldwide must recognize that rising rates of MRSA are just a sign of things to come. Although they do not get the same media attention as MRSA, across the globe hospitals are beset by other forms of antibiotic resistance that threaten the very future of modern medicine such as penicillin-resistant pneumococci, vancomycin-resistant enterococci, and fluoroquinolone-resistant Escherichia coli."