From Mr E. Abela

I refer to the article written by Noel Grima, entitled Malta’s MRSA time bomb (TMIS, 17 December).

His report has referred to the annual report by the European Antimicrobial Resistance Surveillance System (EARSS) and conclud-ed that Malta has one of the worst MRSA infection rates in Europe.

Such interpretation, however, does not take into account a number of factors that paint a much worse picture than reality suggests. The results of EARSS contain a significant bias in the case of Malta. Other countries participating in EARSS have a mixture of tertiary and secondary hospitals, the latter having normally much lower MRSA levels since they are not involved in as intensive medical management. On the other hand, all Malta data refer simply to St Luke’s Hospital and therefore are heavily skewed to the higher prevalence normally found in tertiary care.

On an individual hospital basis, St Luke’s Hospital is by no means the worst hospital in EARSS and has far lower rates of MRSA than many equivalent hospitals in the UK, Ireland, Italy, France, Spain and Belgium.

It has also been shown by EARSS that our blood culture practices differ from those in European hospitals. Blood cultures are the samples from which the MRSA of the study are based. Locally these are usually taken when the patient has not responded to empiric therapy and spiking a fever. In such circumstances, you expect to find more resistant pathogens.

Nevertheless, the Health Division acknowledges that there is undoubtedly room for improvement and has therefore embarked on a number of initiatives aimed at its reduction. Additional infection control nurses have been appointed at St Luke’s Hospital to further intensify efforts.

Only last month, Malta became a signatory to the World Health Organisation’s Global Campaign for Patient Safety. Furthermore, several initiatives aimed at wards improving hand hygiene among healthcare workers will be started early next year.

Our initiatives to encourage a better use of antibiotics have been acknowledged to be among the best in Europe and the efforts we have made in recent years are producing results, with total antibiotic consumption being reduced by 33 per cent since 2001. Recent initiatives to improve ward hygiene also seem to be yielding positive results, judging by the feedback from patients and staff alike.

Finally the imminent migration to Mater Dei hospital will alleviate two unmitigatable factors, overcrowding and the lack of isolation rooms, which have been shown to be major contributors towards our MRSA rates.

Emanuel Abela

Director of Information