From Mr E. Abela

I refer to Marisa Micallef’s article entitled “Bugs, battles and bad news” (TMIS, 11 February).

Any journalistic contribution that increases public awareness on the issue of hospital-acquired infections is welcome, as long as it is based on sound medical evidence and advice. Unfortunately, your contributor makes a number of incorrect claims and conclusions that require comment for the sake of the general public.

Ms Micallef mentions European “league tables” of Methicillin-resistant Staphylococcus aureus (MRSA). These are nothing of the sort despite attempts by various journalists, both locally and abroad, to try and project them as such. The data quoted originates from the European Antimicrobial Resistance Surveillance System (EARSS) – a surveillance network of which Malta was one of the first members. However, the results issued are meant for epidemiologists and microbiologists who are able to interpret them properly as they know the full medical background of this network.

The results of EARSS contain a significant bias in the case of Malta. Other countries participating in EARSS have a mixture of specialised tertiary and district secondary hospitals, the latter having normally much lower MRSA levels since they are not involved in intensive medical management. On the other hand, all the Malta data refers simply to St Luke’s Hospital and therefore is heavily biased to the higher prevalence expected to be found in tertiary care.

On an individual hospital basis, St Luke’s Hospital 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 on which the MRSA of the study are based. Locally, these are usually taken when the patient has not responded to empiric therapy and the fever continues to rise. In such circumstances, one expects to find more resistant pathogens.

There is absolutely no conspiracy to hide MRSA from patients and the public. The Infection Control Unit of St Luke’s Hospital regularly publishes MRSA incidence data in medical fora; more importantly, infection control nurses visit all patients diagnosed with MRSA and, contrary to what was written, explain the nature of the infection to them and, where indicated, arrange for their transfer to an appropriate ward in the hospital where specialised nursing and medical care is provided.

Nevertheless, the Health Division acknowledges that there is undoubtedly room for improvement and has embarked on a number of initiatives aimed to reduce MRSA occurrence. Additional infection control nurses have been appointed at St Luke’s Hospital to further intensify efforts. In November, Malta became a signatory to the World Health Organisation’s Global Campaign for Patient Safety and several initiatives aimed at improving hand hygiene among healthcare workers will be started early next year.

Our initiatives to encourage better use of antibiotics have been acknowledged to be among the best in Europe and we are seeing results of our efforts in recent years as total antibiotic consumption has gone down by 33 per cent since 2001. Recent initiatives to improve ward hygiene also seem to be yielding positive results judging by the feedback of patients and staff alike.

Ms Micallef is correct to identify the imminent migration to Mater Dei hospital as a critical development as this will alleviate two unmistakable factors; overcrowding and lack of isolation rooms, which have been shown to be major contributors to our MRSA rates. Should Ms Micallef want to know all the facts from the professionals themselves, she is more than welcome to contact the Infection Control Unit of St Luke’s Hospital. The dedicated infection control personnel will be happy to answer any queries she may have, as they regularly do with healthcare workers, patients and their relatives, as well as the general public.

Emanuel Abela

Director of Information