There was a time, not so long ago, when we went to the hospital with the hope of a cure for our ills. All our trust was placed in the institution and its personnel, whom we came to revere as semi-gods. But not anymore. The hospital can itself be a dangerous place, where we can be at risk from communicable diseases, where a ?simple? bacterium can end our lives.

Last week?s figures, released by the National Statistics Office in Britain showed that deaths from the superbug MRSA had almost doubled in four years. While there were 487 such cases in 1999, in 2003, the number had shot up to 955. In the past year, deaths from MRSA increased by 19%.

The data also revealed that deaths from MRSA infection were highest in old people. The over 85s were disproportionately affected, with 437.1 deaths per million for men in 2003, reported The Guardian. Women, in the same age group, accounted for 220.8 deaths per million population, that year. Infection arising from hospitalisation is not a new phenomenon but bacteria?s resistance to drugs is increasing at an alarming pace.

In Mauritius, the prevalence of infection originating in hospitals is just under 5%, according to a survey of Mauritian hospitals in the early 90s. The results, published in a collection from the National Library of Medicine (U.S), show that community-acquired infections were three times higher at 15%. On average, 8.2 out of every 100 operations resulted in a surgical wound infection. But, since the hospital population was fairly young (38 years old), the risk factors associated with hospital-acquired infections were relatively low.

MRSA is the acronym for methicillin-resistant staphylococcus aureus, a bacterium that has developed resistance to antibiotics. It is found in healthy subjects, about one-third of the population, on the skin or in the nose. At this point, the person is said to be colonised, but a wound or disease can then trigger an infection. MRSA, also called the superbug, was first noted in Britain in the 1960s, but it has now moved to all parts of the world. The conundrum for medicine and patients is that methicillin was the drug of choice to treat antibiotic-resistant bacteria.

Resistance to antibiotics

As a last resort treatment, infected patients are prescribed vancomycin. But, in 1997, the bacterium evolved again and developed resistance to this antibiotic. This variant, known as VRSA, has since been reported in the US, Brazil, England, France and Asia. The drug pool against these superbugs is becoming ever smaller, leading some scientists to believe that we could be returning to a pre-antibiotic era.

Superbugs are denizens of hospitals, living and multiplying on the wards. They are found on everything, from staff?s clothes, patients? skins to door knobs and medical equipment. This accounts for the high infection levels in post-operation wards. They cause infection when there is a breach in the skin, allowing the bacteria to enter the bloodstream and causing blood poisoning. Skin diseases such as boils, bone infections and pneumonia are also common manifestations of MRSA.

But now a community strain is even threatening young, healthy people before they even set foot in a hospital. This variant could be even more dangerous as it affects people in group activities. Last month ABC News reported that a number of athletes are being affected by superbugs due to close contact associated with dressing rooms. The military is another high-risk sector where superbugs can thrive because of the sharing of towels, uniforms and bars of soaps in communal showers.

The medical journal The Lancet also reported that MRSA could be linked to social deprivation. In a study of 1,739 UK residents undergoing heart surgery, 23 (1.3%) were infected by the bacteria. But there was a seven-fold difference in infection rates for those from the most deprived areas compared to the more well-off. The researchers concluded that there was a direct correlation between socio-economic background and susceptibility to post- operative infection with MRSA.

The spread of superbugs is closely tied to the lack of hygiene in hospitals. The wards have lost their characteristic cleanliness of the past, giving bacteria free reign to wreak havoc. Hand hygiene is the easiest way to keep the bacteria away, together with the use of gloves and gowns. Medical equipment has to be thoroughly cleaned while sterile packs of instruments and dressings have to be carried on aseptic trolleys.

In an effort to tackle superbugs, Britain launched a Clean your Hands campaign to ensure that alcohol-based hand rubs are placed by the bedside for ready availability to staff. The UK, at 44%, has the second highest MRSA infection rate in the EU after Greece. France follows closely behind on 33%, while Germany is at 19%. The Netherlands is where patients are least at risk with only a 1% of all diseases accounted for by MRSA. This is explained by their spotless hospitals.

Need for hygiene

Last year some health experts claimed that overcrowding contributes to the spread of superbugs. A lack of staff is clearly a problem, as procedures are not respected carefully under pressure. Our hospitals in Mauritius, as we saw recently in Flacq, suffer from doctors? absence at their post and people having to wait long hours. Such a scenario can make the hospital hectic, jeopardising the thoroughness of ward practices.

In the UK, Thatcher?s privatisation schemes in the 80s are blamed by UNISON, the largest union, for the increase of superbugs in hospitals. As the cleaning jobs were outsourced to private companies, the drive for profits led them to cut costs. It meant fewer cleaning staff and thus dirtier wards. Increasing pressure from the World Trade Organisation under the General Agreement of Trade and Services (GATS) could mean that Mauritian hospitals head the same way as their British counterparts.

There is no doubt that major health scares will be an integral part of the 21st century. But superbugs manage to strike fear in us because of their attack on hospitals, the very institution where we go to get rid of diseases.

Diren VALAYDEN Outlook Correspondent in Dublin