A study by the University of Aberdeen has found a possible link between the use of disinfectants in hospitals and the rise of methicillin-resistant Staphylococcus aureus (MRSA) on patient wards. The authors are calling for the use of disinfectants to be better regulated.
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The study was led by Senior Clinical Lecturer at the University of Aberdeen Dr. Karolin Hijazi, and was a collaboration with Professor Ian Gould, Consultant Microbiologist at Aberdeen Royal Infirmary.
Hijazi and team looked at the resistance of a specific type of bacteria named Staphylococcus epidermidis to a range of disinfectants.
Staphylococcus epidermidis is found on the skin of healthy people and is normally harmless, producing no symptoms or complications. But, when disinfectant is used liberally, the bacteria can become resistant to antibiotics and pose a threat to patients staying in the hospital. It is also able to potentially spread its ‘resistance’ genes to Staphylococcus aureus, which can then become MRSA.
Patients staying in a hospital are at an increased risk of MRSA infections, as they come into contact with a wide number of people, which allows the bacteria to spread easily.
Some patients are also less able to fight off infections and are more susceptible to bacteria entering the skin or body through wounds, medical tubes, intravenous drips, or urinary catheters.
Symptoms of MRSA include redness, swelling, or pain in the skin, progressing to high temperature, dizziness, and confusion if the bacteria gets deeper into the body.
The disinfectants in question are often used to bathe patients in intensive care units, as well as to keep medical equipment clean. They can also be found in mouthwashes, albeit in lower amounts.
The study looked at disinfectant resistance in a Scottish intensive care unit. But, when analyzing bugs from around the world, the “same alarming trend” was discovered.
Dr. Hijazi explained the scale of the problem:
[MRSA] causes around 10 to 15 infections a month in individual intensive care units. The patients will come down with blood infections which are multi-drug resistant. But of course, patients in intensive care units are clearly more susceptible to infections.”
Dr. Karolin Hijazi, Lead Author
Professor Gould said, “Our research shows that in environments with a high concentration of disinfectant, this previously harmless bacteria can develop resistance to treatments commonly used to treat infection.
“This is potentially a very significant public health issue and highlights the importance of investigating how these bugs can become resistant to disinfectants.”
Dr. Hijazi added, “Basically, we are saying that intensive use of the particular disinfectants used in hospitals can contribute to the prevalence of bugs that are resistant to most antibiotics commonly used to treat infections.”
Some hospitals, which include Aberdeen Royal Infirmary, opt for decontaminating all patients, while others, such as units in Edinburgh and Tayside, only decontaminate patients who are most at risk.
Dr. Hijazi deemed only decontaminating at risk patients the “more rational approach”, stating there is “certainly a higher risk” of increased infections if all patients are decontaminated.
The research does not suggest that these disinfectants should be banned in hospitals as they are necessary to stop other infections from breaking out. However, she adds that “perhaps there is merit” to moving on to using other disinfectants that are equally as safe and effective.
Further research could be carried out to determine the efficacy of other disinfectant products. Health Protection Scotland has welcomed the research and agrees with the study’s recommendation for additional analysis.
Dr. Hijazi also suggests changes to the regulation of disinfectant use. She said:
Our results suggest that we need to change the way we think about using disinfectants, particularly in the hospital setting. We are all aware of the problems associated with the overuse and misuse of antibiotics, and similarly, there is evidence that the use of disinfectant in hospitals should be regulated more strictly.”
Dr. Karolin Hijazi, Lead Author
Time for biocide stewardship? Nature Microbiology. 25th February 2019.