MRSA kills 5,000 people each year

Experts from five institutions, co-ordinated by the Royal Free Hospital, are calling for high quality research into effective ways of reducing MRSA.

Their review of past studies, published in the British Medical Journal, found "major weaknesses" in research to date.

But they stressed isolation measures should continue until further studies establish otherwise.

It's not just more research that is needed, it's better quality research Lead author Dr Sheldon Stone

The level of methicillin resistant staphylococcus aureus (MRSA) infections caught in hospital is continuing to rise globally.

A recent report from the National Audit Office suggested that 5,000 people die each year from MRSA and other similar infections in the UK.

Poor research

The main ways currently used to stop the bug spreading are finding and isolating infected people, ensuring better hand hygiene among health workers and restricting the use of antibiotics.

Earlier this week, the National Patient Safety Agency announced plans to place alcohol-based gels at the end of every patient's bed in NHS hospitals as part of a major drive to tackle superbugs.

But the effectiveness of these measures adopted in most national guidelines has never been tested scientifically.

A research team, funded by the Health Technology Assessment Board, reviewed all the available evidence published between 1966 and 2000, which included 46 studies.

No conclusions could be drawn in a third of studies, while major weaknesses in others meant plausible alternative explanations for reducing MRSA could not be excluded, according to the team.

Sometimes we have to accept the theoretical evidence behind a practice Christine Perry, chairwoman of the Infection Control Nursing Association

Six studies provided stronger evidence and four showed that concerted efforts, including isolation measures, can substantially reduce the spread of MRSA, even when endemic.

Dr Sheldon Stone, author of the research and consultant in services for elderly people at the Royal Free, said: "There's no doubt that there is evidence that even when you have high levels of MRSA a package of measures, including isolating patients, can reduce levels of MRSA in hospitals.

"So we should be very strict in enforcing the national guidelines on isolating patients, screening and on hand hygiene.

"But what we need to know is exactly how many isolation beds do you need for a hospital, how often should you be screening people, which people should you be screening and which people should you be isolating.

"It's not just more research that is needed, it's better quality research."

Further funding

He said without this, other more resistant strains of bacteria could develop.

"Then we would be in real trouble," he said, and called for extra funding.

Christine Perry, chairwoman of the Infection Control Nursing Association, said: "Overall, their conclusions are fair and we do need more funding for more research.

"But sometimes we have to accept the theoretical evidence behind a practice."

There isn't one silver bullet which will crack this particular problem Health minister Lord Warner

For example, she said there was no ethics committee that would allow researchers to test whether it was safe to give injections to patients with a non-sterile needle compared with a sterile needle.

Health minister Lord Warner told BBC Radio 4's Today programme that the review had been carried out in a bid to "improve the policies that work".

He said that while some hospitals had achieved success at tackling MRSA, "there are others... who are not doing as well as they might be".

"What we are engaged in now is trying to get the less good up to the standards of the very best.

"There's going to be further funding... to study the work we've done on hand hygiene and we are going to be adopting a multi-faceted approach.

"There isn't one silver bullet which will crack this particular problem."

'Common sense'

Dr Andreas Voss, an expert from The Netherlands, where MRSA levels are low, said: "We do need better studies, but we must have faith in the strength of common sense and practical experience when it comes to evaluating infection control measures."

A spokeswoman from the Department of Health said: "The Department of Health has already invested �3 million for new research programmes on healthcare associated infections.

"To build on this investment we will, in the autumn, convene a summit of leading international scientists on infection control.

"They will provide advice on potential new approaches to improving infection control, making sure we are up to date with the very latest research."

Paul Burstow MP, Liberal Democrat Shadow Health Secretary, said: "It is shocking that experts' advice on stopping infections on their wards have been ignored.

"Patients go into hospital to get better but are getting sicker because of these infections. Infection control must be a top priority in the NHS.