Sunday, December 29, 2013

Burial Arrangements with Regard to Bacteria Etc

Burial Arrangements with Regard to Bacteria Etc

There is much public misunderstanding about particular bacteria often associated with hospitals and dubbed "superbugs" by the media. Multiply (or methicillin) resistant Staphylococcus aureus (MRSA) and Clostridium difficile (or C Diff) are probably the best known, and the subject of reporting and hospital targets. 

MRSA can cause problems, just like methicillin sensitive Staphylococcus aureus - wound infections, implant infections (artificial hips or heart valves for example) boils, etc. However, a large amount of the MRSA detected in hospitals is simply "sitting" on the skin of patients. It often lives in the nostrils, armpits and groins - warm, moist places. This is a concern because of the potential to infect wounds, but the presence of this microbe causes no harm as such. Some people colonized with MRSA may get rid of the bacterium without any treatment, and in others the bacterium will return after successful treatment. Their skin for various reasons is the ideal place for MRSA to flourish. Although MRSA may be acquired in hospital, the majority is acquired in the community, particularly in care homes. It is a consequence of widespread antibiotic use.

Clostridium difficile is a bacterium which is present in the large bowel of many people in small numbers. It is also present in soil, as are many other bacteria like Clostridium tetani (cause of tetanus) and Clostridium botulinum (cause of botulinum poisoning and source of Botox!*). Clostridium difficile only causes a problem when its numbers in the bowel grow - this is usually as a result of antibiotic treatment (particularly with a class of antibiotics known as cephalosporins) rather than by transmission from person to person. It then causes a difficult-to-treat diarrhoea. Thus the method of control is to restrict the use of the antibiotics most likely to cause this. Infection control is less important.

The relatives of a patient colonized with MRSA and suffering Clostridium difficile diarrhoea would not be particularly prone to problems from contact with their loved one. It is a wise precaution to prevent transmission, but it is transmission to other patients which is the main concern. 

In this context, it can be seen that the accounts of Deb Hazeldine about her mother make no sense. This may be a result of poor communication. Various sources say the same things, some as direct quotes:

"Ellen Linstead was admitted with bone cancer but died on December 13, 2006, from C.difficile and MRSA, hospital acquired infections that so ravaged the frail pensioner she had to be buried in a sealed body bag."


"When Mrs Linstead died in December 2006 her body was so badly infected with C. difficile that she had to be buried in a sealed body bag."#


"At the undertakers, her body was in a sealed bag covered in stickers warning it was highly contagious. We were allowed a few minutes, a few moments, with my mum. We saw her head protruding from a body bag. And we were allowed to spend a couple of minutes with her, just really to say goodbye. And what they said was 'we now have to put your mum's head back into the body bag and seal it because she is at risk of infecting the ground that she is buried in'."



"And even in death there would be no dignity. Ellen’s corpse was so riven by hospital-borne infections that no one was allowed to touch her body.
‘She was sent to the undertakers in a body bag with instructions that I couldn’t hold her hand or kiss her goodbye,’ she says. ‘I will never forget that.’"

 
This is medically nonsense. Clostridium difficile is present in the soil. The precautions required for various microbes are listed here in the Health Protection Agency guidelines for funeral directors: 

Clostridium difficile:
Body bag not required (unless there has been faecal leakage)
The body can be viewed
Hygiene and embalming permitted
MRSA:
Body bag not required
The body can be viewed
Hygiene and embalming permitted
So if there is no faecal leakage, no special precautions are required.


In fact, in some reports there is an acknowledgment that the funeral directors were misinformed about the management of the body:

"Furthermore, there was a mix-up at the hospital mortuary in which the undertakers were handed forms saying that Ellen's body was highly infectious, so people should not be allowed to see her.

In the end, Deb did see her - but only for a few minutes when she was in a body bag."


This clarification is omitted in most of the reports.

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