Objective The aim of this study was to compare the knowledge and views of nursing staff on both acute elderly care and rehabilitation wards regarding elderly persons' oral care with that of carers in nursing homes. Subjects One hundred nurses working on acute, sub-acute and rehabilitation wards for elderly people (Group 1) and 75 carers in nursing homes (Group 2) were surveyed. Design A semi-structured questionnaire. Results Similar percentages of each group of nurses were registered with a dentist (86% and 88% respectively), although more hospitalbased nurses were anxious about dental treatment compared with the nursing home group (40% and 28% respectively). More carers in nursing homes gave regular advice about oral care than the hospitalbased nurses (54% and 43% respectively). Eighteen per cent of each group thought that edentulous individuals did not require regular oral care. Eighty-five per cent of hospital-based nurses and 95% of nursing home carers incorrectly thought that dentures were 'free' on the NHS. Although trends were observed between the two groups, no comparisons were statistically significant (Chi-square; level p < 0.05). Conclusions Deficiencies exist in the knowledge of health care workers both in hospital and in the community setting, although the latter were less knowledgeable but more likely to give advice to older people.
Sixty percent of all meat consumed in the UK is imported from European countries where there have been increasing reports of methicillin-resistant Staphylococcus aureus (MRSA) identified in food-producing animals, but rarely from such animals in the UK. Thirty samples each of raw chicken, pork and beef, sourced in England, were collected from retail outlets in Greater Manchester. MRSA was recovered from three chicken samples and one each of pork and beef, all from prepackaged supermarket meat. Four isolates were identified as representatives of the most common human healthcare-associated MRSA clone in the UK [EMRSA-15, spa type t032, belonging to multilocus sequence type clonal complex 22 (MLST-CC22)], suggesting contamination from human source(s) during meat processing. The fifth isolate (from chicken) was multiply-resistant (including oxacillin, ciprofloxacin, erythromycin, clindamycin and tetracycline), identified as ST9-SCCmecIV, spa type t1939 and lacked the immune evasion cluster, a characteristic of livestock-associated strains. This lineage has been identified previously from animals and meat products in Asia and mainland Europe but not the UK.
Community associated methicillin resistant Staphylococcus aureus (CA-MRSA) is an emerging pathogen typically associated with skin and soft tissue infection, with occasional reports of fatality in previously healthy children and young adults. We report a case of invasive CA-MRSA and highlight the potential impact of such infections on empirical treatment of staphylococcal infections.A n 11 year old boy of African origin was admitted to his local hospital with left hip pain, fever, and an inability to weight bear (day 1). The day before, he had fallen on to his left hip while playing football; his symptoms started soon afterwards. He had no significant past medical history; four months previously he had moved to the UK. At presentation he was unwell and febrile (40.1˚C) with a high C-reactive protein (CRP) of 104 mg/l. An ultrasound scan of his left hip was inconclusive. The pain extended to his left inguinal region and testis; he was treated with intravenous flucloxacillin and cefotaxime for epididymo-orchitis, and ibuprofen for pain relief. He remained febrile over the next four days and the pain spread to his left thigh and loin. MRSA was isolated from the single blood culture bottle taken at presentation. He developed acute renal failure on day 5 (urea 20.3 mmol/l, creatinine 396 mmol/l), which was treated with intravenous fluids without improvement; he was transferred to our renal unit. MRSA was identified again, from a blood culture drawn on day 2, and vancomycin was added to his therapy. He had no skin lesions. He now described right sided pleuritic chest pain. Examination revealed a right sided pleural rub and coarse crackles. A chest radiograph showed right basal consolidation with a pleural effusion. An MRI scan identified osteomyelitis of the left pubic ramus with a subperiostial collection, which was drained and irrigated surgically. MRSA was cultured from the intra-operative periosteum and pus specimens and histology confirmed acute osteomyelitis. His antibiotics were rationalised to vancomycin and oral rifampicin (600 mg once daily). Unusually, the MRSA isolates were susceptible in vitro to erythromycin and ciprofloxacin. He remained febrile (temperatures >38˚C) over the next six days, his CRP remained raised, and he developed a soft systolic murmur. Transthoracic echocardiography did not show vegetations and the murmur resolved. Pleural fluid aspirated on day 12 was purulent but sterile. His renal failure, which improved, was attributed to interstitial nephritis, secondary to b-lactams and/or ibuprofen. On day 16 his fever and CRP (35 mg/l) were settling. He was discharged to his local hospital on vancomycin and rifampicin.The MRSA susceptibility pattern and the epidemiology suggested that this might be a community associated strain. Genotypic analyses (including pulsed field gel electrophoresis, detection of the Panton-Valentine Leukocidin (PVL) genes, exfoliative toxin D gene, and SCCmec type IVc) confirmed this isolate to be representative of the sequence type 80 clonal lineage, the so called Eur...
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