"City warned to act now on superbugs," South China Morning Post, 16 May 2011
This three-story package was the culmination of a months-long fight for data about hospital-acquired MRSA infections in Hong Kong, collected for years by the quasi-public Hospital Authority but never released to the public.
The Authority agreed to release the data on a quarterly basis after it was confronted with partial data, obtained from a government website using smart-search techniques.
Hong Kong must act now to contain an alarming number of blood infections from deadly superbugs that are resistant to antibiotics, a leading researcher warns.
Professor Ho Pak-leung, who heads the University of Hong Kong's Centre of Infection, says a determined campaign to reduce these infections can save lives. New figures obtained by the South China Morning Post show the city's public hospitals saw 651 cases of bloodstream infections of the most well-known superbug, methicillin-resistant Staphylococcus aureus (MRSA) in 2010.
'These figures are alarming,' said Professor Ho.
'Assuming a third of the 651 died, then we have more than 200 patients that died last year, and that's a lot. These deaths were potentially preventable,' said Ho. The Hospital Authority plans to formally release the numbers this week.
Antibiotics have been the first line of defence against infection for more than 60 years but the spread of superbugs is threatening the effectiveness of these life saving drugs.
The authority refused to provide the number of deaths of MRSA blood-infection patients, but a document found on the authority's website shows that in 2008, nearly 39 per cent of Hospital Authority patients with MRSA blood infections died within 30 days. The number of infections has steadily declined since 2007, but hospitals have fallen short of the authority's stated reduction goals and remain far behind countries such as Britain.
The Hospital Authority wants to reduce infection rates to 0.1258 cases per 1,000 acute patient days - a 34 per cent reduction from 2007 levels. But according to the data, the infection rate has dropped only 12 per cent since 2007.
In the first year, the 15 hospitals that handle acute cases saw a 10 per cent decline in the rate of infection, which is calculated on the number of patient days per year, and the number of blood infections dropped from 813 to 778.
But in the three years since, improvements have been much slower.
'From 2007 to 2008, you can say the baseline is higher. That's why improvement is easier and the efforts are more obviously shown when you first implement. To sustain these efforts is harder,' said Dr Dominic Tsang, the Hospital Authority's chief infection control officer.
70% reduction in MRSA blood infections in five years in Britain is much higher than in Hong Kong hospitals which have seen just 12 per cent decline since 2007.
ONLY FOUR OUT OF 15 HOSPITALS HIT SUPERBUG TARGET
A vast gulf exists between the city's best and worst-performing hospitals in the fight against deadly superbug blood infections.
Among the 15 public hospitals that provide acute services, the worst performer by far was Ruttonjee and Tan Shiu Kin Hospitals, which recorded 37 infections in 2010.
The hospital's infection rate (.418infections per 1,000 acute patient days) was 10 times higher than that of the least infection-prone, Tseung Kwan O Hospital, which recorded five infections.
The Hospital Authority released the information after the Post made repeated requests to both the authority and the Department of Health.
Public hospitals are required to contain the rate of MRSA blood infections to fewer than .1258 cases per 1,000 acute patient days. But only four hospitals met that goal.
'That's an arbitrary target, based on our 2008 figure,' Hospital Authority chief infection control officer Dr Dominic Tsang Ngai-chong said. 'We tend to set this target a little bit high ... we wanted to make this a difficult target.'
Hospitals that provide acute services are the ones most at risk of MRSA bloodstream infections.
Those with the best records were Tseung Kwan O Hospital, Prince of Wales Hospital, North District Hospital, Kwong Wah Hospital, which all met the authority target.
After Rutonjee, the worst-performing hospitals were Pok Oi Hospital, Yan Chai Hospital, Caritas Medical Centre, Pamela Youde Nethersole Eastern Hospital, Tuen Mun Hospital and Queen Elizabeth Hospital.
Hospitals that do not provide acute services had far lower infection rates. All but one achieved the authority's infection goal. The exception, Fung Yiu King Hospital, recorded nine infections, at a rate of .141 cases per 1,000 acute patient days.
Hospitals failing to effectively cut infection rates may face budget cuts under the authority's pay-for-performance plan, which went into effect more than a year ago, according to Tsang. While the authority provided support and enforced some accountability, ultimately each hospital was responsible for its own performance.
'It is up to the hospitals to run their own programme,' Tsang said. 'What we are doing is to give some motivation ... to run programmes, to provide central coordination and to perhaps give them some seed money to do some exploratory work.'
Countries that have successfully reduced infection rates, such as the UK and Australia, have central co-ordinating bodies to track infection rates and enforce infection control measures among public and private hospitals. Hong Kong does not.
'The Department of Health should be the one to take the lead on infection control measures in Hong Kong,' authority board member and Legislative Council member Joseph Lee Kok-long, who represents the Health Services functional constituency, said.
'But resources are almost always underfunded. Most of the money goes to the Hospital Authority. We may need to see whether we need to fund the Department of Health more to take a stronger lead in addressing hospital infection control.'
Reporting on hospital-acquired infections in the city is hit and miss.
The Health Department does not require hospitals to report on MRSA infections, but it says those acquired outside of hospitals are a 'statutorily notifiable disease.'
'Hospital-acquired MRSA is already prevalent in Hong Kong and its incidence is better monitored by other surveillance systems rather than making it a statutorily notifiable disease,' a spokesman said.
While the Hospital Authority shares MRSA infection information with the Health Department, it is under no legal obligation to do so. A department spokesman said he could not release Hospital Authority infection figures because the authority 'owned' the data.
Information about private hospitals is even more elusive - nine hospitals participate in a surveillance programme that tracks MRSA infections, but the department refused to provide the data nor even say which hospitals participated.
The tight control of information isn't new. In 2003, the government-commissioned SARS Expert Committee identified the lack of co-ordinated data-sharing between the Hospital Authority and Health Department as one of the key problems during the SARS epidemic, hindering the government's response.