Overcrowding, understaffing and infection in hospitals.

Infections acquired in hospitals or healthcare-associated infections (HCAI), caused by methicllin-resistant Staphylococcus aureus (MRSA) and other pathogens, have risen to the top of the political and healthcare agenda in recent times. There is unease that, rates of MRSA such as measured by the proportion of bloodstream isolates of Staph. aureus that are methicillinresistant, are unacceptably high by European standards. Factors that contribute to high levels of HCAI and MRSA include inappropriate and excessive prescribing of antibiotics, the absence of or the inadequate provision for infection control teams in hospitals and healthcare institutions, poor facilities for the care of patients, e.g. overcrowding and inadequate numbers of isolation rooms, sub-optimal professional practice such as in the area of hand hygiene and finally, poor standards of hospital hygiene. While improvements in hospital hygiene and better compliance with hand hygiene recommendations are essential in controlling and reducing HCAI, more fundamental changes are required. In particular, consideration needs to be given to the role that overcrowding and inadequate staffing levels, especially amongst nursing staff, play in HCAI rates.