ABSTRACT: Veterinary nurses are on the front line in the treatment and nursing of animals with methicillin-resistant Staphylococcus aureus (MRSA) infections. This article focuses on the unique relationship between one dog, Bella Moss, and her owner. MRSA took that relationship away but Bella left a legacy through her death after suffering not only the effects of the infection, but also stigmatisation owing to a lack of awareness. We look at advances since Bella's death in 2004 and whether the stigma associated with MRSA is justified.

Bella’s story

Most of us can relate to the unique relationship between a dog and its owner. Most can empathise with the pain when that relationship is broken through death. When that death is a whirlwind of stigmatisation affecting the treatment of the dog and owner, that pain is unbearable.

Bella, an eight-year-old Samoyed, owned by Jill Moss, lost her life in 2004, having contracted MRSA following routine surgery. While attempting to chase a squirrel, Bella ruptured her cruciate ligament and emergency surgery was performed. She was given pain medication a week after surgery at home as she went off her food but continued to deteriorate, requiring readmission to the veterinary hospital.

At Jill’s request, a further week later, Bella was transferred to a specialist hospital, where further emergency surgery was performed. Bella was suffering from septic shock, a urinary tract infection (UTI) and the onset of pneumonia. Critically ill, she was further diagnosed with MRSA but against the odds made great improvement. Her care was discharged back to her local veterinary team. Her future looked promising, with planned reconstructive surgery in two months if she continued to recover but she deteriorated requiring readmission to her local team.

The caring professional attitude Jill and Bella had experienced at the specialist centre was a distant memory. Bella’s label of ‘MRSA’ condemned her and Jill to 48 hours of complete distress leading up to her death. Nurses were confused and anxious about catching MRSA and Jill was left to change bedding and incontinence pads, to take Bella’s temperature and to fight the fever with wet towels.

Jill kept strength, hoping her presence was, at least, a comfort to Bella who, despite her owner’s care, went into organ failure. She died on August 24th 2004 – a death that could have been prevented had there been greater awareness about MRSA and knowledge of barrier nursing, which in turn could have quashed some of the stigmatisation experienced.

Bella in her heyday

Four letters

MRSA are four letters that can – and do – raise feelings of fear, anxiety, confusion, and misunderstanding. It is often referred to as ‘the killer superbug’ within the media; and it is frequently assumed to be associated with lack of hygiene and dirty environments, so there is little wonder there appears to be a stigma attached to it. Many pet owners have experienced changed attitudes towards themselves once there is an MRSA diagnosis.

One owner was made to feel very much like this when her Doberman, Freya, was diagnosed with MRSA. It was not until she told veterinary staff that she was being made to feel like the criminal when, in fact, it was more likely her dog had contracted the infection in the veterinary surgery, that their attitudes changed. This suggests the stigmatisation shown was on a subconscious level and arguably not intentional.

Following advice from regulatory bodies, practices have, without doubt, improved awareness and barrier nursing methodology in recent years. However, with an abundance of negative media coverage on the subject in human healthcare systems, it is difficult to destroy the universal stigma associated with MRSA.

All controversial subjects raise difficult questions and consideration has to be given as to whether the MRSA general stigmatisation is justified? As previously defined, the root cause of the stigma is the association with death and lack of hygiene. It cannot be argued that if the MRSA infection is not caught early enough it can and does cause death.

In addition, the main preventive method against MRSA is good hygiene practice. However, these two ends of the spectrum do not touch on other aspects such as the antibiotic overuse that invites the evolution of MRSA and other resistant pathogens.

Greater awareness within the veterinary profession of the facts about MRSA can go a long way in promoting an understanding of the condition, but the average pet owner is not going to encounter MRSA until he, she or their pet becomes affected. Unfortunately it is likely their perception of MRSA is going to be fuelled by previous negative media coverage.

As with any new diagnosis, therefore, they are reliant on those treating their animals for information, reassurance and comfort. It is vital that veterinary nurses – who are invariably in the forefront of caring for the infected animals – are aware of how they could be making the client feel. With all scenarios it is paramount to try and imagine how you would feel if it was you that was personally affected.

Turning the corner

Recent years have seen a positive awareness of MRSA and all its implications in practice. Many veterinary nurses have encountered a MRSA case and report a positive outcome. Sensible barrier nursing is proving effective in most cases along with good environmental and personal hygiene practice. Nevertheless, it is the responsibility of everyone to inform, educate and advise when encountering MRSA.

Bella Moss died from MRSA – there is no escaping that fact. It could have been prevented. The stigmatisation she and her owner, Jill, experienced should not have happened – but it did. Bella left a legacy in her death.

Motivated through the pain and realisation of the lack of awareness, Jill set up The Bella Moss Foundation to educate, inform and advise the veterinary profession and pet owners on MRSA and other serious infections. Today it is the leading charity in the area of MRSA in animals, working closely with universities, government authorities, veterinary professionals and pet owners not only in the UK but worldwide, to provide advice to individual pet owners, CPD for veterinary nurses and bringing together leading academics in the fight against MRSA in animals. Thankfully, this increased awareness is eliminating some of the stigma associated with MRSA. 

Author

Lorena Hall

DipHE Animal Management and Welfare

Prior to graduating from Lincoln University in 2009, Lorena held various roles within the animal care sector, ranging from kennels to veterinary establishments, even to parrot keeper. She is preparing for a MRes/PhD focusing on MRSA pathogenesis. Lorena has worked closely with the Bella Moss Foundation, initially assisting with publications and recently the establishment of a membership scheme and advisory role where relevant.

Bibliography and further reading

BAPTISTE, K., WILLIAMS, K., WILLIAMS, N., WAT
TRET, A., CLEGG, P. D., DAWSON, S., CORKILL, J., O'NEILL, T., HART, A. C. (2005) Methicillin- resistant Staphylococci in companion animals. Emerging Infectious Diseases 11:1942-4 DUQUETTE, R. A., NUTTALL, D. J. (2004) Methicillin- resistant Staphylococcus aureus in dogs and cats: ar emerging problem? Journal of Small Animal Practice. 45: 591-597.

GOULD, I. (2007) MRSA in practice Royal Society of Medical Press Ltd. London, UK.

GUARDABASSI, I., SCHWARZ, S., LLOYD, D. H. (2004) Pet animals as reservoirs of antimicrobial-resistant bacteria. Journal of Antimicrobial Chemotherapy. 45: 321-332.

JONES, J. C., ROGERS, J. T., BROOKMEYER, P., DUNNE, W. M., STORCH, G. A., COOPERSMITH, C. M., FRASER, V. J., WARREN, D. K. (2007) Mupirocin Resistance in Patients Colonized with Methicillin- Resistant Staphylococcus aureus in a Surgical – Intensive Care Unit. Clinical Infectious Diseases 45: 541-547.

LOEFFLER, A., BOAG, A. K., SUNG, J., LINDSAY, J. A., GUARDABASSI, I., DALSGAARD, A., SMITH, H., STEVENS, K. B., LLOYD, D H. (2005) Prevalence of methicillin-resistant Staphylococcus aureus m Veterinary Teaching Hospitals. Journal of Antimicrobial Chemotherapy. 56:692-697. www.thebellamossfoundation.com www.vetennarynursetrainingonline.org

• VOL 25 • No9 ♦ September 2010 • Veterinary Nursing Journal