Mike the Mad Biologist

Good News About MRSA Infections

Here’s some very good news about MRSA (methicillin resistant Staphylococcus aureus): U.S. hospitals are beginning to implement their own versions of ‘search and destroy‘ (italics mine):

Hospitals can stem the alarming spread of a dangerous and drug-resistant staph infection by screening new patients and keeping them quarantined, say doctors who tried this novel approach.

One model is a pilot program started in 2001 at the Pittsburgh Veterans Affairs Healthcare System, which has dramatically cut the rate of the potentially deadly germ, called methicillin-resistant Staphylococcus aureus, or MRSA. It is resistant to most antibiotics and usually acquired in hospitals and nursing homes.

Pittsburgh VA guidelines require that all patients get their noses swabbed for MRSA upon admission and discharge. Those with the bug are isolated from other patients and treated by health care workers in gowns and gloves.

Even non-invasive instruments, like blood pressure cuffs and stethoscopes, are disinfected after every use with these patients. There are also strict hand-washing policies and regular data sharing.

MRSA infections in the Pittsburgh VA surgical care unit have dropped more than 70 percent, according to Dr. Robert Muder, the infectious diseases director.

“You don’t necessarily have to do it the way we did it, but you can do it,” Muder said this week at a meeting of infection control doctors at the University of Pennsylvania.

Officials plan to expand the program to the 150-plus VA hospitals nationwide after seeing the Pittsburgh results. They’ll start testing for MRSA in intensive care units next month and expand incrementally until everyone is getting screened.

MRSA is a big problem in health care settings where it is primarily spread from patient to patient by the contaminated hands, equipment and clothing of health care workers. When it gets into the body, this form of staph can cause anything from flesh-eating infections to pneumonia.

About a third of people have the germ on their skin or in their nose but aren’t sick. Even so, they can still spread it.

The Centers for Disease Control and Prevention estimate that about 90,000 people die from hospital-acquired infections annually. About 17,000 of those deaths involve MRSA.

Other hospitals have myriad anti-MRSA approaches — a few places screen everyone, some test just high-risk patients such as those with weak immune systems or who live in nursing homes, and others screen just those in high-risk units like intensive care.

“Having different hospitals doing it different ways will help us see what works,” said Dr. Harold Standiford, the University of Maryland Medical Center’s infection control chief. “It’s going to be a continual process.”

The CDC suggests screening at-risk patients but stops short of recommending universal testing. That is criticized by advocates for across-the-board screening who say Denmark, Finland and the Netherlands essentially eradicated soaring MRSA rates using that method.

Muder said hospitals should have flexibility to tailor their own programs.

“The CDC says that if whatever approach you’re using is not working, you need to become tougher and do universal screening,” he said. “They’re trying to avoid a one-size-fits-all approach.”

Another U.S. hospital taking a more aggressive stance is Evanston Northwestern Healthcare in Illinois. In addition to screening everyone, MRSA carriers also get special soap washes and antibiotic nasal cream, and the hospital uses a new gene-based MRSA test that provides results in hours as opposed to days.

The faster test is more expensive — $27 instead of $9 for the traditional test — but it pays for itself in the long run, said Dr. Lance Peterson, Evanston Northwestern’s infectious disease director. The hospital saves about $25,000 in uncovered medical costs per patient for every MRSA case they can prevent, he said.

“This is a really nasty bug, and it’s becoming more apparent that we don’t have to live with it,” Standiford said. “Now we have new techniques and good studies to show that they’re effective.”

The one thing I don’t understand is why universal screening isn’t adopted. It really does dramatically lower MRSA infection rates. While I understand that we don’t want to establish silly, inflexible rules, virtually every hospital in the U.S. has an MRSA problem. These hospitals need to be held accountable. That requires publicly reported surveillance, followed by benchmarks towards reduction. Until then, we really won’t make a dent in the problem. A voluntary hospital by hospital program won’t accomplish much.

Comments

  1. #1 Roy
    February 12, 2007

    Any patient transfering in with a catheter should be checked closely. Biofilms are a refuge for scoundrel bacteria.

  2. #2 bigTom
    February 12, 2007

    If I read correctly approx 1/3 of the population has (non-clinical) infection. Is there any way to eliminate the infection on these people -or must extra careful hygiene be used on them forever?

  3. #3 Chromosome Crawl
    February 13, 2007

    I agree with you on the point about not understanding why more hospitals don’t go the universal screening route. One reason why ENH became so aggressive is that they had an episode of MRSA in their NICU, and any time you get babies involved it’s a bit easier to get the bean counters to loosen the purse strings. I was involved in implemeting (PFGE)molecular strain typing in the ENH Micro Lab in 1999 – and can say that the Executives have seen the light on making the commitment for bringing in molecular technologies. This is easier to do at a University teaching hospital than at a local med center that is already struggling to keep it’s ER doors open. I’m thinking that CA- MRSA screening will follow the pathway that TB screening has – money and resources will be thrown on fires that pop up. It will take a real paradigm shift to move to the ‘search & destroy’ model that has helped in the EU. Public Health efforts once again at the bottom of the dustbin. Guess Laurie Garrett’s 2nd book was too big for folks to get through. (gnashes teeth in frustation)

  4. #4 Mike the Mad Biologist
    February 16, 2007

    bigTom,

    while roughly 20% are asymptomatic carriers of staph, only about 0.8% (of the total population, not of the 20%) are asymptomatic carriers of MRSA. I think the clinical setting serves as a reservoir of MRSA for the community, so decreasing MRSA there will lower the asymptomatic community staph.