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June 2011 Issue

MRSA Bacteria
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Report Shows Precautionary Measures Prevent Spread of MRSA in Hospitals

By Katie Pence
Published June 2011

Methicillin-resistant Staphylococcus aureus, more commonly known as MRSA, has been a medical issue that has been affecting populations globally for over a decade.

It’s been gaining attention as a hospital-acquired infection but has been spreading rapidly to the outside community.

"MRSA is one of the most common causes of ventilator-associated pneumonia, bloodstream infection associated with catheters and surgical-site infections, which are present in all hospitals nationwide in the U.S.,” says Gary Roselle, MD, professor of infectious diseases at UC and chief of medical service at the Cincinnati VA Hospital Medical Center.

Now, a report by Roselle, Stephen Kralovic, MD, associate professor of infectious diseases, and Marta Render, MD, professor of pulmonary and critical care at UC and director of the VA’s National Inpatient Evaluation Center, recently published in the New England Journal of Medicine, revealed a process that could prevent the spread of the disease and possibly change the way everyday care is delivered in hospital settings nationally.

MRSA is a bacterium that lives on the skin and sometimes in the nasal passages of healthy people.

MRSA refers to S. aureus strains that do not respond to some of the antibiotics used to treat staph infections. The bacteria can cause infection when they enter the body through a cut, sore, catheter or breathing tube and have varying levels of seriousness.

"Based on a successful demonstration project at the Pittsburgh VA Healthcare System, leadership in the Veterans Health Administration (VHA) of the Department of Veterans Affairs, took bold action and implemented a nationwide initiative to decrease health care-associated MRSA infections in patient care facilities,” says Roselle, senior author on the report who is also the National Program Director for Infectious Diseases in VA.

Medical centers were directed to implement a "bundle” of evidence-based practices which included universal nasal surveillance (nasal swabbing) upon hospital admission, contact precautions for patients who were infected, hand hygiene and an institutional culture change where infection control became the responsibility of everyone who had contact with patients.

These centers were directed to implement the MRSA bundle in one patient care unit, preferably an ICU, beginning in March 2007 and to implement the bundle in all other units, with the exception of mental health units, by October 1, 2007.

A MRSA prevention coordinator was designated at each facility to oversee implementation of the bundle, to collect and report data on the program at the facility, to provide feedback to frontline health care workers and to deal with local challenges.

As part of the bundle, samples of nasal secretions were obtained by swabbing the nostrils of patients within 24 hours after their admission to the hospital.

Samples were also taken from patients who were not known to have MRSA when they were transferred between or discharged from units within each facility.

"From October 2007 through June 2010, there were 1,934,598 admissions to or transfers or discharges from ICUs and non-ICUs which contributed to 8,318,675 days of care,” Roselle says. "During this period, the percentage of patients who were screened at admission increased from 82 percent to 96 percent, and the percentage who were screened at transfer or discharge increased from 72 percent to 93 percent.”

He adds that the rates of health care-associated MRSA infections in ICUs had not changed in the two years before October 2007 but decreased with the bundle by 62 percent, and the rates of health care-associated MRSA infections in non-ICUs fell about 45 percent.

"Active surveillance identified more than 90 percent of MRSA carriers who would have been missed with clinical cultures alone,” Kralovic says. "The implementation of the bundle was consistent with an institutional culture change that resulted in health care workers being more aware of health care-associated MRSA infections and increasing their adherence to hand hygiene and contact precautions."

He adds that this initiative may have also affected rates of C. difficile and vancomycin-resistant enterococci (VRE), other antibiotic-resistant bacteria present in hospital settings.
"An important approach to dealing with multidrug-resistant bacteria is to control their spread among patients,” says Roselle. "The data from the VA suggests that proactive efforts to prevent the transmission of MRSA are associated with a reduction in health care-associated infections.

"Other hospital settings may also benefit from an aggressive campaign like this to eradicate health care-associated MRSA infections. Expanding elements of the program to long-term and ambulatory care settings may also be necessary but further studies are needed to confirm this.”
VA Central Office provided resources for this initiative.

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