Hospital Survey On MRSA Reveals Obstacles And Potential Solutions

By Brian McCurdy, Senior Editor

With the incidence of methicillin-resistant Staphylococcus aureus rising, how can healthcare institutions protect patients? The Association for Professionals in Infection Control and Epidemiology (APIC) recently conducted a survey of 1,237 hospitals and has formulated recommendations for preventing MRSA transmission.

The study noted the rate of MRSA was 46 in 1,000 patients. Of those patients, 34 in 1,000 patients were infected and 12 in 1,000 patients were colonized.

The APIC emphasizes the importance of good hand hygiene, including frequent hand washing, alcohol-based hand rubs and the use of gloves. Mark Kosinski, DPM, advises washing one’s hands before and after seeing each patient.

“Many people underestimate the importance of such a simple act,” points out Dr. Kosinski, a Professor in the Department of Medicine at the New York College of Podiatric Medicine. “As part of a recent infection control surveillance study in a New York City hospital, about 60 percent of hospital personnel were observed to wash their hands before and after each patient contact.”

Addressing The Barrier Of Preventive Costs
Another APIC recommendation is placing patients with MRSA in private rooms and using gloves, gowns and other precautions to avoid transferring microorganisms to other patients or environments.

Peter Wilusz, DPM, concedes that cost is a significant barrier when it comes to isolating patients who are diagnosed with any form of resistant bacteria. However, the APIC notes that an analysis of 55 studies found that the cost of treating hospital-acquired MRSA was $35,367 in comparison to $13,973 for treating other hospital-acquired infections.

“It is important to demonstrate to (hospital) administrators that costs of the intervention can indeed be less than the cost of not adopting a MRSA control program,” notes the APIC.

Healthcare institutions should also follow proper environmental and equipment cleaning and decontamination, recommends the APIC, which also emphasizes the importance of educating environmental and housekeeping staff on correct cleaning procedures since MRSA “can survive outside the human body for up to 56 days on patient charts, tabletops and cloth curtains.”

Emphasizing The Appropriate Use Of Cultures And Antibiotics
The APIC recommends changes in hospital culture and Dr. Kosinski says the two biggest barriers in hospitals are “habit and complacency.” For example, he says DPMs know that the overuse of antibiotics fuels resistance “yet time and again, we see so-called prophylactic antibiotics being used in clean orthopedic surgery. The patient is sent home with a prescription for Keflex after a bunion or hammertoe procedure to ‘prevent infection,’” says Dr. Kosinski, a member of the Infectious Diseases Society of America (IDSA).

Further, Dr. Kosinski says the complacency “is rooted in the belief that the drug companies will discover new antibiotics to bail us out.”

Calling MRSA prevention “key to all healthcare providers,” Vickie Driver, DPM, advocates that practitioners “reduce and or limit antibiotic usage in the first place.” As an example, she says institutions could use the IDSA guidelines to avoid over-prescribing antibiotics.

Dr. Wilusz cites the problem of healthcare professionals using “cookbook” medicine to treat an infection without appropriate identification through culture and sensitivity. He says some physicians may start with a penicillin and then, seven to 10 days later when the infection is still persistent, switch to another broad spectrum antibiotic such as a quinolone without identifying a bacterial source through culture and sensitivity.

“By the time a culture is taken, a patient may have been on one or two different antibiotics, which may affect the outcome of the culture and sensitivity, and/or generate a resistant bacterial infection through the process,” says Dr. Wilusz, a Clinical and Surgical Instructor at the Foot and Ankle Clinic at the Southeastern Michigan Surgical Hospital.

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