Published January 13, 2015
Hospitals can successfully tackle the alarming spread of a dangerous and drug-resistant staph infection with an aggressive program to immediately identify and quarantine patients carrying the superbug, infectious disease doctors said at a conference Tuesday.
A pilot program started at the Pittsburgh Veterans Affairs Healthcare System in late 2001 has dramatically reduced 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.
MRSA infections in the Pittsburgh VA surgical care unit have dropped more than 70 percent, infectious diseases director Dr. Robert Muder said.
"You don't necessarily have to do it the way we did it, but you can do it," Muder told members of the Association for Professionals in Infection Control & Epidemiology at a meeting at the University of Pennsylvania.
VA guidelines require that all patients get their noses swabbed to screen for MRSA upon admission and discharge. Those with the bug are isolated from other patients, treated by health care workers in gowns and gloves, and with equipment — from blood pressure cuffs to stethoscopes — that gets disinfected after each use.
There are also administrative changes such as weekly briefings and data sharing as well as an aggressive push for strict hand-washing policies.
VA officials decided to roll out the experiment to its 150-plus hospitals nationwide after seeing the Pittsburgh results, Muder said. They'll start testing for MRSA in intensive care units next month and expand incrementally until everyone is getting screened, he said.
MRSA is a big problem in health care settings, where patients have invasive catheters and open wounds, and is primarily spread from patient to patient on the contaminated hands, equipment and clothing of health care workers. When it gets into the body, it 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. They are said to be "colonized" but not infected with MRSA — but they can still spread the germ.
CDC estimates 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 who have weak immune systems or 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, who also gave a presentation at the program. "It's going to be a continual process."
The Centers for Disease Control and Infection 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."
One 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, as opposed to $9 for the traditional test — but 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."