Tuesday, March 18, 2008
Concerns about the rising incidence of methicillin-resistant Staphylococcus aureus (MRSA) infections have prompted lawmakers in a number of states around the country to push hospitals to take more aggressive steps to prevent its spread. Three states have passed laws requiring hospitals to screen certain patients for MRSA upon admission and similar proposals have been introduced in Congress and in seven states and the District of Columbia.
The debate over the need for stricter MRSA prevention measures is heating up just as new research published today in the Annals of Internal Medicine shows that universal screening can lead to dramatically lower infection rates. Researchers who evaluated a program at the Evanston Northwestern Healthcare found that universal screening for MRSA coupled with additional precautions for those who test positive resulted in an over 50 percent reduction in hospital-acquired MRSA infections throughout their three-hospital system. An abstract of the article is available at http://www.annals.org/
“We know that MRSA infections are all too common in hospitals across the country, but most hospitals are not doing enough to protect patients,” said Lisa McGiffert, Director of Consumers Union’s Stop Hospital Infections campaign (www.StopHospitalInfections.org). “Screening patients for MRSA is a critical part of an effective strategy to stem the alarming spread of these debilitating and sometimes deadly infections.”
Consumers Union supports efforts by states to require MRSA screening coupled with special precautions for those found colonized with the bacteria to prevent the spread of infections. For more information, see Consumers Union’s MRSA Screening Policy Brief.
The Centers for Disease Control and Prevention (CDC) estimated last fall that nearly 19,000 Americans died in 2005 from Methicillin-resistant Staphylococcus aureus (MRSA) infections. An estimated 95,000 people developed MRSA infections during that year, and 85 percent of those infections were acquired in the hospital or some other healthcare setting.
A study by the Pennsylvania Healthcare Cost Containment Council found that hospital patients with MRSA infections are four times as likely to die, will stay in the hospital two and a half times as long, and are charged three times as much compared to patients without MRSA infections.
In addition to strict hand hygiene, successful strategies recommended by the Society for Healthcare Epidemiology of America for controlling MRSA include screening high risk patients active surveillance cultures (nose swabs), isolating patients colonized with MRSA, using gowns, gloves, and masks when treating them, and routine decontamination of patient rooms and operating rooms.
However, most U.S. hospitals do not follow these recommended MRSA prevention protocols. A 2007 survey by the Association of Professionals in Infection Control (APIC) found that only 29 percent reported screening patients to identify those colonized with MRSA. Fifty percent of infection control professionals in a subsequent APIC survey said their hospital was not doing “as much as it could or should to stop the transmission of MRSA.”
Hospitals in the U.S. that follow these MRSA prevention strategies have documented impressive results. A pilot program at the VA Pittsburgh Healthcare System in Pennsylvania started in 2001 reduced infections in the hospital’s surgical unit by 70 percent. The program proved so successful that the VA decided to expand the program to all 150 of its hospitals nationwide. Similarly, MRSA screening at the University of Pittsburgh Medical Center has reduced MRSA infections in its intensive care units by 90 percent and significant results have been documented at the University of Virginia Health System.
So far, three states have passed laws requiring hospitals to screen certain patients upon admission for MRSA. Illinois, New Jersey, and Pennsylvania require hospitals to screen patients admitted to Intensive Care Units and high risk patients in other parts of the hospital to identify those colonized with MRSA.
Lawmakers in seven states and the District of Columbia are debating bills that would require hospitals to take more aggressive steps to curb MRSA, including screening certain patients upon admission to determine whether they are colonized with MRSA. MRSA screening bills have been introduced in California, Hawaii, Iowa, Kentucky, Maryland, Missouri, Tennessee, and the District of Columbia. New Jersey lawmakers are considering legislation to expand the state’s law to require hospitals to screen all incoming patients for MRSA.
MRSA screening legislation also has been introduced in Congress. S. 2525, introduced by Senator Robert Menendez (D-NJ) initially would require hospitals to screen high risk patients for MRSA. Under the legislation, MRSA screening would be expanded to all patients admitted to hospitals by 2012.
“Many antibiotics are ineffective for treating severe MRSA infections, so it is imperative that aggressive prevention strategies are implemented throughout the country,” said McGiffert. “Stopping these infections from occurring in the first place is our best defense.”
Lisa McGiffert: 512-477-4431, ext 115
Michael McCauley: 415-431-6747, ext 126