MRSA, Staph, Staff, Mersa, Methicillin Resistant Staphylococcus Aureus Symptoms & Treatment

General screening cost effective?

Link: HighWire Press -- Medline Abstract.

The recommendations of the German Robert Koch Institute, concerning microbiological screening of newly admitted hospital patients for MRSA colonization, referred to specific risk groups such as patients admitted from long-term care facilities. New literature data indicate that a general MRSA screening policy of all incoming patients may be a cost-effective measure in intensive care units of large tertiary care hospitals.

General screening cost effective?

Link: HighWire Press -- Medline Abstract.

The recommendations of the German Robert Koch Institute, concerning microbiological screening of newly admitted hospital patients for MRSA colonization, referred to specific risk groups such as patients admitted from long-term care facilities. New literature data indicate that a general MRSA screening policy of all incoming patients may be a cost-effective measure in intensive care units of large tertiary care hospitals.

Rapid screening saves money if used only on high risk patients

Link: Rapid screening for carriage of Methicillin-resistant Staphylococcus aureus by polymerase chain reaction and associated costs -- Bühlmann et al., 10.1128/JCM.01957-07 -- Journal of Clinical Microbiology.

PCR tests for rapid and valid detection of methicillin-resistant Staphylococcus aureus (MRSA) are now available. We evaluated the costs associated with contact screening for MRSA carriage in a tertiary care hospital with low MRSA endemicity. Between October 1, 2005 and February 28, 2006, 232 patients were screened during 258 screening episodes (644 samples) for MRSA carriage by GenoType® MRSA Direct (Hain Lifescience GmbH, Nehren, Germany). Conventional culture confirmed all PCR results. According to in-house algorithms 34 of 258 screening episodes (14.7%) would have qualified for preemptive contact isolation, but such isolation was not done upon negative PCR results. MRSA carriage was detected in four (1.5%) of 258 screening episodes (i.e. in four patients), whereof none qualified for preemptive contact isolation. The use of PCR for all 258 screening episodes added costs of CHF 104'328.- and saved CHF 38'528.- (for preemptive isolation). Restriction of PCR screening to the 34 episodes qualifying for preemptive contact isolation, and screening all others by culture only, would have lowered costs for PCR to CHF 11'988.-, but still saved CHF 38'528.-. Therefore, PCR tests are valuable for rapid detection of MRSA carriers, but high costs require careful evaluation of their use. In patient populations with low MRSA endemicity, broad use of PCR is probably not cost-efficient.

Rapid Screening - Will it make a difference?

Link: Screening for MRSA -- Wilcox 336 (7650): 899 -- BMJ.

Controversy about the effectiveness of screening for meticillin resistant Staphylococcus aureus (MRSA) stems from the scarcity of robust data from controlled studies. Typically, studies supporting screening have used multiple control measures to curtail hospital outbreaks of MRSA and have lacked control groups.1 The effectiveness of screening depends on key factors including compliance with and sensitivity of screening, capacity to isolate or form cohorts out of identified MRSA carriers, efficacy of decolonisation regimens, and compliance with standard infection control precautions (such as hand hygiene, aseptic procedures when handling vulnerable sites or devices, and prophylaxis).2 In the accompanying study, Jeyaratnam and colleagues report a randomised controlled trial of the effect of rapid screening for MRSA on acquisition of MRSA on hospital general wards in the United Kingdom.3

MRSA Test cuts Incidents by 50% in Boston Hospital

Link: WHDH-TV - 7 Healthcast - MRSA Test.

Maureen Spencer, New England Baptist Hospital "Back in the fall of '05 we had a series of patients that developed positive blood cultures with staph aureus and MRSA." Now New England Baptist Hospital is fighting back in an effort to prevent infection before it strikes. All surgery patients at the hospital now go through a pre-screening for MRSA. Maureen Spencer, New England Baptist Hospital "What we're looking for is colonization, where the organism lives in your nose, but it's not causing infection." Two weeks before surgery- a patient's nose is swabbed and tested. Maureen Spencer, New England Baptist Hospital "We can tell the patient within a day that you have this, and start the treatment protocol." If the test comes back positive- the patient is prescribed a special antibiotic and instructed to wash with an antiseptic skin cleanser. They are then re-tested, and if they're MRSA-free, they're good to go for surgery. Maureen Spencer, New England Baptist Hospital "We've been able to show that we've been able to reduce by 50 percent the infections that are caused by staph aureus in orthopedic surgery at this hospital."

Utah Hospital Study Helps track High Risk MRSA Patients

Link: HighWire Press -- Medline Abstract.

Patients who are asymptomatic carriers of methicillin-resistant Staphylococcus aureus (MRSA) are major reservoirs for transmission of MRSA to other patients. Medical personnel are usually not aware when these high-risk patients are hospitalized. We developed and tested an enterprise-wide electronic surveillance system to identify patients at high risk for MRSA carriage at hospital admission and during hospitalization. During a two-month study, nasal swabs from 153 high-risk patients were tested for MRSA carriage using polymerase chain reaction (PCR) of which 31 (20.3%) were positive compared to 12 of 293 (4.1%, p < 0.001) low-risk patients. The mean interval from admission to availability of PCR test results was 19.2 hours. Computer alerts for patients at high-risk of MRSA carriage were found to be reliable, timely and offer the potential to replace testing all patients. Previous MRSA colonization was the best predictor but other risk factors were needed to increase the sensitivity of the algorithm.

Swiss Screening Conclusions Flawed

Link: GenomeWeb News: Cepheid Reaffirms Financial Guidance in Wake of Swiss MRSA Study.

The study, which was published online today in the Journal of the American Medical Association, suggested universal screening does not significantly reduce hospital-acquired MRSA infections in surgical patients. The study was conducted over a nearly two-year period at the University of Geneva Hospitals in Switzerland. In response to the study results, Cepheid CEO John Bishop posted a letter on the company’s website saying that the conclusions of the study were “not surprising,” considering “the institution had already achieved an infection rate of less than 1 percent. However, applying the same conclusions to environments where the rates of infection may be in excess of 8 percent or more … may be problematic.” The test used in the Swiss study was not Cepheid’s or a rival test sold by Becton Dickinson, but rather a home brew. As Bishop pointed out in his letter, the test used in the study required an average of 22.5 hours to provide results, whereas Cepheid’s Xpert MRSA test, which was cleared by the US Food and Drug Administration in April 2007, can provide results in 72 minutes. “This time-to-result is critical for reducing infection rates in hospitals,” said Bishop. In addition, he said that since 57 percent of patients in the Swiss study incurring infections were not colonized with MRSA upon admission, “it would seem to be clear that the patients’ resulting infections were a consequence of a failure in the hand hygiene and barrier precaution programs which might have been improved had the patient been identified as colonized earlier.”

N Ireland mandates high risk MRSA screening

Link: eGov monitor - A Policy Dialogue Platform |.

New best practice guidance on MRSA screening is an important step in the drive to reduce infections, Health Minister, Michael McGimpsey said today. The guidance, from Chief Medical Officer Dr Michael McBride, requires Trusts to identify those groups most at risk of MRSA infection and implement a screening policy based on those assessments. The Best Practice Guidance on Screening for MRSA Colonisation in hospitals will help standardise approaches for vulnerable patients, and Trusts will undertake a number of key actions. These include: pre-operative MRSA screening for patients in orthopaedics, cardio-thoracic surgery, and neurosurgery; assessing the feasibility of designating relevant surgical wards, especially orthopaedic wards, as ‘MRSA-free’ zones; screening all patients admitted to critical care on admission and at weekly intervals if their stay is prolonged; and screening all patients on renal dialysis on admission to the programme and then at regular intervals, determined by local practice. The Minister said: “Lowering the rates of MRSA infections is a priority and I have set a target of a 10% reduction in this Healthcare Associated Infection (HCAI) by March 2009.

Only 3 USA Hospitals Screen All Patients For MRSA

Link: PCMH surveillance program targeting MRSA.

Dr. Keith Ramsey, medical director of Infection Control at PCMH, said the program is making significant progress in reducing the number of patients bringing MRSA into the hospital. As a result, the hospital experienced a drop in ventilator-associated pneumonia stemming from MRSA, he said. MRSA, short for methicillin-resistant Staphylococcus aureus, is a type of bacteria that is resilient to most commonly used antibiotics and has the capability of causing serious infections. It can cause longer hospital stays, larger medical bills and a higher mortality rate, according to a press release from PCMH. "In spring 2006, we realized we had a greater burden of MRSA," Ramsey said. "If we eliminated MRSA first, we would make the hospital even safer. We would reduce infections across the board." Ramsey said the hospital made a considerable investment in its "search and destroy" approach to MRSA, totaling $950,000 for new technology, kits and employees. PCMH has the ability to run 30 MRSA tests at a time in its detection system for up to 150 tests per day. Ramsey said the hospital is now looking at an automated system that would increase the amount of tests performed each day while lightening the workload of the staff. "The key was to purchase the new technology," Ramsey said. "It should save patients money." Steve Lawler, president of PCMH, said he is excited about the hospital being one of the national leaders in reducing the amount of MRSA-related infections. "Our MRSA-testing program has had a great halo effect in identifying other areas of improvement," he said. Lawler said he has been leading an effort on the VHA Central Atlantic Region's Board of Directors to adopt a new quality initiative to reduce the number of infections caused by MRSA. For the patients testing positive for MRSA, Ramsey said he and the rest of the hospital staff are working on reinforcing the educational component for the antibiotic cream used to treat the bacteria. Ramsey said PCMH is one of three hospitals in the nation that screens 100 percent of its patients.

Screening Failure Study Highly Flawed

Link: PR03122008.pdf (application/pdf Object).

A new study in the Journal of the American Medical Association (JAMA) purports to show that screening for MRSA (methicillin-resistant Staphylococcus aureus), a simple skin or nasal swab, is not effective in reducing MRSA hospital infections (“Universal Screening for Methicillin-Resistant Staphylococcus aureus at Hospital Admission and Nosocomial Infection in Surgical Patients,” JAMA vol. 299, no. 10, March 12,
2008).

The findings of the authors will be seized upon by the Centers for Disease Control and Prevention (CDC) and advocates of the do-nothing status quo. But the study is seriously flawed – rendering its findings meaningless.

1. Researchers used a ‘rapid test,’ but many patients were not tested until they had already been in the hospital for twelve hours. Furthermore, the results of the MRSA tests were not acted upon for another 22½ hours on average. Most patients had completed more than half of their hospital stay before their results were known. Therefore, the precautions they needed – isolation, proper antibiotics, chlorhexidine baths – were taken late or not at all

2. Unbelievably, almost a third of surgical patients (31%) who tested positive didn’t get their test results until after their surgery. Therefore they too didn’t receive the precautions they needed – the appropriate prophylactic antibiotics, chlorhexidine baths, and mupirocin for the nose. Also amazing, of the patients who tested positive before surgery, fewer than half (43%) received these follow up precautions. Some people carry MRSA germs in their noses or on their skin without realizing it. The bacteria do not cause infection unless they get inside the body – usually via a
catheter, a ventilator, or an incision or other open wound. Patients identified as MRSA positivebefore or immediately upon hospitalization can take precautions to reduce their risk of infectionand can be isolated to prevent spreading the germ to others.

3. No weekly MRSA testing was conducted, which is de rigour when conducting universal screening to prevent patients colonized with MRSA from passing it on to other patients in the hospital.

4. A previous study by the same lead author at the same location, The University of Geneva Hospital, found that universal screening on admission with preemptive contact precautions (the way it’s supposed to be done) decreased MRSA infections in the medical intensive care unit.

The study released today, says Betsy McCaughey, Chairman of the Committee to Reduce Infection Deaths,
“doesn’t prove that MRSA screening is ineffective. The study omits the precautions that are supposed to follow a MRSA positive test result. It’s like testing a recipe, but omitting half the ingredients or test-driving a car without the tires.”

Today’s JAMA article provides false support for the CDC’s persistent do-nothing position on the dire problem of MRSA. The CDC’s lax guidelines continue to give hospitals an excuse to do too little.