NEWS SCAN Special Edition: MRSA in healthcare settings

Mar 25, 2009 – The annual meeting of the Society for Healthcare Epidemiology of America took place Mar 20-22 in San Diego. This News Scan Special Edition surveys a selection of the abundant research from that meeting on combating MRSA in healthcare institutions.

'Positive Deviance' makes difference in reducing MRSA rates
Three hospitals and healthcare systems in different parts of the United States significantly reduced their in-house transmission of methicillin-resistant Staphylococcus aureus (MRSA) by mounting a multi-pronged prevention effort of active surveillance, hand hygiene, and contact precautions. A key to the program's success was "Positive Deviance," an organizational technique that identifies personnel who are good problem solvers and keeps their ideas from being stifled by custom and hierarchy. The trial, co-sponsored by the Robert Wood Johnson Foundation, Centers for Disease Control and Prevention (CDC), and the Plexus Institute, reduced MRSA incidence in the hospitals by up to 62%.

Invasive MRSA declining, may be due to hospital control efforts
A CDC analysis of data from the Active Bacterial Core surveillance system, drawn from nine sites across the United States, shows that cases of invasive hospital-onset MRSA declined 16% from 2005 to 2007. Invasive cases that were due to hospital infection, but arose after discharge, declined 8.7%. In a related survey of 134 hospitals, almost all were deploying some MRSA-prevention measures out of a generally accepted menu of seven recommended practices, though no hospital was using all seven. The reduction in invasive MRSA may be linked to hospitals' increased efforts.

MRSA control in ICU leads to reductions throughout hospital
A MRSA-prevention campaign at the Billings Clinic, a 270-bed community hospital in Billings, Mont., demonstrated that limited control efforts may have broad reach. The hospital instituted active surveillance and hand hygiene in its 22-bed ICU and saw hospital-wide MRSA incidence fall from 1.2 cases per 1,000 patient-days to 0.27 per 1,000; reductions continued for 20 months.

MRSA cases in hospitals may have been acquired in community
An analysis of patients in a large Delaware healthcare system who were newly identified as having MRSA colonization shows that the vast majority of colonizations were not acquired during the hospital stay, but were present on admission. Only 13% were acquired in-hospital, suggesting that programs aimed at stopping hospital transmission could not have prevented them, and demonstrating that the complex epidemiology of MRSA in hospital and community is likely to complicate MRSA control.

Community strains causing increasing number of hospital infections
At Stroger Hospital, the main public hospital for downtown Chicago, the incidence of hospital-associated bloodstream infections caused by MRSA has not changed significantly over 7 years. However, the proportion of those invasive infections caused by a community-genotype MRSA strain has more than doubled, from 32% of cases in 2000-2003 to 68% in 2004-2007.

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