More than half of hospitals don’t screen all ICU patients for MRSA

By KEVIN B. O'REILLY, amednews staff. Posted Oct. 31, 2012.

MRSA and other multidrug-resistant organisms account for most hospital infections. State-mandated screening may prove ineffective.

The majority of hospitals are eschewing aggressive, time-consuming and costly interventions that might help prevent the spread of multidrug-resistant organisms such as methicillin-resistant Staphylococcus aureus.

Forty percent of infection-control directors said their intensive care units screen all newly admitted patients for multidrug-resistant organisms, according to a study in the October American Journal of Infection Control. About 30% of ICUs do such screening periodically, said the study, based on a nationwide survey of infection-control directors at 250 hospitals operating 413 ICUs.

An estimated 70% of bacteria that cause health care-associated infections are resistant to at least one antibiotic, the study said. Patients with staph infections, vancomycin-resistant Enterococcus or Clostridium difficile are 40% likelier to be readmitted within a year than other patients, said a study in June’s Infection Control and Hospital Epidemiology (ncbi.nlm.nih.gov/pubmed/23021413/).

Does universal screening help?

Whether so-called universal screening of high-risk patients can help slash the toll of multidrug-resistant organisms has been hotly debated. At least 10 states mandate such screening. A study about a randomized trial published in the April 14, 2011, issue of The New England Journal of Medicine found that screening ICU patients for MRSA and VRE had no impact on infection rates after six months (ncbi.nlm.nih.gov/pubmed/21488763/).

However, contact precautions such as wearing gloves and gowns when caring for patients colonized with these bacteria were employed only after their test results came back positive, which takes days. Experts say it is possible that the delay in taking precautions diminished the effect of universal screening.

The Society for Healthcare Epidemiology of America opposes mandatory universal screening for antibiotic-resistant organisms. The organization supports the policy of taking contact precautions and isolating high-risk patients while their test results are pending. Only 31% of ICUs implement such a policy, said theAJIC study.

Until stronger evidence emerges of a clear benefit from universal screening, infection-control directors should evaluate their local circumstances when deciding how to proceed, said Monika Pogorzelska-Maziarz, PhD, MPH, the study’s lead author.

“It’s difficult to recommend infection-control policies that will work across all hospitals,” said Pogorzelska-Maziarz, associate research scientist at the Columbia University School of Nursing in New York City. “Hospitals might not have the resources to do universal screening, so focusing on patients we know are at high risk seems to be a good idea.”

amednews

MRSA Strategy in ICU Cuts All Infections

By Ed Susman, Contributing Writer, MedPage Today

Published: October 18, 2012

Reviewed by Zalman S. Agus, MD; Emeritus Professor, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse Planner

SAN DIEGO – Bathing all patients in the ICU with antibacterial agents rather than simply screening for methicillin-resistant Staphylococcus aureus (MRSA) reduced all bloodstream infections by more than 40%, researchers said here.

In a study conducted at 43 hospitals, universal treatment – without screening – cut MRSA colonization by 37% and resulted in a 44% reduction in all bloodstream infections, said Susan Huang, MD, MPH, associate professor of infectious diseases at the University of California, Irvine School of Medicine.

That compared with essentially no difference in reduction of infections when patients were given the standard-of-care treatment of screening and isolation, Huang said at a press briefing during IDWeek 2012.

Huang also said that universal treatment without screening proved more effective than screening, followed by washing patients with chlorhexidine and using mupirocin to decolonize MRSA in the nose. That strategy was 22% better than the standard of care , but universal treatment was better than screening first then treating ), she said.

"I am pleased to say that on the basis of this study, Hospital Corporation of America has adopted the universal strategy for treating patients in ICU at their 160 facilities," Huang told MedPage Today.

"This study is compelling enough to change standard practice of screening and isolation," briefing moderator Daniel Diekema, MD, professor of medicine and director of infectious diseases at the University of Iowa, Iowa City, told MedPage Today. He was not involved in the study.

Huang noted, "This trial provides strong evidence that removing bacteria from the skin and nose is highly effective at preventing serious infection in high-risk ICU patients. 

Article Concluded: Med Page Today