10.17.2007

Screen For MRSA

New JAMA Report out this a.m. that MRSA -- a antibiotic resistant staph infection -- is more common that thought. We see a ton of it come in the door at our hospital. That's the little secret of MRSA is that it is out there in the community. It shows up in hospitals and nursing homes because it is a skin bacteria that tends to get introduced into the sterile areas of the body through invasive practices in the hospital. As the New York Times explains:
MRSA, which was first isolated in the United States in 1968, causes 10
percent to 20 percent of all infections acquired in health care
settings, according to the disease control agency. Resistant to a
number of front-line antibiotics,
it can cause infections of surgical sites, the urinary tract, the
bloodstream and lungs. Treatment often involves the intravenous
delivery of other drugs, causing health officials to worry that overuse
will breed further resistance.
We see a lot of it from drug users who shoot up of course (they always claim it is a "spider bite") but we're also seeing it in folks who get small breaks in the skin allowing infection to enter.

The bacteria can be brought unknowingly into hospitals and nursing
homes by patients who show no symptoms, and can be transmitted by
contact as casual as the brush of a doctor’s lab coat. Highly
opportunistic, they can enter the bloodstream through incisions and
wounds and then quickly overwhelm a weakened immune system.


So how do you decrease MRSA -- besides washing your hands of course?

The findings are likely to stimulate further an already active
debate about whether hospitals and other medical centers should test
all patients for MRSA upon admission. Some hospitals have had notable
success in reducing their infection rates by isolating infected
patients and then taking extra precautions, like requiring workers to
wear gloves and gowns for every contact.But other research has
suggested that such techniques may be excessive, and may have the
unintended consequence of diminishing medical care for quarantined
patients. The disease control agency, in guidelines released last year,
recommended that hospitals try to reduce infection rates by first
improving hygiene and resort to screening high-risk patients only if
other methods fail. Dr. Lance R. Peterson, an epidemiologist
with Evanston Northwestern Healthcare, said his hospital system in the
Chicago area reduced its rate of invasive MRSA infections by 60 percent
after it began screening all patients in 2005.




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