A New Weapon against Hospital-Acquired MRSA Infections
The bacterium Staphylococcus aureus can live on our skin and in our noses without causing disease. Such a condition is called bacterial colonization, to contrast it from infection in which the bacteria causes illness. When the skin is broken or when host immunity is weakened Staph. aureus can enter the blood stream or other body spaces and cause life-threatening infection. Because medical procedures frequently involve puncturing or cutting the skin, Staph. aureus accounts for more health care-associated infections than any other germ.
That would be bad enough, but one strain of Staph. aureus, called methicillin-resistant Staph. aureus (MRSA), has developed resistance to many of the antibiotics most commonly used against Staph. infections, making it particularly difficult to treat. Controlling the spread of MRSA in health-care settings has become a national priority. Many hospitals have implemented programs to remind staff to wash their hands before and after contact with patients and to identify and isolate patients colonized with MRSA. Hospital-acquired MRSA infections have actually declined in recent years, perhaps due to these efforts, but in 2011 they still affected 62,500 patients and killed more than 9,000.
ICU patients are especially vulnerable to life-threatening hospital-acquired infections, for two reasons. First, they are the sickest patients in the hospital and their immune system is frequently not working well. Second, they undergo many invasive procedures that cause potential portals of entry for infection. Some hospitals screen all patients (or all ICU patients) for MRSA by swabbing their nose. Those who test positive are then placed under contact isolation – they are moved to a private room and all staff must don gloves and a disposable gown prior to coming into contact with them. Nine states have mandated by law such MRSA screening and isolation procedures.
But is this the best way to protect hospitalized patients from MRSA infection?
Other hospitals have stepped up their MRSA efforts even further. They screen all patients for MRSA. Those who test positive are isolated and also undergo decolonization – an attempt to kill the MRSA on their skin and in their nose. This is usually done with an antibiotic gel that is placed in the nostrils and antibacterial wipes that are used to clean the patient’s skin.
Last week the New England Journal of Medicine published ” target=”_blank”>An editorial in the same issue of NEJM states
[T]he folly of pursuing legislative mandates when evidence is lacking has been shown, and laws mandating MRSA screening should be repealed.
That is indeed a worthy goal. If this were generalized to the repeal of all “legislative mandates when evidence is lacking”, the effects of this study would be revolutionary.
” target=”_blank”>New Tack in Preventing Hospital Infections (Wall Street Journal)
” target=”_blank”>Targeted versus Universal Decolonization to Prevent ICU Infection (NEJM article, by subscription)