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VA DOCTORS SAY FIGHT CAN BE WON AGAINST
DRUG-RESISTANT BUG -- MRSA is resistant to
most antibiotics and is usually acquired in
hospitals and nursing homes.
MSRA
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http://www.cumberlink.com/
articles/2007/02/06/ap-state-pa/d8n4ft580.txt
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Doctors say fight can be won against
drug-resistant bug
By JOANN LOVIGLIO
PHILADELPHIA - Hospitals can successfully tackle the alarming spread of
a dangerous and drug-resistant staph infection with an aggressive
program to immediately identify and quarantine patients carrying the
superbug, infectious disease doctors said at a conference Tuesday.
A pilot program started at the Pittsburgh Veterans Affairs Healthcare
System in late 2001 has dramatically reduced the rate of the potentially
deadly germ, called methicillin-resistant Staphylococcus aureus, or
MRSA. It is resistant to most antibiotics and usually acquired in
hospitals and nursing homes.
MRSA infections in the Pittsburgh VA surgical care unit have dropped
more than 70 percent, infectious diseases director Dr. Robert Muder
said.
"You don't necessarily have to do it the way we did it, but you can do
it," Muder told members of the Association for Professionals in
Infection Control & Epidemiology at a meeting at the University of
Pennsylvania.
VA guidelines require that all patients get their noses swabbed to
screen for MRSA upon admission and discharge. Those with the bug are
isolated from other patients, treated by health care workers in gowns
and gloves, and with equipment _ from blood pressure cuffs to
stethoscopes _ that gets disinfected after each use.
There are also administrative changes such as weekly briefings and data
sharing as well as an aggressive push for strict hand-washing policies.
VA officials decided to roll out the experiment to its 150-plus
hospitals nationwide after seeing the Pittsburgh results, Muder said.
They'll start testing for MRSA in intensive care units next month and
expand incrementally until everyone is getting screened, he said.
MRSA is a big problem in health care settings, where patients have
invasive catheters and open wounds, and is primarily spread from patient
to patient on the contaminated hands, equipment and clothing of health
care workers. When it gets into the body, it can cause anything from
flesh-eating infections to pneumonia.
About a third of people have the germ on their skin or in their nose but
aren't sick. They are said to be "colonized" but not infected with MRSA
_ but they can still spread the germ.
CDC estimates that about 90,000 people die from hospital-acquired
infections annually. About 17,000 of those deaths involve MRSA.
Other hospitals have myriad anti-MRSA approaches _ a few places screen
everyone, some test just high-risk patients such as those who have weak
immune systems or live in nursing homes, and others screen just those in
high-risk units like intensive care.
"Having different hospitals doing it different ways will help us see
what works," said Dr. Harold Standiford, the University of Maryland
Medical Center's infection control chief, who also gave a presentation
at the program. "It's going to be a continual process."
The Centers for Disease Control and Infection suggests screening at-risk
patients but stops short of recommending universal testing. That is
criticized by advocates for across-the-board screening who say Denmark,
Finland and the Netherlands essentially eradicated soaring MRSA rates
using that method.
Muder said hospitals should have flexibility to tailor their own
programs.
"The CDC says that if whatever approach you're using is not working, you
need to become tougher and do universal screening," he said. "They're
trying to avoid a one-size-fits-all approach."
One U.S. hospital taking a more aggressive stance is Evanston
Northwestern Healthcare in Illinois. In addition to screening everyone,
MRSA carriers also get special soap washes and antibiotic nasal cream,
and the hospital uses a new gene-based MRSA test that provides results
in hours as opposed to days.
The faster test is more expensive _ $27, as opposed to $9 for the
traditional test _ but pays for itself in the long run, said Dr. Lance
Peterson, Evanston Northwestern's infectious disease director. The
hospital saves about $25,000 in uncovered medical costs per patient for
every MRSA case they can prevent, he said.
"This is a really nasty bug, and it's becoming more apparent that we
don't have to live with it," Standiford said. "Now we have new
techniques and good studies to show that they're effective."
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Larry Scott --
