The Association for Professionals in Infection Control and Epidemiology (APIC) released (June 2007) initial results from a nationwide study of 1,237 U.S. healthcare facilities, examining the prevalence of Methicillin-resistant Staphylococcus aureus (MRSA), a virulent multi-drug resistant organism. Findings demonstrate MRSA prevalence rates to be at least 46 cases per 1,000 patients – significantly more widespread and established than previous estimated rates.
In the most comprehensive MRSA survey of its kind, infection control personnel from approximately 21 percent of U.S. healthcare facilities in all 50 states participated in the study. The survey took a one-day “snapshot” of MRSA prevalence at these facilities between October and November 2006. The detailed survey looked at facilities caring for virtually every type of patient: acute care, cancer, cardiac, pediatric, rehabilitation and long-term care, and included county, public and private facilities.
The survey also represents a cross-section of all sizes of facilities, from less than 100 to more than 300 bed facilities. This is the first study to measure rates of both MRSA infection and colonization (patients carrying and able to transmit MRSA), to more accurately determine MRSA prevalence. Of the 46 in 1,000 MRSA patients, approximately 34/1,000 were infected while 12/1,000 patients were colonized. Additionally, the survey determined that 77 percent of MRSA patients were identified within 48 hours of admission. This finding suggests that 35 out of 46 patients walk into healthcare facilities with MRSA, having acquired it either in a previous stay in a healthcare facility or in the community.
“APIC’s MRSA survey presents a grim picture,” said William Jarvis, MD, principal investigator of the study and president and co-founder of Jason and Jarvis Associates, a private consulting firm in healthcare epidemiology. “The findings argue for immediate, aggressive efforts to detect and prevent transmission of MRSA. Because the true magnitude of the total MRSA burden in the U.S. healthcare population is unknown, our objective was to provide the first national estimate of MRSA in U.S. healthcare facilities.”
The research indicated that once MRSA cases are identified, healthcare facilities employ recommended practices to prevent transmission of the organism, such as practicing barrier precautions (use of gloves and gowns), hand hygiene and isolating MRSA patients. 81 percent of patients in the study were not identified until they presented signs or symptoms of an active infection prompting doctors to order lab tests. This finding implies that a significant number of patients are potentially transmitting MRSA to healthcare workers and other patients before the bacteria are identified.
“Quite simply this survey is a wake up call for healthcare facilities to save lives by dedicating more resources to infection prevention and control because the transmission of MRSA is preventable,” said Denise Murphy, president of APIC and Vice President of Safety and Quality, and Chief Patient Safety and Quality Officer at Barnes-Jewish Hospital at Washington University Medical Center in St. Louis.
“Some healthcare facilities are aggressively addressing MRSA, but the scope of this public health threat demands commitment and participation from every hospital, at all levels of the facility. Hospitals should commit the resources to conduct a thorough risk assessment of patient populations and implement viable strategies to prevent MRSA and other antimicrobial-resistant infections. These measures could help prevent this epidemic from continuing to spiral upward and out of control.”
APIC guidelines for the elimination of MRSA transmission include a risk assessment to identify high-risk areas for MRSA within the hospital; surveillance program to outline activities and procedures to identify MRSA cases; adherence to CDC hand hygiene guidelines; use of contact precautions (e.g., gloves, gowns and separating MRSA patients from other patients); environmental and equipment cleaning and decontamination, especially items that are close to patients such as bedrails and bedside equipment, and targeted active surveillance cultures (testing of high-risk groups).
APIC’s mission is to improve health and patient safety by reducing risks of infection and other adverse outcomes. The Association’s more than 11,000 members have primary responsibility for infection prevention, control and hospital epidemiology in health care settings around the globe. APIC advances its mission through education, research, collaboration, practice guidance, public policy, and credentialing.Visit APIC online at www.apic.org.