Methicillin-resistant Staphylococcus aureus (MRSA) is an important public health issue. MRSA can cause bacterial infections that range from mild skin infections to life-threatening illness. MRSA can infect people anywhere and many people acquire MRSA infections in their own communities. However, many MRSA infections shockingly occur in healthcare settings--so MRSA is considered a serious 'healthcare-associated infection," or HAI. The Centers for Disease Control (CDC) estimates that 1 out of every 20 hospitalized patients will contract an HAI. MRSA infections are a high priority for the CDC in both the community and in healthcare settings. The MRSA bacteria is particularly dangerous for surgery patients - open wounds are vulnerable to the bacteria - but IVs and other minor skin infections are also vulnerable to infection. The risk of acquiring a MRSA infection in the hospital, nursing home, dialysis clinic, or other outpatient environments is compounded by the growing problem of MRSA infections that are acquired in communities.
By the Numbers: The Impact of MRSA
- 1.7 Million: the number of people estimated to have died from MRSA infections in 2002.
- $35.7 to $45 billion: The estimated direct medical costs of HAIs to U.S. hospitals.
- 1 out of 20 hospitalized patients may acquire an infection during their care.
- In 2010, The rate of life-threatening MRSA infections was 21.76% per 100,000 people.
- There was a 28% drop in life-threatening MRSA infections from hospitals from 2005 - 2008.
Health Care–Associated Invasive MRSA Infections, 2005-2008
JAMA. 2010;304(6):641-647.
doi:10.1001/jama.2010.1115
National Prevention Goals:
CDC's 2015 targets to ensure safe healthcare for all
Americans by reducing healthcare-associated infections:
The Centers for Disease Control
and Prevention outline Healthcare Associated Infections (HAI’s) among their
Winnable Goals. The CDC's objectives for 2015 are:
- Reducing central line-associated blood stream infections (CLABSI) in hospitals by 60%,
- Reducing healthcare-associated invasive methicillin-resistant Staphylococcus aureus (MRSA) by 60%,
- Reducing surgical site infections (SSI) in hospitals by 30%,
- and reducing catheter-associated urinary tract infections (CAUTI) in hospitals by 30%.
What are current rates of HAI
that these goals have been set to reduce? Here are baseline levels and the
goals that were outlined above:
What actions do they plan to
take in order to achieve these targets? Promoting and tracking the use of
proven HAI prevention practices and also by improving the use of the National
Healthcare Safety Network to intervene, track and report HAI’s.
Although rates of HAI’s have
dropped drastically over time, rates for MRSA infections are still
substantially higher than the 2015 Target as seen in the following graph:
Healthy People 2020 Goals and Objectives:
Healthcare Associated Infections (HAIs) are a top priority for Healthy
People 2020 goals and objectives.
The goal associated with HAIs is to prevent, reduce, and ultimately
eliminate health care associated infections because these infections lead to
extended hospital stays, increased medical costs and a significant cause of
morbidity and mortality.
The following are objectives of Healthy People 2020 to reduce invasive
MRSA infections:
Baseline:
|
27.08 infections per
100,000 persons were reported in 2007–08
|
Target:
|
6.56 infections per
100,000 persons or 75 percent reduction
|
Target-Setting
Method:
|
Maintain
consistency with national programs, regulations, policies, and law
|
Data Source:
|
Active Bacterial
Core Surveillance (ABCS), CDC/NCIRD
|
Interventions to Reduce MRSA Infections Nationally and in Colorado:
Keeping patients safe from infection is a never-ending
operation that requires constant vigilance. Prevention happens at all levels of our society – from the
national to the individual all the way to the genetic level. Fortunately, it
seems prevention measures are working: a 2010 CDC study showed that
life-threatening hospital-acquired MRSA infections declined 28% from 2005
through 2008 (Kallen, et al, 2010).
Interventions:
- Wash those hands--and you can destroy the MRSA bacteria. At the most basic level, preventing MRSA infections begins with strong soap and employees who wash their hands. The most common intervention is to establish and enforce employee hand washing policies and practices. Hand hygiene may be more effective at preventing the spread of MRSA than isolating an infected patient. It’s no wonder that practicing ‘hand hygiene’ is recommended in the top CDC recommendations to prevent HAI infections.
- What can you do? The U.S. Department of Health and Human Services provides great advice for patients: tell your doctors to wash their hands (everybody needs a reminder). Don’t be afraid to talk with your doc about the risk for infection—just be sure to follow doctor’s orders after your surgery. Make a plan. The CDC offers this guide to making a plan to keep yourself safe for surgery.
- What your Dr. should do: Wash those hands! Healthcare providers and healthcare facility staff are the common denominator for infections. The Agency for Healthcare Quality and Research (AHRQ) provides free, evidence-based practices for healthcare facilities to adopt so that they can be efficient and effective in their prevention.
- What your doctor’s boss should do: Prevention begins with good management. Hospitals, nursing homes, and outpatient clinics should ensure that clinicians and nurses are properly trained, have the equipment they need (e.g., sterile tools, disinfectants), have a clean environment to work in, and comply with prevention policies (like washing their hands). While the basic wisdom seems simple enough, ensuring that staff follow procedures requires constant vigilance (Bailey and Upshaw-Owens, 2012). It’s why the CDC has resources on “the latest technological advances in hand hygiene adherence measurement” (CDC, 2013).
In 2007, VA hospitals across the nation adopted
an intervention strategy of policy changes to reduce MRSA infections. The “MRSA
Bundle” policy and organization level changes included infection surveillance,
contact precautions for infected patients, hand hygiene, and a guided shift in
institutional culture. The bundle successfully reduced healthcare acquired MRSA
infections by 65% in the ICUs. (Jain, et al, 2011).
- What your government should do: At the state level, Colorado has developed it’s own strategic plan and adopted legislation to enforce prevention and reporting. In 2006, Colorado passed legislation (HB 06-1045) that requires certain healthcare facilities to report healthcare-associated infections to a national database (NHSN, see below) to maintain their state licensure. The Colorado Department of Public Health and the Environment oversees and enforces licensing and reports out through the Division of Health and Safety Data Services. While it is difficult to measure the impact of the legislation through scientific studies, CDC data shows that Colorado had 41% fewer patient healthcare associated infections in 2011 than would have been predicted by baseline data.
- Surveillance, surveillance, surveillance. At the national level, the U.S. has adopted strategic goals, created a network of data sharing to track the infections, and published proven, effective practices to prevent the spread of MRSA. The National Healthcare Safety Network (NHSN) collects data from healthcare facilities across the U.S. and plays a critical role in identifying and targeting where infections occur since the data can show real time outbreaks and help facilities track their progress towards prevention. Going ‘electronic’ with medical records may be a great way to quickly identify and prevent transmission. A study of California hospitals that implemented an automated tracking system showed that those hospitals who automated the process were more likely to be rigorously practicing the recommended prevention methods (Halpin, et al, 2010).
Recommendations
on reaching CDC’s winnable battles goals:
Our group’s recommendations for
reaching CDC’s winning battles goals in reducing MRSA is in line with the
National MRSA Education Initiative:
to help every community to better recognize and prevent MRSA skin infections
in the different settings as follows:
1.
Personal prevention
a. Washing hands
a. Washing hands
b.
Covering
wounds, cuts and scrapes
c.
Avoid
sharing personal items such as razors and towels
2.
Health
Care settings
a.
Follow
health care setting precautions such as gloving, hand washing, gowning,
appropriate device handling
b.
Follow
visitors polices and avoid contact with infected family members and friends
c.
Employees
and visitors should wash hands before leaving room of infected persons
d.
Patient
education is critical
e.
Follow
health care facility guidelines
3.
Schools
a.
Personal
hygiene
b.
Environmental
cleaning and disinfecting
c.
School
notification policies
d. Educate
students, teachers and parents
4. Athletic
Facilities
a. Important
personal hygiene
b. Uniform
and facility hygiene
c. Health
care provider evaluating and excluding athletes at risk from participating
d. Education
is key!
Links to additional resources,
further reading
- This site provides some reading on other initiatives and goals for eradicating HAI’s: U.S. Department of Health and Human Services: Healthcare Associated Infections: http://www.hhs.gov/ash/initiatives/hai/
- A plethora of information on HAI’s including MRSA and other multi-drug resistant organisms (MDRO): http://www.jointcommission.org/hai.aspx
- The Agency for Research Health and Quality outlines some current initiatives and research being done to reduce HAI’s in all 50 states. Also gives good links to scholarly journals, articles, conference dates, and much more: http://www.ahrq.gov/professionals/quality-patient-safety/patient-safety-resources/resources/hais.html
- Great pamphlet about HA-MRSA (Hospital or Healthcare Associated MRSA): http://www.achd.net/biostats/pubs/pdf/HAMRSA.pdf
- Terrifying but very interesting research results from a 10 year study on HA-MRSA: Al-Ghusein, Hasan, Budd, Emma L., Knight, Lindsay, Jodi A., Gwenan M., Planche, Timothy, Thornley, Alastair, & Whitney, Laura. Shift in dominant hospital-associated methicillin-resistant Staphylococcus aureus (HA-MRSA) clones over time .J. Antimicrob Chemother. (2012) 67 (10): 2514-2522. doi: 10.1093/jac/dks245 Available online: http://jac.oxfordjournals.org.hsl-ezproxy.ucdenver.edu/content/67/10/2514.full.pdf+html
- Very informative article about MRSA rates and anti-biotic use policies: Yuan-Ti Lee, Shih-Ming Tsao, Hui-Chih Lin, Huey-Jen Huang, Meng-Chih Lee, Po-Ren Hsueh. Decline in the incidence of healthcare-associated methicillin-resistant Staphylococcus aureus (HA-MRSA) correlates with decreased antimicrobial consumption at a tertiary care hospital in Taiwan, 2001–2009. (2010). Int J. of Antimicrob Agents. 36 (6) 523-530. http://dx.doi.org.hsl-ezproxy.ucdenver.edu/10.1016/j.ijantimicag.2010.07.014
- The following consumer resources are from the Quick Guide to Healthy Living at healthfinder.gov.
References:
Kallen AJ, Mu Y, Bulens S, et
al. Health Care–Associated Invasive MRSA Infections, 2005-2008. JAMA. 2010;304(6):641-647.
doi:10.1001/jama.2010.1115.
AHRQ's Efforts to Prevent and Reduce Health Care-Associated
Infections: Fact Sheet. October 2009. Agency for Healthcare Research and
Quality, Rockville, MD. http://www.ahrq.gov/research/findings/factsheets/errors-safety/haiflyer/index.html
Halpin H, Shortell SM, Milstein A, Vanneman M., Hospital adoption of automated
surveillance technology and the implementation of infection and control
programs. Am J Infect
Control. 2011 May;39(4):270-6. doi: 10.1016/j.ajic.2010.10.037.
Society for General Microbiology (2009, March 31).
Handwashing More Important Than Isolation In Controlling MRSA Superbug
Infection, Study Suggests. ScienceDaily.
Retrieved May 9, 2013, from http://www.sciencedaily.com /releases/2009/03/090330200708.htm
Bailey, Catherine A., and
Marcella Upshaw-Owens. "Preventing hospital-associated infection: MRSA."
MedSurg Nursing Mar.-Apr. 2012: 77+. Health Reference Center Academic. Web. 9
May 2013.
Jain, R.,
Kralovic, S. M., Evans, M. E., Ambrose, M., Simbartl, L. A., Obrosky, D. S., et
al. Veterans Affairs Initiative to Prevent Methicillin-Resistant Staphylococcus
aureus Infections. New England Journal of Medicine, 364(15), 1419-1430. 2011
Centers
for Disease Control and Prevention. (2012). Winnable
battles: 2015 Targets. Retrieved from: http://www.cdc.gov/WinnableBattles/targets/PDF/WinnableBattlesTargets.pdf. Accessed on 5/7/2013
Centers for Disease Control and Prevention (April 8, 2011)
MRSA Infections: available at: http://www.cdc.gov/mrsa/statistics/. Accessed 5/09/13
Health Care–Associated Invasive MRSA Infections, 2005-2008. JAMA. 2010;304(6):641-647. doi:10.1001/jama.2010.1115.
Health Care Associated Infections: Healthy People 2020
(April 24, 2013). Available at: http://healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=17. Accessed 5/10/13.
Colorado Department of Public Health and the Environment (CDPHE). State of Colorado Status Report on the Health Facility-Acquired Infections Disclosure Initiative, January 15, 2013. http://www.colorado.gov/cs/Satellite/CDPHE-HF/CBON/1251590876310. Accessed May 11, 2013.
Scott, Douglas R. (March 2009). The Direct Medical Costs of Healthcare-Associated Infections in U.S. Hospitals and the Benefits of Prevention. Division of Healthcare Quality Promotion for the National Center for Preparedness, Detection, and Control of Infectious Diseases Coordinating Center for Infectious Diseases, Centers for Disease Control and Prevention. http://www.cdc.gov/HAI/burden.html. Accessed May 11, 2013.
No comments:
Post a Comment