Wednesday, July 14, 2010

Study: HAIs, Universal Surveillance, & MRSA



# 4724



Note: Although this story falls more under the purview of Maryn Mckenna and her superb Superbug Blog,  Maryn has been on a brief hiatus the last few days, and so I’ll take a stab at it.



HAI’s are Hospital Acquired Infections, and they create a heavy burden on the healthcare system in this country – and around the world.


MRSA, C. Diff, garden variety staph, various pneumonias, and other infections cost thousands of lives and add billions of dollars to healthcare costs each year. 


This from the CDC on HAI’s (Hospital Acquired Infections)

A new report from CDC updates previous estimates of healthcare-associated infections. In American hospitals alone, healthcare-associated infections account for an estimated 1.7 million infections and 99,000 associated deaths each year. Of these infections:

  • 32 percent of all healthcare-associated infection are urinary tract infections
  • 22 percent are surgical site infections
  • 15 percent are pneumonia (lung infections)
  • 14 percent are bloodstream infections


Last April, for the seventh year in a row, the Agency For Healthcare Research and Quality (AHRQ) released a National Healthcare Quality Report (PDF File, 4.4 MB), along with a National Healthcare Disparities Report  (PDF File, 5.7 MB).


Here are a few excerpts from the AHRQ press release.


Annual Quality and Disparities Reports Include Data on Rates of Health Care-Associated Infections, Obesity and Health Insurance

Press Release Date: April 13, 2010


Very little progress has been made on eliminating health care-associated infections (HAIs), according to a new section in the 2009 quality report. For example, of the five types of HAIs in adult patients who are tracked in the reports:

  • Rates of postoperative sepsis, or bloodstream infections, increased by 8 percent.
  • Postoperative catheter-associated urinary tract infections increased by 3.6 percent.
  • Rates of selected infections due to medical care increased by 1.6 percent.
  • There was no change in the number of bloodstream infections associated with central venous catheter placements, which are tubes placed in a large vein in the patient's neck, chest, or groin to give medication or fluids or to collect blood samples.
  • However, rates of postoperative pneumonia improved by 12 percent.



While the problems of HAIs  are obvious, the solutions are subject to ongoing, and often furious, debate. 


Although infection threats include C. Diff, VRE, Acinetobacter, and influenza - one of the biggest, and most draining (no pun intended) that hospital infection control teams must contend with is MRSAMethicillin Resistant Staphylococcus aureus.


As many as 19,000 Americans die each year from MRSA.   Admittedly an impersonal statistic, but one that Maryn McKenna’s terrific book Superbug: The Fatal Menace of MRSA  puts a human face to.


You can read my review of her book here.



Strategies to contain and control MRSA range from passive surveillance to aggressive `search & destroy’ policies – with variations in between.


Passive surveillance – which is the most commonly used protocol in the United States – involves  testing only those who have clinical signs or symptoms of


Since patients may be colonized without exhibiting outward signs, this will fail to detect a great many carriers of the bacteria.



Active Surveillance – requires the testing of high risk admissions (ie.  Hx of MRSA, Antibiotic Use, Admission to Hospital in past year, Resident of Long-term care facility, etc.) for the bacteria.


Patients testing positive may be isolated and decolonized or treated, with strict infection control precautions enforced.



Universal Surveillance – takes the above steps to a higher level, where all admissions and personnel are routinely swabbed and tested for MRSA.



“Search & Destroy” – which is the most intensive protocol, has been used successfully in countries like Finland, Denmark and the Netherlands. 

It combines Active or Universal Surveillance with testing of patients in high-risk wards at intervals and prior to discharge.



The reluctance to adopt these more aggressive measures have been the costs, the inconvenience to patients and their visitors, and quite frankly, objections by some hospital staff over being repeatedly tested.


The bottom line, however, is that despite these objections,  Active and Universal Surveillance – when implemented – have been demonstrated to save lives.


Which brings us to today’s report of a poster session at the APIC 2010 conference being held this week in New Orleans.


It details the success of a North Carolina Hospital group in implementing Universal Surveillance, and their subsequent dramatic drop in Hospital Acquired Infections.



Study shows universal surveillance for MRSA significantly decreased HAIs at PCMH


Greenville, NC (July 13, 2010) – Pitt County Memorial Hospital (PCMH) today announced results of a study demonstrating that universal surveillance for methicillin-resistant Staphylococcus aureus (MRSA) decreased health care-associated infections (HAIs) related to devices. Infection rates decreased 68 percent for ventilator-associated pneumonias (VAP); 51 percent for central line-associated bacteremias (CLA-BSI); and 49 percent for catheter-associated urinary tract infections (CAUTI).


The study was led by Keith Ramsey, M.D., medical director for infection control at PCMH, and professor of medicine at The Brody School of Medicine at East Carolina University. Universal surveillance, also known as all-admissions surveillance, introduces the testing of all patients upon admission, not just high-risk patients, and has been shown to be far more effective than targeted active surveillance when monitoring for MRSA infections. If patients test positive for MRSA, they are put on contact precautions that include isolation, hand hygiene, room signage, patient-dedicated equipment, personal gowns and gloves, and they are decolonized with mupirocin/chlorhexidine bath.


"At PCMH we have made it our mission to take pre-emptive action to reduce the risk of patients transmitting or acquiring an infection while under our care," Ramsey said. "This particular study demonstrates that universal surveillance plus eradication help to reduce HAIs related to devices, which continues to be a major challenge for hospitals and health care facilities in the United States."


The study was presented today by Kathy Cochran, manager of infection control at PCMH, during a poster session (Poster #: 8-056) at the Association for Professionals in Infection Control and Epidemiology (APIC) 2010 annual conference in New Orleans. The BD GeneOhm™ MRSA assay, an in vitro molecular diagnostic test that provides definitive results within two hours of laboratory time, was used in the study.


During the surveillance period, rates for MRSA-associated HAIs decreased for each device as follows:

  • VAPs per 1,000 vent days decreased 68 percent from 1.065-to-0.296 (p < 0.006) in the intervention year, and to 0.183 (p < 0.002) in the maintenance year.
  • CLA-BSIs per 1,000 line days decreased 51 percent from 0.244-to-0.124 (p < 0.292) in the intervention year, and to 0.111 in the maintenance year (p < 0.196).
  • CAUTI rates per 1,000 foley days decreased 49 percent from 0.207-to-0.101 (p< 0.254) in the intervention year, and to 0.099 (p < 0.266) during the maintenance year.

In addition to the poster presentation, Ramsey will present Universal MRSA Screening: Selecting the Best Practice for the Best Price on Wednesday, July 14, 2010 at 4 p.m. in Conference Auditorium 3. In addition, Ramsey will discuss necessary steps for implementing universal admission screening for MRSA.

(Continue . . . .)

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