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Hospitals marshal resources to wipe out MRSA
By Paul S. Howell for USA TODAY
Rosetta Robertson cleans equipment in the intensive-care unit at the University of Texas Medical Branch.
"MRSA" redirects here. Methicillin-resistant Staphylococcus aureus
Species: S. aureus Binomial name Staphylococcus aureus (Rosenbach 1884 )
Methicillin-resistant Staphylococcus aureus (MRSA) (usually pronounced in short as "Mursa" in American English, spelled out as M-R-S-A in British English), is a bacterium responsible for difficult-to-treat infections in humans. It may also be referred to as multiply-resistant Staphylococcus aureus or oxacillin-resistant Staphylococcus aureus (ORSA). The organism is often sub-categorized as Community-Associated MRSA (CA-MRSA) or Hospital-Associated MRSA (HA-MRSA) depending upon the circumstances of acquiring disease, based on current data that these are distinct strains of the bacterial species.
MRSA is a resistant variation of the common bacterium Staphylococcus aureus. It has evolved an ability to survive treatment with beta-lactam antibiotics, including penicillin, methicillin, and cephalosporins. MRSA is especially troublesome in hospital-associated (nosocomial) infections. In hospitals, patients with open wounds, invasive devices, and weakened immune systems are at greater risk for infection than the general public. Hospital staff who do not follow proper sanitary procedures may inadvertently transfer bacterial colonies from patient to patient.
MRSA was discovered in 1961 in the UK. It is now found worldwide. MRSA is often referred to in the press as a SUPERBUG.
HOW TO AVOID MRSA AND OTHER STAPH INFECTION
By Paul S. Howell for USA TODAY
Epidemiologist Pamela Falk takes a nasal swab from patient and retired physician A.J. Jinkins to test him for MRSA upon admission to the University of Texas Medical Branch.
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By Phil Galewitz, Special for USA TODAY
A recent federal report on the growth of "superbugs" - deadly bacteria resistant against most antibiotics - has renewed public attention to how hospitals are faring in their decades-long war.
Hospitals across the USA have been stepping up their fight against all types of infections, especially superbugs that have been found to be more common and more deadly than previously believed.
Among the methods some hospitals are employing:
In October, a federal report estimated that nearly 19,000 people died in the USA in 2005 after being infected with a virulent drug-resistant bacterium called methicillin-resistant staphylococcus aureus, or MRSA - more than the number killed by HIV/AIDS. A study released on Thursday in the journal Emerging Infectious Diseases found that hospitalizations related to MRSA nearly doubled between 1999 and 2005, from 127,000 to almost 280,000.
"It's a battle for us, a big battle," says Nina Shik, infection control manager at the University of Kansas Medical Center in Kansas City.
The hospital had an MRSA outbreak in its burn unit in 2005. The culprit was found to be pillows, which had small holes in them that enabled the bacteria to pass from patient to patient. When the hospital changed the type of pillow, the infection rate dropped.
Secret observers mobilized.
While MRSA, labeled a superbug because it is resistant to so many antibiotics, affects healthy people in the community, about 85% of cases are in health care settings, such as hospitals. Hospitals have long been known as breeding grounds for MRSA because bacteria can be transported from patient to patient by doctors, nurses and unsterile equipment. The bugs also gain an edge because patients' immune systems are often compromised.
Numerous studies have documented that on average, doctors, nurses and other health care workers fail to clean their hands properly more than half the time.
To fix that problem, hospitals such as University of Kansas are using secret observers to spy on their co-workers to make sure they are washing up. "They may look like they are just looking at a chart, but they are observing whether employees wash before touching a patient," Shik says. The hospital talks to staffers who are not washing their hands and shares the data with each department.
The hospital is also focusing attention on cleaning surfaces to rid them of invisible germs. The organisms can live on common surfaces for days, including tabletops and the TV remote control. To improve cleaning, the University of Kansas hospital uses Glo-Germ to help identify germs. The chemical is dabbed on a surface, and an ultraviolet light is held over it to identify the germs. "We found our rooms looked clean but were not as clean as we thought," Shik says.
At the University of Texas Medical Branch in Galveston, the main battle strategy against MRSA is what it calls the "search and destroy" method. The hospital screens all adult intensive-care-unit patients each week for MRSA and places those testing positive in isolation. About 10% to 20% have tested positive through a nasal swab. In isolation, patients are placed in a private room, and staff must wear gloves and protective gowns whenever entering, says C. Glen Mayhall, director of infectious diseases at UTMB.
The high cost of testing
Infection-control experts differ on whether hospitals should test all patients for MRSA or just focus on those at highest risk, such as those in intensive care. About 2% of the U.S. population is estimated to harbor the MRSA bacteria, but because most are healthy enough to resist infection, they have no idea they are carrying something that can expose and harm others. When these "colonized" individuals enter the hospital (typically for an unrelated reason), they bring MRSA with them.
"I'm not sure it's cost-effective to test everybody," says Keith Kaye, medical director of infection control at Duke University Hospital in Durham, N.C. His hospital tests only ICU patients.
Pitt County Memorial Hospital in Greenville, N.C., this year began testing all patients for MRSA. About one in 12 patients tested positive, higher than administrators expected. While each test costs $60 - the fee is tacked on to the patient's bill - the hospital had to invest another $1 million in labor costs and equipment.
Keith Ramsey, director of infection control, says the hospital's MRSA-caused pneumonia rate dropped 65% this year, and MRSA-caused urinary tract infections were down 60%. "We decided this would be the best return for our investment," Ramsey says.