"Battling the Bug". . ."Superbugs Spread Fear Far and Wide" . . . "Infectious Disease: MRSA Emerges as a Threat Outside Hospitals"

A look at recent headlines shows that the little known germ with the big name — MRSA — has been causing widespread concern and, in some cases, panic about the potential for the spread of infection in schools, health clubs, and other public places. But, what is MRSA? Should you worry about MRSA and infections? What are health care providers doing to combat the spread of these infections? What can individuals do to help stop the spread?

What is MRSA?

MRSA stands for Methicillin-Resistant Staphylococcus aureus. This type of bacteria causes “staph” infections that are resistant to treatment with usual antibiotics. MRSA effects most frequently hospital patients who have undergone invasive medical procedures or who have weakened immune systems. Patients in nursing homes and dialysis centers can be vulnerable too.

But, another strain of MRSA — community-associated MRSA — has emerged. It generally appears as skin infections that can look like insect bites, pimples or boils and can be swollen, painful and have draining pus. These skin infections often occur in otherwise healthy people.

It’s important to note that Staphylococcus aureus (staph) is a germ that often lives in the noses and on the skin of healthy people — not all staph infections are resistant to antibiotics like MRSA. Staph is spread from person to person through contaminated hands, skin, and objects.

Recent news reports have been prompted not only by deaths due to MRSA but by new evidence that infections from the bacteria are increasing faster — both in health care settings and in the community — than experts previously realized. Because MRSA is resistant to antibiotics, it is important that we all work together — hospitals and health care providers, schools, and members of the community to prevent the spread of this and other infections.

Maryland Hospital Initiatives to Combat MRSA and Other Infections

Because the majority of invasive MRSA infections occur in hospitals and other health care settings, health care providers have decades of experience in combating these and other germs. Maryland hospitals have a track record of implementing effective measures to prevent infections and the transmission of germs.

One of the most effective ways to prevent the transmission of infections is vigorous hand hygiene. It’s critical for health care professionals to wash their hands with soap and water or alcohol-based hand rub before they have contact with a patient; put gloves on to insert catheters or other invasive devices that don’t require surgery; and after they have contact with a patient’s skin, contact with body fluids or excretions, non-intact skin, wound dressings, and removing gloves. But often that’s not enough to protect some severely ill patients from MRSA.

Hospitals and health care professionals also employ other “standard” precautions to prevent the spread of infection including the use of gowns, gloves, faces masks, and goggles, as well as disinfecting equipment and patient care furnishings.

Testing High Risk Patients

More recently, most hospitals have begun “active surveillance” of high-risk patients in “high risk” areas of the hospital such as the intensive care units (ICUs). This means that hospitals are testing patients for MRSA in the intensive care unit, the neonatal intensive care unit, or the surgical care unit.

But, testing of all patients for MRSA is very controversial and most infectious disease experts don’t believe that testing every patient is the most effective way to fight this superbug. Instead they suggest resources are better spent on alcohol rubs.

Maryland hospitals are also working to combat MRSA together through the Maryland Patient Safety Center, operated by the Maryland Hospital Association and Delmarva.

Positive Deviance

It involves an innovative approach, called Positive Deviance (PD). Ten Maryland hospitals have already been trained in PD and another 29 hospitals and health providers are now being trained. PD is an approach based upon the philosophy that certain groups of individuals have the skills to solve a problem better than others with access to the same resources. These solutions and practices are identified and then shared from department to department, from person to person.

As a result of PD, new, effective steps are being taken to prevent the spread of infection. For example, a group of chaplains realized that by bringing their bibles from patient to patient, they could inadvertently be spreading infection — as a result, they now cover the bibles with disposable covers.

Demonstrating Public Accountability Through Reporting

Late last year the Maryland Health Care Commission approved the report of a panel of experts in infection control regarding the steps the commission should take to expand public reporting relating to health care-associated infections. At the same time, the Office of Health Care Quality has issued infection prevention and control licensing requirements to address recent concerns regarding health care-associated infections.

The commission’s new report will broaden this further to include public reporting of both process and outcome measures to help reduce health care-associated infections, including those related to MRSA. The first phase will specifically require hospitals to report their compliance with active surveillance testing for MRSA in all ICUs.

As part of the report Maryland hospitals will be required to participate in the Centers for Disease Control and Prevention’s National Healthcare Safety Network as the means to collect and report health care-associated infections. Already 10 Maryland hospitals voluntarily participate. Finally, the report recommends a statewide hand hygiene campaign to reduce MRSA and other infections. Maryland hospitals have a long track record with support of all types of public reporting, and have endorsed all the recommendations in the state’s report.