Another report from the CDC expected next month will look at infections at 18 Department of Veterans Affairs medical centers. Meanwhile, the VA is drawing attention for a new policy mandating that all patients be screened for the MRSA bug upon admission and discharge. That policy is based on a pilot study conducted at the 692-bed VA Pittsburgh Healthcare System, where Chief of Staff Rajiv Jain said they were averaging about 60 MRSA cases a year earlier this decade, but saw only 18 last year.
The Pittsburgh VAs anti-MRSA program used a search and destroy strategy and cost roughly $500,000 but resulted in savings of $1.2 million, Jain said, based on the assumption that it costs $32,000 to treat a hospital-acquired MRSA infection and they had 40 fewer cases in 2006 than in previous years.
According to Jain, all acute-care centers at the VAs 153 hospitals will have an MRSA-prevention program in place by December, and all VA skilled-nursing units should by the spring. While the traditional MRSA culture test takes 48 hours, Jain said about 40 VA hospitals have rapid-testing equipment producing results in two to three hours.
While the VAs results are impressive, some experts disagree with mandatory screening policies, especially those that call for universal screening and are aimed only at MRSA. Instead, they advocate tailor-made solutions that identify the patients facing the highest risk and that target the particular pathogens that may be plaguing an individual hospital.
For about a year at nine-hospital Alegent Health system in Omaha, Neb., intensive-care and rehabilitation patients have been cultured on admission, after 14 days and on discharge at its 400-bed Immanuel Medical Center. At its 290-bed Bergan Mercy Medical Center, babies in the neonatal ICU are monitored for MRSA. While acknowledging that by focusing on MRSA, they are putting all their resources into one area, Peggy Luebbert, Alegents infection-control consultant, said that MRSA is a good general indicator of the effectiveness of a hospitals infection-control. What were finding is that people think they are practicing good hand hygiene and precautions, but as they go through their day, it gets lost in the shuffle, Luebbert said.
Both Luebbert and Jain said culturing on discharge is especially useful when it uncovers cases where patients were colonized by the MRSA bug in the hospital, because it allows an opportunity to work backward to find where infections are occurring.
Jain said an investigation led to a review of housekeeping procedures and it was discovered that the curtain separating patients in a two-bed room could lead to colonization if not cleaned regularly. Another hot spot that was uncovered was the handle of the drawer underneath the table that goes across the patients beds.
Institute of Healthcare Improvement Senior Vice President Donald Goldmann said that general measures used to prevent ventilator-associated pneumonia and central-line infections help reduce MRSA infections as well. MRSA is a huge problem, and I would never want people to not focus on it, Goldmann said.
Some administrators, however, fear that politicians will instruct them to do otherwise. If we are proactive and do this, we wont need legislators telling us what to do and who we have to do it to, Luebbert said.
This summer, Illinois became the first state to do just that. Two bills were introduced and later passed, one calling for hospitals to do a risk-assessment and create programs designed to protect patients with the highest risk and another to screen every ICU patient specifically for MRSA.