Studies Highlight Challenge of Controlling Resistant
Bacteria in Hospitals04/13/11
WEDNESDAY, April 13 (HealthDay News) -- Two new studies
highlight the complexities hospitals face in controlling and
containing the spread of potentially lethal bacteria that are
resistant to many antibiotics.
While one study showed that certain interventions could decrease
transmissions and infections with methicillin-resistant
Staphylococcus aureus(MRSA), the other found no improvement
when a somewhat different set of precautions were used. The second
study looked at both MRSA and vancomycin-resistant
Overall, though, the news can still be viewed in a positive
light, said one expert.
"These organisms are very difficult to manage, but what we have seen over the last several years is that many of these infections are preventable by a variety of measures," said Dr. Marcus Zervos, director of infection control at Henry Ford Health System in Detroit.
Zervos was not involved in the studies, which appear in the
April 14 issue of the
New England Journal of Medicine.
MRSA, which is resistant to all first-line antibiotics, has
become a scourge of hospitals. According to an accompanying
editorial, MRSA affects more than a quarter of a million
hospitalizations each year and contributes to many thousands of
The first study, conducted at different Veterans Affairs
Hospitals around the United States, looked at the effect of
screening incoming patients for MRSA as well as "contact
precautions" such as donning clean gloves and gowns along with
using better hand hygiene and educating all staff to consider
themselves responsible for infection.
Between October 2007 and June 2010, implementation of this "MRSA
bundle" reduced the rate of infections with MRSA and VRE in
intensive care units (ICUs) from 1.64 per 1,000 patient days to
0.62 per 1,000 patient days, a 62 percent decline.
In other parts of the hospitals, infection rates dropped from
0.47 per 1,000 patient days to 0.26 per 1,000 patient days, a 45
percent decrease. Infection with
Clostridium difficile may also have been reduced, and
antibiotic prescriptions did decline.
The second study looked at whether screening patients at
admission and use of "barrier precautions" (wearing clean gloves
and gowns) when seeing a MRSA or VRE carrier would have an effect
on spread within intensive care units. The researchers did not look
specifically at infection.
Although many patients carrying MRSA or VRE were identified, the
intervention did not have an effect on spread of the bacteria.
"The strategy that we tested as applied in our study would not indicate that this approach is going to be broadly effective, that this would not a one-size-fits-all strategy," said study author Dr. W. Charles Huskins, a consultant in pediatric infectious diseases at the Mayo Clinic in Rochester, Minn.
This may have had to do with the fact that the health-care
providers involved did not use barrier precautions as required, the
There was also a five-day lag between the time a person was
checked for the organism and the time the lab tests came back. "In
an ICU, anything can happen in terms of transmission of bacteria,"
Any number of factors could have contributed to the different
findings, including different study designs, Zervos said.
But while other precautions are important, Zervos also said that
there is still one tried-and-true method for minimizing spread and
infection which is perhaps most important and most underused. That
method is simple hand washing.
"Hand washing has been shown to be the most important measure to reduce hospital-related infections . . . but studies have shown that hospitals are only 40-to-60 percent compliant," he said. "That's something we should just not accept. They should be at 100 percent compliance. There's no excuse for people not washing hands or using hand hygiene going in and out of patient rooms."
the Prudent Use of Antibiotics has more on resistant
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