CDC - Blogs - Safe Healthcare – Preventing MRSA in healthcare – Is there a silver bullet? (Part 3 of 3)

Preventing MRSA in healthcare – Is there a silver bullet? (Part 3 of 3)
Categories: Healthcare-associated infections, MRSA
April 13th, 2011 4:00 pm ET -

Charles W. Huskins, MD

Author: em>Charles W. Huskins, MD
Consultant in Pediatric Infectious Diseases and
Assistant Professor of Pediatrics in the College of Medicine, Mayo Clinic

In today’s issue of the New England Journal of Medicine, my co-authors and I report the results of a study examining an intervention to reduce the spread of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin resistant enterococcus (VRE) in adult intensive care units (ICUs). The intervention included culture-based screening of patients admitted to ICUs for MRSA or VRE carriage—called “active surveillance”—and expanded use of barrier precautions (gloves and gowns) by health care providers during the care of patients colonized or infected with these bacteria.

The study—a cluster- (ICU-) randomized trial conducted in 18 ICUs around the US—was scientifically rigorous. The results showed no difference in the incidence of MRSA or VRE colonization or infection events in 10 ICUs implementing the intervention vs. 8 ICUs that followed their existing practices. Notably, some ICUs showed substantial decreases while others showed dramatic increases.

This result was surprising to us because active surveillance identified many patients who were not previously recognized to be colonized with MRSA or VRE and all MRSA- or VRE-positive patients were cared for using barrier precautions for nearly their entire ICU stay. Potential explanations for this result are discussed in the report.

We conclude that “the results indicate that merely improving detection of colonized patients and expanding use of barrier precautions, at least as achieved during the trial, is not likely to be broadly effective.”

It is important to note that this study focused on reducing the spread of MRSA and VRE, not infections caused by these bacteria. Other interventions developed to reduce healthcare-acquired infections, including infections caused by MRSA and VRE, have been very successful. To reduce the spread of MRSA and VRE, health care facilities must emphasize reliable, sustainable adherence to isolation precautions, but this may need to be complemented by other interventions, such as use of topical skin antiseptics and enhanced environmental cleaning.

I thank the National Institute of Allergy and Infectious Diseases for its support of this trial.

We must conduct additional research regarding ways to prevent the spread of antimicrobial resistant organisms. What are your ideas for additional research in this area?

CDC - Blogs - Safe Healthcare – Preventing MRSA in healthcare – Is there a silver bullet? (Part 3 of 3)