Last week’s good news of a decline in serious MRSA health care-acquired infections, is a victory for patient safety, but we still have a long way to go to eliminate this very preventable crisis.
The study by CDC researchers looked at cultures from laboratories in nine US cities. The overwhelming majority (82%) were associated with the delivery of health care. From 2005 to 2008, they found a 28% decrease in hospital-acquired MRSA infections and a 17% decrease in patients with symptoms of health care-acquired infections either from a prior hospitalization, stay in a nursing home, dialysis treatment, outpatient surgery or an existing central line catheter. They also noted that bloodstream infections made up the bulk of these infections and were declining at a greater rate than other types. This makes sense because these infections have been the focus of hospital ICUs for decades and a 2009 study found the rates already declining.
While this news is welcome, far too many patients suffer from MRSA infections each year. In 2007, when CDC researchers did a similar evaluation for 2005, they estimated 94,360 patients get serious MRSA infections every year in the U.S. (and similar to this 2010 report, 85% were health care-acquired), resulting in nearly 19,000 “in-hospital deaths.” That’s more than the number of people who died from the swine flu worldwide. One can only imagine how we could appropriately tackle the MRSA problem if it was given the priority these statistics warrant!
The most pressing question that consumer advocates are asking now is “How did this happen? What are the prevention strategies that led to this decrease?” The CDC says “it’s not clear.”
We have some thoughts on this that surprisingly were not mentioned by the CDC researchers (but mentioned in the accompanying commentary). What happened between 2005 and 2008 that had never happened before? Public reporting of infection rates.
During this period, almost every state legislature debated the issue and the subsequent publicity and media coverage significantly raised the profile of these infections. Specifically, for the first time, there was a call for public accountability. We saw a cultural shift within the health care system from acceptance and inevitability to “these infections should not be happening.” Only a handful of the public reporting laws require inclusion of MRSA infections, but 21 of the 27 states now requiring this disclosure are using the CDC National Healthcare Safety Network as the collector of data for the state reports. Many of these reports include information about the pathogen causing the infection and the NHSN data will be much richer for future analysis of hospital infection in general and those like MRSA caused by superbugs. One review said with these state mandates a “natural experiment is brewing” and there is no doubt we now have a better picture of the problem.
While hospitals were feeling the pressure of upcoming disclosure of how well their infection control methods worked, organizations like the Institute for Healthcare Improvement (IHI) and federal and collaborative initiatives began campaigns to help hospitals prevent the most common infections, such as surgical, bloodstream, and those caused by the MRSA superbug. IHI’s website is rich with reports of successful MRSA infection prevention strategies and tool kits to guide hospitals in preventing medical harm.
Also, during these years more hospitals began adopting aggressive MRSA prevention strategies, including using active surveillance cultures to proactively identify patients who are MRSA carriers, isolating them to prevent the spread to other patients and sometimes “decolonizing” them to reduce their risk of infection (ADI). The CDC guidelines recommend this very effective practice but not as a priority strategy, which means it is not considered a necessary activity by infection preventionists. A national professional organization of epidemiologists issued guidelines in 2003 on using this strategy, but their membership has not embraced it. The Veterans Administration has been using ADI with other strategies since 2007 and reported results at the June CDC infection advisory committee meeting: MRSA infection rates in the ICU declined 76% and infections in other parts of the hospital declined 28%. Many hospitals have reported similar success stories. Clearly, this is a strategy that works and should be given more serious consideration by CDC.
Bottom line: It is always good news when we hear of health care-acquired infection rates decreasing. We welcome this evidence that these incredibly dangerous and deadly infections can be prevented. However, there are still far too many patients getting and dying from MRSA infections. Every hospital in the country must step up their efforts to eliminate them and consumers should have access to information about each hospital’s record on preventing the spread of MRSA within their walls.
Lisa McGiffert, Director of Consumers Union's Safe Patient Project