Monday, September 21, 2009

MRSA miscellany....

I wanted to pass along an interesting moment from an MRSA session at ICAAC, entitled, “Controversies in the Management of MRSA Infections”. The session started with Chip Chambers, from UCSF, discussing the emergence of USA300 as a healthcare-associated pathogen. Near the end of his talk, and just prior to the “pro-con” session on active MRSA surveillance (with Lance Peterson “pro” and Stephan Harbarth “con”), Dr. Chambers showed the past few years of data from San Francisco General Hospital. The data revealed a dramatic reduction in MRSA infection (I can’t recall if it represented bloodstream only, all nosocomial infections, or all infections….), in line with what many have reported over the past few years (~60-70%). After he showed these data, he revealed SFGH’s aggressive approach to MRSA, which included....no active surveillance, and no use of contact precautions for colonized or infected patients. That’s right—no “MRSA specific” measures. Then, for good measure, he good-naturedly implored the audience to remember, while listening to Lance Peterson extol the benefits of MRSA screening, that his hospital achieved the same reductions without any of the expense and trouble! Sadly, California’s MRSA screening legislation no longer allows hospitals to successfully reduce MRSA infections without the use of at least some screening.

Dr. Peterson gave his standard talk, but spent even less time than usual on his disclosure slide…several nanoseconds, but not enough time for the audience to note the degree of financial support he has received, both in honoraria and research support, from the makers of rapid MRSA detection tests. He also spoke in the evening at a satellite symposium, complete with dinner, funded by Roche. I didn’t go to that session…..

Imagine this scenario: your hospital has successfully reduced MRSA infection rates (and those due to other pathogens) using a broad-based strategy that includes excellent hand hygiene adherence and significant reductions in device-associated and surgical site infection rates. You are nonetheless forced (by state legislation) to start an active MRSA screening program, draining money from other important prevention priorities and exposing patients to important noninfectious adverse outcomes. All this as a result of the efforts of MRSA screening advocates who have major conflicts of interest with companies that stand to reap financial benefit from MRSA screening. Our colleague Kathy Kirkland hit this nail on the head (really!) in her response to a recent letter to the editor from Farr and Jarvis:
“It is said that to a person with a hammer, everything looks like a nail, and perhaps this is even more true of someone who consults for a hammer company. When 2 experts in the field of health care epidemiology repeatedly call for “every health care facility” to implement a program of active detection and isolation, they rightfully attract our attention. When one of these experts discloses potential conflicts of interest that include a relationship with a company that markets a diagnostic test for MRSA, we must view these calls with caution.”

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