Tuesday, August 7, 2012

It's ok to shut down your MRSA PCR machine

There's a recent paper in the American Journal of Infection Control outlining an an active surveillance program for MRSA at a small acute care hospital in Montana. Patients found to be colonized were then placed in contact precautions. Of note, the hospital has had 1-2 MRSA healthcare associated infections yearly for the last several years. In 2010, isolation of asymptomatically colonized patients was discontinued with no subsequent increase in MRSA HAIs noted. The authors conclude that contact precautions are not necessary for asymptomatically colonized patients and the cost of consumable products for contact precautions was an unnecessary expense. I agree with the authors, but would go further to question the value of performing active surveillance for MRSA in a hospital with 1-2 infections per year.

Photo:  CDC

3 comments:

  1. Just curious, what are you guys' thoughts regarding how generalizable these findings are? Think the findings would hold for hospitals that are larger, have heavier burden of MRSA infections, or have higher colonization pressure? Also, for facilities considering implementing this, do you think a prevalence survey every now and then is still advised even if active surveillance for colonization is d/c'd?

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  2. Ay my hospital (an 820-bed, safety net, academic medical center) we had 5 device related HAIs across the entire hospital last year. We don't do active surveillance for MRSA. We do isolate patients incidentally found to be MRSA colonized though I would like to stop this practice.

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  3. You raise an excellent point, Hozomeen--single center studies such as this are always of limited generalizability. Whether and how a hospital incorporates MRSA screening depends upon so many factors, a couple of which you mention (HA-MRSA infection rate, colonization pressure). The SHEA/IDSA compendium is being updated, but I still think the flow chart in the MRSA transmission prevention guidance is a reasonable approach (it drives home horizontal practices first, adding vertical ones for hospitals that do not achieve results--see: http://www.jstor.org/stable/10.1086/591061). Of the many remaining questions about MRSA prevention, one of the most important is what Mike raises above--when can (or should) hospitals stop the practice of isolating MRSA colonized patients? Some places have done so with no adverse impact on MRSA control, and likely experience benefit in reduced adverse events among a formerly isolated patient population.

    Note also that at least 3 multicenter (and therefore more generalizable) studies comparing selected approaches to MDRO control are set to report findings in the next few months. So stay tuned!

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