When is an MRSA reduction not really an MRSA reduction?

Like the proverbial tree falling soundlessly in the forest, MRSA reductions apparently make no noise unless someone is spending millions of dollars on screening and isolation.

In the latest example of this phenomenon, Dr. Bill Jarvis* ignores evidence that MRSA infections can be prevented without active detection and isolation (ADI). For example, he attributes the impressive MRSA reductions in the UK to ADI. Unfortunately for Dr. Jarvis, ADI for elective admissions wasn’t mandated in the UK until March 2009, and still hasn’t been mandated for urgent admissions. But MRSA bloodstream infection (BSI) rates began falling in the UK in 2005, and had fallen 56% by the end of 2008. An NHS website and a recent parliamentary report attribute these reductions to improvements in horizontal infection control practices (primarily hand hygiene and environmental disinfection), not to ADI.

Similarly, Jarvis doesn’t mention the over 50% reduction in MRSA BSI achieved in U.S. hospital ICUs (again, without widespread ADI). Mike will soon report (at the Decennial Meeting) the elimination of MRSA infections from ICUs without ADI. At Dan’s hospital, where only the burn unit performs ADI, the MRSA infection rate (nosocomial MRSA BSI/10K patient days) is lower than the lowest rate achieved by universal ADI in this much-heralded study.*

Jarvis belittles those who believe MRSA infections can be prevented without resorting to ADI as “active resisters and organizational constipators” who have only “emotional” arguments. In doing so he alienates those who share his goal (the prevention of all healthcare associated infections, including those due to MRSA) and who have taken concrete strides to achieve it (he also appears to have forgotten that the largest controlled trial of ADI demonstrated no benefit).

Dan and Mike (joint posting)

*COI alerts: Dr. Jarvis, and five of the eight authors of the Robiscek study, all have documented conflicts-of-interest with makers of rapid MRSA detection tests.


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