Despite ongoing efforts by U.V.A. and a handful of other U.S. hospitals to identify and isolate colonized patients, MRSA raced through the health care system virtually unchecked because most facilities lacked effective infection-control programs. By the 1990s, "the whole health care system became completely permeated by [MRSA]," says Farr, who for the past three decades has been a leading proponent of active detection and isolation to control superbugs. In 1995 MRSA infections accounted for 22 percent of all health care–associated staph infections, compared with only 2 percent in 1974.
Today, "close to 70 percent of staphylococcus causing infections in intensive care units are MRSA," says Fred Tenover, acting director of the CDC's National Center for Infectious Diseases Office of Antimicrobial Resistance, noting that within that average there is huge variation from one hospital to the next.
The University of Virginia is one of many exemplars of infection control in the U.S. Between 2001 to 2005, a group of 32 Pennsylvania hospitals working with the CDC slashed the rate of central lineassociated bloodstream infections (associated with catheters placed in veins) in intensive care units by 68 percent. One of the participants in that initiative, Allegheny General Hospital in Pittsburgh, reduced the total number of these infections by nearly 90 percent in one year (2003 to 2004) and the unit has recently gone nearly 18 months without an infection. The dramatic decline at Allegheny occurred despite a near doubling in the use of catheters and a steady increase in the severity of illness of patients in its intensive care unit. "Using more catheters and caring for sicker patients are not justifications for higher numbers of infections," Richard Shannon, then chair of Allegheny's department of internal medicine, told a congressional panel last year that was considering proposals designed to reduce hospital-acquired infections.
Shannon, who has since become chair of the department of medicine at the University of Pennsylvania in Philadelphia, outlined his successful campaign during a recent interview with Scientific American.com. "We took the Toyota production system and applied it to placement and maintenance of catheter insertions," and later ventilator insertions, he says. To create a perfect product, "all things have to be executed perfectly," and everyone in the organization must be on board, he says.
The same is true for infection control. In order to determine the perfect way to execute each step of placing and maintaining catheters, Shannon says he tapped the doctors, nurses and medical technicians in his hospital for advice. After developing standardized procedures for everything from putting on a hospital gown and cap to washing hands to actually placing the catheter, "we trained people and observed them" instead of just handing out a document with instructions, he notes, adding that leadership is a key component of eradicating the problem. "This will never occur," he says, "until a senior person says, 'I've had enough.'"
Despite the success of these hospitals and several others, critics say the U.S. lags far behind some countries in keeping superbugs in check. Denmark's MRSA prevalence reached 33 percent in the 1960s but steadily declined after a strict infection-control policy was implemented; it has remained below 1 percent for 25 years. In the Netherlands and parts of Scandinavia health care–associated MRSA prevalence has been maintained at 1 to 3 percent for decades through an aggressive "search and destroy" approach: Hygiene practices are strictly enforced and all high-risk patients and staff members are systematically screened for MRSA; those found to be infected or carriers are quarantined.
Many experts believe that the search-and-destroy method is the best answer to America's superbug problem. "We need to start looking for these [drug-resistant strains] on admission and putting patients in isolation," says Marcia Patrick, spokesperson for the Washington D.C–based Association for Professionals in Infection Control and Epidemiology (APIC).
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Add CommentYou might want to learn about NovaBay pharmaceuticals. They have a new compound that kills MRSA on compact. Phase two trials should be finished in Jan. 2008
Reply | Report Abuse | Link to thisThe really sad thing here is that had this woman been at home with a good midwife she would have had neither the c-sec nor MRSA.
Reply | Report Abuse | Link to thisThis article is very timely given the crowding conditions that hospitals are faced with. With occupancy levels higher than capacity strains all resources including the ability to ensure infection control practices are consistently applied.
Reply | Report Abuse | Link to thisLook like we have to design the hospital similar to standard of bio-hazard facilities. Compartmentalisation, negative pressure and UV light need to be introduced for the bacteria spreading wards.
Reply | Report Abuse | Link to thisAn article like this that does not discuss Ewald's work is not credible, it's just "Oh, gosh. Oh, golly." Ewald showed that M.D.s were THE primary vector for MRSA, the most frequent violators of handwashing protocols, and that resistance can evolve in a closed hospital setting in 6 weeks. He showed that opening up the system to competition from staph from outside will improve effectiveness of antibiotics and lower incidence of such infections. The response of the hospitals was to bar him from entry to their facilities, most likely due to an attempt to avoid legal liability in a malpractice scandal. The response from the medical profession responsible for curricula has been to continue to teach disproven theories that are now as out of date as those prior to Lister. Dr. Ewald has continued his fight and is now faculty in Kentucky.
Reply | Report Abuse | Link to thisSee:
Ewald, Paul W. Evolution of Infectious Disease (Oxford University Press, New York, 1996). http://www.amazon.com/Evolution-Infectious-Disease-Paul-Ewald/dp/0195111397
Okay, folks. Likewise, I was unable to dialate so I had to have a c section. One day after the surgery I came down with a horrible fever.....one that almost cost my life. turned out I contracted E COLI in blood and urine. While my son was in NICU...the doctors were attempting to cook the right dose of drugs to give to me via PIC line. I left the hospital 7 days later where my husband had to administer IV drugs from home. The whole experience was HORRIBLE. I'm having such a rough time trying to get over it....so many things I should have questioned and asked more questions of while I was in the hospital. I'm now responsible for several bills, total to approx 9000.00. (Even with Health Insurance) O and get this, the hospital has decided to "comp" my bills from Infectious disease...and other bills. However, I'm still responsible for other bills they didn't take care of or bills that the insurance company wouldn't pay due to hospital germs. I can't find a lawyer in town that will take our case and I feel TAKEN ADVANTAGE OF and there isn't a darn thing I can do about this. Bottom line, the hospital gave me an infection that nearly killed me. UGH
Reply | Report Abuse | Link to thisHad c section, contracted E coli from hospital. So sick that it nearly killed me...wasn't able to bond with baby. Sent home with PICC line to administer for 2hrs a day for 7 weeks. I'm now responsible for several bills including Infectious Disease...BUT when I contacted hospital...they decided it would be wise to open investigation where they found they COULD have infected me. They are now comping my co pays and other bills...BUT I'm still stuck with bills that the insurance company won't cover or that they are not willing to cover. Are they admitting guilt here? Not to mention the fact that I can't find legal representation anywhere....I would think this would be cut and dry?
Reply | Report Abuse | Link to thisThere is an ozone and hydrogen product callee AsepticSure which is being developed for distribution. It is a mist that fills the room and sterilizes everything without toxic residue. Interestingly it is probably also the one known cure for bedbugs. They cannot survive it either.
Reply | Report Abuse | Link to thisBefore long it will be standard in every hopital that wants accreditation.