Pat Wechsler
Published: August 10, 2010

(Bloomberg.com) -- Invasive MRSA, a hospital-acquired infection that kills at least 15,000 people annually in the U.S., may be in retreat as health providers strengthen practices to control its spread.

The rate at which patients contracted this drug-resistant germ, one of the most common causes of infections in hospitals, dropped 28 percent from 2005 through 2008 in nine metropolitan areas across the U.S., according to a study published today in the Journal of the American Medical Association. There was also a 17 percent decline in health-care-associated outbreaks that occur outside hospitals, said the Centers for Disease Control and Prevention, which collected and analyzed the data.

As hospitals and nursing homes wrestle with these bacterial diseases, which cost the U.S. about $20 billion yearly, the CDC study suggests that federal guidelines on ways to contain them through better hygiene and standardized practices may be starting to work, said Russell Olmsted, president-elect of the Association for Professionals in Infection Control & Epidemiology, in Washington.

�While we need to better understand why the rates are dropping, this study is still very encouraging news,� Olmsted said in a telephone interview.

90,000 Sickened

Every year, about 90,000 people are sickened by invasive MRSA, the most virulent type of staphylococcus bacteria typically found in hospitals, according to Alex Kallen, chief medical officer for the Atlanta-based CDC and lead author of the study. There are 1.7 million cases of hospital-acquired infection in the U.S. annually that result in 99,000 deaths, according to the CDC website.

Formally called methicillin-resistant Staphylococcus aureus, MRSA is still a �sizable public health threat,� even given the results of today�s study tracking about 15 million patients a year in the nine urban centers from 2005 to 2008, Kallen said.

The CDC called on hospitals and nursing homes to make controlling MRSA and other hospital-acquired infections an �organizational priority� and told them they should know at all times whether their rates are increasing or decreasing.

Patients can contract MRSA infections from fractures, surgical wounds, tubes inserted in the bloodstream and in other ways. To curb the infection rate through the bloodstream, the agency issued guidelines in 2002 that created a five-step process for installing an intravenous line.

New Guidelines

This process includes prepping a patient�s skin with chlorahexadine and draping the body as if in surgery to leave exposed only the area where the IV will be placed. New guidelines will be issued in late August or September, Kallen said.

�It�s equivalent to the checklist a pilot goes through before taking off,� said Olmsted, who works at St. Joseph Mercy Health System in Ann Arbor, Michigan.

In today�s study, the rate of MRSA bloodstream infections dropped 34 percent from December 2005 through December 2008, Kallen said.

The U.S. Department of Health and Human Services issued an action plan in 2009 that established a goal of cutting the invasive MRSA rate in half in five years.

�There�s definitely pressure on hospitals and other health care institutions to make an impact on health-associated infections,� said CDC�s Kallen.

Medicare Policy

Another incentive for hospitals to shape up is Medicare�s policy since 2009 not to pay for complications acquired after admission that are considered preventable. Among the conditions that Medicare, the federal plan for the elderly and disabled, lists as avoidable is vascular infections from catheters. This would include MRSA-contamination of the bloodstream from a central line.

�It�s definitely more of a stick than a carrot,� Kallen said.

The result has been initiatives nationwide by hospitals to control MRSA and other health-care-associated infections, said Tobi Karchmer, worldwide medical director for infectious diseases with BD Diagnostics, a Baltimore unit of Franklin Lakes, New Jersey-based Becton Dickinson & Co.. The unit specializes in testing and diagnostic equipment and materials.

This study �shows the progress that can be made,� Karchmer said. �But we still need to get the disease down to an acceptable level.�

To contact the reporter on this story: Pat Wechsler in New York at [email protected]

World Health Watch Archive