Taking proactive measures to prevent MRSA infections in ICU

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It is certainly no secret that we are becoming progressively more vulnerable to bacterial infections because of the explosion of antibiotic resistant bacteria, methicillin-resistant Staphylococcus aureus (MRSA) being the best-known example.

In the absence of new antibiotic development, it becomes increasingly important to take measures to prevent infections, since treating them can be very difficult. Fortunately, this is a major focus of hospitals today, and recent results are encouraging.

Dr. Susan Huang, medical director for infection prevention at the UC Irvine Medical Center reported this week in the New England Journal of Medicine, on a study of more than 74,000 patients in 43 hospitals. The report clearly indicates that using proactive, common sense methods can significantly decrease the incidence of MRSA infections in intensive care units.

In particular, MRSA infections can be reduced by about 40 percent by: 1. Bathing patients with chlorhexidine, a powerful antiseptic; and 2. Administering the antibiotic ointment mupirocin intranasally. The nose is known to be an area where asymptomatic carriers are colonized with MRSA. Rather than testing patients for the presence of MRSA, which is now recommended, these procedures were applied to all ICU patients, who are the most susceptible to infection.

In an accompanying editorial, Drs. Michael B. Edmond and Richard P. Wenzel of the division of infectious diseases at the Virginia Commonwealth University School of Medicine wrote, The implications of this study are highly important. Edmond and Wenzel went on to suggest, Hospitals should discontinue screening and isolating patients for MRSA control and that laws mandating screening should be repealed.

In a related story, hospitals are trying some not-so-subtle methods to encourage hand washing.

As reported in yesterday s New York Times, North Shore University Hospital on Long Island is using a system of motion sensors that go off every time someone enters an intensive care room. These in turn activate video cameras (in India fans of irony, take note) where workers keep track of whether doctors and nurses are washing their hands.

Likewise, many other hospitals are trying carrot and stick approaches to encourage adequate hand washing, such as ID chips and undercover monitors to ensure that proper hygienic procedures are used. Although some view these tactics as overly intrusive, studies have shown that proper hand washing is only done about 30 percent of the time.

ACSH s Dr. Josh Bloom agrees wholeheartedly. He says, Drug companies are not doing enough antibiotic research to control the resistance problem anytime soon. In the meantime, anyone entering the hospital is at risk. In the absence of new drugs, minimizing the spread of these deadly organisms becomes of paramount importance.