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February 5, 2014

Should hospitals screen every patient for MRSA?

Daily Briefing

A universal screening process at the Louisville Veterans Affairs (VA) Medical Center has prompted a 20-fold drop in methicillin-resistant Staphylococcus aureus (MRSA) infections.

In 2007, VA implemented a national effort to prevent MRSA outbreaks called the "MRSA bundle." The initiative requires clinicians to screen patients for MRSA with a nasal swab before they are admitted or moved from another unit. Additionally, the initiative stresses hand washing and being cautious about items that come into contact with MRSA-positive patients, such as gloves and gowns.

Nationally, a 2011 study in NEJM found that MRSA infections dropped from 1.64 per 1,000 patient days in October 2007 to 0.62 per 1,000 days in June 2010 in ICUs and from 0.47 to 0.26 in non-ICU settings.

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At the Louisville-based facility, the results were even more dramatic: The rate of infection dropped from 1.89 per 1,000 patient days in 2008 to 0.09 in 2013.

Should all hospital implement routine MRSA screening?

Some infection-control experts say that all hospitals should adopt VA's protocols, such Health Watch USA's Kevin Kavanagh and Lisa McGiffert, director of consumer protection group Safe Patient Project at Consumers Union.

"All hospitals should be doing this," McGiffert says, adding that the investment is worth the cost because treating a severe MRSA infection can cost anywhere from $20,000 to millions. "It's a cost to the patients, as well as the system," she says.

But some health experts say the costs associated with screening patients—about $55 per patient—would be better invested in different MRSA-fight strategies, such as decolonizing the virus with antibiotics and anti-infective cloths. CDC does not require or recommend routine MRSA screening.

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At nearby Norton Healthcare, officials stress hand washing, isolating MRSA-positive patients, and wearing protective clothing while treating MRSA patients. "In general, we have not done surveillance screening," says Norton infectious disease specialist Paul Schulz, adding that such screening is "somewhat of a controversial topic... We do all we can do that makes the most sense."

Since hospitals are only required to report MRSA outbreaks and not infection rates, it is difficult to gauge whether VA's approach is more effective than more traditional infection-control strategies, Laura Ungar writes in the Louisville Courier-Journal.

Kentucky considered a bill in 2008 that would require hospitals to adopt routine MRSA screening protocols and report MRSA cases, but the bill did not pass. California, Illinois, New Jersey, Pennsylvania, and Washington require screening of targeted populations of high-risk patients, according to McGiffert (Ungar, Louisville Courier-Journal, 2/3).

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