Categories: Antimicrobial Resistance, Healthcare-associated infections, MRSA
April 13th, 2011 5:02 pm ET -
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John Jernigan, M.D.
Author: John Jernigan, M.D
Director for CDC’s Office of HAI Prevention Research and Evaluation, Division of Healthcare Quality Promotion
The optimal approach to controlling MRSA in healthcare facilities has been a topic of ongoing controversy. Of particular interest is the question of whether the use of active detection and isolation of patients colonized with MRSA, also known as ADI, should be routinely used. Despite ongoing research and vigorous scientific debate, a simple answer has remained elusive. This week, two studies were published in the New England Journal of Medicine that illustrate the complexities of the scientific evidence surrounding ADI. One of these studies, the STAR*ICU Trial (Intervention to Reduce Transmission of Resistant Bacteria in Intensive Care), found that ADI as implemented in the study was not effective in reducing transmission of MRSA or VRE. A separate observational study (“Veterans Affairs Initiative to Prevent Methicillin-Resistant Staphylococcus aureus Infections“) involving the entire national VA hospital system
, found that after implementing a multifaceted MRSA prevention program that included ADI, MRSA transmissions and HAIs decreased significantly. The fact that these studies seem to give different answers illustrates the challenge we as scientists face in making recommendations on how best to use limited prevention resources-sometimes the answers aren’t simple as we would like.
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Categories: Antimicrobial Resistance, Healthcare-associated infections, MRSA
April 13th, 2011 5:01 pm ET -
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Martin Evans, MD
Author: Martin Evans, MD
Director of the VHA MRSA/MDRO Program
MRSA hospital-acquired infections (HAIs) cause increased suffering, the need for increased procedures, treatments, and time in the hospital, and sometimes an increased risk of death among patients. Beginning in 2002, staff working at the VA Pittsburgh Healthcare system successfully brought down MRSA HAIs using a “bundle” of infection control strategies. In 2007, VA leadership in Central Office, Washington, D.C. decided to have all 153 medical centers nationwide implement the bundle.
The “MRSA bundle” consisted of gently swabbing the nose of all patients admitted or transferred within the hospital to detect those carrying MRSA (known as universal active surveillance); preventing spread of the organism by placing those with MRSA in their own room away from those not carrying the organism; insisting that healthcare workers do hand hygiene and wear gloves and gowns when caring for the patient, and striving for a culture change where infection prevention and control becomes everyone’s responsibility.
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Categories: Antimicrobial Resistance, Healthcare-associated infections, MRSA
April 13th, 2011 5:00 pm ET -
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Charles W. Huskins, MD
Author: Charles W. Huskins, MD
Consultant in Pediatric Infectious Diseases and
Assistant Professor of Pediatrics in the College of Medicine, Mayo Clinic
In today’s issue of the New England Journal of Medicine, my co-authors and I report the results of a study (“Intervention to Reduce Transmission of Resistant Bacteria in Intensive Care“) examining an intervention to reduce the spread of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin resistant enterococcus (VRE) in adult intensive care units (ICUs). The intervention included culture-based screening of patients admitted to ICUs for MRSA or VRE carriage—called “active surveillance”—and expanded use of barrier precautions (gloves and gowns) by health care providers during the care of patients colonized or infected with these bacteria.
The study—a cluster- (ICU-) randomized trial conducted in 18 ICUs around the US—was scientifically rigorous. The results showed no difference in the incidence of MRSA or VRE colonization or infection events in 10 ICUs implementing the intervention vs. 8 ICUs that followed their existing practices. Notably, some ICUs showed substantial decreases while others showed dramatic increases.
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Categories: Antimicrobial Resistance, Healthcare-associated infections, MRSA
March 18th, 2011 1:43 pm ET -
Catherine Liu, MD
Author – Dr. Catherine Liu
Assistant Clinical Professor, Division of Infectious Diseases, University of California
Methicillin-resistant Staphylococcus aureus (MRSA) – both healthcare- and community-associated – has become an enormous public health problem. MRSA is responsible for about 60 percent of skin and soft tissue infections seen in emergency rooms, and invasive MRSA kills about 18,000 people annually. Clinicians often struggle with how best to treat MRSA, resulting in wide variations in approaches to therapy. The growing clinical impact of MRSA, particularly community-acquired infections, prompted the Infectious Diseases Society of America to develop its first treatment guidelines for MRSA. Charged with reviewing the evidence and developing the guidelines, my coauthors and I aimed to create a framework to help clinicians evaluate and treat uncomplicated and invasive MRSA infections. As with all IDSA guidelines, they are voluntary and are not meant to replace clinical judgment, but rather synthesize the available evidence and support the decision-making process, which must be individualized for each patient.
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Categories: Antibiotic use, BSIs, CLABSI, Healthcare-associated infections, MRSA
March 14th, 2011 1:01 pm ET -
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John A. Jernigan, MD, MS
Author – John Jernigan, M.D.
CDC’s Division of Healthcare Quality Promotion
Today, I am proud to announce that my office is awarding $10 million for new research to five academic medical centers as part of our Prevention Epicenter grant program. This program supports efforts to develop and test innovative approaches to reducing infections in healthcare settings. It is more than research – we are taking novel discoveries and translating them into clinical practice. These efforts save lives.
We founded the Prevention Epicenter program in 1997. CDC staff work closely with academic investigators to discover solutions, and refine them so they can work to prevent infections for all healthcare settings. It has been thrilling over the years to watch the innovations in infection prevention that have come out of this program. Some of our biggest breakthroughs in infection prevention and strategies to save lives have been rooted in research of the Prevention Epicenter program.
Some of the breakthroughs that I have been particularly proud of are:
- using skin antiseptic in routine bathing of patients to prevent HAIs, including the use of chlorhexidine to prevent Methicillin-Resistant Staphylococcus Aureus (MRSA) infections,
- developing cutting edge methods for detecting HAIs such as using computer algorithms to detect bloodstream infections, and
- pioneering a new method for determining the effectiveness of HAI prevention strategies among a large group of hospitals.
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