more on mrsa: Staph infections rampant in US

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*Staph infections rampant*

*Study: 1.2 million hospital patients at risk*

By Judith Graham

Tribune staff reporter

Published June 25, 2007

http://www.chicagotribune.com/news/nationworld/chi-mrsa25jun25,1,1355761.story

As many as 1.2 million hospital patients are infected with dangerous,

drug-resistant staph infections each year, almost 10 times more than

previous estimates, based on findings from a major new study.

And 48,000 to 119,000 hospital patients a year may be dying from

methicillin-resistant staphylococcus aureus (MRSA) infections, far more

than previously thought, the study suggests.

The Tribune obtained the results during the weekend from the Association

for Professionals in Infection Control & Epidemiology (APIC), which is

releasing the report publicly on Monday. The author is Dr. Jarvis,

former acting director of the hospital infections program at the Centers

for Disease Control and Prevention.

The findings come amid mounting public concern about the spread of

antibiotic-resistant bacteria in health-care facilities and community

settings. Medical experts consider the rise of so-called superbugs such as

MRSA, a leading cause of deadly blood infections and pneumonias, one of

the most alarming public health threats in the nation.

" We're hoping this survey is a wake-up call to health-care workers across

America, " said Kathy Warye, the association's executive officer.

It is the largest, most comprehensive survey of MRSA in health-care

facilities to date. It's based on surveys sent last year to 10,000

infection-control practitioners, including doctors and nurses in

hospitals, nursing homes and rehabilitation facilities.

Health-care professionals were asked to select one day between Oct. 1 and

Nov. 10, 2005, and report all known MRSA cases in their institutions. More

than 1,200 hospitals and 100 nursing homes and rehabilitation facilities

responded, supplying data about patients with MRSA infections and patients

colonized with the bacteria.

People colonized with MRSA typically carry it in their nose without being

symptomatic. They're at risk of passing the superbug to others unknowingly

by wiping their nose and then touching a table that a doctor or nurse

later touches, for instance. MRSA can live on surfaces for days or even

weeks.

The new survey confirms what's been observed anecdotally for years -- MRSA

is rampant in health-care facilities.

It found that 34 of 1,000 patients in the survey had active MRSA

infections and that 12 were colonized with the superbug, for a total MRSA

prevalence rate of 46 per 1,000 patients. (In Illinois, the prevalence

rate was 37 per 1,000 patients, based on responses from 74 hospitals and

other acute-care facilities.)

The most widely cited previous study, published by CDC researchers in June

2005, had estimated that the MRSA infection rate at in-patient hospitals

was 3.9 per 1,000 patients. Based on that rate, it estimated that 126,000

patients were infected with the superbug each year.

The new report didn't translate its findings into actual numbers, but

Jarvis outlined a means of doing so to the Tribune. He said it was

important for the public to see the ballpark figures.

The calculation involves 35.2 million people hospitalized in the U.S. in

2005, the latest year for which information is available. Applying the

prevalence rates in the new study, the data suggest that 1.2 million

hospital patients are afflicted with MRSA each year and that an additional

423,000 patients are colonized with the superbug.

This is only an estimate, subject to the accuracy of the numbers reporting

by infection-control practitioners and the limitations of a " single point

in time " snapshot of the data, Jarvis said. Many hospitals don't routinely

test patients to see whether they're colonized with MRSA, he said. Also,

the findings haven't been peer-reviewed, which is standard in scientific

publications.

" Most hospital leaders are paying very close attention to infections

within their institutions. ... But I think this tells us that MRSA is an

even bigger problem than we thought it was, " said , vice

president of quality and patient-safety policy at the American Hospital

Association, after reviewing an advance copy of the APIC report.

Dr. Jernigan, a medical epidemiologist at the CDC and the agency's

lead expert on MRSA, said he " applauded the study " even though he hadn't

examined its results or methodology. He has co-written articles on MRSA

with Jarvis that appeared in leading infection-control publications.

" Everything we're finding is telling us the same thing: MRSA is an

enormous problem in health-care facilities, more needs to be done to

prevent it, and hospitals need to make infection control more of a

priority, " Jernigan said.

The CDC has said at least 5,000 patients die after being infected by MRSA

at surgical sites, in their blood or in their lungs. That's a mortality

rate of 4 percent, assuming a base of 126,000 patients. Using new

prevalence estimates of 1.2 million MRSA patients a year, it suggests

48,000 patients a year may die of MRSA.

There is considerable uncertainty about the mortality rate associated with

MRSA, however, and it may be as high as 10 percent, said Dr. Lance

, director of infectious disease research at ton Northwestern

Healthcare. Using the new estimates, that suggests as many as 119,000

hospital patients a year may be felled by the superbug.

To put that figure in context, the Institute of Medicine has estimated

that nearly 100,000 patients die of 2 million infections acquired in

hospitals every year. MRSA constituted only a portion of those infections

and deaths. The new numbers suggest the actual number of hospital-related

infections and deaths could be much larger.

An important finding in the new study suggests that hospitals may not be

focusing infection-control strategies on the right locations in their

institutions. Though earlier research has indicated intensive-care units,

which often treat patients with compromised immune systems, are hot spots

of infection, this report shows that 67 percent of patients with MRSA

infections were on medical wards.

" This suggests that MRSA has become a problem throughout the institution

and that [hospital staff] may need to look for it beyond the ICU, " Jarvis

said.

The study shows that 77 percent of patients with MRSA were identified

within two days of entering a hospital, making it likely they were

colonized or infected before being admitted. The vast majority of these

patients picked up MRSA during an earlier stay at a hospital or nursing

home, Jarvis said.

On the positive side, there is strong consensus about the steps hospitals

need to take to control MRSA, said Dr. Don Goldmann, a senior vice

president at the Institute for Healthcare Improvement in Boston.

All health-care workers should practice rigorous hand-washing, and all

institutions should have robust programs for disinfecting medical

equipment and patients' rooms, he said. When patients are known to have

MRSA, hospital staff should wear gowns and gloves to prevent transmission.

And patients deemed at risk of carrying MRSA should be screened to

determine where bacterial hot spots are festering.

" Now that the true extent of this scandalously tragic epidemic is known, I

hope that health-care leadership will finally confront it with the

effective means that have always been available, " said ,

president of the Coalition for Patients' Rights in land.

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About MRSA infections

WHAT IS IT? Methicillin-resistant staphylococcus aureus (MRSA) are strains

of staph bacteria that have mutated to become resistant to common

antiobiotics such as penicillin.

WHAT DOES IT LOOK LIKE?

Common signs are red or swollen boils, abcesses and skin lesions.

HOW IS IT ACQUIRED?

Physical contact with infected patients or contaminated surfaces and

medical devices.

HOW CAN I PROTECT MYSELF?

Clean hands regularly. Keep wounds bandaged. Do not share towels or razors.

Sources: CDC; Dr. Barry Farr, professor emeritus, University of Virginia

Chicago Tribune

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