An overview of the MRSA problem in the USA
The Centre For Disease Control (CDC) estimate that there are
about 90,000 deaths per annum related to Hospital Acquired
Infections (HAI's) most commonly MRSA, also known as Staph
infections. About one in twenty Americans will contract a HAI
during a stay in hospital but most states are not required by
law to provide this information. Apart from the incalculable
human cost the CDC estimate that this adds $5 billion to the
national healthcare bill. Other estimates put the real figure at
twice this amount. States where it is mandatory to supply this
information include Illinois, Pennsylvania, Missouri, Florida
and New York.
A recent report from one of these states, Pennsylvania , came up
with the following figures. Number of hospital-acquired
infections in 2004: 11,668. Number of deaths associated with
hospital-acquired infections: 1,510. Extra number of hospital
days associated with these infections: 205,000. Additional
hospital charges: $2 billion. The survey was carried out by the
Pennsylvania Health Care Cost Containment Council (PHC4).
Incredibly, these figures are almost certainly understated, as
sixteen hospitals reported no infections at all! It is all the
more unbelievable when it is a matter of record that the
hospitals billed for some 115,631 hospital acquired infections
whilst only reporting 11,668!
If these figures are mirrored ac ross the country, the scale of
the problem would beggar belief.
The Archives of Internal Medicine, estimate that between 40
percent and 60 percent of hospital MRSA infections are resistant
to first-line antibiotics and the percentage is increasing. This
is based on examined records from 7 million hospital stays at
one-fifth of U.S. hospitals.
As in other countries, MRSA infections occur most frequently
among persons in hospitals and healthcare facilities (such as
nursing homes and dialysis centres) who have weakened immune
systems. There is a second type of MRSA infection and it is
called Community Associated MRSA (CA-MRSA) and d ata from a
prospective study in 2003, suggests that 12% of clinical MRSA
infections are community-associated, but this varies by
geographic region and population. This is an unusually high
figure when compared to a country like the UK , which has a high
rate of MRSA but a very low incidence of CA-MRSA. The CA-MRSA
infections are defined as infections that are acquired by
persons who have not been recently (within the past year)
hospitalised or had a medical procedure (such as dialysis,
surgery, catheters) are know as CA-MRSA infections. MRSA
infections in the community are usually manifested as skin
infections, such as pimples and boils, and occur in otherwise
healthy people. There have recently been clusters of CA-MRSA
skin infections involving Alaskan Natives, Native Americans, men
who have sex with men, and prisoners. Factors that have been
associated with the spread of MRSA skin infections include:
close skin-to-skin contact, openings in the skin such as cuts or
abrasions, contaminated items and surfaces, crowded living
conditions, and poor hygiene.
The CDC is implementing a range of measures to prevent the
spread of MRSA:
- CDC is collaborating with state health departments and
academic medical centres to identify and promote effective
strategies to reduce MRSA transmission in healthcare and
community settings.
- CDC has launched a national evidence-based educational
Campaign to Prevent Antimicrobial Resistance in Healthcare
Settings .
- CDC is conducting proficiency testing to assist public health
laboratories in determining the antibiotic susceptibility of
staph bacteria.
- CDC is building a national resource library of MRSA (PulseNet)
to identify genetic patterns or relationships among different
types MRSA that could be used to take public health action.
- CDC is researching the role of staph toxins that may provide
answers to questions about why some MRSA infections are more
invasive, or lead to rapid death.
But without an accurate picture of the scale of the problem, how
successful can their efforts be?
The UK has a big MRSA problem but it is at least serious in its
attempt to tackle it. One of the most effective approached taken
so far is the mandatory requirement for all hospitals to publish
MRSA infection data. This has been successful in focussing the
politicians and health managers on the MRSA problem. Results are
being seen already. More successful again are the Dutch, who had
a big MRSA problem but now have it under control. They took it
very seriously, very quickly and implemented a rigorous hygiene
and segmentation protocol nationwide.
The US needs to follow suit but not everybody thinks so. The
Governor of California has just recently vetoed a bill which
would have required public disclosure of hospital infection
rates! I guess he's not ready to say hasta la vista to the
superbugs just yet!
There is a public campaign underway and you can join their
efforts at www.stophospitalinfections.org