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
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© MRSAinfections.org 2005
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