This letter is in response to the Centers for Disease Control and Prevention (CDC) study on Methicillin-Resistant Staphylococcus aureus (MRSA), published this week in the Journal of the American Medical Association. The CDC has posted a fact sheet summarizing this article.
The study showed that the estimated number of people developing a serious (i.e., invasive, such as bloodstream) MRSA infection in 2005 was about 94,360; this is higher than estimates using other methods. Approximately 18,650 persons died during a hospital stay related to these serious MRSA infections. Serious MRSA disease is still predominantly related to exposures to healthcare delivery. About 85% of all invasive MRSA infections were associated with healthcare, and of those, about two-thirds occurred outside of the hospital, while about one third occurred during hospitalization.
The California Department of Public Health (CDPH) is taking this opportunity to urge all healthcare facilities to develop new or review existing policies and procedures on the prevention and control of antibiotic resistant organisms in your facilities. The following references are intended to guide the implementation of strategies and practices to prevent the transmission of MRSA. Additional references, including ones on community-associated MRSA (CAMRSA), are available in the attached document prepared for local health departments.
The CDC has developed recommendations for the control of multidrug-resistant multi-drug resistant organisms (MDROs) such as MRSA and VRE, primarily in acute care hospitals: Management of Multidrug-Resistant Organisms in Healthcare Settings, 2006 available along with additional information.
A practice guidance for the elimination of methicillin-resistant Staphylococcus aureus (MRSA) transmission in hospital settings is available from the Association for Professionals in Infection Control and Epidemiology (APIC). Both of these documents stress that successful prevention and control of MRSA (and other MDROs) requires administrative and scientific leadership and a financial and human resource commitment.
Additional information for long-term care facilities is available at the CDC site.
MRSA has been an issue in healthcare facilities for many years. This latest study warns us that the problem may be more pervasive than we were previously aware. In June 2007, APIC released the results of a nationwide survey of the prevalence of MRSA in U.S. healthcare facilities. Over 1200 healthcare facilities participated, including approximately 1100 hospitals. The total number of patients with MRSA colonization or infection was 8,654, yielding an overall MRSA rate of 46.3 per 1,000 inpatients. The infection rate of 34 per 1,000 inpatients is 8.6-fold higher than that estimated previously by CDC using hospital discharge data. Both the new CDC study and the recent APIC survey, as well as other sources of information, indicate that not only are increasing numbers of patients with severe CAMRSA infections being admitted to hospitals but the CAMRSA strains are increasingly causing healthcare associated infections. Irrespective of the precise numbers, MRSA presents a significant challenge to California healthcare facilities. It is up to all of us responsible for healthcare in California to become informed on these issues, adopt and follow policies and procedures based on evidence-based guidelines such as those above, and provide support to others to do the same.
Healthcare facility personnel other than infection control practitioners should seek assistance on MRSA from their practitioner. The CDPH Licensing and Certification District Office, local health department, or infection control professionals in your community (who may be able to be contacted through APIC chapters) may be able to provide additional assistance if it is needed.
Original Signed by Kathleen Billingsley, R.N.
Kathleen Billingsley, R.N.
Center for Healthcare Quality
Attachment: Summary of MRSA Article and List of On-line Resources