Here’s the problem: More than 200,000 patients get infections every year while receiving healthcare in Canada; more than 8,000 of these patients die as a result. Methicillin-resistant Staphylococcus aureus is the most common cause of serious hospital-acquired infections. Its rate increased more than 1,000% from 1995 to 2009. In the United States, MRSA numbers are the same, population adjusted.
Here’s the decades-old solution: Hospitals commonly screen patients for nasal carriage of MRSA. If you test positive, you’re isolated from other patients and treated (if infected) or decolonized (if you’re a MRSA-carrier but not yet sick). In the US, nine states mandate such screening.
Screen and treat seems reasonable enough. However, studies are trickling out suggesting that this is not the way to do it. Instead, they say, decolonize everyone at admission, or at least the “at risk” admissions such as surgery and ICU. This is called universal decolonization.
The prestigious New England Journal of Medicine published a study last summer that found universal decolonization of patients in the ICU was the “most effective strategy” versus screen and treat, or screen and decolonize. Its effectiveness was due to it “significantly reducing” MRSA-positive clinical cultures, and bloodstream infections from any pathogen. The reason, researchers say, is this method gets MRSA as well as other kinds of germs, it gets them right away at admission thus preventing spread to others, and it’s more easily incorporated into regular hospital procedures.
Just today, the British medical journal, The Lancet, published a study (unfortunately, subscription required) saying there’s insufficient evidence to support screening and isolating infected patients. In an interview with the BBC, one of the researchers, Gerd Fatkenheuer, said: “In the haste to do something against the rising tide of MRSA infection, measures were adopted that seemed plausible but were not properly assessed, bundling the effective and harmless with the ineffective and harmful.
With respect to isolating patients he said they found an unintended consequence: “We know for example that isolating patients can result in anxiety and depression and fewer visits by doctors and nurses,” thus lowering the overall standard of care.
And in Canada we have a real-world example of universal decolonization that bears out what the studies are saying. Over a 12 month period, the Vancouver General Hospital universally decolonized all of their 5,000 surgical patients. They found a 39% reduction in the number of surgical site infections, readmissions due to SSIs declined from 4 to 1.25 cases per month, and VGH saved more than $1 million in costs associated with treating patients who develop SSIs.