Guidelines For Preventing MRSA And VRE

Frank Bailey
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Posted by Frank BaileyApril 13, 2009 3:53 PM

Thanks to Michael Bennett for his comment and link to the 2003 SHEA Guidelines for Preventing Nosocomial Transmission of Multidrug-Resistant Strains of Staphylococcus aureus and Enterococcus. The Guidelines present a scholarly look at Antibiotic-resistant pathogens and their important and growing threat to the public health.

The Guidelines recognize that infectious diseases are in aggregate the leading cause of human death worldwide and the third leading cause of human death in the United States. More than 70% of the bacteria that cause hospital-acquired infections are resistant to at least one of the drugs most commonly used to treat these infections.

The Guidelines make recommendations in nine critical areas:

  • I. Surveillance Cultures to Identify the Reservoir for Spread
  • II. Proper Hand Hygiene
  • III. Barrier Precautions for Patients Known or Suspected to Be Colonized or Infected With Epidemiologically Important Antibiotic-Resistant Pathogens Such as MRSA or VRE
  • IV. Antibiotic Stewardship
  • V. Decolonization or Suppression of Colonized Patients
  • VI. Education Programs
  • VII. Adequate Methods of Disinfecting
  • VIII. Computer Alerts for Colonized Patients
  • IX. Dedicated Noncritical Patient-Care Equipment

Where these recommendations have been implemented, the incidence of MRSA infections has shown a drastic fall. In Denmark, the prevalence of MRSA blood isolated reached a peak of 33% in the 1960’s, but declined steadily after introduction of a policy to control transmission, and has been maintained at less than 1% for 25 years. In Finland and the Netherlands, the prevalence of MRSA has been maintained at lower that 0.5%.

Why is it that hospitals in the United Stated have been unable to achieve these results? After all, we are the richest country in the world. It is well past time for our hospitals to implement these measures and take their heads out of the sand.

9 Comments

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Pat Gardiner
Posted by Pat Gardiner
April 13, 2009 4:28 PM

The Dutch, Danes and Finns have done well.

Their relative success in beating MRSA lies in the identification of livestock farming, especially pigs, as being a major risk factor.

The Dutch and the Danes have massive pig industries. About five years ago the Dutch spotted a link between MRSA and pig farming. They actually flew to the US, California and even before peer review, and warned the US of their findings. In 2005, at my own expense, I followed with a similar message based on my own research.

The Dutch, Danes, Belgians and most other continental Europeans, unlike the British and Irish, Canadians and US, test all veterinary, pig and pork workers in all non emergency situations before allowing them unrestricted access to their hospitals. The tests are thorough and where necessary de-colonisation in quarantine arranged.

The Dutch call it "search and destroy"

The problems with pigs and pork are well documented from serious scientists, it remains one of the greatest scandals that the "English Speaking nations" have ignored or tried to cover up the problem.

The British Isles and Canada are in a desperate situation with livestock related zoonotic diseases ravaging their hospitals.

The United States will join them unless really urgent measures are taken. Fortunately, in this instance, the lively independent US media and non-government controlled health system are starting to move quickly, but not without opposition from pork production industries in denial.

Your media deserve great praise.

MRSA st398 has reached US pigs and pork. It is time to protect your hospitals by selective screening of patients at high risk of being carriers.

Your friends went to enormous trouble to warn you of a coming storm. Please make all the effort worth while.

--
Regards
Pat Gardiner
Release the results of testing British pigs for MRSA and C.Diff now!
www.go-self-sufficient.com and http://animal-epidemics.blogspot.com/

Frank BaileyInjuryBoard Attorney Member
Posted by Frank Bailey
April 13, 2009 4:46 PM

Pat, Thank you for your comment. I looked at your blog. To anyone who is seriously interested in this pending epidemic of MRSA and VRE...go to Pat's blog. He has some startling information.

Dr Kadiyali M Srivatsa
Posted by Dr Kadiyali M Srivatsa
April 14, 2009 4:18 PM

I have published a poster to help educate doctors and nurses to learn about prevention and method to prepare skin. Now the bacteria are rapidly becoming resistant to antiseptic, excessive hand washing has problem of dry skin and increased colonization.
Please download and pass it on & visit my website: More ...

Jane AkreInjuryBoard Staff
Posted by Jane Akre
April 14, 2009 9:19 PM

What do the experts think about the use of antibiotics in the feed we give to farm animals? Might that be contributing to antibiotic resistance? It seems to make sense.

Frank BaileyInjuryBoard Attorney Member
Posted by Frank Bailey
April 15, 2009 8:23 AM

Jane, Thanks for your comment. Take a look at More ... in today’s New York Times. There is mounting evidence that agricultural use of antibiotics in livestock that are not sick contributes to the problem, but politics has interfered. The large agricultural lobby has so far kept government from doing something about this. How many people will have to die before we wake up and ban the use of these antibiotics.

Dr Kadiyali M Srivatsa
Posted by Dr Kadiyali M Srivatsa
April 15, 2009 9:00 AM

Yes, animal feed has already caused the damage and it will be difficult to reverse this process. Microbiologists have been warning us since 1960s, but doctors who were prescribing antibiotics or surgeons who operated did not take notice. Now they think these bacteria will forget how to combat antibiotics if they stop using them. They are not telling you this is are not a permanent solution. We also know the problem associated with excessive hand washing and using antiseptic hand wash.

These bacteria are already colonized in water, soil and our sewers. Using strong disinfectants and cleaning solutions (shampoo) encourage their growth by killing good bacteria. Today CBS news talks about acne, just try telling teenagers not to use antibiotics and chemical wash on their face.

We must avoid getting infected; doctors and nurses must stop introducing them into human body. By reducing contaminated plastic disposable hospital waste, we can reduce colony count in hospitals. I have tried to bring in changes, informed major device manufacturers, corporations and politicians but they do not care. They have wasted time and money cleaning hospitals but now the infection rate has increased.

There is more to this problem than what you read in the media, so please check out my website (More ... ); you will find all the information you need.

Jane AkreInjuryBoard Staff
Posted by Jane Akre
April 15, 2009 10:23 AM

Frank- Thanks for sending me to the NYT for the article. Today there is another very good one on the overuse of antibiotics.

So what can consumers do?

1- Find doctors who do not overprescribe antibiotics

2- Organic agriculture does not use antibiotic laced feed. Because it is not intensive agriculture, it returns to a more sustainable and responsible way to grow food, and yes is less "modern" and all that that brings. Animals are not crowded together in sick conditions, so they don't need the routine antibiotics.

Too expensive? The Environmental Working Group has a list of which commercially grown foods are the most polluted (apples for one) and organic meats are a safe bet you are not going to get antibiotics in the feed for your animals. Same thing for organic milk- standards as they are now, do not allow the use of antibiotics in dairy cows producing organic milk.

BTW- our new agriculture secretary is a friend of factor or intensive farming, so that has had many safe food groups disappointed with his appointment. Organic Consumers Association is an excellent resource for news on the food front.

3- Always take probiotics if you are prescribed antibiotics. You can find it in the health food store.

Lastly- I'm not sure, anyone chime in here, how to dispose of antibiotics when they are no longer useful. Surely flushing them or throwing them into a landfill is not responsible. Can you hang onto them for a couple of years so they lose their potency? Some help here and thanks!!
Jane Akre

Articles below:

More ...

More ...

Dr Kadiyali M Srivatsa
Posted by Dr Kadiyali M Srivatsa
April 15, 2009 12:10 PM

Ms Akre, Simple NATURAL yoghurt (Lactobacillus acidophilus)will do. Commercial probiotics are muted bacteria, expensive and I do not think we must encourgae companies to mute any living organism or play with their genes. Now with the advent of antibiotic resistant strain it difficult to say how this will help us.

C Diff & Enterococci are behaving differently than they used to. There are studies where people with C Diff were given faecal enema when all treatment failed. More ...

Antibiotic resistant bacteria is now not one or two strains, there are some ten strains. It is like a burgler entering a house with a loaded gun, once he dies, the gun will be picked up another person, who will go mad and shoot indiscriminatly. This is how a harmless bacteria will become letahal lethal super bugs. Please watch this presentation (slightly old), but will tell you more. More ...

How to dispose of antibiotics? Good point but no answer. In India there are thousands of companies producing antibiotics, they dumped the antibiotics in rivers, now the highest colonisation of antibiotic resistant bacteria is their rivers. Sweden stopped importing Antibiotics from India. More ...

Disposing Antibiotics: May be throw them in the open fire or barbeque but do not flush them in your toilet or kitchen sink. Antibiotics (not creams or ointments)are only proteins (enzymes) and sugars.

About doctors, difficult to answer, We know the reason bacteria develops antibiotic resistance when the dose prescribed is low or the patient does not take treatment as advised (often 5-7 days), most patients stop taking antibiotic as soon as they feel better (after 3 doses).

Michael Bennett
Posted by Michael Bennett
April 17, 2009 1:07 AM

Antibiotic stewardship is undoubtedly an important component toward slowing the cycle of resistance. However, it's essentially important for the public to realize that the majority of infections that are caused by antibiotic-resistant bacteria occur in health care settings. In the case of MRSA, the most recent data suggest that approximately 85% of MRSA infections in the United States are health care associated. With VRE the rate is closer to 100%. While the overwhelming majority of C. difficile infections still occur in health care, the number of community associated C.diff infections seem to be growing, but there is much debate about this.

It is also very important to understand that while hand washing is recognized as an essential component in infection control, there is a plethora of data which show that even with aggressive hand washing campaigns hospitals have been unable to stem the tide of infections unless active detection and isolation (ADI), i.e. screening and contact isolation, was added to the program.

Many health care leaders have fought against routine use of ADI. After having studied this issue for the past five years, I find the position of those naysayers untenable and in many instances disingenuous. For any scientist to take a position on controlling the spread of infectious disease while ignoring the boat load of data which support routine ADI is an abrogation of the most fundamental responsibility of anyone who is involved in public health.

For more than 40 years health care leadership virtually ignored the steady increase in the rate of MRSA and for the past 20 years the parallel increase in VRE. Can anyone calculate the amount of unnecessary suffering and death that this failure of leadership has enabled? Can anyone remain un angered by this?

Irresponsible use of antimicrobials in agriculture or in clinical medicine is a long standing problem that must end. Fighting against the use of scientifically proven methods of infection control in health care is unforgivable.

Over the last 4 years much progress has been made in getting hospitals to become more focused on infection control and implement evidence based best practices, such as those advocated by the 2003 SHEA guideline, which also advocates good antibiotic stewardship. This progress has been driven by consumer activists all across the country, and that is a wonderful testimonial to America. But we need more of the same in order to increase the pressure on health care and thereby increase the momentum of progress. We can not simply wait for leadership to accomplish that which they should have initiated decades ago. Consumers in every state should be prodding their representatives to initiate legislation mandating the 2003 SHEA guideline. This, I believe, should be the priority. I'm not downplaying the importance of speaking out against the self interest of the agricultural industry for the irresponsible overuse of antibiotics which is contributing to the emergence of resistance. This must also be done. But stopping the spread of these diseases to patients of all ages and conditions in our hospitals, nursing homes and dialysis clinics is the front line priority.

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