Frank, this is very much an ongoing problem for all Hosptials, Nursing Homes, and Long Term Care Facilities. In our Hosptial, we do place positive MRSA patients in single Isolation rooms and we do flag their record for readmission purposes. We are now testing all patients in ICU/CCU, patients who are readmitted within 30 days, all patients from Nursing Homes/Long Term Care Facilities, and we still don't seem to be winning the battle. Rooms that have had MRSA patients in them are terminally cleaned, that is, the floors, furniture, ceilings and walls. I do believe that the employees should be tested since we are chronically exposed to the problem. MRSA is the reason why I got my husband discharged from our Hospital as quickly as possible and chose to do dressing changes at home. I realize that not everyone has that capability but I certainly recommend it. I even wore a mask at home doing those dressing changes since I am not convinced that my nares would test negative. All facilities need to become very aggressive in order to combat this enormous and very costly problem.

To control MRSA and VRE (the 2 most egregiously out-of-control hospital bugs)he science is overwhelmingly in support of the approach that is advocated by the 2003 guideline published by the Society of Healthcare Epidemiology of America (SHEA). This approach is similar to that which has been successful in Northern Europe, Western Australia and scores of individual institutions around the world. Screening and isolating only a portion of the entire reservoir for spread of these lethal pathogens is shown again and again to result in poor control. As stated in the article, hand washing is far less than optimal and it only takes one healthcare worker to spread these bugs to any number of patients.

Beside the examples cited above, the 2003 SHEA guideline approach is also supported by more than 160 studies, colonization of healthcare workers and the proliferation of community associated MRSA not withstanding. And 14 studies show that the approach is cost effective.

Since healthcare leadership has failed for decades to control MRSA and VRE because they have chosen not to recommend such an approach, it is up to all of us to get it done, either through legislation, regulation or hospitals implementing the approach on their own. The later seems unlikely in light of the decades of failure.

Michael Bennett
President
The Coalition For Patients' Rights

Implementing the SHEA guidelines--indeed, implementing any processes in today's hospitals--can be incredibly difficult. The VA Pittsburgh Healthcare System did an experiment in partnership with the CDC in increasing isolation precautions in MRSA rooms. As a baseline, they every single patient on this unit for MRSA upon admission, transfer and discharge. What made the difference this time was that the hospital adopted process improvement ideas from Toyota. Layer after layer of problems were addressed, resulting in an 85% reduction in MRSA on that unit within 6 months. Since then, the VA has adopted similar process improvements (including screening) nationwide.
I visited Hvidivore Hospital in Denmark last November to see how seriously they take MRSA. They treat it like we used to treat TB in this country, as a public health threat. They had maps with pins in them denoting which strain of MRSA was where. Public health nurses pay house calls to do the detective work. What's the point of decolonizing one person in the family if everyone else in the family has it and will reinfect each other again? Getting to the bottom of MRSA requires persistence, detective work, education...and funding!
And oh, when it came to "terminal cleaning" of a room at the Denmark hospital, after they finish, they deploy a robot that fogs the room with hydrogen peroxide and silver ions, which kill MRSA in every nook and cranny.
Like so many things in the US, we have let this problem get away from us, and it will be very expensive and require a culture change to remedy.
The VA case is written up in my book, and I'd be glad to share my photos from Denmark.
Naida Grunden
Author, The Pittsburgh Way to Efficient Healthcare

Can you please site the study in Infection Control and Hospital Epidemiology. Thanks.

More ... offers SHEA guidelines.

While I certainly agree with the assessment that getting institutions to impliment and then comply with with any infection control guidleine is difficult, I reject the argument that cost is truly a barrier. In the case of the 2003 SHEA guideline for control of nosocomial MRSA and VRE, 14 studies showing the cost effectiveness of that approach should be enough for any institution to dispense with that argument.

Hospital administrators look at sources of revenue above anything else. Infection control of any kind does not generate revenue. This is the primary reason why infection control has been neglected in US hospitals which has resulted in the unnessesary injury and death of legions of patients over the past several decades..

When it comes to infection control guidleines themselves, most people would be shocked to learn of the politics involved in these policy decisions. And this is not just relegated to politically charged issues such as HIV or Global Warming. The CDC policy towards control of MRSA and VRE has not been spared this unfortunate dynamic. Detailing this failure is too lengthy a topic for this forum. Perhaps Jacob Bronowski said it best when he said "No science is immune to the infection of politics and the corruption of power."

The web site listed above is to a joint position paper published by a recent group from SHEA and IDSA. It is not the 2003 SHEA guideline for control of nosocomial MRSA and VRE. Here is the URL for the 2003 SHEA guideline:
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Michael Bennett