Hand Hygiene Prevents Infections

Some Metro Detroit hospitals will start swabbing the noses of arriving patients to test them for one of the most problematic bacteria, in response to the growing threat of drug-resistant infections.

Those patients found carrying Methicillin-resistant Staphylococcus aureus (MRSA) -- even if they don't have infections -- will be isolated in rooms where hospital staff take special precautions (such as wearing gowns and gloves) to keep the organism from spreading.

"We know that isolation works," said Paula Keller, technical director of epidemiology at Beaumont Hospital in Royal Oak. "It limits transmission, or reduces it."

Keller and doctors at other health systems say they are aggressively screening in light of the increased rates of MRSA infections and the results of recent studies that show early screening and isolation works.

Faced with a rise in hospital-acquired infections that risk the lives of patients and cost billions of dollars annually to treat, hospitals across the country are aggressively trying to lower infection rates.

According to the Centers for Disease Control and Prevention, health care-associated infections account for an estimated 1.7 million infections and 99,000 associated deaths each year in American hospitals. Hospitals are particularly concerned about containing the spread of infections by drug-resistant bacteria like MRSA, which first emerged in the U.S. in 1968 and is especially difficult and costly to treat because of its resistance to antibiotics.

Veterans Affairs hospitals in Ann Arbor and Detroit must start screening every patient for MRSA by September, in response to a mandate from the Department of Veterans Affairs this spring that requires all 155 VA medical centers in the U.S. test for the bacteria. VA hospitals have been phasing in testing since the spring in intensive care units, said Dr. Carol Kauffman, chief of infectious diseases at the Veterans Affairs Ann Arbor Healthcare System.

Beaumont Hospital, Royal Oak started screening open-heart surgery patients for MRSA in July, and in September will begin testing patients deemed a high risk for carrying MRSA and another organism called Vanocomycin-resistant Enterococci (VRE). High-risk patients include those transferred from other hospitals and patients who live in nursing homes or assisted living facilities.

Henry Ford Health System has been screening patients in intensive care units for MRSA for about three months, and will begin testing surgical patients in September. The health system is planning to screen more high-risk patients in the future.

The infection is costly for hospitals. Each case of a MRSA infection adds about 10 days to hospital stays and $30,000 to $60,000 in direct costs per patient, said Dr. Marcus Zervos, division head for infectious disease and director of infection control for the Henry Ford Health System.

Many people carry bacteria like MRSA normally in their nose and throat. Most of the time the bacteria aren't a problem to the person carrying it or the people around them, unless they are undergoing surgery or are ill.

Most efforts to prevent the spread of infections in hospitals have focused on making contact with patients more sterile, like with judicious hand-washing. But more hospitals across the country are screening patients with no symptoms of infections.

The process has generated a national debate over whether it's really necessary and actually works.

"Strict hand hygiene is what prevents infection," said Dr. George Alangaden, infectious disease specialist at Harper University and Karmanos Cancer hospitals. He notes the science is still undecided about the benefits of aggressive screening of MRSA, and says it has a number of downsides.

Focusing on one organism can mean missing others that could cause infection, Alangaden said, and testing and isolating patients carrying MRSA costs hospitals a lot of money. At the VA in Ann Arbor, it will reach into the hundreds of thousands of dollars per year for the test and the extra gowns and gloves for patients in isolation, Kauffman said.

But doctors who support aggressive screening argue that it's needed. "What we know for sure is that the status quo is not working," Zervos said