Maryn McKenna

Journalist and Author

MRSA research round-up: hospitals, vitamins, pets

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Because I’ve been so behind, there’s so much to cover! So let’s dive in:

In today’s Archives of Surgery, researchers from Seattle’s Harborview Medical Center report that one simple addition to the routine of caring for trauma patients made a significant difference to the patients’ likelihood of acquiring a hospital-associated infection: bathing them once a day with the antiseptic chlorhexidine (in an impregnated wipe). Patients who were bathed with the antiseptic wipe, compared with patients wiped down with an inert solution, had one-fourth the likelihood of developing a catheter-related bloodstream infection and one-third the likelihood of ventilator-associated MRSA pneumonia. Cite: Evans HL et al. Effect of Chlorhexidine Whole-Body Bathing on Hospital-Acquired Infections Among Trauma Patients. Arch Surg. 2010;145(3):240-246.

How important are hospital-acquired infections? Here’s a piece of research from a few weeks ago that I sadly failed to blog at the time: Just two categories of HAIs, sepsis and pneumonia, account for 48,000 deaths and $8.1 billion in health care costs in a single year. Writing in the Archives of Internal Medicine, researchers from the nonprofit project Extending the Cure analyzed 69 million hospital-discharge records issued in 40 states between 1998 and 2006. Hospital charges and number of days that patients had to stay in the hospital were 40% higher because of those infections, many of which are caused by MRSA — and all of which are completely preventable. Cite: Eber, MR et al. Clinical and Economic Outcomes Attributable to Health care-Associated Sepsis and Pneumonia. Arch Intern Med. 2010; 170(4): 347-53.

 What else could reduce the rate of MRSA infections? How about Vitamin D? South Carolina scientists analyze data from the NHANES (National Health and Nutrition Examination Survey 2001-2004), a massive database overseen by the CDC, and find an association between low blood levels of Vit. D and the likelihood of MRSA colonization. More than 28% of the population is Vitamin D deficient. MRSA colonization is increasing in the US. Can giving Vit. D decrease MRSA carriage? More research needed. Cite: Matheson EM et al. Vitamin D and methicillin-resistant Staphylococcus aureus nasal carriage. Scand J Infect Dis. 2010 Mar 8. [Epub ahead of print]

And finally: Who else carries MRSA? Some unlucky pet owners have found that animals can harbor human strains, long enough at least to pass the strain back to a human whose colonization has been cleared. So it makes sense to ask whether humans who spend time with pets are carrying the bug. Last month’s Veterinary Surgery reports that the answer is Yes. Veterinarians are carrying MRSA in very significant numbers: 17% of vets and 18% of vet technicians at an international veterinary symposium held in San Diego in 2008. Cite: Burstiner, LC et al. Methicillin-Resistant Staphylococcus aureus Colonization in Personnel Attending a Veterinary Surgery Conference. Vet Surg. 2010 Feb;39(2):150-7.

Brilliant entrepreneur asks: “So why CAN’T you fix this?”

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Constant readers, you’ll note that posting has slowed down a bit: I am deep into a chapter that is giving me some difficulty. (And I seem to be playing holiday host to an unexpected bout of bronchitis. I’m sure I didn’t need both lungs…)

But here’s something that crossed my monitor this morning, and it’s worth looking at. Sir Richard Branson, founder of Virgin Air and many other extremely successful entrepreneurial efforts. has accepted a post as vice-president of the Patients Association, a nationwide nonprofit that advocates for hospital patients in the UK. Speaking up in his new position, Branson gave an interview to the BBC in which he talked about hospitals’ failure to curb MRSA:

It feels like they have tinkered with the problem rather than really got to the heart of the problem. The hospitals are there to cure people. They are not there to kill people.

It’s a marvelous interview — read the whole thing, it’s not long — because it’s such a breath of fresh air. Branson is an outsider to health care, but he knows how to make businesses work. And as the head of an airline, he’s extremely familiar with what we in the US call “never events”:

Sir Richard says the health service could learn a lot from the airline and rail industries on how to avoid mistakes.”In the airline industry if we had that kind of track record we would have been grounded years ago,” he said.”In the airline industry if there is an adverse event that information is sent out to every airline in the world. And every airline makes absolutely certain that that adverse event doesn’t happen twice.”

So his advice is brutally practical: Health care workers carry MRSA? Screen and swab them. Workers are positive for MRSA? Treat them, and take them out of direct patient contact for two weeks. That costs money? Spend the money: It’s less costly in the end than killing your patients.

MRSA in newborns on Prince Edward Island: HA? CA? Matters?

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There’s been a running story for several weeks now about the Queen Elizabeth Hospital on Prince Edward Island (home to mussels and Anne of Green Gables). The hospital struggled earlier this year with an outbreak of MRSA and a second outbreak of VRE among adult patients. It got those under control, but since earlier this month has been dealing with a new outbreak of MRSA in its newborn nursery, according to the PEI Guardian:

Nine newborns and one mother have now tested positive for MRSA. Five of those nine cases can be connected to the same source. (Byline: Wayne Thibodeau)

The stories are detailed, for a small paper — they go into depth about the cleaning measures the hospital is taking — and yet they don’t answer the questions that we here want to know. Does “tested positive” mean colonized or infected? Does “connected to the same source” mean they all have the same strain, or does it mean there is an epidemiologic link?

In the latest news (Tuesday’s paper and online edition), the hospital reports that it is doing nasal swabs on more than 300 staff, with the intention to do a 7-day decolonization regimen on anyone who turns up positive. They won’t however, disclose the source when they find it — though, again, it’s not clear whether that means not identifying the staffer (appropriate) or not admitting that it is a nosocomial outbreak (inappropriate and at this stage lacking in credibility):

Rick Adams, CEO of the Queen Elizabeth Hospital, said about 290 staffers have already been screened.
“In terms of the test results, we’re not going to be making anything public,’’ Adams told The Guardian.
“We want to make sure the environment here is supportive of staff and create a climate where they can feel comfortable and open to come forward and be screened knowing that any results will be kept strictly confidential.’’
Adams said he realizes a solid argument can be made that the public should be informed if the source is found and that source is a staff member.
But he said the public should also realize the hospital is doing everything it can to prevent a further spread of the superbug.
“The staff are under enormous pressure. They feel like they are under a microscope.’’ (Byline: Wayne Thibodeau)

Some readers may know that it is outbreaks among newborns that have demonstrated that the designations “community-associated” and “hospital-acquired” are passing out of usefulness. There have been several MRSA outbreaks in newborns and their mothers in the US (in New York City, Houston, Chicago, Los Angeles and Houston again because Baylor College of Medicine has been particularly alert to this) that were clearly nosocomial, and yet when the microbiology was done, were found to be caused by community strains.

Why does this matter? Well, for the PEI hospital, it may not: They have an outbreak, it appears to be nosocomial in nature, and whether it is HA left over from their earlier outbreak, or CA that came in via a health care worker or a pregnant woman, mostly affects what drugs they give the children and mothers if those patients do in fact have infections. And for those of us who are primarily concerned with nosocomial infections, the distinction may also feel not-relevant: Failures of infection control are failures of infection control and should not happen period full stop.

But for those of us who are are also interested in the natural history of this perplexing bug, the answer to what is going on at the Queen Elizabeth will be an important piece of information, because it could underline that the distinction between HA and CA is becoming increasingly artificial. The epidemics are converging.