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Decline In Most Serious MRSA Infections, More Work To Be Done

Posted on by CDC's Safe Healthcare Blog
Alexander J. Kallen, MD, MPH
Alexander J. Kallen, MD, MPH

Author — Alex Kallen, MD, MPH
Medical Epidemiologist
CDC Division of Healthcare Quality Promotion

Few people would disagree with me that reducing the number of devastating healthcare-associated methicillin-resistant Staphylococcus aureus (MRSA) infections continues to be important. We now have some encouraging results from CDC’s Emerging Infections Program/Active Bacterial Core Surveillance system (ABCs) that MRSA infections acquired in the healthcare setting are on the decline. This important laboratory-based surveillance system has tracked rates of serious invasive MRSA infections since mid-2004 in nine diverse metropolitan areas in the U.S.

A recent analysis of data has shown about a 28% decrease in invasive MRSA infections that had onset in the hospital from 2005 through 2008. Decreases in infection rates were even larger for the subset of patients with bloodstream infections. Even more interesting to me, was a 17% drop over the same time period in invasive MRSA infections that had onset in the community but occurred in people with recent exposures to healthcare settings.

Although the reduction of these invasive infections was substantial, the reasons behind the decreased rates are not completely clear. The fact that rates fell more in hospitals than outside of hospitals might argue that at least some of the drop was due to MRSA prevention activities that are going on in those facilities. As most of the infections captured by this surveillance system were bloodstream infections, device-specific prevention activities like the implementation of CDC Healthcare Infection Control Practice Advisory Committee (HICPAC) evidence-based central line insertion practices could explain some or all of this decrease.

Another important point raised in this study is the increasing role of state health departments in these issues. This surveillance system is based at state health departments and demonstrates the important contribution of state and local health departments in the prevention of healthcare-associated infections.

This research complements data from the National Healthcare Safety Network (NHSN) that found rates of MRSA bloodstream infections fell nearly 50% from 1997 to 2007. Taken together, these studies provide even stronger evidence that rates of these infection are truly falling in the United States. While MRSA remains an important public health problem and more remains to be done to decrease rates of these infections further, this decrease in serious MRSA infections is welcome and encouraging news.

Posted on by CDC's Safe Healthcare Blog

13 comments on “Decline In Most Serious MRSA Infections, More Work To Be Done”

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    USA surveillance data done in 2003 :Estimated CA-MRSA Prevcalence of 1.3% in the community ( Clin Infect Dis 2003; 36:131-139), but among Emergency room patients with Skin Soft tissue infection is quite high average out to be 59% ( Moran GJ for Academic Emergency Medicine 2005), do you have newer data of it prevalence in various communities in USA or Europe and other countries?

    I am a hospice nurse and am required to bring my computer and phone with me for all calls to patients inorder to chart while with the pt and to answer and place calls for patient care. I am very concerned about this practice because of the inability to clean these items. My solution has been to chart in my car after cleaning my hands. If i use my phone I isolate it or clean it with clorox wipes between pt calls and to keep it from contaminating other items I carry. With more and more electronic charting the lack of information about these items as sources of spreading infections surprises me.

    Hi thanks for this article -was very informative – Im a GP from England MRSA surveillance over hear is overseen by the NHS – ill be sure o pass this article on to my collegues

    I had no idea how scary this could be. I wish I could get other articles on such disease not well known by the majority of us.

    We do have data on the extent of MRSA specific interventions in the catchment areas for the time period in question and this will be the subject of an upcoming paper. The bottom line is that many facilities had very active MRSA prevention programs but few employ all of the first line interventions recommended in the HICPAC MDRO guideline. In addition, although we did not ask about interventions involving coordinating care between LTC and acute care this is the focus of a large number of efforts that are currently in place.

    Alex Kallen, MD, MPH

    Pretty nice post. I just stumbled upon your blog and wanted to say that I have really enjoyed browsing your blog posts. In any case I’ll be subscribing to your feed and I hope you write again soon!

    Dr Kallen,
    I am so happy to hear of this reduction of invasive MRSA. The CDC is doing tremedous work in this area. My questions are…

    1. What are “invasive” MRSA infections? It was well known that CLABSIs have been reduced with the use of preventative “bundles”. Did UTIs, SSIs and pneumonia MRSA infections get reduced too? These three that I just named are the most common Hospital acquired MRSA infections and any or all of them can result in horrible suffering and disability and sometimes death. Could you provide a list of which infections were included as “invasive” in the data collected for this study?

    2. What preventative steps did these hospitals use to produce this reductions? This seems to be the most important part of any study…the path to the positive result. We want to be able to continue this success.

    8 of the 9 metropolitan areas that were included in this study were in States that require public reporting. It is my guess that because of that requirement, these hospitals have aggressive MRSA prevention programs, including Active Detection and Isolation in some part or form.
    Please continue the great work toward elimination of MRSA for all of the US. My belief is that CDC recommendations need repriortizing and that ADI needs to be recommended early in Tier one recommendations for MRSA prevention.
    Maureen Spencer’s earlier comment here is an excellent example of the success of ADI.

    The latest infection I spotted was early in the AM with (4) four red streaks from my middle finger bite. Went to the very small hospital ER. By the time I went into the back, of course checking if I had health insurance, my middle finger where a bug bite bit me was (3) times it’s size. The arm was growing more streaks, the original one was 2 1/2 inches from my right arm pit. Being a heart patient, I did not need this stress. The assistant/nurse, no idea went out and corresponded with the MD, the checked the computer and she came back with a needle and numbing, of course I requested the numbing of the finger as it felt like it was going to exploid. They haggled with me on antibotics and said, you have a infection of the lymph noides…….Just say blood poisioning from bug bite (to myself). Was handed a piece of bandage, given a cipro 500 tablet and a rx for the pharmacy. It was night time, no drug store was open after 8 pm………….as I was walking out in total shocked how I waited over 4+ hours just to get in, there where no high emergencies at the time. Ethics, do no pain??? If this is MRSA, Northern Florida needs bi-weekly or monthly spraying on all grass/trees. I understand Type O people get bit more than other blood types…your the expert. You Have Your Hands Full-Thank You So Much!! Just a retired typist from Washington, DC, miss you guys.

    We initiated a MRSA and Staph aureus eradication program in July 2006 for all our inpatient surgical patients. We obtain a nares screen using rapid PCR technology to get results back in one hour. This is done during their pre-admission testing visit. If found to be positive, a decolonization protocol (mupirocin ointment to nares and body wash with chlorhexidine for 5 days before surgery) is ordered by the Nurse Practitioner. We experienced a 60% reduction in Staph aureus surgical site infections the first year. We have found a 4% MRSA colonization rate and 23% sensitive Staph aureus in our patient population. If they are colonized with MRSA they have their surgical prophylaxis adjusted (to Vancomycin). If more hospitals adopted this program and delivered the appropriate surgical prophylaxis to MRSA patients (rather than give Cefazolin), and decolonized and educated the patients – we would have less surgical site infections.

    We recently published our program and results in the August issue of the Journal of Bone and Joint Surgery. 2010;92:1820-1826

    I am a grad student in a Health Law and Policy Program. I had no idea how scary this could be until I was assigned to design a MRSA surveillance and evaluation program for a small town. I am glad the numbers are down. Good Job! CDC!

    Can you tell us which IC efforts were used and whether any of these efforts involved cooperation between LTC and hospitals?

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