Going Overboard With MRSA Screening?
Could it be hospitals aren't backing down from unreasonable and unsustainable infection control guidelines when aiming to prevent MRSA transmission in healthcare facilities? That's the question pondered by Michael B. Edmond, MD, MPH, MPA, professor of internal medicine, epidemiology and community health, Virginia Commonwealth University Health System, Richmond during a symposium held Tuesday afternoon at ASM.
Dr. Edmond spoke on safety issues related to contact precautions taken by hospitals with active surveillance programs for methicillin-resistant Staphylococcus aureus (MRSA). "Colonized patients bear all of the burden but get none of the benefit," he explained. For example, at hospitals requiring pre-admission screens, patients with no insurance coverage are often forced to bear the financial burden.
Dr. Edmond's facility has focused on decreasing all infections to an irreducible minimum via a horizontal approach. That includes these three principles:
- Implement evidence-based non-pathogen specific interventions.
- Monitor/provide feedback on compliance.
- Provide feedback on implementation.
The Virginia Commonwealth University has examined alternatives to pre-admission screening. One approach has been to employ roving hygiene observers. The university employs college and grad students who are trained to observe compliance (at an annual cost of $21,000). Compliance in 2008 was estimated at 87 percent.
The speaker also reminded participants in Tuesday's session of the three most common points of patient contact:
- hands/wrists,
- sleeves, and
- stethoscopes.
He advised hospital administrators to take an approach embraced by many hospitals in the United Kingdom: Be bare below the elbows. This translates into:
- short sleeves,
- no watches,
- no jewelry except wedding bands,
- no neck ties, and
- no white coats.
Finally, stethoscopes should always be wiped down after patient encounters.
For more on controversies in hospital infection prevention, visit Dr. Edmond's blog at http://ha1controversies.blogspot.com.