By: David Reilly Oct. 25, 2017
Methicillin-resistant staphylococcus aureas (MRSA) can lead to endocarditis, osteomyelitis, and septicemia in severe cases.1 And for as many as 11,000 people in the United States each year, MRSA can also be fatal.2, 3
For many years, the number of patients with MRSA infection in US hospitals continued to rise dramatically—from less than 2,000 cases in 1993 to approximately 368,600 cases in 2005.4 But as awareness has grown and protocols for reducing the transmission of MRSA have been implemented, significant inroads have already been made for its reduction. According to Centers for Disease Control data, the incidence of hospital-acquired MRSA fell by as much as 54% from 2005 to 2011 while the number of annual MRSA-associated deaths reduced by 9,000 over the same period.2, 3
In addition to reducing considerable morbidity and mortality, efforts to curb MRSA can also bring about significant reductions in healthcare costs. MRSA infection is strongly associated with increased length of stay (LOS) in hospital.4-6 For patients without MRSA infection, the average LOS is 4.6 days incurring an average of $7,600 in total hospital costs.4 For patients with MRSA infection, LOS more than doubles to 10.0 days at an average cost of $14,000.4
MRSA infection is also associated with increased risk of hospital readmission.7 According to a large study tracking data for 136,513 patients across 8 years, patients with a MRSA-positive culture more than 48 hours after hospital admittance have a 40% greater risk of being readmitted to hospital within a year compared to patients with a MRSA-negative culture (HR, 1.40; 95% CI, 1.33-1.46).7
Across the nation, institutions have taken various approaches against MRSA, with differing rates of success. According to a recent analysis from Dexur which compiled averages for excess LOS due to MRSA and MRSA-associated readmissions for each state, Rhode Island has one of the lowest differences in average LOS of just 1.63 days and also has one of the lowest differences in average excess readmission. So how does Rhode Island fare so well? According to the Rhode Island Department of Health (DOH), the state is vigilant in performing inspections of residential healthcare facilities and hospitals, tracking infection outbreaks, and monitoring rates of infection in hospitals as part of a broader Healthcare Quality measurement initiative.8
According to the Dexur analysis, New Hampshire also had one of the lowest LOS differences, with an average of just 1.95 excess days. A closer look at the Dexur data identifies St. Joseph Hospital of Nashua as having the lowest average MRSA-associated LOS in the entire state, with a difference of just 0.34 days compared to patients without MRSA. So Dexur reached out to their infection preventionist, Ashley Conley, MS, CPH, CHEP for her insights.
One of the most successful initiatives for primary prevention at St. Joseph Hospital involved reaching out to the community—collaborating with various groups to educate athletes, schools, and other at-risk sub-populations on MRSA, its symptoms, and its prevention because as Ms. Conley put it, “infectious diseases don’t stop at the hospital walls.” This initiative alone appears to have been a great success, with the number of MRSA cases reducing dramatically in the five years since its introduction.
A robust antibiotic stewardship program serves as the foundation for addressing existing infection. Ms. Conley explained the key tenets of the program as, “ensuring we obtain the appropriate cultures and prescribe the right antibiotic at the right time.” This is complemented by an attention to recognizing risk factors, testing for colonization in at-risk patients, and using appropriate isolation. The hospital also seizes the opportunity to further heighten awareness by educating not only MRSA patients but also the family members who visit them. Through their dedication to educational initiatives, it seems St. Joseph Hospital is empowering an entire community to control infection. It’s an approach delivering impressive results and one that other institutions could learn from.
References
1. Sutton J, Steiner C. Hospital-, Health Care-, and Community-Acquired MRSA: Estimates From California Hospitals, 2013: Statistical Brief# 212. 2006.
2. Centres for Disease Control and Prevention. Antibiotic resistance threats in the United States, 2013: Centres for Disease Control and Prevention, US Department of Health and Human Services; 2013.
3. Dantes R, Mu Y, Belflower R, Aragon D, Dumyati G, Harrison LH, et al. National burden of invasive methicillin-resistant Staphylococcus aureus infections, United States, 2011. JAMA internal medicine. 2013;173(21):1970-8.
4. Elixhauser A, Steiner C. Infections with methicillin-resistant Staphylococcus aureus (MRSA) in US hospitals, 1993–2005. 2007.
5. Gilligan P, Quirke M, Winder S, Humphreys H. Impact of admission screening for meticillin-resistant Staphylococcus aureus on the length of stay in an emergency department. Journal of Hospital Infection. 2010;75(2):99-102.
6. Macedo-Vinas M, De Angelis G, Fankhauser C, Safran E, Schrenzel J, Pittet D, et al., editors. Excess length of stay due to methicillin-resistant Staphylococcus aureus (MRSA) infection at a large Swiss hospital estimated by multi-state modelling. BMC Proceedings; 2011: Springer.
7. Emerson CB, Eyzaguirre LM, Albrecht JS, Comer AC, Harris AD, Furuno JP. Healthcare-associated infection and hospital readmission. Infection Control & Hospital Epidemiology. 2012;33(6):539-44.
8. State of Rhode Island Department of Health (DOH). Healthcare-Acquired Infections: State of Rhode Island DOH; 2017 [Available from: http://www.health.ri.gov/diseases/healthcareacquiredinfections/.