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3 Steps Might Help Stop MRSA's Spread
Date:3/20/2009

E-monitoring of hand washing, better room cleaning and checks on patient transfers are key, studies find,,,,

FRIDAY, March 20 (HealthDay News) -- A high-tech way of monitoring hand washing, a better means of disinfecting rooms and improved tracking of patients as they transfer from one hospital to another could all help prevent the spread of the MRSA "superbug" and other pathogens, researchers report.

Methicillin-resistant Staphylococcus aureus (MRSA) is a type of staph bacteria that's resistant to certain antibiotics. It can cause severe infections for people in hospitals and other health-care facilities, such as nursing homes. MRSA can also cause serious skin infections in healthy people who have not recently been hospitalized.

But MRSA can be beaten, suggest three studies that were to be presented this week at the annual meeting in San Diego of the Society for Healthcare Epidemiology of America.

In the first report, Dr. Philip Polgreen, an assistant professor of internal medicine at the University of Iowa, described an inexpensive way of electronically monitoring staff to be sure that they wash their hands before entering an intensive care unit. The system uses a wireless technology similar to Wi-Fi to transmit signals to a computer.

"Hand washing is one of the most important actions health-care workers can take to protect patients from developing hospital-acquired infections," Polgreen said during a March 12 media teleconference. "Yet hand hygiene compliance among physicians, nurses and other health-care workers remains unacceptably low," he said.

Currently, many hospitals have staff sit outside hospital rooms to record when people wash their hands, Polgreen noted.

In the new system, health-care workers wear a badge that interacts with a sensor on an automated hygiene dispenser placed outside or inside patients' rooms. Using this method, researchers were able to determine compliance with hand-washing protocols and identify staff who were following or not following hand-washing procedures.

"Testing has shown this new system to be accurate," Polgreen said, but he added that it still has to be tested in a variety of situations.

Dr. Marc Siegel, an infectious disease expert and associate professor of medicine at New York University School of Medicine in New York City, called the new system "impressive."

"We all agree that washing your hands is the way to go," Siegel said. But he is not convinced that hand sanitizers are totally effective. "Washing your hands with soap and water is better," he said.

In the second report, a team led by Rupak Datta, an M.D./ Ph.D. candidate at the University of California at Irvine, found that 40 percent of MRSA and vancomycin-resistant enterococci (VRE) infections are transmitted by touching nearby surfaces. VRE is another dangerous antibiotic-resistant pathogen.

"These infections can be cultured off a variety of surfaces, such as doorknobs, countertops, computer keyboards and bed trays," Datta said during the teleconference.

To combat this problem, the researchers developed a new cleaning method for disinfecting patient rooms. Instead of using spray bottles, the method involved cloths saturated with disinfectant and included instruction in proper cleaning techniques.

The enhanced cleaning significantly cut down on MRSA but was only moderately effective in killing VRE. The researchers believe that a different method will be needed to reduce VRE infections.

"This suggests that cleaning measures over and above national standards can be important in reducing the transmission of multi-drug-resistant organisms, such as MRSA and VRE in high-risk patient care areas, such as the ICU," Datta said.

"It is interesting," Siegel noted, "that VRE is even more resistant to standard cleaning techniques than MRSA. That implies that the more resistant a bug, the more crafty it becomes and harder to eradicate."

In the third presentation, Dr. Susan S. Huang, director of epidemiology and infection prevention at the University of California at Irvine School of Medicine, examined the transfer of patients between hospitals in Orange County, Calif.

Sharing patients often means sharing hospital-based infections, she noted. "Our study is focused on trying to quantify how much patient-sharing occurs between acute-care hospitals," Huang said during the teleconference.

For the study, Huang's team looked at almost 240,000 people admitted to Orange County's acute-care hospitals in 2005.

"We found that 22 percent of patients will be rehospitalized within a year of discharge," Huang said. Most are readmitted to different hospitals than the one where they were initially treated. In an average month, each hospital exposed other hospitals to 10 of their patients, she noted.

According to Siegel, the transmission of infections from hospital to hospital is "being overlooked."

"Patients become deposits of bacteria, especially when they go from one facility to the next," he said, adding that it should be assumed that someone coming from another hospital is infected with drug-resistant bacteria.

In fact, routine decontamination of patients -- whether they are known to be carrying dangerous pathogens or not -- should be the status quo, Siegel said. "It has to become standard practice to decontaminate all patients who are in areas of high prevalence of dangerous bacteria," he said.

More information

The U.S. Centers for Disease Control and Prevention has more on the health-care aspects of MRSA.



SOURCES: Marc Siegel, M.D., associate professor, medicine, New York University School of Medicine, New York City; March 12, 2009, teleconference with: Philip Polgreen, M.D., M.P.H., assistant professor, internal medicine, University of Iowa, Iowa City, Ia.; Susan S. Huang, M.D., M.P.H., director, epidemiology and infection prevention, University of California at Irvine School of Medicine, Irvine, Calif.; Rupak Datta, M.P.H., University of California at Irvine, Irvine, Calif.; March 18-20, 2009, presentations, Society for Healthcare Epidemiology of America, annual meeting, San Diego


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