John Jernigan, M.D.

Author: John Jernigan, M.D
Director for CDC’s Office of HAI Prevention Research and Evaluation, Division of Healthcare Quality Promotion

The optimal approach to controlling MRSA in healthcare facilities has been a topic of ongoing controversy. Of particular interest is the question of whether the use of active detection and isolation of patients colonized with MRSA, also known as ADI, should be routinely used. Despite ongoing research and vigorous scientific debate, a simple answer has remained elusive. This week, two studies were published in the New England Journal of Medicine that illustrate the complexities of the scientific evidence surrounding ADI. One of these studies, the STAR*ICU Trial (Intervention to Reduce Transmission of Resistant Bacteria in Intensive Care), found that ADI as implemented in the study was not effective in reducing transmission of MRSA or VRE. A separate observational study (“Veterans Affairs Initiative to Prevent Methicillin-Resistant Staphylococcus aureus Infections“) involving the entire national VA hospital system
, found that after implementing a multifaceted MRSA prevention program that included ADI, MRSA transmissions and HAIs decreased significantly. The fact that these studies seem to give different answers illustrates the challenge we as scientists face in making recommendations on how best to use limited prevention resources-sometimes the answers aren’t simple as we would like.

Martin Evans, MD

Author: Martin Evans, MD
Director of the VHA MRSA/MDRO Program

MRSA hospital-acquired infections (HAIs) cause increased suffering, the need for increased procedures, treatments, and time in the hospital, and sometimes an increased risk of death among patients. Beginning in 2002, staff working at the VA Pittsburgh Healthcare system successfully brought down MRSA HAIs using a “bundle” of infection control strategies. In 2007, VA leadership in Central Office, Washington, D.C. decided to have all 153 medical centers nationwide implement the bundle.

The “MRSA bundle” consisted of gently swabbing the nose of all patients admitted or transferred within the hospital to detect those carrying MRSA (known as universal active surveillance); preventing spread of the organism by placing those with MRSA in their own room away from those not carrying the organism; insisting that healthcare workers do hand hygiene and wear gloves and gowns when caring for the patient, and striving for a culture change where infection prevention and control becomes everyone’s responsibility.

Charles W. Huskins, MD

Author: Charles W. Huskins, MD
Consultant in Pediatric Infectious Diseases and
Assistant Professor of Pediatrics in the College of Medicine, Mayo Clinic

In today’s issue of the New England Journal of Medicine, my co-authors and I report the results of a study (“Intervention to Reduce Transmission of Resistant Bacteria in Intensive Care“) examining an intervention to reduce the spread of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin resistant enterococcus (VRE) in adult intensive care units (ICUs). The intervention included culture-based screening of patients admitted to ICUs for MRSA or VRE carriage—called “active surveillance”—and expanded use of barrier precautions (gloves and gowns) by health care providers during the care of patients colonized or infected with these bacteria.

The study—a cluster- (ICU-) randomized trial conducted in 18 ICUs around the US—was scientifically rigorous. The results showed no difference in the incidence of MRSA or VRE colonization or infection events in 10 ICUs implementing the intervention vs. 8 ICUs that followed their existing practices. Notably, some ICUs showed substantial decreases while others showed dramatic increases.

Catherine Liu, MD

Author – Dr. Catherine Liu
Assistant Clinical Professor, Division of Infectious Diseases, University of California

Methicillin-resistant Staphylococcus aureus (MRSA) – both healthcare- and community-associated – has become an enormous public health problem. MRSA is responsible for about 60 percent of skin and soft tissue infections seen in emergency rooms, and invasive MRSA kills about 18,000 people annually. Clinicians often struggle with how best to treat MRSA, resulting in wide variations in approaches to therapy. The growing clinical impact of MRSA, particularly community-acquired infections, prompted the Infectious Diseases Society of America to develop its first treatment guidelines for MRSA. Charged with reviewing the evidence and developing the guidelines, my coauthors and I aimed to create a framework to help clinicians evaluate and treat uncomplicated and invasive MRSA infections. As with all IDSA guidelines, they are voluntary and are not meant to replace clinical judgment, but rather synthesize the available evidence and support the decision-making process, which must be individualized for each patient.