An infection-control activist says every hospital patient in the U.S. should be screened for a certain type of staph infection that can be deadly, citing data that shows this is the best way to decrease the spread of such infections.
Dr. Kevin Kavanagh of Somerset, chair of Health Watch USA, made several assertions and recommendations in a commentary published in the medical journal Antimicrobial Resistance & Infection Control, and also wrote an op-ed about the issue for BioMed Central.
The commentary was prompted by new data from the federal Centers for Disease Control and Prevention showing that more than 119,000 people in America had a staph infection in 2017, and nearly 20,000 of them died from it.
These numbers reflect rates for all Staphylococcus aureus infections, including methicillin-resistant Staphylococcus aureus, or MRSA, and methicillin-susceptible Staphylococcus aureus, or MSSA.
After dropping by an average of 17 percent a year between 2005 and 2012, the rate of decline for hospital-onset MRSA has stalled. The report notes that the U.S. is not on track to meet its goal of 50% reduction by 2020.
Department of Veterans Affairs hospitals had a much larger decrease in MRSA infections, as opposed MSSA, since 2005: 55% and 12%, respectively.
Kavanagh says the difference is that the VA has universal MRSA surveillance and isolates all MRSA carriers, and those results mirror the results in the United Kingdom's National Health Service, which has similar infection-control practices.
"These findings support the contention that the marked decline in hospital-onset MRSA infections observed in these studies is due to interventions which are specifically targeted towards MRSA," he writes.
Kavanagh argues that because MRSA is regularly found in 2% of hospital patients, all U.S. hospitals should screen all patients for MRSA when admitted.
He says hospitals have moved away from early identification and isolation of MRSA carriers as a first line of intervention, to strategies that are based on poorly designed studies — perhaps as a reaction to patient-advocacy groups' push to mandate MRSA testing and isolation, which is costly.
Kavanagh further argues that daily bathing with the antiseptic chlorhexidine, a common practice in U.S. hospitals, is not supported by solid research. He says one study supporting it has data interpretations that have been questioned, and has "apparent conflicts of interest." He also argues that random, controlled trials haven't demonstrated uniform effectiveness of chlorhexidine bathing.
Kavanagh also points out instances where facilities have asked for "risk adjustments" to be made for their rates of hospital-acquired infections, such as adjusting the numbers to allow for high rates of infection among opioid users. He holds firm that this should not be allowed.
He argues that instead of adjusting numbers to make the problem seem less than it really is, hospitals should follow a standard of care that includes not only screening and isolation, but decolonization, which means getting rid of the MRSA virus in people who carry it in their nose or on their skin even though they are not sick with a MRSA infection.
Kavanagh says some of Kentucky's major hospitals have the highest numbers of MRSA infections in the U.S., but after manipulating the data for "risk adjustment" they are designated "no different from national benchmark."
He calls for a different way of thinking about MRSA in the U.S. that includes increased transparency; making surveillance, isolation and decolonization a standard of care that is fully funded; and a more comprehensive tracking system.
He concludes, "Until these reforms are universally enacted in the United States health-care facilities, I have grave reservations that the epidemic of drug-resistant bacteria will be brought under control."
Dr. Kevin Kavanagh of Somerset, chair of Health Watch USA, made several assertions and recommendations in a commentary published in the medical journal Antimicrobial Resistance & Infection Control, and also wrote an op-ed about the issue for BioMed Central.
The commentary was prompted by new data from the federal Centers for Disease Control and Prevention showing that more than 119,000 people in America had a staph infection in 2017, and nearly 20,000 of them died from it.
These numbers reflect rates for all Staphylococcus aureus infections, including methicillin-resistant Staphylococcus aureus, or MRSA, and methicillin-susceptible Staphylococcus aureus, or MSSA.
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| Centers for Disease Control and Prevention chart; click on it for a larger version |
Department of Veterans Affairs hospitals had a much larger decrease in MRSA infections, as opposed MSSA, since 2005: 55% and 12%, respectively.
Kavanagh says the difference is that the VA has universal MRSA surveillance and isolates all MRSA carriers, and those results mirror the results in the United Kingdom's National Health Service, which has similar infection-control practices.
"These findings support the contention that the marked decline in hospital-onset MRSA infections observed in these studies is due to interventions which are specifically targeted towards MRSA," he writes.
Kavanagh argues that because MRSA is regularly found in 2% of hospital patients, all U.S. hospitals should screen all patients for MRSA when admitted.
He says hospitals have moved away from early identification and isolation of MRSA carriers as a first line of intervention, to strategies that are based on poorly designed studies — perhaps as a reaction to patient-advocacy groups' push to mandate MRSA testing and isolation, which is costly.
Kavanagh further argues that daily bathing with the antiseptic chlorhexidine, a common practice in U.S. hospitals, is not supported by solid research. He says one study supporting it has data interpretations that have been questioned, and has "apparent conflicts of interest." He also argues that random, controlled trials haven't demonstrated uniform effectiveness of chlorhexidine bathing.
Kavanagh also points out instances where facilities have asked for "risk adjustments" to be made for their rates of hospital-acquired infections, such as adjusting the numbers to allow for high rates of infection among opioid users. He holds firm that this should not be allowed.
He argues that instead of adjusting numbers to make the problem seem less than it really is, hospitals should follow a standard of care that includes not only screening and isolation, but decolonization, which means getting rid of the MRSA virus in people who carry it in their nose or on their skin even though they are not sick with a MRSA infection.
Kavanagh says some of Kentucky's major hospitals have the highest numbers of MRSA infections in the U.S., but after manipulating the data for "risk adjustment" they are designated "no different from national benchmark."
He calls for a different way of thinking about MRSA in the U.S. that includes increased transparency; making surveillance, isolation and decolonization a standard of care that is fully funded; and a more comprehensive tracking system.
He concludes, "Until these reforms are universally enacted in the United States health-care facilities, I have grave reservations that the epidemic of drug-resistant bacteria will be brought under control."
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