By Karissa Minn
kminn@salisburypost.com
Aggressive prevention measures have reduced the spread of a potentially deadly infection at Veterans Affairs hospitals nationwide ó including the one in Salisbury.
A Department of Veterans Affairs initiative that began in 2007 lowered methicillin resistant Staphylococcus aureus (MRSA) infections by more than 60 percent in intensive care units (ICUs) across the nation.
ěOverall, this is something our veterans can be proud of. This is a major patient safety initiative,î said Dr. Charles de Comarmond, head of the infectious disease department at the W.G. (Bill) Hefner VA medical center.
In October 2007, Salisbury centerís rate of hospital-acquired MRSA infections was 0.63 per 1,000 patient nights. That rate dropped to an average of 0.09 for the fiscal year ending in September 2010.
There were no MRSA infections in the ICU for fiscal years 2008 and 2009, Comarmond said, and just one in 2010.
MRSA is difficult to treat because the bacterium is often resistant to many antibiotics.
The latest issue of the New England Journal of Medicine reports data from the first three years of the initiative, and how a bundle of infection control practices showed dramatic improvement in prevention. These include patient screening programs, contact precautions for patients found to have MRSA, and hand hygiene reminders with readily available hand sanitizer stations. The strategy also involved creating a culture that promotes infection prevention and control as everyoneís responsibility.
Comarmond said nearly all patients ó 97 percent in the most recent quarter ó are being tested for MRSA. (They can refuse the test.) If a colony is found, those who work with the patient take extra precautions, including the use of disposable masks, gloves and gowns. ěItís a truly preventable infection,î he said. ěOur motto is, ëOne infection is one too many.í î
The Salisbury hospital began taking similar measures before 2007, but it only tested high risk patients and had to wait 24 to 48 hours for the results. New technology can identify a MRSA colony within one hour.
ěThat means when a patient is admitted, they are tested in the emergency room, and by the time they get onto the floor, we already know if they are colonized,î Comarmond said.
Not all patients who test positive for MRSA have an infection. The bacteria can live inside the nose or on the skin of a healthy person without causing problems, he said. But MRSA easily can infect vulnerable hospital patients with open wounds, catheters or IV lines. Thatís why the VA has focused on preventing it from spreading between patients and health care providers.
ěThis is an organism that mostly lives in the hospital,î Comarmond said. ěIf we are the ones giving it to patients, we must find a way to prevent that transmission.î
A newer MRSA strain has been found in close community environments, like sports teams, that is spread through cuts, scrapes or sores on the skin. Testing infected wounds for MRSA can help catch this as well, Comarmond said.
Veterans Affairs started the intervention program after finding that 14 percent of VA patients carried MRSA ó compared to 6.3 percent of non-VA hospital patients and 1.5 percent of the general population. At the Salisbury hospital, about 17 percent of patients carry MRSA colonies in initial screening, Comarmond said.
More than 1.7 million screening tests for MRSA were done during the period reported in the analysis.
Veterans Affairs operates the largest integrated health care system in the United States with more than 1,000 medical facilities throughout the United States serving more than 6 million veterans a year.
Contact reporter Karissa Minn at 704-797-4222.