A Chicago-area hospital system has launched an ambitious effort to sharply reduce the rate of in-hospital methicillin-resistant Staphylococcus aureus infections by screening all patients.

The new admissions screening process at each of three Evanston Northwestern Healthcare (ENH) hospitals is intended to reduce the rate of MRSA infections by 50% within 2 years.

A recent prevalence study conducted by ENH showed that about 8% of patients being admitted were colonized with MRSA, Lance Peterson, M.D., told this newspaper. That figure is in line with other studies from around the United States that also suggest that the incidence of this dangerous disease is on the rise.

“Our feeling was that we were seeing more and more patients with MRSA in the hospital … and we decided that it was necessary to go ahead and start dealing with MRSA from a patient safety standpoint,” said Dr. Peterson, director of clinical microbiology and infectious diseases research at ENH.

Patients with active infection can infect others in the hospital, and those who are colonized with MRSA pose a risk to others as well as to themselves; about 75% of infections originate from a person's own strains, he explained.

Furthermore, the cost of infection is high, as is the mortality. Some estimates put the total cost at about $30,000 for an inpatient with a bloodstream infection, and at $40,000 for a wound infection. A recent study suggests the 30-day mortality is 50%, with 23% directly related to the MRSA.

“It's a very aggressive organism to get in the blood … but MRSA infection is totally preventable,” said Dr. Peterson, who also is professor of pathology and medicine at Northwestern University, Chicago.

“If we get it out of health care, we can eliminate this problem,” he added, noting that Dutch and Swedish hospitals have been successful in their efforts at eliminating MRSA.

The ENH effort involves an attempt to screen every patient on admission. A nasal swab is collected from each patient as part of the admission process, and the swab is tested for MRSA using new real-time DNA analysis that can detect the microorganism at the molecular level within 2 hours, compared with the 2–3 days that previous culture methods required.

Patients diagnosed with MRSA are treated with a nasal antibiotic ointment for 5 days, and must bathe using a special antiseptic soap on the first, third, and last day of the treatment. A recent study showed that this approach decolonized 95% of patients who had unexpected MRSA colonization, Dr. Peterson noted.

Screening for S. aureus has been used successfully throughout the ENH system for the past 2 years in high-risk patient areas, such as the infant special care unit. A pilot program was also implemented using a rapid molecular testing method for MRSA in patients undergoing knee replacement.

That program reduced the rate of postsurgical S. aureus infection by nearly fourfold, according to an ENH statement.

The new screening process, which is being watched closely nationwide by other hospital systems that are also battling MRSA, is off to a good start, Dr. Peterson said.

After a year of planning, including a cost-benefit analysis showing that a 50% reduction in the bacteremia rate is necessary for the screening program to break even, 90% of patients were being captured within the second week of implementation, he said.

Patients—who are often well aware of the risk of nosocomial infection—have been amenable to the process, he added.

Hospital systems and infectious disease experts alike are keeping a close eye on the program. Several facilities have inquired about the process. Interest in the idea also is growing because the molecular technology for testing was recently approved for use. It is an approach that every hospital could do right now, Dr. Peterson said.

Michael Climo, M.D., of Hunter Holmes McGuire VA Medical Center in Richmond, Va., is among those watching closely.

The ENH approach is a novel one on a large scale, and it will be interesting to see if these aggressive—and costly—measures are worthwhile, Dr. Climo said in an interview.

Among the questions that remain to be answered include what the actual cost and feasibility of such a process might be, whether hospital laboratories can shoulder the burden of tens of thousands of additional tests each year, and whether the hospitals can adequately manage MRSA patients once they are identified.

“These are complicated patients in complicated hospital settings, and it's difficult to determine the best strategies,” he said, noting that a tremendous amount of hospital resources will be required to manage the large number of MRSA patients now being admitted.

The ENH program makes sense, but it will be some time before it's clear how effective it will be and whether it can be done logistically and financially. “But it's commendable that they're trying,” Dr. Climo said.

Hospital System Begins to See Success in MRSA Screening