Superbug staph screening praised

Adding to the debate over how to control drug-resistant bacteria, researchers reported Monday that screening all hospital patients could sharply reduce hospital-acquired infections.

The study published in the Annals of Internal Medicine comes a week after a well-publicized study in the Journal of the American Medical Assn. concluded that screening of surgical patients for methicillin-resistant staphyloccocus aureus, or MRSA, isn’t particularly effective.

The take-home message is that “a very comprehensive, aggressive MRSA screening program can significantly reduce the number of infections,” said Dr. Lance Peterson, founder of the MRSA screening program at Evanston Northwestern Healthcare in Illinois, which published the second report.

“Testing high-risk groups isn’t enough,” he said. “You stop some [of the bacteria’s] spread but not enough” to make a difference in hospital-acquired infections.

The Evanston Northwestern study describes a three-stage rollout of MRSA screening across Evanston Hospital, Glenbrook Hospital and Highland Park Hospital. First, epidemiologists tested all hospital patients to estimate the number of people who carry the drug-resistant bacteria on their bodies. That was 8.5%.

Then, the hospitals began testing every patient being admitted to intensive-care units for MRSA. Those with the bacteria were placed in isolation and special precautions were taken, including gowns and gloves for providers and rubdowns with disinfectants.

But the intervention didn’t make a dent in the rate of hospital-acquired MRSA infections.

Peterson suspected the screening had been insufficient. In August 2005, Evanston Northwestern became the first hospital group in the U.S. to screen all patients for MRSA. This time, the intervention worked, and hospital-acquired MRSA infections plummeted by 70%.

But an editorial in the Annals of Internal Medicine sounded a note of caution.

Dr. Ebbing Lautenbach of the University of Pennsylvania School of Medicine questioned which part of the screening intervention worked. Was it the isolation of affected patients, the use of antibiotic ointments, or other actions?

Until further evidence comes in, “each institution may need to tailor its intervention to its unique needs and resources,” he concluded.