The incidence of MRSA infections in the United States: Is a more comprehensive tracking system needed?

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Health Watch USA: Recent data from the United States' National Healthcare Safety Network shows little change in MRSA infections, casting doubt on the effectiveness of current prevention protocols. However, various tracking systems, using various patient populations and methodologies, gave differing results, underscoring the need for a comprehensive uniform system involving all healthcare facilities for the tracking of MRSA and other multi-drug resistant organisms.

Methicillin-resistant Staphylococcus aureus (MRSA)

MRSA is a dangerous infectious bacteria which does not appear to be being brought under control, casting doubt on current prevention protocols and underscoring the need for more comprehensive data.

The effectiveness of MRSA control strategies in the United States is unclear due to discrepancies in the systems used to track MRSA infections, according to a recent article published in Antimicrobial Resistance & Infection Control. Dr. Kevin Kavanagh, Board Chairman of Health Watch USA and a team of policy researchers reviewed various tracking systems used in the United States to monitor MRSA infection rates.

The researchers found that the tracking systems gave conflicting results because they studied data that had different baselines, and were from differing patient populations, geographic areas and healthcare systems.

Data from the National Healthcare Safety Network (NHSN) for 2015 (last year data is available) showed an increase in the rate of MRSA infections, which approximated the 2010 to 2011 baseline rate, while Veterans Health Administration (VA) hospitals reported excellent control, with over an 80% reduction in MRSA infections.

The VA tracking system is not comparable to that of the NHSN and the VA does not report to the NHSN. Smaller, rural hospitals are not required to use the NHSN, so their data may be missed. In addition, the NHSN only measures bloodstream infections, a subset of total MRSA infections.

Dr Kavanagh said: “Even though the observed increase according to the NHSN data may be artifactual due to changes in the tracking method, the United States is nowhere near on track for meeting the 2020 U.S. Dept. of Health and Human Services’ goal of a 50% reduction.”

Firm and effective mandates are needed to control MRSA. Two which have been extensively discussed in the literature are universal chlorhexidine bathing versus screening and isolation/decolonization. Many facilities are implementing universal bathing along with hand hygiene to control MRSA. The VA uses a methodology which also stresses hand hygiene but in addition implements facility-wide surveillance and isolation of MRSA carriers.

Dr Kavanagh said: "Hand washing is an important intervention, but it is not the most important in preventing the spread of MRSA. In many ways it is a backup measure. If a staff member’s hands at any time becomes contaminated with MRSA, then there has already been a failure in containment and control. Without an effective tracking system determining the comparative effectiveness of the two interventions will be difficult at best.”

A comprehensive well-functioning tracking system which encompasses all types of healthcare facilities is also needed to monitor for the emergence of new antibiotics resistant organisms. Facilities will need to commit significant resources to patient safety, as well as provide and support adequate staffing to implement effective infection control, according to the authors.

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Health Watch USA
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