Screening not found to limit MRSA

The Baltimore Sun

Less than a month after the Maryland General Assembly rejected a bill that would have required hospitals to test incoming patients for the dangerous MRSA bacterium, researchers in Switzerland are reporting that screening doesn't reduce MRSA infections.

Researchers found that MRSA infection rates in wards where patients were pre-screened for the superbug were no different from infection rates in areas without screening, according to an article in today's Journal of the American Medical Association.

"It's just not very helpful," said Dr. Stephan Harbarth, the epidemiologist who led the study at the University of Geneva Hospitals.

Harbarth examined MRSA infection rates among 21,754 patients treated in 12 surgical wards. His researchers tested incoming patients in half the wards for nine months and then switched testing to the other half for nine months.

Screening on admission identified 515 patients with MRSA - including 337 who would have otherwise been missed, according to the study. Infected patients were isolated, treated by personnel wearing gowns and gloves, cleaned with antimicrobials and given medications adjusted for the infection.

But the researchers found that only 93 additional patients developed MRSA while in wards where screening was conducted, compared with 76 in nonscreened wards - a difference they consider insignificant.

"There was not even the slightest trend toward reduction of MRSA infections in the screening wards," Harbarth said.

Harbarth recommends screening only in areas where the risk is highest: intensive care, critical care and cardiovascular surgical units.

Critics said the duration and scope of the study were too limited. Because patients in some wards weren't screened, MRSA could survive to be spread by hospital personnel, they said.

MRSA, or Methicillin-resistant Staphylococcus aureus, is a bacterium that can live harmlessly in the skin or nose but will attack wounds and cause life-threatening infections, including pneumonia and blood poisoning, when someone is hospitalized. Over the years, it has evolved into a superbug that resists most common antibiotics.

The federal Centers for Disease Control and Prevention estimates that MRSA caused 18,000 deaths in 2005. Last June, a study by the Association for Professionals in Infection Control and Epidemiology (APIC) found MRSA in 46 out of every 1,000 hospital patients.

The CDC also has identified at least 12 MRSA subtypes. One new variant at large in the population killed a Virginia youth last fall and can spread in gyms, locker rooms and other community settings.

State Sen. Lisa A. Gladden, a Baltimore Democrat, proposed legislation this year that would have required Maryland's hospitals to screen patients they consider at high risk of infection - such as those previously infected or transferred from nursing homes.

Several states have enacted similar mandates, and the Department of Veterans Affairs recently began requiring its hospitals to conduct MRSA screenings.

But Gladden's legislation was killed in the Senate Finance Committee last month after the Maryland Hospital Association - along with a variety of health officials - argued that safeguards are evolving. The association is sponsoring public forums on MRSA at hospitals around the state.

The legislation's opponents said yesterday that the Swiss study supports their arguments that mandatory screening is unwise. "It reinforces my belief that embedding guidelines into law is just bad law," said Dr. William Minogue, executive director of the Maryland Patient Safety Center. "MRSA is a moving target."

But advocates for improved screening argue that the MRSA legislation is necessary because hospitals are moving too slowly in screening patients.

"This does not invalidate the 200 studies that support the approach we've been advocating," said Michael Bennett, who as president of the Coalition for Patients Rights has fought unsuccessfully for MRSA legislation for three years. "Those who are against this are against this because they just don't want to be bothered with it."

For information about the MRSA forums, visit www.mdhospitals.org.

dennis.obrien@baltsun.com

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