INTRODUCTION & HISTORY

Antibiotic-resistant bacteria have been the scourge of the practices of medicine for many years, particularly in the hospital setting where 2 million patients in the United States are infected while hospitalized. Incidence is also on the rise in general community (schools, sports facilities, etc.), and the increasing spread of MRSA in these settings poses a legitimate public health threat. One of the most troublesome bacterial strains is methicillin-resistant Staphylococcus aureus (MRSA) also referred to as the “Superbug”. MRSA infections can lead to death, and the US Centers for Disease Control reports there are now more deaths in the U.S. per year from these infections than AIDS. The hardy S. aureus bacterium is extremely resilient and has demonstrated a remarkable ability to adapt to changing antibiotic environments. In fact, the bacteria has developed resistance to every antibiotic in its path, beginning with penicillin 60 years ago. Pharmacologic innovations can barely keep pace with the development of drug resistance among strains of bacteria as 70% of the bacteria causing these infections are resistant to any currently developed antibiotic (Journal of the American Medical Association).

MRSA TRANSMISSION

MRSA is primarily a nosocomial microbe meaning that the infection is a result of treatment in a hospital or a healthcare service unit, but secondary to the patient's original condition. Infected or colonized patients are the major reservoir of MRSA in institutions although computer keyboards and sink faucets are fairly common as well. MRSA is easily transferred from patient to patient and the general consensus identifies health care providers (due to inadequate hand washing) as the major mechanism for patient-to-patient transmission of MRSA (Journal of Hospital Infection; Lancet; Postgraduate Medicine).  However, because most colonized patients carry the MRSA with no obvious signs of colonization it seems plausible that discharged patients and visitors are likely transporting MRSA and other deadly bacteria from healthcare settings into the community at large.

CURRENT STRATEGY…NOT WORKING

In the past, numerous strategies have been implemented to eradicate colonization in patients who carry MRSA. Health care providers are presently investing heavily in increasing the number of accessible sinks, posting reminders and signs on patient rooms and hospital units, and offering educational programs for health care workers. Despite the investment in such campaigns the average rate of compliance with MRSA precautions is alarmingly low. Studies show that under routine hospital practices, health care provider compliance with hand washing protocol between patients is less than 50% and the hand washing technique and duration is also often inadequate (Annals of Internal Medicine; Lancet Infection Control). According to surveys, reasons for inadequate compliance include lack of sufficient facilities, lack of time, excessively high patient care load, urgency of care for patients, and dermal irritation from antiseptic soap. Over 40 different nasal decolonization strategies have been tested over the past 60 years to eradicate MRSA in carrier patients and no single strategy to eradicate the carrier state has proven successful or practical in controlling nosocomial spread of MRSA (Journal of Hospital Infection; American Journal of Infection Control).

VIDEO: MRSA IN THE NEWS

VIDEO: CNN NEWS REPORT