An aggressive four-year effort to reduce the spread of deadly bacterial infections at veterans' hospitals is showing impressive results and may have broad implications at medical centers across the country.
As published in the New York Times, The Veterans Affairs strategy employs a "bundle" of measures that include screening all patients with nasal swabs, isolating those who test positive for MRSA, requiring that staff treating those patients wear gloves and gowns and take other contact precautions and encouraging rigorous hand washing. The results may not be easily replicated in the private sector, but they are likely to step up pressure by further undercutting the notion, prevalent at many hospitals not long ago, that infections are an unavoidable cost of doing business
The study of 153 Veterans Affairs hospitals nationwide found a 62 percent drop in the rate of infections caused by methicillin-resistant Staphylococcus aureus, or MRSA, in intensive care units over a 32-month period. There was a 45 percent drop in MRSA prevalence in other hospital wards, like surgical and rehabilitation units.
But a second large study of intensive care cases, also published Wednesday, raises doubts about whether a key component of the veterans' approach -- the testing of every patient upon admission and discharge -- is necessary or cost-effective. Taken together, the studies are likely to stoke a raging debate among infection control specialists about the wisdom of universal testing, which can be expensive and time-consuming for hospitals.
The studies were published in tandem in The New England Journal of Medicine one day after the Obama administration announced a new initiative aimed at preventing hospital infections and other medical errors. With a goal of reducing preventable conditions by 40 percent over three years, the Department of Health and Human Services plans to spend up to $1 billion made available by the 2010 health care law to improve patient safety at hospitals and avoid costly readmissions.
A study published last year found that the incidence of MRSA in hospitals in nine cities dropped by 28 percent between 2005 and 2008.
But the Centers for Disease Control and Prevention in Atlanta still estimates that one of every 20 patients will acquire an infection while hospitalized. Using data from 2002, the agency concluded that hospital infections were associated with 99,000 deaths and costs of $28 billion to $34 billion a year.
The quantification of the human toll, and the cost to state and federal health programs like Medicaid and Medicare, has spurred governments to attack the problem.
Reimbursements to hospitals may now be docked when patients develop infections or require readmission for infections and other errors. Many states mandate public reporting of hospital infection rates and other quality measures. Ten states require that patients be tested for antibiotic-resistant bacteria like MRSA upon admission to intensive care units, where the threat of infection is typically highest.
It has long been clear that patients and health care workers pass the germs to one another, and that diligent hand hygiene and other precautions can significantly reduce the risk of transmission. But compliance with guidelines has been uneven at best.
The study of intensive care units released Wednesday, for instance, found that health care workers wore gloves only 82 percent of the time when such precautions were specified, donned gowns only 77 percent of the time and washed their hands after only 69 percent of patient contacts. The lead author, Dr. W. Charles Huskins of the Mayo Clinic in Rochester, Minn., noted that those numbers were "not woefully bad," as previous studies had found hand-washing compliance to be as low as 50 percent.
The study, of 9,000 cases in 2005 and 2006, was the first exploration of the question in a randomized controlled trial, the gold standard of epidemiological research.
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