Updated Guidelines Look to Reduce Hospital-Acquired MRSA

This digitally colorized scanning electron microscopic (SEM) image, depicts numerous mustard-colored, spheroid shaped, methicillin-resistant, Staphylococcus aureus (MRSA) bacteria, enmeshed within the pseudopodia of a red-colored human white blood cell (WBC), known more specifically as a neutrophil. Photo Cedit: National Institute of Allergy and Infectious Diseases

Healthcare-associated infections (HAI) continue to challenge clinicians and staff working in acute-care hospital settings. According to the CDC, on any given day, 1 in 31 inpatients has an HAI, and the federal agency estimates approximately 722,000 infections and 75,000 deaths occur each year as a result of HAIs.

In a survey conducted in 2015, results showed the most common HAIs were pneumonia, Clostridium difficile (C diff), and surgical-site infections.¹

Another HAI, Methicillin-Resistant Staphylococcus aureus (MRSA), has become particularly burdensome. Healthcare-associated MRSA infections often follow invasive procedures, such as surgeries, or the use of devices, such as central venous catheters, and can be spread within hospitals by the hands of healthcare personnel or through contact with contaminated surfaces and equipment.

MRSA is believed to cause approximately 10% of hospital-associated infections in the United States and such infections are associated with an increased risk of death. Certain infections caused by MRSA rose by as much as 41% during the pandemic after falling in preceding years.

“The enormous strain put on healthcare during the pandemic may have contributed to the observed increase in some hospital infections. We have data that show MRSA infections rose,” David Calfee, MD, editor of ICHE, the journal of the Society for Healthcare Epidemiology of America (SHEA), said in a statement.

With these concerns in mind, SHEA in collaboration with the Infectious Diseases Society of America, the Association for Professionals in Infection Control and Epidemiology, the American Hospital Association, and The Joint Commission, with major contributions from representatives of several organizations and societies with content expertise wrote updated guidance to the 2014 Strategies to Prevent Methicillin-Resistant Staphylococcus aureus Transmission and Infection in Acute Care Hospitals.

“The evidence that informs these recommendations shows that we can be successful in preventing transmission and infection. We can get back to the pre-2020 rates and then do even better,” Calfee said who also served as senior author of the updated guidance.

The updated recommendations elevate antimicrobial stewardship from an “additional practice” to an “essential practice,” meaning all hospitals should do it. When someone who is colonized with MRSA receives treatment with antibiotics for another infection, they may have a higher risk of developing MRSA infection and may be more likely to transmit MRSA to others. Avoiding unnecessary use of antibiotics may decrease these and other risks associated with antibiotic use, such as C difficile infection.

The guidance describes other practices, such as surveillance to detect asymptomatic MRSA carriers and decolonization to eradicate or reduce the burden of MRSA among people who are colonized with MRSA—for specific patient populations.

When infection prevention measures are put into practice, incidence reductions can be realized. One study carried out by the Veterans Administration and published as a poster at the SHEA spring conference, showed there were fewer MRSA cases when active surveillance (AS), contact precautions for patients colonized (CPC) or infected (CPI) with MRSA were practiced.

“The MRSA HAI rate for all infection sites in non-ICUs was 0.07 (95% CI 0.05-0.08) for facilities practicing AS + CPC + CPI compared to 0.12 (95% CI 0.08-0.19, P = 0.01) for those not practicing any of these strategies…in ICUs was 0.20 (95% CI 0.15-0.26) and 0.65 (95% CI 0.41-0.98, P < 0.001) for the respective policies,” the investigators wrote.

This compendium, was first published in 2008, and is sponsored by SHEA. The compendium is a multiyear, highly collaborative guidance-writing effort by over 100 experts from around the world.

In the coming weeks, SHEA said a new compendium section will be published outlining approaches to the implementation of infection prevention strategies, followed by an update to strategies to prevent catheter-associated urinary tract infections.

Reference
1. Magill SS, O'Leary E, Janelle SJ, et al. Changes in Prevalence of Health Care-Associated Infections in U.S. Hospitals. N Engl J Med. 2018;379(18):1732-1744. doi:10.1056/NEJMoa1801550