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French hospitals make progress in battle against MRSA through large-scale prevention and monitoring

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mrsa decrease hospitals franceA group of French hospitals has reduced the burden of MRSA (methicillin resistant Staphylococcus aureus) among patients by more than a third after a 15-year-long multi-prong control program, according to a new report published online March 22 in the Archives of Internal Medicine.

The 38 teaching hospitals run by Assistance Publique-Hôpitaux de Paris (AP-HP) make up France’s biggest hospital organization and together admit about one million patients each year. In the 1980s, 35 percent of all cultured strains of S. aureus in France were MRSA, a finding that prompted AP-HP to assemble a broad plan of attack, which they launched in 1993.

"The program focused on a bundle of measures aimed at decreasing cross-transmission, including single room placement, promotion of hand hygiene, active surveillance in high-risk patients, quick notification of cases, and feedback," the researchers, led by Vincent Jarlier, of the Laboratorie de Bactériologie-Hygiène at the Université Pierre et Marie Curie-Paris, noted in the study.

Aside from these preventive measures, the hospitals didn’t make any broad changes in their antibiotic prescription rates or promote decolonization with mupirocin (which presents a risk of inducing further resistance).

The findings, which are based on observational data from 1993 to 2007, support the case that broad control measures can help put a dent in health care-associated MRSA. "Effective control of MRSA in epidemic settings has been extensively demonstrated, but the feasibility of controlling endemic situations with high MRSA rates has been questioned," the researchers noted. "Our study demonstrates that this objective can be reached at the scale of a large medical institution." Although MRSA infections have been declining in many northern European countries, during the first eight years of the study, the rates continued to increase in other hospitals in the Paris area, the researchers reported.

In the U.S., the overall number MRSA hospital infections increased by more than twofold (to more than 477,000) between 1999 and 2005, a 2007 study from the U.S. Centers for Disease Control and Prevention found. In U.S. intensive care units, however, the rate of MRSA infections dropped by half between 1997 and 2007, according to a 2009 study in JAMA The Journal of the American Medical Association.

But the French hospitals in the new study beat even that number, reducing infections in ICUs by 59 percent. Surgical ward MRSA infections dropped in the AP-HP by 44 percent and those in general medical wards decreased 32 percent.

Although "virtually all" of the MRSA cases in the French study were determined to be hospital-acquired, community-associated cases are on the rise in many places, including the U.S. Additionally, in the U.S., another superbug is gaining infamy. C-diff (Clostridium difficile) rates in a sample of Southeast community hospitals were 25 percent higher than MRSA, according to new research presented at the International Conference of Healthcare-Associated Infections in Atlanta.

Image courtesy of iStockphoto/lovleah

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  1. 1. Sharon McEachern 1:36 pm 03/23/2010

    Much of the responsibility for the spread of MRSA in American hospitals belongs to the doctors. More than 50 percent of physicians working in hospitals refuse to simply wash their hands, according to the National Quality Forum. Hospitals are so desperate today to get doctors to wash their hands before touching patients that they’ve installed hidden cameras up to catch those who refuse to wash. Ethic Soup blog has a good post on this at:

    http://www.ethicsoup.com/2009/01/dont-kill-me-doctor-wash-your-hands.html

    Additionally, what physicians wear — ties and white coats — spread MRSA. Some hospitals have already banned ties and the AMA is discussing the need to leave white lab coats in the closet in the future. You can read more on this at:

    http://www.ethicsoup.com/2009/06/doctors-white-coats-spread-infection-so-do-their-hands.html

    Link to this
  2. 2. brmendes 12:11 pm 03/24/2010

    And it is not the only point. There are a lot of small things that make all the difference, this considering that doctors and other medical staff have an example to transmit. For example their medical wear, they tend continuosly to exit and reentry to/for the medical facilities with it. And with their instinct and their needs, this kind of colonization agents easily advanced for these gateways to damage the unprotected human system.
    Think about it…the small things of today make the great differences tomorrow!

    Link to this
  3. 3. brmendes 12:11 pm 03/24/2010

    And it is not the only point. There are a lot of small things that make all the difference, this considering that doctors and other medical staff have an example to transmit. For example their medical wear, they tend continuosly to exit and reentry to/for the medical facilities with it. And with their instinct and their needs, this kind of colonization agents easily advanced for these gateways to damage the unprotected human system.
    Think about it…the small things of today make the great differences tomorrow!

    Link to this
  4. 4. jerseyshorejohn 12:48 pm 03/24/2010

    Sharon’s point is valid. In addition to what doctors and staff wear, the environment of care also can contribute to the spread of MRSA and other pathogens. A November 2008 study at the Cleveland Veterans Administration Hospital found that 42% of patient privacy curtains were infected with VRE, 22% with MRSA and 4% with C.diff, concluding that Hospital curtains are a potential source for dissemination of healthcare-associated pathogens. Hospitals in the UK have converted to fully recyclable disposable curtains that incorporate advanced biocide technology that kills pathogens on contact. brmendes is right – little things mean a lot.

    Link to this

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