Addressing MRSA

Anthony Sanzo, for HealthLeaders News , November 30, 2007

In 2005, more than 94,000 Americans developed hospital-acquired MRSA infections. Nearly one in five died. MRSA accounts for over 60 percent of hospital staph infections, up from just 2 percent in the mid-1970s. Patients with hospital-acquired infections are seven times more likely to die than the average patient. Deaths, experts say, that are largely preventable. The recent revelation that MRSA is killing more Americans than AIDS compels us to look for better answers--and fast.

Improved isolation communication
A simple answer, yet one which could have a huge impact, involves how we communicate the location of infected patients who are in isolation. What is evident is that quarantine itself is not enough. Right now, housekeepers, transport personnel and other staff can easily walk into a room without knowing an infected person has been there. That's because, in many hospitals, infection control nurses still have to manually prepare lists of "blocked" rooms. Those lists can be outdated before they leave their office. Because these workers can be exposed inadvertently to infection, the possibility of wider contamination increases. Fully 85 percent of invasive MRSA infections are associated with healthcare treatment. We now know that infection cases are moving out of intensive care units, through the hospital and into the general population. Two thirds of MSRA infections reported by hospitals last year were in general medical wards.

To protect both workers and patients throughout the hospital, technology is now available which automatically alerts staff of isolation conditions when a page goes out to clean a room. So workers not only know what they are facing, they know to bring the proper equipment for their own protection and optimal hygiene. That same technology can also give infection control nurses a mobile visual reference tool to help them assess isolation needs as they make clinical rounds.

This capability is even more vital now that a new strain, known as community-associated MRSA, is spreading outside the hospital. MRSA-CA has the potential of becoming more lethal since it is often misdiagnosed as the hospital-acquired version and treated with the wrong drugs, which could possibly increase its resistance.

Reduced overcrowding
Great Britain reports findings that overcrowded hospital conditions worsen the spread of MRSA. Studies there found that the most crowded hospitals--with bed occupancy over 90 percent--had MRSA rates 42 percent higher than average. "Boarding" emergency patients in close proximity while they wait for inpatient rooms presents a risk of cross-infection. Since most of America's 4,600 hospital EDs are "at" or "over" critical capacity, this presents another major concern.Again, information technology has an important role to play. Hospital overcrowding is caused by log jams in patient traffic, due primarily to poor communications and conflicting priorities. Patient flow technology provides real-time information to help hospitals avoid those log jams, thereby reducing or eliminating the need for boarding. Some hospitals have had notable success in reducing their infection rates by isolating infected patients and then taking extra precautions, like requiring workers to wear gloves and gowns for every contact. But isolating patients can be extremely difficult in "overcrowded" hospitals. It requires real-time knowledge of bed status throughout the institution. Otherwise, non-infected patients can be placed next to the wrong patient in the wrong room at the wrong time. Those "mismatches" can now be largely avoided because of improvements in patient flow processes, combined with advanced patient flow technology. These advances allow for more flexibility in making room assignments and blocking access to rooms with infected patients.

Smoother patient flow
Another resource in the fight against MRSA is time. The British studies found that overcrowding pressure denied hospital staff the time they need to thoroughly disinfect beds and surrounding areas. Addressing patient flow problems helps remove the "urgency" associated with overcrowded conditions, so housecleaners can complete the task of disinfection in a reasonable time period. About 20 to 30 percent of hospitals are already using information technology to track and manage hospital-acquired MRSA. These include automatic surveillance systems and rapid-testing devices. Another 47 percent are actively considering such technology. New computer systems allow hospitals to pull together data from bedside monitors, lab-test results and more to identify problem areas more quickly. But this fight will take more than a single solution. The very presence of MSRA disproves the theory that there is a silver bullet for infection. It's going to take a great deal of effort on many fronts. Communicating information about isolation in real-time, reducing overcrowding and smoothing out the patient flow process are powerful weapons in the war against MRSA that hospitals cannot afford to ignore.

Anthony Sanzo is CEO of TeleTracking Technologies, Inc., a provider of patient flow automation solutions. He is a former senior executive at Pittsburgh's two major academic medical centers and also served as CEO of one of those institutions.

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