Staph cases drop at hospital

Pitt Memorial program shows stubborn infections, some of them deadly, can be reduced

Under pressure to curb antibiotic-resistant staph infections, which kill 19,000 people a year across the nation, one North Carolina hospital is pioneering a system that tests every patient to identify carriers of the superbug.

The effort by Pitt County Memorial Hospital in Greenville has slashed infection rates by more than 60 percent and demonstrated that the bacteria may be more prevalent than scientists suspected.

The bug in question is methicillin-resistant Staphylococcus aureus, or MRSA, which is thought to be carried by as many as 5 percent of people, and doesn't cause harm unless it enters a cut or wound. Nearly 90,000 people develop serious MRSA infections nationally, more than 80 percent in hospitals, according to the U.S. Centers for Disease Control and Prevention.

In Washington on Tuesday, the director of the centers called MRSA "the cockroach of bacteria" and called on Congress to help develop a vaccine to fight it, Cox News Service reported. With no vaccine and few new antibiotics available, Julie Gerberding said the CDC is vigorously pushing prevention messages. American hospitals have been slow to seek out and contain MRSA carriers.

Pitt County Memorial is one of just six hospitals in the United States that tests all admitted patients for MRSA, hospital officials said.

In February, hospital staff began taking nasal swabs from every patient. Carriers of the bacteria are placed under "contact isolation." Hospital staff and visitors don fresh gloves and paper gowns each time they enter the patient's room. Such precautions stop only after carriers are de-bugged with antibiotic ointment and soaps.

Since the effort began, infections associated with ventilators have plummeted 67 percent, Pitt County Memorial infection control specialists said Wednesday during a news briefing. Urinary tract infections caused by MRSA fell 60 percent.

"You can imagine an MRSA-free hospital," said Dr. Keith Ramsey, the hospital's medical director. "That's the end of the rainbow, and that's our goal."

Ramsey said hospital officials expected to find that no more than 5 percent of patients carried MRSA, based on the latest national research. They were surprised to find that 8 percent of the more than 27,000 patients tested since February were carriers.

Testing people to identify carriers is a proven way to reduce MRSA infections, which are considered the most active and dangerous in hospitals today. "Active surveillance" has helped hospitals in Canada limit MRSA to less than 10 percent of infections, and Scandinavian countries such as Denmark have used such testing to virtually eliminate the bug from their health-care facilities.

American hospitals have known about MRSA since the late 1960s but have become especially concerned about it in recent years because of the rapid emergence of a new strain that is easily picked up in the community and strikes healthy people. That's the strain that made headlines in recent weeks after it caused the death of a Virginia teen.

Patients infected with the community-acquired bug, which causes more serious illness than MRSA strains traditionally found in health-care facilities, bring it into hospitals through the emergency room. From there, it can spread.

"The community-acquired strain is now a major threat to hospitals," said Dr. Jeffrey Engel, North Carolina's state epidemiologist. "It can be very easily transmitted to patients, usually on the hands of health-care workers."

The test Pitt County Memorial has used to detect the bug is simple. A swab from inside the patient's nose is taken, and samples are sent to the hospital's laboratory. The hospital invested in technology that delivers results within hours rather than the two to three days it takes using conventional laboratory tests.

Such expenses are likely to inhibit other hospitals from adopting the program. In addition to laboratory costs, hospitals must spend thousands more on protective gear such as gowns and gloves. Pitt County Memorial, the flagship of University Health Systems, a private nonprofit health system affiliated with East Carolina University's Brody School of Medicine, has invested about $1 million in its MRSA testing program, according to president Steve Lawler.

Other hospitals

At Wake Forest Baptist University Medical Center in Winston-Salem, a smaller, targeted program to detect MRSA costs about $250,000 a year. It has focused efforts on testing patients in intensive care units and other high-risk patient groups. That program has cut MRSA infections by more than half, said Dr. Christopher Ohl, an infectious disease specialist there.

Wake Forest expects to begin a universal surveillance program starting next year, Ohl said.

In the Triangle, the Duke University Health System, which includes facilities in Raleigh and Durham, is the only one that actively seeks out MRSA carriers, testing patients in most of its ICUs, oncology ward and neonatal nursery. UNC Hospitals in Chapel Hill and Rex Hospital in Raleigh, which is part of the UNC system, are both pursuing targeted surveillance programs for MRSA. And WakeMed Health & Hospitals in Wake County will start a trial program doing targeted surveillance next year.