U.S. Department of Veterans Affairs launches new fight against MRSA

May 2007

BALTIMORE — In response to the growing threat of methicillin-resistant Staphylococcus aureus in hospitals, the U.S. Department of Veterans Affairs is launching a new program to improve surveillance and prevention of the disease.

Results from the department’s pilot program, conducted at the V.A. Pittsburgh Medical Center, demonstrated that the incidence of MRSA was reduced by nearly 40%. These results were presented at the 17th Annual Scientific Sessions of the Society for Healthcare Epidemiology of America (SHEA), held here in April.

Concerns have grown in recent years because the resistance of S. aureus to antibiotics is increasing, making treatment more difficult.

“These infections were once treated with conventional antibiotics,” said Gary Roselle, MD, national program director for infectious diseases at the Department of Veterans Affairs central office in Washington, D.C. “In recent years, however, we’re seeing more and more staph infections that are resistant to antibiotics such as methicillin.”

Increasing resistance

According to study results presented by Roselle, the overall percentage of S. aureus isolates that are methicillin-resistant increased from a median percentage of 46.9% to 58.3% between 2001 and 2006.

Because resistance rates are increasing, many hospitals are now putting more emphasis on prevention. “As resistance increases, physicians become more limited in their options to treat bacterial infections,” Roselle said. “This is why preventing infection becomes increasingly important.”

To improve prevention of MRSA, the Department of Veterans Affairs is implementing a new intervention program that incorporates techniques that have been successful in curbing the spread of nosocomial and hospital-related infections in other parts of the world.

The new program includes improved surveillance. Patients will now be tested for MRSA when they are admitted to the hospital. The program also calls for improved hand hygiene techniques and stricter contact precautions, which require health care workers to wear gloves and gowns when treating patients with MRSA.

On January 12, the Department of Veterans Affairs issued a nationwide directive instructing all Veterans Affairs Medical Centers to begin implementation of this intervention program.

Pittsburgh results

The new program was implemented first at the V.A. Pittsburgh Medical Center. Health officials have been monitoring the Pittsburgh facility for several years to determine the effects of the intervention program on the transmission of MRSA.

According to results from a study conducted at the Pittsburgh facility and presented at SHEA’s annual scientific sessions, the new MRSA prevention program was associated with a 39% reduction in the incidence of MRSA during the last two years of the program.

The Pittsburgh study, presented by John A. Jernigan, MD, at the division of health care quality promotion at the CDC, examined the hospital-wide incidence of both MRSA and methicillin-susceptible S. aureus isolates from October 1999 to June 2006.

In the two years prior to the implementation of the intervention program, the incidence of MRSA was 2.31 per 1,000 patient-days. By the final two years of the intervention program, the incidence rate had decreased to 1.4 per 1,000 patient-days. There was no significant change in the incidence rate of methicillin-susceptible S. aureus during this time. The percentage of S. aureus seen in the hospital that were resistant to methicillin decreased from 63% to 44% during this period.

“The success of the Pittsburgh program resulted in part from interventions designed to improve adherence with infection control practice,” Jernigan said.

For more information:

• Roselle G, Jain R, Kralovic SM, et al. Rates and plans for MRSA Prevention Initiative Nationwide: Methicillin/Oxacillin-Resistant Staphylococcus aureus in U.S. Department of Veterans Affairs Medical Centers.
• Jacob J, Muder R, Cunningham C, et al. Transmission rates during a sustained Methicillin-Resistant Staphylococcus aureus Prevention Program in a non-intensive care unit.
• Both presented at: The 17th Annual Scientific Sessions of the Society for Healthcare Epidemiology of America; April 14-17, 2007; Baltimore.