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Got MRSA? 'Yes we do,' ICPs answer in all 50 states
All sizes, types of facilities participate
Key points and findings from the Association for Professionals in Infection Control and Epidemiology that are from its national prevalence survey of methicillin-resistant Staphylococcus aureus (MRSA) are summarized as follows:
Summary: The study found an MRSA rate of 46.3 per 1,000 inpatients in the United States, (including infection or colonization) is eight to 11 times higher than previous estimates made with different hospital samples and using incidence rather than prevalence data. The survey data are more general to all U.S. health care facilities, since the sample included a broad range of health care facilities from every state. The sample is large, with the 1,237 responding facilities representing approximately 21% of all U.S. health care facilities and 28.5% of the average daily census.
Participants and Facilities: Respondents were recruited from APIC member facilities, and APIC members were asked to recruit non-APIC members to participate. The survey was made available through a secure website and via hard copy. All participants were asked to complete the survey on one day during the period of Oct. 1-Nov. 10, 2006. On the one day chosen during this period, each participant was asked to identify all patients known to be colonized or infected with MRSA using existing microbiology, medical, and infection control records. No additional patient culturing was requested. The 1,237 responding facilities were located in every state. These facilities ranged in size from eight to 1,668 licensed beds (avg. = 256). These facilities had a total of 187,058 inpatients (avg. = 69) during the survey period. Respondents included: acute care facilities, rehabilitative care, long-term care facilities, women's facilities, long-term acute care facilities, children's hospitals, and Veteran's Administration (VA) hospitals. Of these facilities, 64% were urban and 36% were rural.
MRSA patients and rate: The total number of patients with MRSA colonization/infection was 8,654. The overall MRSA rate (infection and colonization, HA-MRSA and CA-MRSA) was 46.3 per 1,000 inpatients. For states with reporting from > five facilities, the MRSA rate ranged from 16-91 per 1,000 inpatients. The clinical culture-positive MRSA rate (i.e., including only infections) ranged from 16-48 (avg. = 34) per 1,000 inpatients.
From the detailed data provided on 7,944 patients with MRSA:
(*Many papers in the literature divide HA-MRSA from CA-MRSA using this artificial cutoff of hours after admission, ignoring the fact that many patients are repeatedly admitted and thus become colonized with MRSA at one admission and then are detected with infection at a subsequent admission. Our data (see above) on site of infection and antimicrobial susceptibility results suggest that the majority of MRSA isolates reported were from HA-MRSA rather than CA-MRSA).
Surveillance activities: The mean number of infection control professionals (ICPs) per facility was 1.6. Almost all used CDC definitions of HAI; those in long-term care facilities most frequently used the McGeer criteria for infection. Approximately 45% conducted hospitalwide surveillance for all HAIs and 55% conducted focused surveillance (ICU patients, surgical patients or high-risk nursery patients. Of those conducting surveillance, 42% conducted routine surveillance for all HAIs, 62% conducted bloodstream infection surveillance, 59% conducted surveillance for ventilator-associated pneumonia or surgical site infections, and 31% conducted surveillance for catheter-associated urinary tract infections. Approximately 28% reported performing active surveillance cultures (ASC) for MRSA (to detect patient colonization). Of those performing ASC, 42% performed ASC on transfers from long-term care facilities, 34% on transfers from other health care facilities, 20% on patients with repeated admissions, 18% on selected ward patients, 16% on ICU patients, and 14% on dialysis patients.