PA law calls for testing HCWs for resistant staph

Measure part of broad health care reform

In a controversial provision in sweeping health care reform legislation, Pennsylvania is requiring the testing of health care workers who are exposed to patients with methicillin-resistant Staphylococcus aureus (MRSA).

Pennsylvania Gov. Edward Rendell signed the bills in late July as part of his "Prescription for Pennsylvania," which seeks to improve access, quality, and affordability of health care. His plan includes a tax-supported Cover All Pennsylvanians (CAP) program that would offer health care coverage to the uninsured and to small businesses. Reducing health care-acquired infections is a part of those efforts.

Reducing health care-acquired infections and specifically MRSA involve "not just an issue of quality, but also of cost," says Elisabeth Myers, deputy director of communications in the Governor's Office of Health Care Reform. "Individuals who acquire infections end up staying in the hospital for much longer."

In fact, in 2005, there were 19,154 cases of hospital infections and 2,478 related deaths in Pennsylvania. The infections cost about $3.5 billion in hospital charges. The average charge for a patient with a health care-acquired infection was $185,260 compared to $31,389 for patient who did not have an infection.

Those statistics come from the mandatory reporting of health care-acquired infections. In 2004, Pennsylvania became one of the first to implement a mandatory reporting law.

The latest legislation again targets hospital infections. "There's been reporting, but there haven't been [any measures] to mandate or help health facilities with [efforts that would] affect these numbers," says Myers.

The most recent legislation requires hospitals to have an infection control plan. It also requires infection control professionals to identify patients who are colonized or infected with MRSA or other multidrug-resistant organisms and to have "procedures for identification, cultures, screenings, and follow-up care for staff who may have had exposure to a patient known to be colonized with an MDRO [multidrug-resistant organism] before that patient was identified."

The Pennsylvania Department of Health will develop guidelines to implement the screening later this fall, says Myers.

Meanwhile, the governor is pressing forward with a broader health care reform bill. In addition to the CAP program, it would require "randomized screening" of inpatients, nursing home residents and health care workers. It does not specify whether employees would receive treatment if they test positive for MRSA, but requires health care facilities to "take all actions necessary to prevent the spread of MRSA to other inpatients, residents or staff." Failing to comply could threaten a hospital's license.

Screening patients for MRSA upon admission has been gaining favor around the country. The Veterans Health Administration recently expanded its successful MRSA program that began at the VA Pittsburgh Healthcare System. But the VHA does not screen employees for MRSA.

"Even if [someone] were to become colonized, it's hard to know what that information means," explains Rajiv Jain, MD, FACP, chief of staff at the VA Pittsburgh Health Care System. "The majority of the time the employees are transient carriers. They just carry the organism for a very short time."

In fact, the Centers for Disease Control and Prevention do not recommend the screening of employees. In 2006 guidelines, an advisory panel to CDC, the Healthcare Infection Control Practices Advisory Committee, stated: "Some MDRO control reports described surveillance cultures of health care personnel during outbreaks, but colonized or infected health care personnel are rarely the source of ongoing transmission, and this strategy should be reserved for settings in which specific health care personnel have been epidemiologically implicated in the transmission of MDROs."1

As the reform efforts progress in Pennsylvania, the provision on health care worker testing has raised some concerns.

"We need to be sure workers' rights are not infringed upon in this requirement to test workers," says Evie Bain, RN, MEd, FAAOHN, coordinator of the Division of Health and Safety for the Massachusetts Nurses Association who has been involved with the issue of MRSA and potential occupational risks to health care workers.

However, health care workers should know if they are colonized and should be provided with adequate personal protective equipment. For example, health care workers who are colonized with MRSA might need to take treatment before having surgery.

(Editor's note: More information about the Pennsylvania health care reform legislation is available at www.rxforpa.com.)

Reference

1. Siegel JD, Rhinehart E, Jackson M, et al. Management of multidrug-resistant organisms in healthcare settings, 2006. Centers for Disease Control and Prevention, Atlanta, GA, 2007. Available at www.cdc.gov/ncidod/dhqp/pdf/ar/mdroGuideline2006.pdf.