New findings from the CDC show that while hospital infection prevention efforts have successfully reduced the rates of Staphylococcus aureus (staph) bloodstream infections in recent years, this progress has apparently stalled. There is a concern that healthcare providers may be backsliding in their activities and focus regarding infection control.
According to electronic health record data from more than 400 acute care hospitals and population-based surveillance data from the CDC’s Emerging Infections Program, methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections in healthcare settings decreased by about 17% each year between 2005 and 2012. However, that progress slowed, with no significant change from 2013 to 2016. Further, the data also reveal there was a nearly 4% per year increase in methicillin-susceptible Staphylococcus aureus (MSSA) infections that started outside of healthcare settings from 2012 to 2017. In 2017 alone, the CDC reported 119,000 people acquired staph bloodstream infections in the United States, leading to nearly 20,000 deaths.
In a press briefing held in March, Anne Schuchat, MD, the principal deputy director of the CDC, explained that the ongoing opioid crisis is one possible factor driving the incidence of S. aureus bloodstream infections.
“In 2016, 9% of all serious MRSA infections happened in people who inject drugs, rising from 4% in 2011,” she said. “Healthcare providers should be aware that people who inject drugs are 16 times more likely to develop a serious staph infection than those who do not.”
To prevent the spread of MRSA in healthcare settings, Schuchat advised clinicians to adhere to CDC recommendations, including contact precautions such as wearing gowns and gloves when caring for patients with MRSA, and targeted screening of patients who might carry MRSA.
“We believe those actions, along with preventing infections in the first place — keeping hands clean and improving how antibiotics are used — have contributed to the decline in overall staph infections nationally,” she said. “But inconsistent or declining adherence to these recommendations might also be slowing our progress.”
Schuchat said that while many staph infections have been prevented, the data show that more effort is needed to address the problem.
“For healthcare providers and administrators, this means prioritizing the prevention of staph infections and implementing programs based on CDC recommendations,” she said. “[They] should review their data on an ongoing basis and decide when to add additional interventions if they are not meeting their infection reduction goals.”
For instance, Schuchat pointed to the success at Veterans Affairs medical centers regarding reductions in overall staph burden by 43% between 2005 and 2017. These centers achieved this by implementing interventions to reduce the spread of MRSA and by enhancing adherence to recommended infection prevention practices.
“We think if a facility or a community is seeing a plateau [in progress against staph infections], they should add on more steps,” Schuchat offered. “We don’t have the data yet to say that everybody should be doing everything all the time, but we do recommend that clinicians consider additional measures for high-risk patients or high-risk circumstances like those in the intensive care unit or people undergoing particular types of higher-risk surgery.”
Schuchat noted that it is crucial for healthcare providers to use checklists and to maintain consistent adherence to infection prevention practices across teams that work in healthcare facilities. Further, she said that pharmacists play an important role in addressing antimicrobial resistance.
“We really think the right drug needs to be used at the right time for the right purposes and for the right duration. That can help us avoid the increases in antimicrobial resistance that we’re seeing,” she explained.