EVANSTON, Ill. -- On Aug. 1, 2005, Evanston Northwestern Healthcare (ENH) will launch a system-wide admission screening program across its three hospitals -- Evanston, Glenbrook and Highland Park -- to detect methicillin-resistant Staphylococcus aureus (MRSA), a difficult-to-treat strain of bacteria that doesn't respond to common antibiotics and is a significant cause of hospital-acquired infections. The Centers for Disease Control and Prevention (CDC) estimates that in 1999 there were 126,000 Americans in U.S. hospitals with infections from MRSA, and the problem has grown worse ever since then. Emerging infections like this are most acute in large urban areas such as Chicago, so ENH has decided to tackle this head-on as a major patient safety initiative.
"This initiative is the first of its kind in the country that uses a combination of the electronic medical record and same-day molecular testing to screen patients on admission and determine if they are infected with MRSA or are colonized with the bacteria but are not yet infected," said Lance Peterson, MD, FASCP, epidemiologist and director of clinical microbiology and infectious disease research at Evanston Northwestern Healthcare, and professor of pathology and medicine at Northwestern University's Feinberg School of Medicine.
The combination of these technologies allows doctors to immediately identify and treat patients who may otherwise be unaware of having MRSA. That's because the electronic medical record contains an admission sheet as part of each patient's treatment plan that prompts the admitting team to order and collect a nasal swab before a healthcare provider moves to the next computer screen.
"This electronic 'red flag' alert ensures compliance and allows us to document cases in which a patient may refuse the test," said Peterson. Then, each patient's nasal sample is tested using real-time DNA analysis developed by GeneOhm Sciences, Inc. The test detects the microorganism at the molecular level and compresses the time frame to identify MRSA from the current two to four days, using traditional culture methods, to less than two hours. Once diagnosed, patients are treated with a nasal antibiotic ointment for five days. They also need to bathe using a special antiseptic soap on the first, third and last day of the nasal ointment treatment.
"No other hospital in the country has ENH's level of commitment to reduce MRSA among its patient population," said Peterson. "In fact, every member of our community ultimately will benefit from this initiative because patients with active MRSA infections will be isolated and receive immediate treatment; those colonized with the bacteria but not yet infected also will be treated so they don't develop an active infection or unknowingly spread MRSA to others elsewhere in the hospital or community after they are discharged."
Patients undergoing a complex medical procedure or surgery are highly susceptible to MRSA, which already may be present on their mucous membranes or skin. In fact, one-fourth of the population carries staph bacteria without becoming sick. But if someone carrying MRSA needs medical treatment such as surgery, there is real risk that the organism will invade the surgical incision. Symptoms of MRSA range from mild skin sores to life-threatening surgical wound infections and blood poisonings. Avoiding MRSA infections reduces the need for follow-up surgeries and additional hospitalizations, several weeks of intravenous antibiotics, and a prolonged risk of recurrent infection.
"This also makes good economic sense," said Peggy King, senior vice president of hospitals and clinics for Evanston Hospital, "because it will reduce hospital days and costs associated with treating MRSA complications. ENH has screened regularly for S. aureus in its highest risk patient areas, such as the Infant Special Care Unit (ISCU) for the past two years, and also conducted a targeted pilot program with a rapid molecular method to screen selected pre-operative patients undergoing knee replacement surgery. This program reduced the rate of post-surgical S. aureus infection nearly four-fold."
In September 2004, however, the hospital system conducted a prevalence study and found eight percent of its patients in a one-day period of time were colonized with MRSA. "This incidence reflects a recent finding that between eight and nine percent of inpatients in the Chicago metropolitan area are MRSA carriers and was the impetus for the current initiative," said Peterson. "Our goal is to reduce the incidence of MRSA infections by 50 percent over the next two years among our patient population."
Source: Evanston Northwestern Healthcare