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GREENVILLE, N.C. -- Pitt County Memorial Hospital (PCMH) announces preliminary data suggesting a statistically significant reduction in the rate of ventilator-associated pneumonia (VAP) due to methicillin-resistant Staphylococcus aureus (MRSA) in the surgical intensive care unit (SICU) with the implementation of an active surveillance program for MRSA. These data were presented April 6 as a poster at the Society for Healthcare Epidemiology of America (SHEA)’s 18th Scientific Annual Meeting in Orlando, Fla. by Titu Das, MD, MPH, of the Infectious Disease Division at the Brody School of Medicine at East Carolina University. Further analysis of these data will be submitted to a medical journal for peer review.
Led by Keith Ramsey, MD, medical director for infection control at PCMH, and professor of medicine at the Brody School of Medicine at East Carolina University, the study is among the first to specifically look at VAP reduction in the SICU using a targeted active surveillance program.
During the 12-month intervention period, MRSA VAP rates in the SICU decreased by 68 percent due to the implementation of a comprehensive infection control program that included hospital-wide active surveillance using the BD GeneOhm(TM) MRSA real-time polymerase chain reaction (PCR) diagnostic test. The analysis of the SICU-specific data shows that the MRSA VAP rate decreased from 1.74 to 0.54 per 1,000 ventilator days.
"We were seeing an upward trend in the number of patients coming to the hospital with MRSA and we wanted to prevent transmission in our hospital," said Ramsey. "At our facility, active surveillance of patient admissions using PCR testing, combined with immediate isolation of MRSA carriers and eradication treatment with topical antibiotics, helped to significantly reduce our VAP MRSA rate in the SICU. We have not seen any VAPs since June 2007 in our SICU."
MRSA is an important cause of VAP in the ICU, and can cause longer hospital stays and a high mortality rate. According to a study published in the American Journal of Respiratory Critical Care Medicine, the mortality rate for VAP ranges from 24 percent to 50 percent and can reach 76 percent in some settings or when lung infection is caused by high-risk pathogens. ICU ventilated patients with VAP have been reported to have a two- to 10-fold higher risk of death compared with patients without pneumonia. In addition to having a high mortality rate, MRSA VAP is also associated with an increased utilization of resources, including longer ventilator dependence and excess costs of approximately $8,000.
In a separate study comparing VAP due to MRSA or methicillin-sensitive Staphylococcus aureus (MSSA), mortality was found to be directly attributable to pneumonia for 86 percent of the MRSA patients and 12 percent in the MSSA patients, with a relative risk of death equal to 20.7 for MRSA pneumonia.
These study results add to a growing body of data released over the past few years demonstrating the impact of active patient surveillance for MRSA, coupled with a comprehensive infection prevention program to reduce MRSA infections.
MRSA bacteria can cause a potentially fatal infection that does not respond to commonly used antibiotics and is a significant cause of healthcare-associated infections. The Centers for Disease Control and Prevention (CDC) estimates that approximately 126,000 people are hospitalized each year with MRSA infections and about 19,000 die, with an estimated annual cost of $3.2 billion to $4.2 billion to U.S. hospitals.
PCMH, located in Greenville, N.C., serves a rural population in 29 counties. The SICU-data represent a subset of a wider study conducted by PCMH over the past year, which looks at the impact of a hospital-wide, all-admission surveillance, the data for which is being compiled for future release.
Source: Pitt County Memorial Hospital