Methicillin-Resistant Staphylococcus aureus (MRSA):
What Can Be Done to Control Infection?
The deaths of two previously healthy school children in October 2007 have focused the nation's attention on invasive infections from the strain of bacteria known as methicillin-resistant staphyloccous aureus (MRSA). Also fueling concern is a recent report indicating that the infection, which does not respond to many common antibiotics, is much more prevalent and much more dangerous than previously recognized. A new analysis issued by The George Washington University School of Public Health and Health Services (GW/SPHHS) examines the associated public health challenges.
In 2005, an estimated 94,360 cases of invasive diseases caused by MRSA occurred in the United States and 18,650 of those cases - almost 20 percent of the total - were fatal, according to the Journal of the American Medical Association (JAMA) (Oct. 17, 2007). Once confined largely to hospitals and other health care settings, MRSA infection is spreading. Almost 14 percent of the estimated invasive disease cases occurred in the community, with reports coming from schools, day care centers, and prisons. The MRSA strains that originate in the community are genetically distinct from those in health care environments, suggesting that new and possibly more virulent strains are emerging.
Basic infection control and prevention measures in health care settings are well-characterized and widely known, if not always fully respected. Among them are strategies for hand hygiene, contact precautions, environmental decontamination, judicious use of antimicrobial agents, active surveillance for high-risk patients, and staff education.
Mandatory reporting and more aggressive approaches to surveillance are under debate. At least 19 states now require hospitals to collect and report data on health-care associated infections. The CDC emphasizes the importance of a science-based approach to developing and implementing reporting systems that are accurate and useful.
Broader surveillance techniques are more controversial. Two states - Illinois and New Jersey - now require all patients to be tested for MRSA when they are admitted to the hospital, but several professional associations oppose such legislative mandates. They argue that decisions about how to assess risk and use limited resources to maximize infection control should be left to individual facilities.
Strategies for gaining control in the community are only beginning to be considered. Some educational materials are available and broader initiatives to reduce the use of antibiotics, which contribute to the spread of antibiotic-resistant bacteria, may be relevant. But as invasive MRSA infections in community settings grow, much more will likely be needed. As they follow unfolding events, public health officials and health care experts will need to identify new strategies and act with an appropriate sense of urgency.
For more information on MRSA policy, contact:
Marisa Cox, MA, MPH
Senior Research Associate, Department of Health Policy
School of Public Health and Health Services
The George Washington University
Washington, DC 20052
Phone: (202) 530-2307
Email:
mcox@gwu.edu
For more information on the science of MRSA, contact:
Gary Simon, MD, PhD
Co-Director, The George Washington University HIV/AIDS Institute
Department of Medicine, Infectious Disease
2150 Pennsylvania Avenue, NW
Washington, DC 20037
Phone (202) 741.2234
Email:
gsimon@mfa.gwu.edu
The George Washington University Medical Center is an internationally recognized interdisciplinary academic health center that has consistently provided high-quality medical care in the Washington, DC metropolitan area for 176 years. The Medical Center comprises the School of Medicine and Health Sciences, the 11th oldest medical school in the country; the School of Public Health and Health Services, the only such school in the nation's capital; GW Hospital, jointly owned and operated by a partnership between The George Washington University and Universal Health Services, Inc.; and the GW Medical Faculty Associates, an independent faculty practice plan. For more information on GWUMC, visit www.gwumc.edu.
