Patient Safety Focus: Healthcare-Associated MRSA in the United States

Pamela Wagner


By Pamela T. Wagner, MSN, RN

Clinical Application Specialist, GOJO

Antibiotic resistance is a major public health issue today—both in the healthcare industry and in our communities—and methicillin-resistant Staphylococcus aureus (MRSA) is a key focal point in the fight against so-called superbugs.

This article examines the prevalence of MRSA in the United States, how it spreads in hospitals and affects patient safety, and how a comprehensive solution for hand hygiene monitoring and improvement can help to prevent the spread of MRSA and other healthcare-associated infections (HAIs).

How Common Is MRSA in U.S. Hospitals?

The Association for Professionals in Infection Control and Epidemiology (APIC) estimates that at least 5% of patients in U.S. hospitals carry MRSA at any given time. In total, more than 120,000 hospital patients are infected with MRSA annually.1 Studies suggest that MRSA accounts for more than 60% of all Staph infections today.2

It is also estimated that about 2% of the total U.S. population carries MRSA3 —but many people are healthy enough that they resist infection, and thus remain unaware they have been colonized and could put others at risk.

How Does MRSA Affect Patients, Healthcare Workers, and Hospitals?

The Centers for Disease Control and Prevention identifies three primary issues associated with MRSA in healthcare settings:

  • Pathogenicity
  • Transmissibility
  • Limited treatment options

The Institute for Healthcare Improvement (IHI) estimates about 5,000 patients die each year as a result of becoming infected with MRSA. Healthcare workers face the same lethal hazard from exposure to MRSA and other HAIs. There is also a major impact on hospitals themselves. A patient’s stay is extended by an average of up to 10 days if they become infected with MRSA—leading to tens of thousands of dollars in extra expenses both public and private payers are increasingly refusing to reimburse. The total cost of MRSA to the U.S. healthcare system amounts to billions of dollars per year.4

How Does MRSA Spread in Healthcare Settings?

Like other HAIs, healthcare-associated (HA) MRSA is typically spread by either direct or indirect contact with contaminated individuals, objects or surfaces. MRSA is particularly difficult to eradicate because it is resistant to first-line antibiotics and can survive for extended periods of time on common surfaces and objects found in hospitals—including fabric, sinks and cleaning equipment.5 It is possible for patients to acquire HA-MRSA in a room previously occupied by an infected or colonized person.

Another challenge in controlling MRSA is that millions of Americans don’t know they’ve been colonized because they do not present the symptoms of an infection. Cases of community-associated MRSA are becoming increasingly common, and these patients can spread the infection any time they visit a healthcare facility—even if they are healthy enough to resist infection. Healthcare workers don’t immediately know these patients are carrying MRSA, so they are unable to take extra precautions.

A study in the New England Journal of Medicine examined hospitals in three major U.S. cities in 2005 and found that up to 20% of patients isolated for MRSA acquired the infection in the community, rather than in a healthcare setting. The increasing frequency of such infections makes it even more challenging to control MRSA in hospitals.

What Can Hospitals Do to Prevent the Spread of MRSA?

Public health authorities worldwide agree that complying with recommended hand hygiene practices is one of the most important ways to prevent the spread of HAIs—especially antibiotic-resistant pathogens like MRSA. Several studies have examined hygiene-centered strategies to either eliminate or prevent the spread of MRSA.

Impact of a hospital-wide hand hygiene promotion strategy on health-care associated infections

According to the Antimicrobial Resistance and Infection Control. 2012

  • Hospital’s hand hygiene compliance rate improved from 20% in 2007 to 61% in 2010
  • HA-MRSA infections per 1000 patient-days decreased by 50%, from 0.6 in 2007 to 0.3 2010

Promoting and sustaining a hospital-wide, multifaceted hand hygiene program resulted in significant reduction in health care-associated infections

According to the American Journal of Infection Control. 2013

  • Hand hygiene compliance rate increased from 38% in 2006 to 65% in 2010 and then to 85% in 2011
  • HA-MRSA infection per 1000 patient-days reduced by 80%, from 0.42 in 2006 to 0.08 in 2011

How Can the SMARTLINK™ Technology Electronic Hand Hygiene Monitoring System Help?

Electronic monitoring systems provide critical tools to infection prevention teams as they strive to increase hand hygiene compliance and reduce the incidence of HA-MRSA, because accurate, efficient and reliable measurement is essential for sustained improvement.

The SMARTLINK™ electronic monitoring system from GOJO runs 24/7, capturing a far larger data set than any direct observation program with 98% accuracy.6 On the back end, raw hand hygiene compliance data is automatically collected from soap and sanitizer dispensers and organized for reporting purposes or displayed in real time on customizable dashboards.

This integrated system leverages industry-leading technology and clinical expertise to give infection preventionists unprecedented insight into hand hygiene behavior at their healthcare facility, enabling them to develop and execute targeted interventions. SMARTLINK™ Technology also helps make time for clinical training and coaching by automating or streamlining back-end administrative work related to collecting and reporting hand hygiene data.

Email us at SMARTLINK@GOJO.com to learn more about how SMARTLINK™ Technology can help your healthcare facility in the fight against HAIs, like MRSA, by providing the tools you need to increase and maintain hand hygiene compliance.

1 Institute for Healthcare Improvement. Reducing MRSA Infections: Staying One Step Ahead. http://www.ihi.org/resources/Pages/ImprovementStories/ReducingMRSAInfectionsStayingOneStepAhead.aspx
2 APIC. Guide to the Elimination of Methicillin-Resistant Staphylococcus aureus (MRSA) Transmission in Hospital Settings. http://www.apic.org/Resource_/EliminationGuideForm/631fcd91-8773-4067-9f85-ab2a5b157eab/File/MRSA-elimination-guide-2010.pdf
3 CDC. General Information About MRSA in Healthcare Settings. http://www.cdc.gov/mrsa/healthcare/index.html
4 APIC. Guide to the Elimination of Methicillin-Resistant Staphylococcus aureus (MRSA) Transmission in Hospital Settings.
5 Neely AN, et al. Survival of Enterococci and Staphylococci on Hospital Fabrics and Plastic. February 2000. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC86187/
6 SMARTLINK™ System Accuracy Lab Testing. 98% room entry and exit accuracy and 100% dispense event accuracy. Conducted in GOJO laboratory. Data on file.

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