Patients who go to a hospital hope to be treated for their illness and then be sent home healthy. However, statistics show that many times, patients in a hospital will pick up a fierce infection during their stay. Among the bacterial infections that more and more patients seem to be catching in hospital settings are methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE).
In response to the increased prevalence of MRSA and VRE infections, the Hopkins Hospital has instituted many preventative measures to protect patients and staff. These infections with "superbugs" are particularly worrisome because they resist most known antibiotics, making treatment difficult.
It is estimated that MRSA can cause over 1 million serious infections per year in hospital settings, making it the most common nosocomial (hospital-acquired) infection. It is frequently spread through direct contact with bodily fluids and respiratory droplets, infected medical surfaces or equipment and hospital workers with poor sanitation.
Depending on the source, the infection can cause a variety of complications, ranging from a simple skin infection to urinary tract or central nervous system infections to life-threatening bacteremia (infection of the blood) if undetected.
VRE has been cultured on hospital beds and other surfaces and can be very dangerous to patients with compromised immune responses. It has the unique ability to pass antibiotic resistance genes to other, more serious bacteria that grow in the gastrointestinal tract naturally. In addition, the presence of these infections can increase a patient's susceptibility to other, more serious bacterial diseases.
Preventing these conditions in hospitals has become exceedingly important given the high number of cases among at-risk populations such as ICU patients, elderly patients in nursing homes and children, all of whom are especially vulnerable to infections due to their weaker immune systems.
Children are particularly likely to become infected because their immune systems are not fully developed and there are fewer approved drugs that can safely be used on children without causing harmful complications.
Hopkins Hospital has initiated aggressive screening for MRSA and VRE in every child admitted to the pediatric ICU. The increased testing for these bacteria is an attempt to detect and treat infections early, before symptoms begin. For the adult ICU, screening for these "superbugs" is already part of standard admission procedures.
The intense screening of children was instituted in March based on the results of a previous study at Hopkins that showed the effectiveness of early screening. The study was initiated after reports indicated that the incidence of both MRSA and VRE were rising, especially among children.
The earlier detections prevented both the spread of germs among children in the ICU and the onset of infections. The study was one of the first to show that more intensive screening beforehand was effective in slowing the spread of the harmful bacteria in the pediatric ICU. Instead of testing for bacteria when symptoms appear, which is the current practice, the subjects in the study were swab-tested every week to screen for both MRSA and VRE.
In weekly tests, MRSA was detected in one and a half times as many patients as compared to the standard monitoring procedures. VRE detection was six times higher in weekly tests. Under the current system, 35 percent of MRSA infections and 82 percent of VRE infections are missed.
Hospital epidemiologist Trish Perl and her team believe that aggressive testing programs such as the one initiated in their study should replace the standard practices in order to actively improve patient safety in hospitals. Patients and hospital staff will benefit from identifying patients who are at risk of developing an infection and are also capable of unknowingly passing these infections onto others.
Based on these tests, the hospital can take more specific precautions earlier on, such as isolating infected patients and confining treatment to designated areas, especially for open wounds. Extra measures such as frequent cleaning of equipment and use of disposable gloves and masks are already taken in the hospital when an infection is suspected.
Although further studies will be required in order to recommend that other hospitals adopt similar measures in the pediatric ICU, the study's success indicates that aggressive screening will be effective in reducing the number of resistant bacterial infections caught during hospital stays.
