How carriers of Staphylococcus aureus do worse in the hospital

Originally published in Insidermedicine

Infections with a type of bacteria known as Staphylococcus aureus, or S. aureus, can be diminished by identifying and treating those who carry it in their nasal passages, according to research published in the New England Journal of Medicine.

Here is some information about hospital-acquired infections:

• They are a common problem in hospitals worldwide

• They are a leading cause of death among hospitalized patients

• They increase the cost of healthcare, primarily by extending the length of hospital stays

Researchers from Erasmus University Medical Center in Rotterdam identified over 900 individuals about to be admitted to hospital who were nasal carriers of S. aureus. The investigators randomized these patients to use an antibiotic nasal ointment and body soap or to a placebo group.

The overall rate of infection was more than twice as high for the patients using a placebo, as compared with those using the antibiotic ointment and soap. The treatment was particularly helpful with respect to preventing deep surgical infections – those who used the placebo were five times more likely to develop such an infection, as compared with those who used the antibiotic therapy. Overall survival rates were similar for both groups of patients.

Today’s research suggests that simple procedures for identifying and treating S. aureus in the nose can help reduce the risk of infection among hospitalized patients.

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All patients admitted to ICU in our hospital are being screened for MRSA by a nasal swab. If MRSA is found the patient is put in isolation. No specific treatment is ordered unless there is an active infection. I wonder if we should be even more aggressive in treating MRSA carriers even with no evidence of active infection.
mommatwo
There’s a confounder there: MRSA-carrying patients *only* are being “measured.” Where’s the control group of non-MRSA-carrying patients, who couldn’t possibly be “infecting themselves.”
When looking at fruit rot in cellar storage, it’s kind of pointless to disinfect the apples and point proudly to uncovering the reason/solution for the rot, while ignoring the pears and oranges that are also rotting.
And then there’s the research around hospital staff and hand washing. Not all “dirty” is visible: hospitals for all their spit-polish-and-shine, use of noxious and sometimes harmful cleaning agents are dirty places. Apparently “Dr. Oz” says most people’s toilets are cleaner than their kitchen counters. Given the lower incidence of home-bedroom/bathroom-acquired MRSA, I’d suggest that most people’s beds (and possibly bathrooms too) might be a lot cleaner than most hospitals.
I live in Ontario, Canada, where theoretically at least all medically necessary health care is a public right. Here it is now a patient’s well-publicized *right* to *see* the healthcare worker (whether in hospital or clinic) wash their hands before approaching. And that alone cut the rates of hospital-acquired infections.
Apparently, though, doctors and nurses aren’t particularly compliant when it comes to observing the appropriate procedures to keep the levels of the infectious agents they themselves carry to a minimum.
And the research around hospital staff wearing work clothes “outside,” before work, during breaks and home from work, is a demonstrated risk. But there are no requirements here around that (though there used to be).
Clearly we can’t censure doctors, orderlies and nurses in a way that further hurts the public that needs them. But there’s no reason at all why it can’t be made an infraction to neglect scrupulousl attention to their own cleanliness, and to make mandatory “contributions” for incidents of failure to an education fund around how infections are spread — and how that spread can be prevented.
This is largely a simple sanitation issue, folks.
I wonder, respecting MRSA, how many doctors are aware of the recent research showing sequential spraying with household white vinegar and 3% hydrogen peroxide provides better kill of MRSA than the “fancy” hospital antiseptics?

How carriers of Staphylococcus aureus do worse in the hospital

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