Screening for drug-resistant staph

WILLMAR -- Hoping to stem the tide of drug-resistant staph, Rice Memorial Hospital has begun screening newly admitted patients for the bacteria.

The local rate of methicillin-resistant staphylococcus aureus, or MRSA, is not high, said Barb Piasecki, the infection control nurse at Rice Hospital.

"We're lower than the national average," she said. "However, we also realize we're part of the world. We may some day catch up."

The screening, which started in October, is aimed at identifying patients who have either already had MRSA or are at highest risk of being colonized with the bug.

Since 2000, Rice Hospital has been flagging the charts of patients who have a history of MRSA so that the right precautions can be taken to avoid spreading it, Piasecki said.

What's new is the broader surveillance, which all Minnesota hospitals are required to do as the result of legislation enacted in 2007.

Staph that's resistant to the category of antibiotics that includes all the penicillins has been around since the 1960s. A study by the U.S. Centers for Disease Control and Prevention estimated that 94,000 cases of invasive MRSA, the majority of them associated with health care settings, occurred in the United States in 2005.

People who have been hospitalized or live in a long-term care setting have traditionally been the most vulnerable. Over the past decade, however, MRSA also has been occurring among individuals without these risk factors, prompting more intensive efforts to try to curb its spread before it becomes resistant to an even wider range of antibiotics.

"It takes so long to develop new antibiotics. This is why we've got to respect the ones we have," Piasecki said.

A big question for hospitals has been the scope of testing and monitoring.

"Who do you screen? Is it everybody?" Piasecki said. "Most hospitals are not screening everybody."

To help establish who should be tested, a Rice Hospital committee reviewed the hospital's data on the incidence of MRSA infection to see whether there were any patterns.

What they learned was that patients who had MRSA had either been hospitalized or undergone surgery or had spent time in a skilled care facility within the previous year, Piasecki said. "Those were the most common factors."

These three risk factors are now part of the hospital's screening process when patients are admitted.

If the answer to any of them is yes, the patient is asked to undergo a swab of the nose, the most common site where methicillin-resistant staph colonizes itself.

If the test results show the presence of staph, hospital staff members are alerted to use precautions to minimize the risk of spread. The hospital also is continuing to ask patients if they have any previous history of MRSA infection; in those cases, precautions are automatically put into place.

So far, fewer than 10 percent of patients who've been identified as high-risk and have undergone the nasal swab have turned out to be colonized with MRSA, Piasecki said.

"We were wondering what we would find, and that's what we're finding," she said.

The hospital will continue to review the data so that it can monitor the trend and respond if any new trends emerge, she said. "It may change as to who we're screening."

Patient education also is important.

Colonization with methicillin-resistant staph doesn't mean the person who has it is sick, Piasecki said. "That colonization just means the bacteria is there."

Sometimes the bacteria disappear on their own, and sometimes they later recur, she said.

But people often become worried once they learn they've been colonized, she said. "Probably the most common question I've had is 'Can I have my friends in for coffee? Can I hold my grandchild?'"

Aside from careful hand-washing and making sure that their primary care doctor and household members know about their MRSA status, most people can carry on their life as usual, Piasecki said.

"It's just a piece of information they have that they didn't have before," she said. "Life is going to continue."