Who coulda thunk it?
There are two frustrating attitudes held by a fair number of antibiotic resistance/infectious disease specialists about MRSA (methicillin resistant Staphylococcus aureus). First, some argue that we really shouldn’t be focusing on MRSA, since it’s already evolved–the cat is out of the bag. Never mind that this particular cat kills more people annually in the U.S. than AIDS. While we obviously can’t prevent the evolution of MRSA (that’s already happened), we can contain the problem: we would rather have one percent of all staph infections be MRSA, rather than the current 62 percent (this is all the more critical, since resistant infection are, for the most part, additional infections–high levels of resistance typically mean that the total number of infections, resistant and sensitive, have increased).
Second, a much more commonly held view is that rigorous infection control in hospitals is not worth the effort. These efforts include screening staff for MRSA (and sending them home if they test positive) and isolating MRSA-carrying patients. So what if it worked in the Netherlands (their ‘search and destroy‘ program) as well as the VA hospitals in the U.S.
Now, Norway joins the club of hospital systems that have not
shoved their heads up their assesstuck their heads in the sand:
…Norway’s public health system fought back with an aggressive program that made it the most infection-free country in the world. A key part of that program was cutting back severely on the use of antibiotics.
Now a spate of new studies from around the world prove that Norway’s model can be replicated with extraordinary success, and public health experts are saying these deaths — 19,000 in the U.S. each year alone, more than from AIDS — are unnecessary.
“It’s a very sad situation that in some places so many are dying from this, because we have shown here in Norway that Methicillin-resistant Staphylococcus aureus (MRSA) can be controlled, and with not too much effort,” said Jan Hendrik-Binder, Oslo’s MRSA medical adviser. “But you have to take it seriously, you have to give it attention, and you must not give up.”
….Norway’s model is surprisingly straightforward.
• Norwegian doctors prescribe fewer antibiotics than any other country, so people do not have a chance to develop resistance to them.
• Patients with MRSA are isolated and medical staff who test positive stay at home.
• Doctors track each case of MRSA by its individual strain, interviewing patients about where they’ve been and who they’ve been with, testing anyone who has been in contact with them.
Today, less than one percent of Norway’s staph infections are MRSA. Shamefully, the CDC has been dragging its heels, and only issuing ‘voluntary guidelines’ to hospitals–because the private sector (whether it be profit or non-profit) has shown such a tremendous ability to successfully self-regulate (boldface mine):
Dr. John Jernigan at the U.S. Centers for Disease Control and Prevention said they incorporate some of Norway’s solutions in varying degrees, and his agency “requires hospitals to move the needle, to show improvement, and if they don’t show improvement they need to do more.”
And if they don’t?
“Nobody is accountable to our recommendations,” he said, “but I assume hospitals and institutions are interested in doing the right thing.”
Dr. Barry Farr, a retired epidemiologist who watched a successful MRSA control program launched 30 years ago at the University of Virginia’s hospitals, blamed the CDC for clinging to past beliefs that hand washing is the best way to stop the spread of infections like MRSA. He says it’s time to add screening and isolation methods to their controls.
The CDC needs to “eat a little crow and say, ‘Yeah, it does work,'” he said. “There’s example after example. We don’t need another study. We need somebody to just do the right thing.”
The CDC is in a hard place: hospital lobbies are very powerful. But I had hoped that Gerberding’s departure would lead to better policy positions (and this is one reason why I wanted Besser to get the permanent Director’s position).
Not only would it be the right thing to do, but setting this up would be a pretty good economic stimulus–that saves people’s lives.