Hospital tests for 'superbug' effective

Testing every hospital patient to find and treat carriers of a drug-resistant bacteria can curtail outbreaks of dangerous infections, according to a study released on Monday, but some researchers questioned whether universal screening is the solution to the problem.

The authors of the four-year study conducted in three suburban Chicago hospitals concluded that universal patient screening for methicillin-resistant Staphylococcus aureus, or MRSA, reduced infection rates by 70 percent.

But another researcher who wrote an editorial accompanying the study, which was published in the Annals of Internal Medicine, said credit for fewer illnesses could be due to better hand-washing and cleaning practices by hospital staff.

The study compared MRSA infection rates when no screening protocol was in place, to when only intensive care unit patients were tested, and to when nearly all patients were screened over a 21-month period.

Without the screening there were nearly nine new infections per 10,000 days of patient care. After universal testing was put in place, infections declined to about four per 10,000 patient-days, a 70 percent drop.

"The program we began in August of 2005 had a major patient safety impact for all our patients and demonstrated that a comprehensive effort to reduce MRSA infection can be accomplished," Dr. Lance Peterson of Evanston Northwestern Healthcare in Illinois, who worked on the study, said in a statement.

Among the authors of the study were several researchers with financial ties to Becton Dickinson & Co, a manufacturer of a test for MRSA.

Dr. Ebbing Lautenbach of the University of Pennsylvania, commenting on the study in an editorial in the journal, said it was premature to recommend universal MRSA screening.

Lautenbach said pressure on hospital staff to perform the screening consequently focused attention on following proper hygiene practices.

He also cautioned that extensive use of an antibiotic ointment to treat MRSA carriers may promote additional drug resistance. Only a few antibiotics are effective against MRSA, which is resistant to common infection-fighting medications.

As many as 1.5 percent of Americans carry MRSA, and they may spread it to others while not developing an infection themselves. Most dangerous infections occur in hospitals, where weakened patients are susceptible, and it was blamed for 19,000 U.S. deaths in 2005.

A Geneva, Switzerland, hospital study published in the Journal of the American Medical Association last week concluded universal patient screening did not curtail in-hospital MRSA infections, and found screening was costly because of the need to isolate and treat patients.

But critics of that study said the screening test used was too slow, taking nearly a day to produce results, a gap that might have allowed the contagious bug to spread.

Newer tests can identify carriers in two hours.

Monday's study credited universal screening with preventing 85 MRSA infections, Lautenbach wrote. But he suggested less costly approaches to universal screening, such as testing only at-risk patients and strict adherence to proper hygiene.

A few U.S. states have called for universal patient screening for MRSA, and some hospitals have adopted it. Hospitals face an added financial risk in October when the Medicare and Medicaid health insurance programs plan to halt reimbursements for treating hospital-acquired infections and other "preventable" conditions.

Limit patient screening for infection, study says

Screening all incoming hospital patients for a dangerous drug-resistant staph infection and isolating those infected did not curtail its spread, and proved costly, Swiss researchers said on Tuesday.

Some hospitals and a few U.S. states have called for the controversial approach of testing every incoming patient for methicillin-resistant Staphylococcus aureus, known as MRSA, which was blamed for an estimated 19,000 U.S. deaths in 2005.

But a 1-1/2-year study at the University of Geneva Hospitals and Medical School, where MRSA has occasionally been a problem, found screening did not reduce the number of patients who caught the infection during their hospital stays.

Roughly 85 percent of MRSA cases, which is treatable only with a few antibiotics, occur in hospitals, where infection can kill weakened patients.

Hospitals undertake several approaches to combat outbreaks such as strict hand-washing by staff, frequent equipment changes, and extensive cleaning of operating rooms. MRSA outbreaks struck roughly one-quarter of U.S. hospitals in 2003.

As many as 1.5 percent of Americans carry the highly contagious infection and may spread it to others without developing a serious infection themselves.

In the study published in the Journal of the American Medical Association, 515 of the 21,754 surgical patients tested positive for MRSA. Of those, 337 might not have been caught because they had not been previously identified as MRSA carriers.

Infected patients received five days of treatment and special precautions such as isolated hospital rooms that strained hospital resources and raised costs considerably.

During the initial nine-month period when the screening was done in selected hospital wards, 93 patients contracted MRSA infections while in the hospital. That compared to 76 infected in the wards where standard prevention efforts were in place.

"Overall, our real-life trial did not show an added benefit for widespread rapid screening on admission compared with standard MRSA control alone in preventing (hospital) MRSA infections in a large surgical department," study leader Dr. Stephan Harbarth wrote.

The report recommended targeting the screening to patients undergoing elective surgery with a high risk of MRSA infection.

Two U.S. researchers agreed in an accompanying commentary that a multifaceted approach, and not universal patient screening, was likely to be more effective in combating MRSA and other types of hospital germs that infect a total of 1.7 million Americans and kill 100,000 each year.

Cardiac arrest: avoid nights, weekend

People who have a cardiac arrest in the hospital at night or on the weekend are far less likely to survive than those who suffer one during the day, U.S. researchers said on Tuesday.

Studies suggest this may be at least partly because of inadequate staffing at off-peak hours.

The researchers found only 14.7 percent of people whose hearts stop pumping during the night survive, compared with nearly 20 percent of people during the day.

Those who had a cardiac arrest at around 3 p.m. had the survival rate, Dr. Mary Ann Peberdy of Virginia Commonwealth University in Richmond and colleagues reported in the Journal of the American Medical Association.

The only part of the hospital with difference in survival day or night was the emergency department. "That survival difference by time of day was there regardless of where we looked, except in the emergency department," Peberdy said.

She said emergency departments are the one place in hospitals constantly staffed by senior-level physicians.

Cardiac arrest occurs when the heart stops circulating blood. Without cardiopulmonary resuscitation or CPR and often a shock from a defibrillator, patients can die within minutes.

"Doing the right thing and doing it quickly is very important," Peberdy said.

She said studies at individual hospitals suggested staffing played a role in whether a patient survived a cardiac arrest.

Other studies have shown that doctors make more mistakes at night, hospitals have fewer nurses per patient working at night and that fewer experienced supervisors work the night shift.

TIME TRUMPS OTHER FACTORS

Peberdy wanted to see how this affected survival of cardiac arrest. Her team scoured the National Registry of Cardiopulmonary Resuscitation, which included survival data for more than 86,000 adults who had heart attacks in more than 500 U.S. hospitals between January 2000 and February 2007.

They split up the data by time of day, with the day/evening defined as 7 a.m.-10:59 p.m., night as 11 p.m.-6.59 a.m. and weekends starting at 11 p.m. Friday and running through 6.59 a.m. Monday.

"We factored in how sick people were, what their initial rhythms were. None of that overshadowed the time of day," Peberdy said in a telephone interview.

"Weekend nights were pretty much the same as week nights. Weekend days were kind of in between week days and nights," she said.

She said the difference by time of day held regardless of whether a patient was in a bed with a heart monitor or even in the intensive care unit.

"I think the study confirms what some of us have suspected for a while: That how we staff the hospital determines how well patients do," said Dr. Graham Nichol who helps oversee the NRCPR registry for the American Heart Association.

Peberdy said the study suggests hospitals need to focus on improving their resuscitation systems in off-hours