Polls reveal MRSA controls.

If you have been reading the daily newspaper's comic strips, then you know that even Rex Morgan, MD is fighting the spread of MRSA (methicillin-resistant Staphylococcus aureus). According to an online survey conducted by the Association for Professionals in Infection Control and Epidemiology (APIC), more than three out of four (76%) polled infection-prevention-and-control professionals (ICPs) indicated they have implemented additional measures to prevent the transmission of MRSA in the last year--but 54% said they could and should be doing more to prevent the spread of this virulent pathogen.

In 2007, APIC conducted the first "MRSA Prevalence Study," which found MRSA rates to be eight times greater than previously estimated. This year, the "Pace of Progress" poll was conducted among APIC members to determine if in the year since those results were released, the escalating rates of MRSA had led to increased efforts on the part of healthcare institutions to combat MRSA.

The association's nearly 12,000 members were asked to complete a five-question online survey designed to determine if additional MRSA interventions have been adopted since the release of the June 2007 prevalence study. A total of 2,041 responses were received, representing a 17% response rate; and respondents most often reported to the director of nursing/chief nursing officer or the director of patient safety/quality officer. Many fewer reported to the hospital administrator, chief medical officer, infectious-disease physician, or hospital epidemiologist.

According to this year's poll, rather than a single method to prevent the transmission of MRSA, institutions adopting new interventions use a group of approaches including

* staff education (64%);

* more aggressive hand-hygiene programs (58%);

* stricter use of contact precautions (gloves, gowns, masks) for patients who test positive for MRSA (53%);

* more emphasis on housekeeping and equipment cleaning and decontamination practices (49%);

* targeted screening (49%);

* maintaining a tracking system to flag patients previously identified as having MRSA (42%);

* patient/client education (34%);

* better surveillance technology (21%);

* additional staff or an increase in hours dedicated to infection control (17%);

* universal screening (7%); and

* other answers (8%).

Of those who believe their facility could and should be doing more to control the spread of MRSA, two of the top items on their "wish list" are additional staff and better surveillance technology.

"Staffing and surveillance technology are the greatest enablers to maintaining an effective infection-prevention-and-control effort for MRSA and other multidrug-resistant organisms," says APIC's 2008 President Janet E. Frain, RN, CIC, CPHQ, CPHRM, director of Integrated Services at Sutter Medical Center in Sacramento, CA. "ICPs can get out from behind their desks to conduct education, to train healthcare workers, and to direct interventions that protect patients."

Of the 24% of APIC members polled who have not adopted MRSA interventions during the last year, the primary reason given was they already had programs in place to address the problem and were seeing reductions in their MRSA rates. But 14% cited lack of resources, 13% cited lack of time, and 16% cited lack of support from clinical and administrative leaders as barriers to putting MRSA prevention programs in place.

"As organisms such as MRSA develop increased antibiotic resistance, it is imperative that all of our nation's healthcare professionals, from the executive suite to the front line, embrace the concept of prevention," says APIC's CEO Kathy Warye.

APIC guidelines for the elimination of MRSA transmission include a risk assessment to identify high-risk areas for MRSA within the hospital; surveillance program to outline activities and procedures to identify MRSA cases; adherence to CDC hand-hygiene guidelines; use of contact precautions (e.g., gloves, gowns as well as separating MRSA patients from other patients); environmental and equipment cleaning and decontamination, especially items that are close to patients such as bedrails and bedside equipment; and targeted active surveillance cultures (testing of high-risk groups).