Web Exclusive: Cultures, Bundles, and Other Options for MRSA Control

Methicillin-resistant Staphylococcus aureus (MRSA) infections have become prevalent in healthcare facilities at a time when drug-resistant infections in general are perceived as a growing threat to patient life and health. About 70% of bacteria that cause healthcare-associated infections resist one or more of the drugs most commonly used to treat those infections, according to an estimate by the Centers for Disease Control and Prevention (CDC) (CDC "Campaign to Prevent").

Staph infections have been a problem for decades, but healthcare facilities today are singling out MRSA as a target of infection control measures for several reasons—because the bacteria is endemic in the U.S. population, is frequently transmitted in healthcare facilities, and causes infections that can be virulent and difficult to treat. Perhaps the most important reason for facilities' increased attention is that the share of S. aureus infections that are drug resistant has increased steadily for years to a currently high level. The share of labtested isolates of S. aureus bacteria that resist treatment with methicillin or related drugs (and are, therefore, considered to be MRSA) rose from 29% in 1991 to 60% in 2003, the most recent year for which data is available, at hospitals reporting drug-resistance rates to CDC. (NNIS; Panlilio et al.) (For more on MRSA's reach and impact, see Why Target MRSA?)

The Institute for Healthcare Improvement has further helped push the issue into the consciousness of the patient safety culture at many healthcare facilities by including reducing MRSA infection as a goal in its 5 Million Lives Campaign. (See MRSA and IHI's 5 Million Lives Campaign. )

Overprescribing and other misuses of antibiotics are frequently cited as driving the increase in bacterial drug resistance. However, other factors—particularly poor hand hygiene among healthcare workers and uncertainty about which patients or residents are colonized with these organisms—have played a role in making these organisms an infection control issue in healthcare facilities by aiding bacteria transmission from patient to patient. MRSA is most often...