Antibiotic-resistant infections, especially Methicillin-resistant Staphylococcus aureus (MRSA) are becoming frighteningly common in U.S. hospitals, and we only have ourselves to blame. Up to 85 percent of staph infections are caused by a patient’s own bacteria, meaning that we’re actually infecting ourselves.
Three in 10 Americans carry staph bacteria in their noses, where the germs live benignly unless they are allowed to enter the body through an open wound like a surgical incision. If one of these patients touches his or her nose and then the surgical site, the bacteria can wreak havoc.
Now, a research team at the University of Iowa has published a study in the British Medical Journal outlining a simple, three-step plan to cut MRSA infection rates by up to 71 percent and infections from a broader class of gram-positive bacteria by up to 59 percent.
"We now know we can target staph where it exists naturally in some patients, which is in the nose," lead study author Marin Schweizer, an assistant professor of internal medicine at the University of Iowa, said in a press release. "That's the bull's-eye, and we can wipe it out. What we are recommending is a really simple, cheap solution to a big problem."
Based on their review of 39 studies of infection prevention strategies in U.S. hospitals, the research team recommends that doctors swab patients’ noses before surgery to test for MRSA bacteria. If the patient has MRSA bacteria naturally living in his or her nose, apply an antibiotic nose ointment in the days before surgery. During the procedure, doctors should give those patients an antibiotic that targets MRSA and give all other patients a more general antibiotic.
Schweizer says that a tube of the nose ointment costs about $20 and that insurance often covers the cost.
Rolling Out the Prevention Program
Schweizer’s team is testing their new prevention strategy at 20 hospitals nationwide, including the University of Iowa Hospitals and Clinics and 10 Veteran’s Affairs (VA) medical centers. Her team responded to a call by the U.S. Department of Health and Human Services (HHS) to find a better way to prevent surgical-site infections. The HHS and the Office of Veterans Affairs are funding Schweizer’s study.
Post-surgery MRSA infections can be painful and costly for patients, often requiring follow-up surgeries and multiple rounds of prescription antibiotics, not to mention the associated costs for the healthcare system as a whole.
A 2009 study published in PLOS ONE concluded that preventing a single MRSA infection during surgery could save hospitals up to $60,000. According to the not-for-profit Committee to Reduce Infection Deaths, there are two million hospital-acquired infections in the U.S. each year, costing the healthcare system about $30.5 billion.
Despite the costs of MRSA infection, Schweizer’s team found that 47 percent of hospitals reported in a survey that they don’t use antibiotic nose ointment for staph carriers. Schweizer hopes that her prevention protocol will prove successful in the current trial and eventually become standard practice at all U.S. hospitals.
"The combination matters, and the treatment being in a bundle matters, too," Schweizer said. "By putting it all together in one care bundle, that one checklist, it becomes standard operating procedure for every hospital."