Rising plague, falling plague?

In a continuation of the EIN string I recently blogged about, a commenter discussed the success of an MRSA “search and destroy” program they implemented at their hospital. I thought the response by Brad Spellberg (ID doc extraordinaire, and author of “Rising Plague”) was right on target (and consistent with one of the points Eli and I tried to make in our JAMA editorial):

"With respect to the comment, “With this aggressive search and destroy program, we have had a drop in our MRSA rates for the past 4 years in a row with a marked decline in nosocomial transmissions”, I’d advise caution in interpretation.



I think many healthcare systems are seeing declines in MRSA rates nosocomially, including sites that haven’t done much different. Furthermore, we and others I’ve talked to have been seeing dramatic declines in community MRSA rates as well. Let’s not forget, we have no idea why MRSA emerged into the community, why USA300 took over, and where the related phage 80/81 strain went in 1961 and where it hid for nearly 40 years before re-emerging. Why should we be surprised that it has decided to move on now? Let us not underestimate the impact of changes in bacterial ecology that are not necessarily related to things we’ve done."

MRSA in Decline: England Edition

Don't know what I want
But I know how to get it
I wanna destroy passerby

-Sex Pistols "MRSA? in the UK"

MRSA rates have just reached their lowest levels in recorded history. Per a BBC report, there were 97 cases in the entire NHS in June, which represents the first time rates have been below 100. 25 hospitals had no MRSA cases in the month. C. difficile cases are also falling, so the decline is likely due to an overall emphasis on infection prevention including hand hygiene, which would impact both infections. Good news, overall.

BBC report
Guardian report

See you at Starbucks!

There is a very interesting study in the July/August issue of the Annals of Family Medicine from the Medical University of South Carolina (free full text here). Investigators there analyzed data from the 2003-2004 NHANES study, a survey designed to assess the health and nutritional status of the US populace, using an interview and physical examination on approximately 5,000 persons selected as a representative sample of the population. This study also included a nasal swab done on each participant, which found that 1.4% of persons in the sample were colonized with MRSA.

Using the NHANES dataset, the South Carolina  investigators found that persons who drank coffee or hot tea were half as likely to be colonized with MRSA, even when controlling for age, race, socioeconomic status, health status, hospitalization in the last year and antibiotic use in the last month.

Now it's important to remember that this is an observational study, which doesn't allow us to determine causation, as we know that these studies can be plagued by bias and confounding. Nonetheless, the authors do elaborate on the biologic plausibility for their tantalizing finding.

I'm just saying it sure beats squirting mupirocin up your nose!

The new ICHE is here, the new ICHE is here!!!

Congrats to all of the authors who had articles published in this August's ICHE. Now that ICHE has a massive new impact score, I suspect most of them now feel like Navin when he says, "Page 73 - Johnson, Navin R.!  - I'm somebody now! Millions of people look at this book everyday! This is the kind of spontaneous publicity - your name in print - that makes people. I'm in print! Things are going to start happening to me now."  Well, I hope all the things that happen to these fine authors are a little more positive.

Highlights:

Page 737, Boyce, John M et al. looked at the impact of an automated mobile UV-C light unit on environmental contamination in 25 rooms after patient discharge. They report the unit significantly reduced aerobic colony counts and C. difficile spores.

Page 743, Rutala, William A et al. wrote an accompanying editorial that concluded that "there is now ample evidence that no-touch systems such as UV-C light or hydrogen peroxide can reduce environmental contamination...(however) only a single study using a before-after design has been published that demonstrated that such a system can reduce healthcare-associated infections." There we go again, hospital infection prevention: the queen (or king) of intermediate outcomes. Would be pretty cool if there were more independent (federal or foundation) resources to study HAI prevention interventions, such as these.

Page 791, Gupta, Kalpana et al. report the results of a cohort of all patients at the VA Boston Health Care System that had clean or clean-contaminated in 2008-2009 and a nasal MRSA PCR test less than 31 days prior to surgery. 6.6% of the patients were MRSA+ and were at significantly higher risk for postoperative MRSA infections (RR, 8.46; 95% CI, 1.70–42.04). Interestingly, vancomycin prophylaxis was associated with higher SSI risk in those negative for nasal MRSA (RR, 4.34; 95% CI, 2.19–8.57) but not in MRSA+ patients.

Page 818, Tohme, Rania A et al. reviewed hepatitis B vaccination rates and immunity among healthcare students during a 10-year period at Emory University. They report that among 4,075 students, only 60% had documented vaccination and 84% had anti-HBs concentration greater than or equal to 10 mIU/mL. It is interesting that despite CDC and ACIP (1995) recommendations of routine vaccination of children aged 11-12 years, and for all less than 18yo in 1999, the majority of students were only recently vaccinated.

If I left you off this list, sorry! You are still awesome!