As many as 1.2 million hospital patients are infected with dangerous, drug-resistant staph infections each year, almost 10 times more than previous estimates, based on findings from a major new study in 2007. And about 48,000 to 119,000 hospital patients a year may be dying from Methicillin-Resistant Staphylococcus Aureus (MRSA) infections, far more than previously thought, the study reveals.

Dr. William Jarvis at 2008 CQI Conference

Obtained results are from the Association for Professionals in Infection Control & Epidemiology (APIC), which is releasing the report publicly on August 2007. The author is Dr. William Jarvis, former acting director of the hospital infections program at the Centers for Disease Control and Prevention. The findings come amid raising public concern about the spread of antibiotic-resistant bacteria in health-care facilities and community settings. Medical experts consider the rise of so-called superbugs such as MRSA, a leading cause of deadly blood infections, and pneumonias, one of the most alarming public health threats in the nation.

Kathy Warye, the association’s executive officer, said she hope that this survey will be a wake-up call to all health-care workers around United States. It is the largest, most comprehensive survey of MRSA in health-carefacilities to date. It is based on surveys in 2005 sent to 10,000 infection-control practitioners, including doctors and nurses in hospitals, nursing homes and rehabilitation facilities. Health-care professionals were asked to select one day between Oct. 1 and Nov. 10, 2005,  and to report all known MRSA cases in their institutions. More than 1, 200 hospitals and 100 nursing homes and rehabilitation facilities responded, supplying data about patients with MRSA infections and patients colonized with the bacteria. People colonized with MRSA typically carry it in their nose without being symptomatic. They are at risk of passing the superbug to others unknowingly by wiping their nose and then touching a table that a doctor or nurse later touches,  for instance. MRSA can live on surfaces for days or even weeks.

The new survey confirms what is been observed for years – MRSA is rampant in health-care facilities. It found that 34 of 1,000 patients in the survey had active MRSA infections and that 12 were colonized with the superbug, for a total MRSA prevalence rate of 46 per 1,000 patients. (In Illinois, the prevalence rate was 37 per 1,000 patients, based on responses from 74 hospitals and other acute-carefacilities.) The most widely cited previous study, published by CDC researchers in June 2005, had estimated that the MRSA infection rate at in-patient hospitals was 3.9 per 1,000 patients. Based on that rate,  about 126,000 patients  were infected with the superbug each year. The new report did not translate its findings into actual numbers, but Jarvis outlined a means of doing so. He said it was important for the public to see the ballpark figures. The calculation involves 35.2 million people hospitalized in the U.S. in2005, the latest year for which information is available.

Applying the prevalence rates in the new study, the data suggest that 1.2 million hospital patients are afflicted with MRSA each year and that an additional 423,000 patients are colonized with the superbug. This is only an estimate,  subject to the accuracy of the numbers reporting by infection-control practitioners and the limitations of a “single point intime” snapshot of the data, Jarvis said. Many hospitals do not routinely test patients to see whether they are colonized with MRSA, he said. Also, the findings have not been peer-reviewed, which is standard in scientific publications.  Nancy Foster, vice president of Quality and Patient-safety policy at the American Hospital Association, after reviewing an advance copy of the APIC report said :

“Most hospital leaders are paying very close attention to infections within their institutions. … But I think this tells us that MRSA is an even bigger problem than we thought it was,”

Dr. John Jernigan, a medical epidemiologist at the CDC and the agency’slead expert on MRSA, said he “applauded the study” even though he had not examined its results or methodology. He has co-written articles on MRSA with Jarvis that appeared in leading infection-control publications. Jernigan said that :

“Everything we’re finding is telling us the same thing: MRSA is an enormous problem in health-care facilities, more needs to be done to prevent it, andhospitals need to make infection control more of a priority,”

The CDC has said at least 5,000 patients die after being infected by MRSAat surgical sites, in their blood or in their lungs. That’s a mortality rateof 4 percent, assuming a base of 126,000 patients. Using new prevalence estimates of 1.2 million MRSA patients a year, it suggests 48,000 patients a year may die of MRSA. There is considerable uncertainty about the mortality rate associated with MRSA, however, and it may be as high as 10 percent, said Dr. Lance Peterson, director of infectious disease research at Evanston Northwestern Healthcare. Using the new estimates, that suggests as many as 119,000 hospital patients a year may be felled by the superbug. To put that figure in context, the Institute of Medicine has estimated that nearly 100,000 patients die of 2 million infections acquired in hospitals  every year.

MRSA constituted only a portion of those infections and deaths. The new numbers suggest the actual number of hospital-related infections and deaths could be far larger. An important finding in the new study suggests that hospitals may not befocusing infection-control strategies on the right locations in their institutions. Though earlier research has indicated intensive-care units, which often treat patients with compromised immune systems, are hot spots of infection, this report shows that 67 percent of patients with MRSA infections were on medical wards. As Jarvis said said:

“This suggests that MRSA has become a problem throughout the institutionand that [hospital staff] may need to look for it beyond the ICU,”

The study shows that 77 percent of patients with MRSA were identified within two days of entering a hospital, making it likely they were colonized or infected before being admitted. The vast majority of these patients picked-up MRSA during an earlier stay at a hospital or nursing home, Jarvis said.

On the positive side, there is strong consensus about the steps hospitals need to take to control MRSA, said Dr. Don Goldmann, a senior vice president at the Institute for Healthcare Improvement in Boston. All health-care workers should practice rigorous hand-washing, and all institutions should have robust programs for disinfecting medical equipment and patients’ rooms, he said. When patients are known to have MRSA, hospital staff should wear gowns and gloves to prevent MRSA transmission. And patients deemed at risk of carrying MRSA should be screened to determine where bacterial hot spots are festering.

“Now that the true extent of this scandalously tragic epidemic is known, I hope that health-care leadership will finally confront it with the effectivemeans that have always been available,”

As said by Michael Bennett, president of the Coalition for Patients’ Rights in Maryland.