In the fall, the CDC released an article that MRSA was a growing problem and concern, and that it was becoming more prevalent as a community acquired infection (CAI), as opposed to the more commonly known healthcare acquired infections (HAIs)… yet the CDC also continues to report over and over that MRSA rates are declining.
The article was followed by other media outlets such as USA TODAY, who in their own study, found that MRSA infections, particularly outside of health care facilities, are much more common than government statistics suggest.
So What’s Their Motivation?
Why do there seem to be so many mixed messages about MRSA infection rates coming from the CDC? Good question! I have my theories, but we’ll get there a bit later. First, let’s look at some other info and statistics from another respected health care organization… one that deals with patients with MRSA on a regular basis, the American Academy of Orthopedic Surgeons (AAOS).
According AAOS, MRSA may be more easily transmitted when the following five Cs are present:
- Frequent skin-to-skin Contact
- Compromised skin (cuts or abrasions)
- Contaminated items and surfaces
- Lack of Cleanliness
Locations where the five Cs are common include schools, dormitories, military barracks, households, correctional facilities, and daycare centers, cruise ships and sports facilities (i.e. equipment, mats and locker rooms). In these type of environments, people are informed to take personal precautions, such as avoiding contact, covering wounds and exercising proper hand and body hygiene. But there’s more to it.
Prevalence of MRSA
The AAOS also states that the number of hospital admissions for MRSA has exploded in the past decade:
By 2005, admissions were triple the number in 2000 and 10-fold higher than in 1995. In 2005 in the United States alone, 368,600 hospital admissions for MRSA—including 94,000 invasive infections—resulted in 18,650 deaths. The number of MRSA fatalities in 2005 surpassed the number of fatalities from hurricane Katrina and AIDS combined and is substantially higher than fatalities at the peak of the U. S. polio epidemic.
MRSA in the Community
According to the CDC website, MRSA in the community requires a diligent and thorough process of both personal hygiene, tactics to prevent the spread, and addressing the environment, equipment and other shared items. Here’s what they say about keyboards, difficult surfaces and shared equipment:
Cleaning Keyboards and other Difficult Surfaces
Many items such as computer keyboards or handheld electronic devices may be difficult to clean or disinfect or they could be damaged if they became wet. If these items are touched by many people during the course of the day, a cleanable cover/skin could be used on the item to allow for cleaning while protecting the item. Always check to see if the manufacturer has instructions for cleaning.
Shared equipment that comes into direct skin contact should be cleaned after each use and allowed to dry. Equipment, such as helmets and protective gear, should be cleaned according to the equipment manufacturers’ instructions to make sure the cleaner will not harm the item.— CDC.gov, General Information About MRSA in the Community.
Prevention, Containment & Cross-Contamination
We believe there are a number of root causes to the rising rate of community acquired MRSA — one certainly being the over-prescribing of antibiotics, but that’s another blog post altogether. The other challenge of containing the spread and preventing a larger outbreak, however, is
much more about the environment and surfaces that are difficult to sanitize with traditional spraying, wiping [and sometimes rinsing and mopping], and water and bleach-based methods. We’ve seen this first hand in several cases where a ‘sanitizing service’ is called in after an initial infection, only to have more people infected after the service. We’ve also seen situations where the janitorial service is using a power hose to dispense high-powered, water-and-bleach sanitizer that literally is spraying as much onto nearby areas from overspray and splash back.
I’m not suggesting the service provider caused more infections, I’m only suggesting they must have missed key areas where transmission is occurring, and/or that their protocols are potentially causing cross contamination. I’m also not suggesting that all of the other prevention guidelines aren’t useful on the CDC website, all helpful and important information to prevent and treat MRSA infections.
But clearly, something is getting missed. Traditional spraying, wiping and mopping isn’t doing the job, or these infections would definitely be on the decline… right? Could it be causing cross-contamination? Are they missing key areas and ‘difficult surfaces.’ And are the equipment manufacturers really ‘equipped’ to offer serious, professional sanitizing information on their gear? What about all the other surfaces where water-based chemicals can’t be used, such as metal equipment that can corrode, electronics in locker rooms, medical training and therapy machines, workout machines, leather and sensitive fabrics that water with bleach can break down… ?
Fighting Evolved Superbugs with 70+ Year-Old Techniques
It’s not hard to find videos of other sanitizing services. People in full bunny suits, often spraying and wiping from a handheld bottle and using the same towels from place to place. Or if they are using a spraying ‘machine’ they are using covering up metals, electronics and other materials like leather that would be harmed by their chemicals.
Did you know in a Hospital Control and Epidemeology study, 2 strains of MRSA were found to survive for surprisingly long periods of time on hospital fomites, including:
- 11 days on a plastic patient chart
- Over 12 days on a laminated tabletop
- 9 days on a cloth curtain
MRSA is persistent, not only in its life duration prior to infection, but in its attack during an infection.
We recently pinged Clorox on their social media pages to inquire about using their anti-bacterial wipes on fine electronics and sensitive equipment (which we see a lot of social media chatter about) and here was the exchange:
They responded fast, which was great. Don’t get me wrong, I use Clorox products at home, some great products… but there’s a place and use for them, and it’s not industrial sanitizing. It’s not superbug killing. It’s not infectious disease control.
And that’s exactly my point. Too many people are combating superbugs (living, evolving organisms with only one purpose programmed into their genetic code: to survive and propagate) with outdated or ineffective techniques. Superbugs are mutating every year. This is also why we believe organisms such as methicillin-resistant Staphylococcus aureus —MRSA —are becoming more prevalent in non-healthcare environments. [For more on superbug evolution and antibiotic overuse, check out this helpful post on Wired].
We simply cannot keep using outdated sanitizing methods to combat today’s superbugs, especially when the likelihood of antibiotic usage dropping significantly seems quite low. And despite the message that the CDC would like us to believe, we’re not winning the war on MRSA… yet.
So back to my previous sidebar on the CDC motivations for trying to position MRSA as ‘declining’ and apparently ‘under control’ vs. looking at the real statistics like the AAOS has done (which speak for themselves, frankly). On the one hand, healthcare reform will require mandatory reporting by healthcare facilities on their infection rates by type, and without meeting the mandate, facilities can face steep fines.
Sounds great, right?
Wouldn’t you like to be able to research a hospitals infection rates before your doctor schedules your knee surgery there? Or research the nursing home where you’re putting your dad soon before you sign on the dotted line? Or find out if your son or daughter’s sports team has a sanitizing protocol in their facility? I would.
On the other hand, though, as pay for performance kicks in and reimbursements get tougher and tougher (and take longer and longer) government-run healthcare and payers will not profit enough if they don’t appear to have their act together. Alternative care sources in the private sector could certainly emerge. Take for example, the emergence of concierge practices.
But sending everyone into a long queue at the same facilities where ‘MRSA and other infection rates are declining’ is a profit-generating proposition. Unfortunately, it feels to us a bit more like stacking the deck, and stacking it high against healthcare staff and the public alike.
Ok, I’m getting into yet another potential blog… for now I’ll leave you with this, because our mission remains the same: we desperately want to keep people from the devastating effects of MRSA and other harmful pathogens. So I implore anyone who has decision-making authority in the value chain to take a long, hard look at your sanitizing techniques, at the continuing evolution of superbugs, and at some statistics other than those on the CDC website… and consider there might be a [much] better way.
Thoughts? As always, don’t hesitate to contact me.