May 23, 2018
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Testing begins for potentially devastating bacteria

Kathy Day (Bangor Daily News/Gabor Degre)
By Meg Haskell, BDN Staff

BREWER, Maine — This week marks the beginning of a six-month project in Maine that requires all acute-care hospitals to screen high-risk patients on admission for the presence of a potentially devastating bacteria called Methicillin-resistant Staphylococcus aureus, or MRSA. Infection prevalence data will be compiled and reported to the state midsummer.

On Wednesday, nurses from Eastern Maine Medical Center in Bangor gathered at the Muddy Rudder restaurant in Brewer to applaud the initiative and to support making MRSA screening a permanent part of hospital admission in Maine.

“We need to build on this screening process rather than planning to stop it. Prevention should be the primary goal of MRSA screening,” said Kathy Day, a registered nurse whose father died a year ago after contracting MRSA during a routine hospitalization for a fractured ankle. “Our goal is zero MRSA in hospitals in Maine.”

But Maine hospitals are skeptical, to say the least. Dr. Robert Pinsky, an epidemiologist and infectious disease specialist at St. Joseph Hospital and Eastern Maine Medical Center in Bangor, said the initiative is widely considered “well-intentioned” but ineffective.

“Every infection control practitioner and every infectious disease specialist feels that this is an unnecessary and misguided use of valuable resources,” he said. While the idea of testing high-risk patients and gathering data about the transmission of MRSA seems intuitively valuable, he said, it will result in increased costs and lit-tle practical information.

The screening process consists of identifying new inpatients with recent contact to high-risk settings such as nursing homes, jails and dialysis centers. Those patients will have their nasal passages swabbed and lab-tested for the presence of MRSA.

Routine testing for MRSA is not recommended by the federal Centers for Disease Control and Prevention or other public health groups, Pinsky said.

MRSA commonly is present on the skin and in the nasal passages of healthy people and often causes no illness. But in patients with weakened immune systems, it can infect the urinary tract, the blood, the lungs, open wounds and other body sites.

Because it is resistant to antibiotics, it can be lethal as well as leading to amputations and causing organ failure. It often is acquired in institutional settings such as nursing homes and hospitals, where it may be easily passed from one vulnerable patient to another, often by nurses, doctors and other staff, as well as visitors, who do not practice careful hand washing and other infection control strategies.

But because MRSA is so prevalent, it is hard to track its origins. According to Donna Dunton, director of infection prevention and control at EMMC, it is less important to do that than to prevent its spread, an effort that is best accomplished by the strict adherence to “universal precautions.” Universal precautions include hand washing, maintaining a clean environment, sanitizing medical equipment between patients and using disposable gloves, gowns and masks when caring for infected patients.

Dunton said such efforts are improving among the staff at EMMC and that there have only been one or two cases of potentially hospital-acquired MRSA identified per quarter in recent years.

“There will always be emerging organisms,” Dunton said. Rather than targeting just one, such as MRSA, hospital staff must become more vigilant about protecting their patients from all transmissible diseases, she said.

But EMMC, along with all of Maine’s 39 acute-care hospitals, initiated MRSA admission screening on Monday. Patients who have recently been in high-risk settings will be tested for the presence of the organism. No other clinical actions must be taken, but Day said additional legislation is being drafted to require those who test positive for MRSA to be placed in isolation or with a roommate who also has MRSA and for hospitals to collect comprehensive data on these patients to report to the state.

The MRSA legislation is endorsed by the Maine State Nurses Association.

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