By Peter Laird, MD
MRSA is a ubiquitous problem to patients with chronic renal disease, especially in the dialysis center setting. A recent study highlights the extent that colonization with MRSA can impact patient mortality.
Results We identified 29 MRSA carriers (9.48%) at study entry. After a median of 613 days of follow-up, Kaplan-Meier analysis showed significant survival differences between MRSA carriers and noncarriers (log-rank P = 0.02). Compared with noncarriers, MRSA carriers had a 2.46-fold increased risk of dying from any cause, after adjusting for covariates at the start of follow-up. The adjusted hazard ratios of infection-related mortality and occurrence of subsequent S. aureusinfection in carriers were 4.99 and 4.31, respectively.
Conclusions A major limitation is the relatively small sample size of MRSA carriers. Nevertheless, we demonstrated that there may be an association between MRSA nasal carriage and poor clinical outcomes in an outpatient hemodialysis population. This underscores the need for routine surveillance of MRSA nasal carriage and should alert the physicians of a group at high risk of morbidity and mortality.
Treatment options for nasal MRSA carriage are highly effective and relatively easy to apply. Routine screening for MRSA is not a current practice in the dialysis unit, but the impact that simply having the bacteria in a dialysis patients nose coupled with effective treatment options brings this issue to the forefront of preventable deaths in the dialysis unit. The difficulty of this approach is that many patients in the unit would need to be treated simultaneously as well as the nursing and physician staff members who are likewise at high risk of MRSA colonization. In addition, MRSA nasal carriage recurrence occurs quite frequently. At the very least, adherence to proper hand hygiene could mitigate the spread of MRSA between patients. MRSA will remain a difficult problem for dialysis patients in the foreseeable future.
Peter, having an interest in acquired (preventable) infections in the dialysis population, thanks for sharing this. I found it interesting in one unit -- patients were not covering their mouth/nose when sneezing, nurses, some were coughing/sneezing in their hands. No one was teaching cough etiquette to patients. With patients being close so to each other, some units too close as stated in some surveys, patients should also be taught cough/sneeze etiquette and given masks when needed. I, in fact, remember once, when many patients in our unit were sneezing/coughing, having to ask the unit manager to have staff tell patients the correct way to cover their mouth/nose and to offer them a mask. The next thing I noted was a sign in the lobby addressing such as 'if you want a mask ask your staff', but I NEVER heard or observed a staff teach a patient how not to spread germs...It would be nice if there were MRSA screening in dialysis units as in hospital. IF you look at the surveys on our site almost ALL of the 2010 that are posted had deficiencies in infection control, basic practices.. Hence, if patients do have MRSA and it is not known.... these nasty bugs can be on surfaces of anything in the unit and with staff not implementing correct practices and touching surfaces with gloves then providing care e.g. cannulation, well, big problem. and, obvious from the surveys, some of which have not been done in 8 years, that this lack of infection control practices have been going on for a while. In fact, we are constantly updating the site to show this type of practice, or lack thereof, and why it happens.
Roberta Mikles www.qualitysafepatientcare.com
Posted by: roberta mikles | Monday, January 24, 2011 at 07:15 AM