The MRSA Conundrum

Infection Control at Acme Regional Health hath decreed that known MRSA1 patients must have three clear swabs, done a week apart, in order to be declared free of MRSA. Well and good.  MRSA is a very special form of nastiness.  Except relatively few patients (unless you are condemned to that sinkhole known as designated as ALC2) are admitted for more than a few days, and almost none of them stay long enough to get three clear swabs.

This, you don't want

Trust me, this you don't want

There is, natch, absolutely no community follow-up on putative MRSA cases, i.e. no one thinks to repeat the swabs once patients are discharged.

Which means, in practice, once you are designated as MRSA positive, you will be MRSA positive forever. Even after you’ve been treated for MRSA — and MRSA gets treated aggressively.

Case in point:  a patient comes in repeatedly for poorly controlled congestive heart failure; she gets a little IV diuretic, gets a whack of fluid off her lungs, and is sent home after a couple of days. She’s probably had eight admissions in as many months.  Each time, because her chart is marked MRSA positive for a hospital-acquired infection we gave her maybe 10 years ago, we swab her, and every time, her swabs come back negative. Eight negative swabs in eight months — I am pretty confident that MRSA is the leastest of her problems.3

So in summary: we are probably wasting hundreds of thousands of dollars doing unnecessary MRSA screening, plus all the money wasted in putting these patients in contact isolation, extra nursing hours, gowns, gloves and so on, and not to mention the effect of isolation on patient morale, because we can’t figure an adequate way of doing community follow-up.

__________

1Methicillin-resistant Staphylococcus aureus.
2Alternate Level of Care. Not actually acutely sick, but unable to actually go home because some debility or other. In other words, waiting for placement in (nonexistent) nursing home beds while simultaneously blocking acute care beds — and consequently Emerg beds.  Probably the single greatest cause of long emergency department waits in Ontario.
3Unlike why she is bouncing in every 3 weeks in CHF.

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