The New England Journal of Medicine recently published findings from a multi-institutional VA study that demonstrated drastic reductions in hospital-acquired MRSA infections when a "bundled approach" infection reduction was adopted. This MRSA "bundle" included universal screening of new patients for MRSA colonization, strict isolation and contact precautions of infected patients, and a strong emphasis on hand hygiene after patient contact. After three years, ICU-related MRSA infections had dropped by 62%.
Those are good results, of course. MRSA is depressingly common in the hospital, and even outpatient, setting. Simple maneuvers like washing your damn hands after examining a patient in the ICU have to be considered standard of care measures. I'm not convinced that it's cost effective to screen every single patient who walks in through the ER for MRSA (why not just adopt universal precautions?) but the results certainly speak to the beneficial effects of increased attention to hygiene and a checklist-oriented approach to medicine.
But it strikes me as a somewhat hollow victory. So we've learned how to reduce MRSA and other hospital-acquired infections. Terrific. We could also completely eliminate all hospital infections by forcing doctors and nurses to don HazMat suits when entering a patient room and quarantining every patient in sealed iso-chambers like it's some hackneyed, faux-thriller Ebola outbreak movie on Lifetime Channel starring Brian Austin Green and Valerie Bertinelli.
My question is, what are we doing to address the underlying source of rampant antibiotic-resistant bacterial infections? If MRSA and C. Diff are never events, then why isn't indiscriminate use of prescribed antibiotics also being monitored as strictly? Why don't we have databases documenting all the unwarranted orders for oral and Iv antibiotics? When a PCP calls in a script for a Z-pack on a patient who complains of a "head cold'", why isn't that considered a "never event??