Breaking down silos to beat MRSA

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In the wake of SARS, a renewed appreciation seems to have surfaced for the role hand washing and real time epidemiology play in protecting against infectious disease.

However, disease experts have been actively advocating for years about how the basics of infection control – sanitation, surveillance, standardization – are key to staving off the growing risk to public health posed by viruses and bacteria; a health threat that is the outcome of increased global travel, the proliferation of dense urban centres, and the growing resistance microbes exhibit toward antibiotics.

Among those who have been drawing on this prudent advice is a group of South East Toronto health partners known as the East York MRSA Community Protocol Group – a subcommittee of Silos to Solutions, an initiative undertaken by a group of South East Toronto health organizations to collaborate and take action to provide better, more comprehensive and seamless delivery of health services for its community. Together they have formed a collective front that deploys these time-tested measures against one of the most prevalent and problematic of pathogens, which has been, literally, right under our noses.

For the past decade, the gram-positive bacterium Methicillin Resistant Staphylococcus Aures (MRSA) that colonizes the nose, and skin, has emerged as the poster pathogen for the superbugs – bacteria that have become resistant to antibiotics. Immune, due to mutation, to penicillin and its synthetic cousin methicillin, (the antibiotics usually employed to combat the staph family of bacteria), MRSA is responsible for an increasing proportion of nosocomial outbreaks that spell serious consequences for patients and hospitals.

The Canadian Medical Association Journal1 has reported that rates of MRSA in national hospitals has steeply risen from one to six per cent of hospitalized patients between 1995-1999, compounding the stress experienced by patients and the health-care system.

Transferred via fluid or touch, MRSA causes little harm to the one in four members of the healthy general public who are carriers. But when contracted by patients with weakened immune systems and pre-existing health problems, pneumonia, grave blood infections and other serious conditions emerge, that precipitate further complications, decline and even death in some cases.

And with infected patients requiring longer hospital stays, isolation, and more expensive therapeutic agents for treatment, it is estimated that the bacteria’s economic burden amounts to $41.7 to $58.7 million per year. This cost stands to grow as treatment of MRSA in the community will inevitably increase as we rely more on community based care.

Concerned about the increasing number of patients and community contacts contracting MRSA, South East Toronto health providers from all sectors – long-term care, acute hospital care, rehabilitation services, primary care, community health agencies (see below for complete list of members) – convened in late 2001 as the East York MRSA Community Protocol Group, and collaborated on how they could collectivelyimprove treatment and communication around MRSA. The outcome of their efforts has been the creation of the MRSA Kit that allows for treatment, education, and communications to be standardized for MRSA wherever in the system patients with MRSA are diagnosed and treated.

The kit contains:

  • information handouts to help patients and families understand MRSA transmission, treatment, and prevention;
  • the MRSA Client Card that allows for tracking and
  • monitoring MRSA patients throughout all sectors of health care system by being a portable record of a patient’s MRSA history presented upon admission to hospital or physician appointment

a tracking format to facilitate the homecare coordinator’s central role in the care of these patients.

a community pathway, outlining infection control and treatment guidelines to be employed throughout the system. The pathway encourages a consistent approach to treatment of MRSA by providers in all sectors, reducing the likelihood of worsening the bacterial resistance problem.

The kit, published through support provided by Partners for Health, Toronto East General Hospital, is currently being distributed to all the group’s members. Training sessions, supported by the Toronto CCAC, to equip staff of all participating organizations to implement the materials and protocols are in the final stages of development.

Dr. Jamie Meuser, Medical Advisor for the East York Access Centre and former Chief of Family Practice at TEGH, illustrates how seemingly simple tools, combined with health care organizations working together in their communities, can prevent the spread of antibiotic resistant organisms such as MRSA. “Although MRSA infection rates have been rising, comprehensive strategies akin to what our group is implementing reduce the rates of MRSA infection.”

He continues. “For a striking example of how effective such an approach can be, look to Scandinavia. Jurisdictions in Denmark once had MRSA rates nearing 15%, but then implemented tactics as aggressive screening, surveillance, strict infection control measures, and antibiotic restriction use policies. As a result of enforcing such strategies across the country, their current national rate of MRSA has fallen to less than 1%.”

Dr. Meuser anticipates the front started by the East York group may widen to other areas. “We will be sharing information about this kit with interested groups throughout the GTA. Further, the group’s use of intersectoral cooperation may provide a template for an integrated approach to handling infection disease, a need which the SARS experience made even more evident.”