MRSA Spread Caused in Part by Stressed Health Care Systems

Overcrowding and understaffing of hospitals are two of the major underlying factors driving the spread of methicillin-resistant Staphylococcus aureus in this setting, according to a review.

“The economic benefits of downsizing health care systems are likely to have been offset by the increased burden of adverse events, such as MRSA,” the authors wrote.

Archie Clements, Ph.D., of the division of epidemiology and social medicine at the University of Queensland (Australia), and his colleagues from the fields of mathematics, statistics, infection surveillance, and medicine, cited 140 studies in their review (Lancet Infect. Dis. 2008;8:427-34).

They concluded that the direct mechanisms through which hospital-acquired infections are spread—including a decrease in hand washing, less “cohorting” of patients (meaning patients interact with a large number of health care workers), and closer proximity of infected patients to noninfected patients—are themselves caused by a dearth of health care professionals and a surplus of patients.

For instance, in the case of hand washing—a simple, inexpensive method to reduce the spread of MRSA—overworked health care staff are less likely to wash when indicated, according to several studies cited by the authors. In one, noncompliance was highest in cases of high “intensity of patient care,” when there were more than 40 opportunities for hand washing per hour of care, compared with when there were fewer indications per hour (Ann. Intern. Med. 1999;130:126-30).

Also, “a vicious cycle” can occur in which the spread of MRSA within a facility exacerbates overcrowding, as patients' stays are extended, which in turn fuels chronic understaffing. “This contributes to a vicious cycle, where the occurrence of MRSA makes it more difficult to implement effective infection control strategies,” the authors wrote.

The authors said they had no conflicts of interest to disclose.

Overcrowding and understaffing of hospitals are two of the major underlying factors driving the spread of methicillin-resistant Staphylococcus aureus in this setting, according to a review.

“The economic benefits of downsizing health care systems are likely to have been offset by the increased burden of adverse events, such as MRSA,” the authors wrote.

Archie Clements, Ph.D., of the division of epidemiology and social medicine at the University of Queensland (Australia), and his colleagues from the fields of mathematics, statistics, infection surveillance, and medicine, cited 140 studies in their review (Lancet Infect. Dis. 2008;8:427-34).

They concluded that the direct mechanisms through which hospital-acquired infections are spread—including a decrease in hand washing, less “cohorting” of patients (meaning patients interact with a large number of health care workers), and closer proximity of infected patients to noninfected patients—are themselves caused by a dearth of health care professionals and a surplus of patients.

For instance, in the case of hand washing—a simple, inexpensive method to reduce the spread of MRSA—overworked health care staff are less likely to wash when indicated, according to several studies cited by the authors. In one, noncompliance was highest in cases of high “intensity of patient care,” when there were more than 40 opportunities for hand washing per hour of care, compared with when there were fewer indications per hour (Ann. Intern. Med. 1999;130:126-30).

Also, “a vicious cycle” can occur in which the spread of MRSA within a facility exacerbates overcrowding, as patients' stays are extended, which in turn fuels chronic understaffing. “This contributes to a vicious cycle, where the occurrence of MRSA makes it more difficult to implement effective infection control strategies,” the authors wrote.

The authors said they had no conflicts of interest to disclose.

Overcrowding and understaffing of hospitals are two of the major underlying factors driving the spread of methicillin-resistant Staphylococcus aureus in this setting, according to a review.

“The economic benefits of downsizing health care systems are likely to have been offset by the increased burden of adverse events, such as MRSA,” the authors wrote.

Archie Clements, Ph.D., of the division of epidemiology and social medicine at the University of Queensland (Australia), and his colleagues from the fields of mathematics, statistics, infection surveillance, and medicine, cited 140 studies in their review (Lancet Infect. Dis. 2008;8:427-34).

They concluded that the direct mechanisms through which hospital-acquired infections are spread—including a decrease in hand washing, less “cohorting” of patients (meaning patients interact with a large number of health care workers), and closer proximity of infected patients to noninfected patients—are themselves caused by a dearth of health care professionals and a surplus of patients.

For instance, in the case of hand washing—a simple, inexpensive method to reduce the spread of MRSA—overworked health care staff are less likely to wash when indicated, according to several studies cited by the authors. In one, noncompliance was highest in cases of high “intensity of patient care,” when there were more than 40 opportunities for hand washing per hour of care, compared with when there were fewer indications per hour (Ann. Intern. Med. 1999;130:126-30).

Also, “a vicious cycle” can occur in which the spread of MRSA within a facility exacerbates overcrowding, as patients' stays are extended, which in turn fuels chronic understaffing. “This contributes to a vicious cycle, where the occurrence of MRSA makes it more difficult to implement effective infection control strategies,” the authors wrote.

The authors said they had no conflicts of interest to disclose.