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The growing threat from CA MRSA

January 2010

Published in the January 2010 issue of Today’s Hospitalist

Growing threat from community-acquired MRSA

IN STUDYING ISOLATES from hospitals around the country taken between 1999 and 2006, researchers found a seven-fold increase in the number of cases of community-acquired MRSA (CA MRSA) in outpatient hospital units.

While CA MRSA represented only 3.6% of all MRSA infections in 1999, that percentage jumped to 28.2% in 2006, researchers reported. That increase is being seen in a higher MRSA burden in hospitals. (See “What’s new in pneumonia care.”)

That increase also threatens the safety of hospitalized patients because many hospitals share resources with outpatient facilities, such as surgical sites, and because patients and doctors move between both settings. The analysis was published in the December issue of the CDC’s Emerging Infectious Diseases.

In other MRSA news, researchers at Duke University have reported that surgical site infections due to MRSA can cost a hospital $60,000. These patients also have a seven-fold increase in their risk of death and a 35-fold increase in readmission risk. They also spend three additional weeks in the hospital.

Researchers pointed out that the toll in money and mortality should lead hospitals to do a better job of infection control, and to consider hiring a staffer dedicated to reducing surgical site MRSA infections. The study was published in PLos ONE.

Patients can name less than half of their in-hospital medications

HIGHLIGHTING WHAT THEY CALLED “significant deficits in patient understanding,” researchers at a Colorado academic center found that hospitalized patients, regardless of age, were able to name fewer than half of the scheduled and PRN medications they received in the hospital.

The study, which was published online in December by the Journal of Hospital Medicine, found that the 50 patients studied were prescribed an average of 11.3 medications in the hospital. But virtually all of them (96%) omitted one or more of those medications when trying to list the medications they’d been prescribed.

Patients omitted an average of 6.8 medications, including antibiotics (17%), cardiovascular medications (16%) and antithrombotics (15%). The most frequently omitted PRN medications included analgesics (33%) and GI medications (29%). Patients displayed both errors of omission, not including drugs they’d been prescribed, and of commission by listing drugs that had not been ordered.

The authors said that the results should be used to re-evaluate how hospitalists and staff educate patients about prescriptions and “involve patients” in medication management.

Assessing short-term risk of stroke recurrence

A NEW TOOL to assess ischemic stroke patients’ 90-day risk of recurrence may help identify patients with the most urgent need of stroke follow up.

Harvard researchers designed the Web-based tool using factors like stroke etiology, prior TIA/stroke history, MRI findings, distribution of brain infarcts and age. A retrospective analysis of the tool used in 1,400 patients was published online in December by Neurology. (The tool is online at www.nmr.mgh.harvard.edu/RRE.)

While authors stressed that the tool needs to be validated in multicenter studies, they pointed out that it may hold promise for individualizing patient management.

In other stroke news, researchers have found that one in five patients (19%) who have had a stroke do not take antithrombotic medications, including aspirin.

Patients more likely to take blood thinners post-stroke were men and non- Hispanics. Researchers said further study was needed to determine why patients don’t take blood-thinning medication.

The study is being published in this month’s issue of American Journal of Preventive Medicine.

Hospital liability claims are on the rise

A REPORT RELEASED LAST FALL found that although the number of hospital liability claims had decreased over the past 10 years, claim numbers were once again on the rise.

The report, released by the risk management service firm Aon Corporation, found that the number of claims is rising 1% a year. The study attributed that rise in part to the downturn in the U.S. economy and to changes in reimbursement rates for preventable complications.

Among findings, the report listed the following:

  • One out of every four claims “and 24% of hospital professional liability costs ” are associated with hospital-acquired infections and injuries, medication errors, pressure ulcers and objects left in patients during surgery.
  • In 2010, hospitals can expect to incur liability costs of $181 per birth in the obstetrics unit and more than $7 per ED visit.
  • Claim severity in terms of indemnity and defense costs continues to rise and is projected to increase 5% annually.

Details about purchasing the report are online.