Blog | Wednesday, January 16, 2013

Should we screen all admissions for nasal MRSA

I am on service at the VA once again. The VA screens all patients with nasal swabs and then institutes isolation precautions.

So we must ask two questions: 1) Does this activity decrease dangerous MRSA infections? In 2012, the great majority of MRSA is the "so-called" community acquired MRSA, i.e. sensitive to sulfamethoxazole/trimetheprim, doxycycline and clindamycin. What are we gaining through isolation? 2) What do we lose when we isolate patients? Adverse effects of isolation in hospitalised patients: a systematic review.

We found 16 studies that reported data regarding the impact of isolation on patient mental well-being, patient satisfaction, patient safety or time spent by health care workers in direct patient care. The majority showed a negative impact on patient mental well-being and behaviour, including higher scores for depression, anxiety and anger among isolated patients. A few studies also found that healthcare workers spent less time with patients in isolation. Patient satisfaction was adversely affected by isolation if patients were kept uninformed of their healthcare. Patient safety was also negatively affected, leading to an eight-fold increase in adverse events related to supportive care failures. We found that contact isolation may negatively impact several dimensions of patient care.

Every action induces a reaction. We must ask whether the benefits of the action overcome the adverse effects of the reaction. These patients are coming to the hospital with MRSA, even if they have not had previous hospitalizations.

So I ask, what are we doing positive through this activity? We know that isolation causes problems. We must have great evidence that it is worth the trouble and the money that we spend on isolation gowns, gloves, etc.

db is the nickname for Robert M. Centor, MD, FACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and is the Associate Dean for the Huntsville Regional Medical Campus of UASOM. He also serves as a frequent ward attending at the Birmingham VA Hospital. This post originally appeared at his blog, db's Medical Rants.