I am fascinated at the current trend we see in our hospitals, nationwide, toward precautions for methicillin resistant Staphylococcus aureus (MRSA). Much of this in the USA has arisen since last year’s “present on admission” criteria that limited reimbursement for the increased complexity of treating these patients if the infection was not “present on admission”. A cottage industry now has sprung up in diagnostics and protective gear seemingly overnight to deal with this medical/fiscal issue. Indeed, now patients who are identified as being “carriers” of MRSA (swabbed in the nose and other regions on admission to hospital) are branded with these scarlet letters for life.
One point for thought, though: how often is the MRSA that grows out of the swab of the patient’s nose the actual bug causing the infection which led to the hospital admission? Our initial experience has been that this may be the exception, rather than the rule. While this is the case, many patients are receiving drugs to treat the MRSA while the actual infecting organism (for example in a foot wound) may get second billing. Is this good medicine? Is this good infection control practice? We offer this up for discussion, as it is a frequent topic raised in our SALSA bowl.