Identifying MRSA vectors of transmission

Michael Rumbin tells EHM of soutiens for HAI prevention.

Hospital acquired infections (HAI) are among the most pressing problems in healthcare today.  Five to 10 percent of all patients become infected while hospitalized, with incidences up to 28 percent reported in ICUs. In the United States, more people die from hospital infections than from breast cancer and AIDS combined. The costs involved with hospital infections are staggering, estimated at $1.6 billion per year in the UK, $6 billion per year in the US, or approximately $7000 annually per hospital bed. Once we believed it was easier to treat HAIs than to prevent them. However, we now realize that the enormous scope of the problem argues in favor of prevention.

There are two current lines of prevention. The first is to stop infections from entering the hospital. Rapid PCR-based tests screen for colonization of MRSA upon admittance to a hospital. Positive tests are followed by decolonization of the patient, with isolation from other patients

Detecting transmission of infections within the hospital is the second. Rigorous and consistent maintenance of infection control measures help to prevent transmission of microorganisms. These include hand hygiene, environmental decontamination, personal protective equipment and isolation/cohort nursing. However, without a rapid tool to fingerprint pathogens found within the hospital, these efforts lose importance and focus. Identifying vectors of transmission and monitoring compliance are essential to a rigorous program. With the development of the SpectraCell RA bacterial strain analyzer, available from River Diagnostics, active surveillance is now a reality, providing actionable outbreak information within minutes from culture.

Bacterial identification at strain level can be compared to taking a fingerprint. It enables precise tracking of when and where a specific bacterial strain occurred. Such surveillance is critical to identifying sources of infection and to limiting the spread of an outbreak. Tracking the occurrence of strains over time and location enables early and automated detection of transmissions of microorganisms within the hospital.

Until now, hospitals have had limited means to implement an active surveillance program to detect outbreaks in real-time and to determine pathways of transmission. The standard method for bacterial typing is slow, with hospitals generally having to wait anywhere from three days to as long as several weeks for results. Further, the testing is costly and labor intensive, requiring highly trained personnel and special facilities. Moreover, conclusive identification of reoccurrence is difficult. As a consequence, this method is generally and best limited to analysis only after an outbreak has occurred.

With SpectraCell, positive culture samples from patients, staff and the hospital (hand-touch areas such as beds, doors, and faucets, diagnostic and therapeutic devices) are stored in a SpectraCell database. Information about the origin of the sample (such as time and date of sample collection, subject ID and location [object] of sample collection) is stored in the same database. SpectraCell data of new samples can then be compared to the spectra already in the database. Criteria can be set for alerts to be generated by SpectraCell as matches are found between the database and new spectra. Alerts and epidemiological data provide information enabling infection control specialists to take targeted action.

While MRSA, VRE and C.diff are at the center of attention, the list of species frequently encountered in HAI is much larger and contains both antibiotic resistant and susceptible microorganisms. It is estimated that 30 percent of HAIs can be prevented by means of targeted infection control measures enabled by bacterial fingerprinting (typing) of organisms.

Prevention of an outbreak is the most cost-effective measure to curb the cost of HAIs. SpectraCell enables active surveillance of hospital bugs such as MSSA, MRSA, VRE, Acinetobacter and Klebsiella, providing actionable information for targeted intervention by infection control teams, when a potential problem is signaled.

Michael Rumbin is the Vice President of Marketing and Sales for River Diagnostics B.V. He has held numerous positions in the industry including the VP of Technology Management with the Siemens MicroScan Business Unit. Rumbin holds a Masters Degree from Villanova University and is a graduate of the Wharton School of business at the University of Pennsylvania.