The Challenge of Methicillin-Resistant Staphylococcus aureus
Prevention in Hemodialysis Therapy.
Source
Division of Nephrology and Transplantation, Maine Medical Center, Portland, Maine VA HSR&D Center on Implementing Evidence-Based Practice, Indianapolis VAMC, Indianapolis, Indiana Regenstrief Institute and Indiana University Center for Health Services and Outcomes Research, Indianapolis, Indiana Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
Semin Dial. 2011 Dec 9. doi: 10.1111/j.1525-139X.2011.00999.x. [Epub ahead of print]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) infections have challenged care process and resource utilization in the acute hospital care setting for nearly 30 years. These infections have become important causes of morbidity, mortality, and a source of concern in the primary and emergency care context over the past decade.
As individuals receiving recurrent therapy with features of both ambulatory care and acute care, hemodialysis patients are exposed to numerous opportunities for MRSA acquisition. Surprisingly, high prevalence rates for MRSA colonization have been demonstrated for both hemodialysis patients and their care providers.
The necessity of vascular access and the persistent high prevalence of endovascular catheter use among patients repeatedly exposed to healthcare settings provide the perfect milieu for the troubling rates of MRSA infection, particularly bloodstream infections, in outpatient dialysis care. Dialysis industry shifts, including increased requirements for compliance and reporting in other areas of dialysis care, tax resources for infection prevention processes.
Multifaceted strategies that include reassessment of vascular access care, attention to the interruption of MRSA transmission dynamics, and emphasis on organizational learning processes are needed to accomplish a meaningful reduction in the morbidity, mortality, and cost associated with MRSA infections in dialysis care.
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