Snapshots: Noteworthy New Developments in Medicine

Recent news stories have sounded the alarm that “superbug” infections—those caused by methicillin- resistant Staphylococcus aureus  (MRSA)—have spread beyond hospitals and nursing homes and turned up in athletes and others in the community. But how much of a threat does MRSA infection really pose to your patients—and would you recognize it quickly if it did show up in your practice? A new feature that debuts this month on page 863, “Snapshots: Noteworthy New Developments in Medicine,” provides practical clinical answers to questions raised by medical news stories. The focus is on the implications for your  practice.  This month’s column explores the significance of MRSA infections for primary care practitioners. Of course, our principal concern is the prevention of harm to patients. However, other implications of the increasing rates of MRSA infection are more far-reaching than one might at first suspect. For instance, were you aware that in Great Britain (where the percentage of bloodstream infections caused by MRSA is more than 40%1 ) Secretary of State for Health Patricia Hewitt is trying to hold hospital executives criminally liable for MRSA infections that develop in their institutions as a result of poor hygiene? Why, Hewitt reasons, should hygiene laws and standards for food factories be tougher than those that apply to hospitals? If Britain’s Secretary of State for Health is successful in her quest, the implications for both hospitals and primary care practices in the United States could be enormous. The rate of MRSA infections in American hospitals is even more alarming than that in Great Britain—at least 60% of all staph infections are caused by MRSA.2  Once criminal liability for hospital-acquired MRSA infections gains acceptance, given the litigious nature of our society, can lawsuits against primary care physicians—for failure to diagnose a MRSA infection, or even for office conditions that might have given rise to the infection—be far behind? Yet a still more crucial lesson for primary care practitioners in the international story of hospital-acquired MRSA infection is the importance of scrupulous attention to hygiene. The British Secretary’s controversial stance was likely prompted by the fact that a number of other European countries have managed to reduce previously high rates of inhospital MRSA infections to less than 1%, simply through rigorous observance of protocols on hand washing, cleaning of instruments, and other basic infection-control practices.2  The rising incidence of community-associated MRSA infections underscores the importance of such protocols in the primary care setting as well. These include: • Wash hands before examining each patient. • Clean stethoscope bells, blood pressure monitors, and other instruments before each use. • Thoroughly disinfect all surfaces in examining rooms on a regular basis. It can be all too easy, in today’s time-pressed managed care environment, to give only the most cursory attention to breaking medical news—unless it has immediately obvious relevance, such as has the FDA’s withdrawal of a widely used analgesic. Yet a surprising number of medical news stories are, in fact, quite relevant to primary care. Snapshots of other new developments in medicine that have important implications for your practice will be featured in upcoming issues. With each, a brief, cogent discussion of the pertinent issues involved will be accompanied by illuminating clinical images and an “At a Glance” box to make key points even more accessible. Stay tuned! REFERENCES: 1. Winter G. A bug’s life. Nurs Stand. 2005;19:16-18. 2. McCaughey B. Coming clean. The New York Times. June 6, 2005. Available at: http://www.nytimes.com/2005/06/06/opinion/06mccaughey.html. Accessed June 6, 2005.