January 3rd, 2010
From Norway comes news of a simple, but effective, solution to the problem of Methicillin-resistant Staphylococcus aureus (MRSA) or “superbugs” that, as they spread, pose extreme dangers to us and our healthcare system. In the US and other countries, a visit to the hospital means worrying about exposure to MRSAs. There are 19,000 MRSA deaths in the US every year. But not in Norway.
The reason: Norwegians stopped taking so many drugs….
Norway’s model is surprisingly straightforward.
• Norwegian doctors prescribe fewer antibiotics than any other country, so people do not have a chance to develop resistance to them.
• Patients with MRSA are isolated and medical staff who test positive stay at home.
• Doctors track each case of MRSA by its individual strain, interviewing patients about where they’ve been and who they’ve been with, testing anyone who has been in contact with them.
They allow minor illnesses to take their course:
“We don’t throw antibiotics at every person with a fever. We tell them to hang on, wait and see, and we give them a Tylenol to feel better,” says Haug.
However, Norwegian society has a crucial difference that allows them to wait. They have a social democracy:
All workers are paid on days they, or their children, stay home sick.
Can you imagine such a radical idea in the US?
Acting reasonably also pays off in reduced costs:
Norway responded swiftly to initial MRSA outbreaks in the 1980s by cutting antibiotic use. Thus while they got ahead of the infection, the rest of the world fell behind.
In Norway, MRSA has accounted for less than 1 percent of staph infections for years. That compares to 80 percent in Japan, the world leader in MRSA; 44 percent in Israel; and 38 percent in Greece.
In the U.S., cases have soared and MRSA cost $6 billion last year. Rates have gone up from 2 percent in 1974 to 63 percent in 2004. And in the United Kingdom, they rose from about 2 percent in the early 1990s to about 45 percent, although an aggressive control program is now starting to work.
Alas, Norway is not separate from the rest of the world. It’s success may not last:
But Elstrom [Norway's MRSA control director] worries about the bacteria slipping in through other countries. Last year almost every diagnosed case in Norway came from someone who had been abroad.
“So far we’ve managed to contain it, but if we lose this, it will be a huge problem,” he said. “To be very depressing about it, we might in some years be in a situation where MRSA is so endemic that we have to stop doing advanced surgeries, things like organ transplants, if we can’t prevent infections. In the worst case scenario we are back to 1913, before we had antibiotics.”
Fortunately, Norway’s success is replicable elsewhere:
But can Norway’s program really work elsewhere?
The answer lies in the busy laboratory of an aging little public hospital about 100 miles outside of London. It’s here that microbiologist Dr. Lynne Liebowitz got tired of seeing the stunningly low Nordic MRSA rates while facing her own burgeoning cases.
So she turned Queen Elizabeth Hospital in Kings Lynn into a petri dish, asking doctors to almost completely stop using two antibiotics known for provoking MRSA infections.
One month later, the results were in: MRSA rates were tumbling. And they’ve continued to plummet. Five years ago, the hospital had 47 MRSA bloodstream infections. This year they’ve had one.
“I was shocked, shocked,” says Liebowitz, bouncing onto her toes and grinning as colleagues nearby drip blood onto slides and peer through microscopes in the hospital laboratory.
When word spread of her success, Liebowitz’s phone began to ring. So far she has replicated her experiment at four other hospitals, all with the same dramatic results.
“It’s really very upsetting that some patients are dying from infections which could be prevented,” she says. “It’s wrong.”
Around the world, various medical providers have also successfully adapted Norway’s program with encouraging results. A medical center in Billings, Mont., cut MRSA infections by 89 percent by increasing screening, isolating patients and making all staff — not just doctors — responsible for increasing hygiene.
In Japan, with its cutting-edge technology and modern hospitals, about 17,000 people die from MRSA every year.
Dr. Satoshi Hori, chief infection control doctor at Juntendo University Hospital in Tokyo, says doctors overprescribe antibiotics because they are given financial incentives to push drugs on patients.
Hori now limits antibiotics only to patients who really need them and screens and isolates high-risk patients. So far his hospital has cut the number of MRSA cases by two-thirds.
In 2001, the CDC approached a Veterans Affairs hospital in Pittsburgh about conducting a small test program. It started in one unit, and within four years, the entire hospital was screening everyone who came through the door for MRSA. The result: an 80 percent decrease in MRSA infections. The program has now been expanded to all 153 VA hospitals, resulting in a 50 percent drop in MRSA bloodstream infections, said Dr. Robert Muder, chief of infectious diseases at the VA Pittsburgh Healthcare System.
“It’s kind of a no-brainer,” he said. “You save people pain, you save people the work of taking care of them, you save money, you save lives and you can export what you learn to other hospital-acquired infections.”
Pittsburgh’s program has prompted all other major hospital-acquired infections to plummet as well, saving roughly $1 million a year.
“So, how do you pay for it?” Muder asked. “Well, we just don’t pay for MRSA infections, that’s all.”
Will this approach catch on?
Meanwhile, the Norwegian experience is another reminder that, in healthcare, less is not always worse. If only the breast cancer “advocates” who came out so strongly against the reasonable new recommendations of the US Prevention Task Force that not all women between 40 to 50 need to be screened and that, for many other, biannual screening is enough had understood this lesson.