NCPA - National Center for Policy Analysis


August 6, 2008

Like the better-known MRSA, VRE is a so-called multidrug-resistant organism, able to survive an assault from powerful antibiotics.  Half a century ago these bugs did not exist; a decade ago they were rare; today, nearly 30 percent of the Enterococcus bacteria collected from cultures in hospitals are VRE, and 60 percent of the Staphylococcus aureus are MRSA, says Manoj Jain, an infectious disease physician in Memphis.

Their emergence is an unintended consequence of our use (and overuse) of antibiotics, says Jain:

  • The Centers for Disease Control and Prevention estimates that there are 1.7 million hospital infections a year, resulting in nearly 90,000 deaths, costing the health system more than $11 billion.
  • Contact isolation is part of the battle plan to control the spread of drug-resistant organisms. And it is effective, as long as everyone complies.
  • In the case of SARs, respiratory and contact precautions were credited with stopping the epidemic.
  • Studies show that nearly 30 percent of health care workers don't comply; such measures are hard to enforce, because isolation precautions create a barrier between patients and their caregivers.

Isolation barriers can be dangerous for patients, says Jain:

  • Two studies showed that doctors and nurses were half as likely to enter the rooms of or to examine patients on contact precautions.
  • One study has even shown that patients in isolation have significantly more preventable adverse events, get less care and are more dissatisfied with their treatment than other patients.

Unlike other treatment, contact isolation does not benefit the patient in isolation; rather, it benefits other hospitalized patients and the community.  The goal is to contain the spread of the resistant organism from one patient to another, through health care workers, says Jain. 

Source: Manoj Jain, "The Germs Are Potent. But So Is a Kiss," New York Times, August 5, 2008.

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