Overcrowding and understaffing of hospitals are two of the major underlying factors driving the spread of methicillin-resistant Staphylococcus aureus in this setting, according to a review.
Furthermore, “the economic benefits of downsizing health care systems are likely to have been offset by the increased burden of adverse events, such as MRSA,” the authors wrote.
Archie Clements, Ph.D., of the division of epidemiology and social medicine at the University of Queensland (Australia), and his colleagues from the fields of mathematics, statistics, infection surveillance, and medicine, cited 140 studies in their review (Lancet Infect. Dis. 2008;8:427-34).
They concluded that the direct mechanisms through which hospital-acquired infections are spread—including a decrease in handwashing, less “cohorting” of patients (meaning patients interact with a large number of health care workers), and closer proximity of infected patients to noninfected patients—are themselves caused by a dearth of health care professionals and a surplus of patients.
For instance, in the case of handwashing—a known, simple, and inexpensive method to reduce the spread of MRSA dramatically—overworked health care staff are less likely to wash when indicated, according to several studies cited by the authors. In one, noncompliance was highest in cases of high “intensity of patient care,” when there were more than 40 opportunities for handwashing per hour of care, compared with when there were fewer indications per hour (Ann. Intern. Med. 1999;130:126-30).
Additionally, the spread of MRSA within a facility exacerbates overcrowding, as patients' stays are extended, which in turn fuels chronic understaffing. “This contributes to a vicious cycle, where the occurrence of MRSA makes it more difficult to implement effective infection control strategies, leading to subsequent breakdowns in infection control and further increases in the incidence of MRSA,” the authors wrote.
The number of patients seeking care, inpatient or otherwise, is not likely to decrease any time soon—an aging population in the developed world means that countries like Australia can anticipate a 70%-130% increase in hospital bed requirements by 2050, according to the review. But there is hope—the authors praised institutions in the Netherlands and Scandinavian countries, for example, for keeping MRSA infection down.
On the level of individual facilities, the researchers cited several studies wherein screening of new admissions for infection, isolation of high-risk patients, and use of more effective hand hygiene products have proved successful.
The authors wrote that they had no conflicts of interest to disclose.