MRSA resurgence reflects how COVID diminished quality of care, says study

Methicillin-resistant Staphylococcus aureus (MRSA) is back with a vengeance.

Not that the staph infection that often keeps antibiotics at bay ever left during the COVID-19 pandemic. But its resurgence during the pandemic puts it at levels that eliminate all the gains made against it in the last decade, according to a study in Antimicrobial Resistance & Infection Control. The silver lining in this development might be that the playbook for containing MRSA still works well.

A graph displaying MRSA infections

Veterans Health Administration (VHA) hospitals managed to keep MRSA infection rates at pre-pandemic levels.

“The third quarter of 2021, the Standardized Infection Ratio for hospital-onset MRSA bloodstream infections was 1.17, well above the baseline value of 1.0,” the study found. “In contrast, the Veterans Health Administration (VHA) has been able to maintain its mitigation efforts and low rates of MRSA hospital-onset infections through the second quarter of fiscal year 2022 (Mar. 31, 2022), the most recent available data.”

Kevin Kavanagh, M.D., is the president and founder of patient advocacy organization Health Watch USA as well as one of the authors of the study. Kavanagh argued in his blog that MRSA’s comeback can be attributed to a general lapse in the performance of safety protocols at healthcare facilities. Those facilities had to deal with extreme staffing shortages and inexperienced staff that made it harder to prevent MRSA amid battling COVID-19.

The reason MRSA came roaring back in private healthcare facilities but not in the VHA can be “explained not only by the VHA’s use of uniform mitigating policies which rely on active surveillance and contact precautions, but also on the VHA's ability to maintain adequate staffing during the pandemic,” the study states. “Future research into MRSA mitigation is warranted and this data supports the need for healthcare system transformation.”

Kavanagh notes that the Centers for Medicare & Medicaid Services (CMS) will next year start risk adjusting quality metrics used in financial incentives. COVID-19 patient data have currently been suppressed in almost all metrics in the Hospital-Acquired Condition (HAC) Reduction Program, the Hospital Value-Based Purchasing Program and the Hospital Readmission Reduction Program, all overseen by CMS, Kavanagh said.

Kavanagh told Fierce Healthcare that the significance of the study’s findings “is that it indicates that we need to motivate facilities to support and maintain experienced healthcare staff and create safe working environments rather than normalizing bad outcomes through risk adjustment.”

He added that “what the study shows is that the increase in MRSA may not be directly related to COVID-19 but to the delivered care which was hobbled in facilities by the COVID-19 pandemic.”

The inevitable rejoinder that some experts and policymakers might make is: How are we going to pay for this? To which Kavanagh responds: “We can’t afford not to because the cost to society, patients and healthcare workers is too great. And unless facilities create a safe workplace, they’re not going to be able to overcome their staffing shortages which will impact their bottom line. They’ll be less profitable, and patients and staff will be injured.”

The study found that “despite the added demands of isolation protocols, the VHA was not only able to withstand the stresses of the pandemic but also aid other healthcare facilities in the community. These findings have implications not only regarding protocols for the control of MRSA but also for the need for transformation of our healthcare system in the private sector.”