Ebola missteps

Questions have been raised regarding the United States’ policy to control drug-resistant bacteria.  In an article published in Antimicrobial Resistance & Infection Control, it is explained that evidence regarding the efficacy of identifying and isolating MRSA carriers, along with destroying the bacteria, has been distorted.  According to the Agency for Healthcare Research and Quality, MRSA (methicillin-resistant Staphylococcus aureus) is a dangerous bacterial infection which in 2011 involved approximately 450,000 U.S. hospitalized patients and 23,000 of these hospitalizations resulted in death.

When taken as a whole, our findings raise serious questions on how questionable research was used to lay the foundation for healthcare policy in the United States.

In the article, major studies that have been published in nationally renowned journals are discussed.  In two of the studies major methodological limitations were found.  In one, antibiotics effective against MRSA were not given to the majority of known MRSA carriers prior to surgery.  Ten patients, who were known to be MRSA carriers prior to surgery and who were not given antibiotics effective against MRSA, developed a MRSA infection.  In the second study, admission culture results were not available for five days and staff compliance with gowning and gloving was suboptimal.  Multiple studies regarding the use of the antiseptic chlorhexidine may have overstated their results. Other irregularities include changes in research questions after study initiation and in comparisons of chlorhexidine plus alcohol (two agents) against povidone iodine (one agent), with results attributed to chlorhexidine alone.

A previous publication in Antimicrobial Agents and Chemotherapy discussed that despite these shortcomings, the first study was used to derail recommendations in a 2008 U.S. Congressional Hearing and the first two studies have been cited by medical organizations to justify their inaction regarding surveillance.  Ties to industry have also been documented in several studies. One instance of alleged industrial influence involved chlorhexidine and was the basis of a $40 million U.S. Department of Justice settlement which alleged influencing National Quality Forum patient safety recommendations.

These research studies may have led to inaction regarding setting standards and a mindset of not needing firm standards, which may have laid the foundation for the missteps in the handling of Ebola in the United States. Download the full article at http://www.aricjournal.com/content/4/1/4 and the AAC article at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3837914/.

Kevin Kavanagh is board chairman of Health Watch USA based in Somerset, Ky.



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