The "vicious cycle" of HA-MRSA

In the new issue of Lancet Infectious Diseases there's a marvelous analytical review of the complex relationship between hospital overcrowding and understaffing and the rise of hospital-acquired MRSA.

You can feel intuitively that these phenomena must be linked:

• If a hospital has more patients, its staff will be more stressed;
• If they are more stressed, they may neglect handwashing and other infection-control measures;
• If budget shortfalls cause staff cuts, the remaining staff will be more stressed still;
• If infection control is neglected, more patients will acquire MRSA;
• Since MRSA patients are sicker and stay longer, more beds will be full;
• Since there are more patients, staff will be more stressed;
• Since MRSA patients are more costly, budgets will be more stressed.

And so on. Because it is a review article it is also an excellent guide to the medical literature on this aspect of the MRSA problem, with 140 cites.

The citation is: Clements, A. et al. Overcrowding and understaffing in modern health-care systems: key determinants in meticillin-resistant Staphylococcus aureus transmission. The Lancet Infectious Diseases 2008; 8:427-434.