It was a bum knee that sent William Sparks to the VA Medical Center in Oakland this week, but his nose didn't escape the attention of the hospital staff.

	John Beale, Post-Gazette
	Registered nurse Ellesha McCray performs a nasal swab on William Sparks of Wheeling, W.Va. at the Oakland VA Hospital. A growing number of hospitals are testing people for MRSA, a staph infection resistant to traditional antibiotics. Sparks had surgery for a knee replacement.

Like other patients in the surgical unit, Sparks had the inside of his nostrils swabbed to test for an unseen enemy, an antibiotic-resistant strain of bacteria.

The swab test was part of the standard precautions the VA has used to identify patients who are carriers of methicillin-resistant Staphylococcus aureus, or MRSA, in a surgical ward and an intensive care unit.

Other hospitals in the region are adopting similar procedures in hopes of controlling the spread of the nasty bug, which can cause stubborn infections and, in some cases, be fatal.

The collaborative effort is unusual, said Dr. John Jernigan, a medical epidemiologist at the Centers for Disease Control and Prevention who has been involved in the initiative.

If the participating hospitals can reduce the incidence of MRSA in Western Pennsylvania, "We could potentially see it as a model for other regions of the country," he said. "Perhaps, over time, we can have a national impact on this problem."

Eight local hospitals are performing the nasal swabs and using other infection control measures in intensive care units or other units where patients are at high risk for MRSA infection, said Dr. Jon Lloyd, a retired surgeon who is coordinating the effort locally for the CDC.

Staphylococcus aureus is commonly carried on the skin or in the noses of healthy people and is a common cause of minor skin infection. It also can cause serious surgical wound infections, bloodstream infections and pneumonia.

Methicillin, an antibiotic related to penicillin, has been used to treat staph infections for decades, but some staph bacteria have developed resistance to the drug.

Dr. Carlene Muto, UPMC director of hospital epidemiology and infection control, said MRSA accounts for about 62 percent of staph infections in hospital intensive care units.

"That creeps up every year," she added, noting that the share was about 30 percent a decade ago.

MRSA is not just a threat for people in hospitals, nursing homes and other medical facilities. A study published this month in the New England Journal of Medicine concluded that MRSA infections had become a "common and serious problem" in the community.

Jernigan said the infections often occurred among sports teams or in other settings where personal items are shared.

Last month, two inmates at the Allegheny County Jail died after developing MRSA infections. Late last year, MRSA infections struck students at Mt. Lebanon High School and Ambridge Area High School.

But studies indicate that most MRSA cases are hospital-related, and those cases tend to result in the most serious problems.

At the VA hospital in Oakland, patients who have MRSA are isolated to prevent the spread of the pathogen. Even if nose swab tests are negative, patients are swabbed again when they are released from the targeted units to determine if they acquired MRSA during their stay.

The infection control measures are not new. They were used a generation ago to virtually eliminate MRSA in some northern European countries.

But in the United States, many health care providers have felt pessimistic about controlling such a common problem and have "adopted the attitude that it's just something we have to live with," Jernigan said.

Several local hospitals using the swab tests began doing so in recent months. At UPMC Montefiore and the VA, where some units have employed them for several years, MRSA infections have dropped by 85 to 90 percent.

The surgical unit at the VA hospital, which once had about a dozen MRSA infections a year, now has two or three, said Dr. Robert Muder, hospital epidemiologist for the Pittsburgh VA system.

Within a few weeks, the VA hospital plans to phase in nasal swab testing of all patients admitted and discharged, he said.

Other hospitals now using the procedure in some units include Allegheny General Hospital, Mercy Hospital, LifeCare Hospital, Sewickley Valley Hospital and three UPMC facilities: Montefiore, Presbyterian and Shadyside.

Seven other hospitals plan to implement the procedures within two months, Lloyd said. And about 15 others have been getting information about them from the Southwestern Pennsylvania MRSA Prevention Collaborative.

The effort has attracted influential supporters, including Dr. Bruce Dixon, director of the Allegheny County Health Department.

"If we can do this and show it will work," he said, "we can have a tremendous trendsetter for what should happen in other areas of the country."

Hospitals have strong financial incentives to bring MRSA under control.

Treating a serious MRSA infection can cost $36,000, UPMC's Muto said. The additional supplies and staff time needed to control MRSA infections are just a fraction of that cost, she said.

Muder said the expanded MRSA surveillance at the Pittsburgh VA hospital, together with other infection control initiatives, should save more than $1 million a year in infection-related costs.

One local health insurer plans to provide other financial incentives.

Within the next year, Highmark plans to include MRSA control initiatives in a program that ties payments to certain clinical or quality goals, said Dr. Carey Vinson, vice president for quality and medical performance management. About 15 local hospitals participate in the program.

Isolating infected and colonized patients is just the first step in achieving control. MRSA is primarily spread by touch, often as health care workers move from patient to patient.

As a result, health care workers must wash their hands before and after seeing each patient and wear gowns, gloves and masks when they care for those placed in isolation. Because stethoscopes, blood pressure cuffs and other equipment also can carry MRSA, those items must be reserved for use in the isolation area.

While the infection control measures are easily understood, health care officials said they could be difficult to put into practice. A range of hospital personnel has to support and implement the procedures.

Dr. Rick Shannon, chairman of medicine at Allegheny General, said a drawing of a nose with the inscription, "Did you remember to swab?" was posted in one unit to remind staffers to perform the test.

A retired coal miner and Navy veteran, Sparks, 53, was in the hospital for knee replacement surgery.

The Wheeling, W.Va., resident said he appreciated the swab tests and other precautions. "The less chance for infections, the better."