Mar 25, 2009 – The annual meeting of the Society for Healthcare Epidemiology of America took place Mar 20-22 in San Diego. This News Scan Special Edition surveys a selection of the abundant research from that meeting on combating MRSA in healthcare institutions.’Positive Deviance’ makes difference in reducing MRSA ratesThree hospitals and healthcare systems in different parts of the United States significantly reduced their in-house transmission of methicillin-resistant Staphylococcus aureus (MRSA) by mounting a multi-pronged prevention effort of active surveillance, hand hygiene, and contact precautions. A key to the program’s success was “Positive Deviance,” an organizational technique that identifies personnel who are good problem solvers and keeps their ideas from being stifled by custom and hierarchy. The trial, co-sponsored by the Robert Wood Johnson Foundation, Centers for Disease Control and Prevention (CDC), and the Plexus Institute, reduced MRSA incidence in the hospitals by up to 62%.Invasive MRSA declining, may be due to hospital control effortsA CDC analysis of data from the Active Bacterial Core surveillance system, drawn from nine sites across the United States, shows that cases of invasive hospital-onset MRSA declined 16% from 2005 to 2007. Invasive cases that were due to hospital infection, but arose after discharge, declined 8.7%. In a related survey of 134 hospitals, almost all were deploying some MRSA-prevention measures out of a generally accepted menu of seven recommended practices, though no hospital was using all seven. The reduction in invasive MRSA may be linked to hospitals’ increased efforts.MRSA control in ICU leads to reductions throughout hospitalA MRSA-prevention campaign at the Billings Clinic, a 270-bed community hospital in Billings, Mont., demonstrated that limited control efforts may have broad reach. The hospital instituted active surveillance and hand hygiene in its 22-bed ICU and saw hospital-wide MRSA incidence fall from 1.2 cases per 1,000 patient-days to 0.27 per 1,000; reductions continued for 20 months.MRSA cases in hospitals may have been acquired in communityAn analysis of patients in a large Delaware healthcare system who were newly identified as having MRSA colonization shows that the vast majority of colonizations were not acquired during the hospital stay, but were present on admission. Only 13% were acquired in-hospital, suggesting that programs aimed at stopping hospital transmission could not have prevented them, and demonstrating that the complex epidemiology of MRSA in hospital and community is likely to complicate MRSA control.Community strains causing increasing number of hospital infectionsAt Stroger Hospital, the main public hospital for downtown Chicago, the incidence of hospital-associated bloodstream infections caused by MRSA has not changed significantly over 7 years. However, the proportion of those invasive infections caused by a community-genotype MRSA strain has more than doubled, from 32% of cases in 2000-2003 to 68% in 2004-2007.
MORE: PS5 announcement newsThe specifics of jailbreak are causing some confusion in the community, but we’re here to help.Below is a full list of details on the added “Warzone” twist:What is jailbreak in ‘Warzone?’From the Activision Season 4 patch announcement: “All dead players, even those that are only spectating, come back to life.”It works for those still waiting in the gulag as well as those who are in spectator mode. Those still alive will get an update a minute ahead of time notifying them that a jailbreak is imminent.Even if your entire squad is dead, you can all be brought back by jailbreak.When does jailbreak happen in ‘Warzone?’There’s no guarantee it will occur in a given match — the feature randomly cycles with a feature that makes all items discounted by 80 percent and another one that drops a chopper into the world stacked with high-caliber loot. If it does happen, it appears it will be mid-match after the first drop kit and before the gulag closes.You will know one minute ahead of time that a jailbreak is on the way, lessening the amount of time you’re sitting around in spectator mode not knowing whether an added lifeline is coming. How often does the jailbreak activate?It will happen once in a game at most, but in many games won’t occur at all. Because it in effect wipes the entire slate of the game clean, it wouldn’t make sense to always occur.Something to note is that when jailbreak does happen, everyone will respawn into a game with significantly shrunken circles. Things are bound to be hectic.Is it worth waiting for the chance to come back?Whether you wait depends on when you die and your level of patience. If you’re eliminated in the opening minute, it might not be worth sitting around until a possible jailbreak is announced. By comparison, losing in the gulag just before a potential jailbreak is announced leaves you in a no-lose situation to wait things out for a bit. Refrain from immediately rage quitting if you lose your gulag match in “Warzone” — there’s now a chance you could still return to the “Call of Duty: Modern Warfare” battlefield.The Season 4 update to the game, out for download Thursday, brings a host of substantial changes. Among the biggest is a jailbreak feature that restores all teammates to action, effectively providing a third life to those spectating after a 1v1 gulag defeat.