Hospital infections: the MRSA test and what they must tell you

A nosocomial, or hospital-acquired, infection is one that develops during hospitalization and was not present at the time of admission. Two laws address it: Act 52-2007 obliges hospitals to report them to the Health Department and to keep a control program, and Act 298-2012 adds what actually has a patient’s face: an MRSA test on admission in five situations, immediate notice if it comes back positive, and written instructions before you are discharged.

The rapid MRSA test on admission is not for everyone: the law requires it in five specific situations, listed in this guide’s requirements. Outside those five, the law does not order it. The covered health facility includes hospitals, health centers, diagnostic and treatment centers, nursing homes, long-term care facilities, rehabilitation centers, mental health centers, chronic disease, general and mental hospitals, elderly asylums and non-profit facilities, plus ambulatory services for surgery, renal dialysis, family planning, dental-surgical services and weight-loss or body aesthetic services when invasive or requiring anesthesia.

• That you are scheduled for surgery in the hospital and have a documented health condition making you susceptible to infections.Verified against the official source
• That it is documented you were discharged from a general acute care hospital within 30 days before the current admission.Verified against the official source
• That you are to be admitted to an intensive care unit or a burn unit of the hospital.Verified against the official source
• That you receive dialysis treatment in a hospital.Verified against the official source
• That you have been transferred from a skilled nursing centre.Verified against the official source

Information pending verification.

1. 1

   Step 1: The test goes within 24 hours of admission

   This is the first thing worth knowing if you fall into one of the five situations. The law says that “a rapid molecular MRSA diagnostic test shall be performed on every patient upon admission to a health facility, within twenty-four (24) hours of being admitted.” It is not a recommendation to the hospital: it is written as a duty.

2. 2

   Step 2: If it comes back positive, they must tell you immediately

   This is the part most often breached and the law writes it plainly: “If a patient’s rapid molecular MRSA diagnostic test results come back positive, the attending physician shall inform the patient or their representative immediately or as soon as possible.” The duty falls on the attending physician, not on the hospital’s administration.

3. 3

   Step 3: Verbal and written instructions before discharge

   What matters here is the word “written,” because a hallway explanation does not satisfy it. The law provides the patient who tests positive “must receive verbal and written instructions on subsequent care and precautions to avoid spreading the infection to other people, before being discharged.” If they discharge you without that paper in hand, the law was not complied with.

4. 4

   Step 4: The second test before leaving

   Few people know there is an exit test. The law provides that every patient tested in those situations “and who shows greater risk of invasive MRSA, shall be submitted again to a rapid molecular MRSA diagnostic test immediately, before being discharged from the health facility,” with a written exception: it does not apply “to patients who tested positive for MRSA infection or colonization when they were admitted to that facility.”

5. 5

   Step 5: Ask for the Infection Control Officer’s name

   This is the fact that unblocks a complaint, and almost nobody asks for it because almost nobody knows it exists. The law obliges each facility to name an Infection Control Officer who, together with the Medical Faculty, ensures these provisions are implemented, and closes with a short sentence: “The name of the Infection Control Officer shall be made available to the public upon request.” It is a person with a name and a role inside the hospital, and you can ask for it.

6. 6

   Step 6: What the hospital must do to prevent

   The law goes down to the detail of cleaning, and that helps in pointing to a concrete breach. At a minimum the facility must have norms and procedures on procedures to reduce hospital-acquired infections; periodic disinfection and cleaning of all bathrooms, countertops, furniture, televisions, telephones, bed linen, office equipment and the surfaces of patient rooms, nursing stations and storage units; periodic removal of accumulations of bodily fluids and intravenous substances and cleaning and disinfection of all movable medical equipment, including glucometers and other transportable devices; and periodic cleaning of common areas such as elevators, meeting rooms and waiting rooms.

7. 7

   Step 7: The hospital has two days to report it

   This comes from the 2007 law and is the shortest deadline in the whole subject. “Every person in charge of a health facility or person or health facility shall have the obligation to notify the Department of every detected nosocomial infection case occurring in a health facility in Puerto Rico, within two (2) days of its occurrence.” In addition, the facility must render a semi-annual report to the Department with the analysis of the infections that occurred, the trends found and the actions taken.

8. 8

   Step 8: What the Department is supposed to publish

   The 2012 law orders the Office of Epidemiology and Research to post on the Department’s portal the incidence rates by health facility: central line-associated bloodstream infections, organ or deep space surgical site infections in orthopedic, cardiac and gastrointestinal procedures designated clean and clean-contaminated, and bloodstream infections by MRSA, by Clostridium difficile and by vancomycin-resistant enterococcus, all with the number of hospitalization days. The law sets those duties as of July 1, 2013. We do not publish the portal link here because we did not verify it for this guide.

9. 9

   Step 9: Fines and confidentiality

   Two useful closings. On non-compliance, the 2007 law empowers the Secretary of Health “to impose administrative sanctions and fines against any natural or juridical person, or health facility, that violates this Act’s provisions.” On privacy, the information the Department receives through reports or inspections “shall be confidential,” and may only be reported to divisions or agencies of the United States or Puerto Rico Government for statistical and medical-investigative cases, stating in writing the purpose for which it is requested and maintaining the confidentiality of patient, physician and facility identifications. The law sets no fine amount, so we do not publish one.

The duty to inform you of a positive result is the attending physician’s. The Infection Control Officer’s name is requested at the facility itself, because the law provides it shall be made available to the public upon request. The duty to report cases runs from the facility to the Health Department, and the Secretary of Health is who may sanction. If your matter is a hospital denying you emergency care, or filing a complaint as a patient, those have their own guides here.

• Believing the MRSA test is given to everyone admitted: the law requires it in five specific situations.
• Accepting discharge without written instructions after a positive result: the law requires verbal and written instructions before discharge.
• Waiting for the hospital to come find you: the duty to report the positive result immediately is the attending physician’s.
• Not asking for the Infection Control Officer’s name: the law provides it shall be made available to the public upon request.
• Thinking it only applies to hospitals: the definition includes dialysis centers, ambulatory surgery, elderly homes and other facilities.
• Assuming the hospital has weeks to report the case: the law’s deadline is two (2) days from occurrence.
• Confusing a nosocomial infection with any infection: it is the one that develops during hospitalization and was not present at admission.

These are the government pages this guide is based on.

• Departamento de Salud de Puerto Rico

  Salud

  bvirtualogp.pr.gov

• Act 52-2007 — Nosocomial Infection Control Act (OGP compilation)

  salud

  bvirtualogp.pr.gov