During a residency rotation at the Albert Schweitzer Hospital in Haiti, Victoria J. Fraser, MD, saw cases of tuberculosis, tetanus, salmonella, typhoid fever, and measles often. “Worldwide, these diseases were causing high morbidity and mortality,” says Fraser, the Adolphus Busch Professor of Medicine, “even though, in many patients, they were avoidable.”
Much of Fraser's research work has focused on hospital-acquired infections—an avoidable phenomenon that leads to almost 100,000 deaths in the U.S. each year. Last year, she helped design and oversee a major cross-institutional study examining new and cost-effective ways to protect ICU patients from infection.
Fraser calls Washington University “an extraordinary place” for her work. “Our hospital partnerships and our physicians allow important questions to be asked and answered in ways that couldn’t be done at other institutions,” she says. “There’s a great spirit of collaboration, interdisciplinary research, and collegiality here.”
A Study of Prevention
“Patients in the ICU benefit from tremendous new life-saving treatments, but infections remain one of their biggest causes of mortality,” Fraser says. “It’s devastating and frustrating to see patients cured of cancer or have a successful organ transplant or survive a car accident, and then succumb to an infection.”
Now the head of the School of Medicine’s Department of Medicine, Fraser is the principal investigator of a CDC Prevention Epicenters Program grant and has been funded by the National Institutes of Health and the Agency for Healthcare Research and Quality. She currently serves on a National Institute of Allergy and Infectious Diseases study section and has previously served on several National Institutes of Health special emphasis review panels. Fraser is also a past president of the Society for Healthcare Epidemiology of America.
Fraser’s study focused on methicillin-resistant Staphylococcus aureus (MRSA). MRSA is a bacterium that often lives harmlessly on skin but is resistant to first-line antibiotic treatments and can cause deadly infections, especially in patients who are already sick. It spreads easily from person to person, a problem that is exacerbated in ICUs, where healthcare workers may touch each patient hundreds to thousands of times per day. Fraser is working to understand the transmission dynamics and what makes a person more or less resistant to infection—and more or less likely to shed the bacteria.
Unlike most infection studies, which examine the effects of only one prevention method, Fraser’s compared a variety of strategies to prevent transmission of MRSA between patients. It involved nearly 75,000 ICU patients from 43 hospitals and was administered by infectious disease experts from across the country.
Fraser and her colleagues concluded that bathing all patients daily with antimicrobial soap and applying antibiotic mupirocin ointment in the nose reduced bloodstream infections, including those caused by MRSA, by 44 percent. It also lowered by 37 percent the number of patients who harbored MRSA on their bodies. Excessive use of mupirocin, however, can encourage further antibiotic resistance, so, as Fraser says, “it can’t be the only strategy. The point of the study was to examine a combination of strategies: active surveillance, bathing with antimicrobial chlorhexidine, and use of mupirocin.”
A Future without Infection
“I would love for healthcare to become so safe that the risk of hospital-acquired infections is eliminated and is just part of history,” says Fraser of her long-term goal within the world of infectious diseases. In the short term, however, Fraser’s objective is for medical knowledge to stay ahead of bacteria and its extraordinary ability to mutate. “Our focus on prevention is very intense,” she says, “and there have been some really exciting developments.”
Fraser notes that modern medical advancements that have allowed people to live longer and survive serious illnesses have created a population that is more vulnerable to infection. “The science for infection prevention and treatment has to parallel our investments in other medical research,” Fraser says. She is excited to see that infectious disease research and its funding have begun to keep pace.