Infection rates at hospitals continue to grow

John Colson
Aspen, CO Colorado|Aspen Times
December 30, 2007

ROARING FORK VALLEY — Colorado and local public health officials say they don’t know the extent of reportedly increasing infection rates inside rural hospitals around the state, other than to concede that the rates are generally, if slowly, rising.
Laws are being passed in other states to require public data collection about hospital-acquired infections, in particular new strains of antibiotic-resistant bacterial infections.

Critics of existing health care policies nationwide are demanding that the new rules and techniques be adopted throughout the country to combat what they say is a particularly virulent and dangerous disease, known as MRSA.

In Colorado, however, data collection regarding MRSA (formally named Methicillin-Resistant Staphylococcus Aureus) is required only in Denver County. And Colorado is not one of the states that has adopted stringent new guidelines aimed at curbing the spread of MRSA in hospitals, nursing homes and other health care facilities.

“It is a persistent pathogen and it is out of control in most of the [U.S.] health care system,” declared Dr. Barry Farr, professor emeritus at the University of Virginia, and one of several nationally respected physicians tracking the MRSA phenomenon.
New infection control guidelines in several states in the U.S., as well as in European countries and other regions of the world, are requiring that hospitals screen all “at risk patients” and follow stringent measures to fight the spread of bacteria and disease.
The main enemy in this war is MRSA, although there are other bacteria and germs of concern. Together they amount to what some observers believe is a serious and worsening health care crisis in this country.

Dubbed a “superbug” by some, MRSA is the antibiotic resistant form of Staphylococcus Aureus, or S. Aureus, a type of staph infection that researchers believe has been around as long as humans have walked the earth.

It was not until the latter half of the 20th century that staph bacteria began developing resistance to treatment by antibiotics, particularly methicillin, which was commonly used to treat staph infections in hospitals.

The bacteria lives harmlessly on a person’s skin, and in nasal passages. Most infections result in skin problems ranging from pimples to boils. But the more serious complications from MRSA infections — most commonly in hospitals — are happening much more often, experts say.

And it is in hospitals around the country that the MRSA incidence is reaching what some experts say alarming, if not crisis proportions, causing serious diseases that can result in lengthy hospital stays, the amputation of limbs and even death.
An Illinois woman, Jeanine Thomas, founder of the MRSA Survivors Network and advocate for state and national legislation to combat the disease, writes on her Web site that she contracted an MRSA infection during ankle surgery in 2000. The infection went into her bone marrow, leading to seven surgeries to save her leg from amputation. She said she has spent 17 months out of the past five years in a sick-bed dealing with secondary infections, and still has health concerns.

Thomas, working with others, convinced the Illinois state legislature to pass laws requiring mandatory screening of “at-risk” patients for MRSA before they enter a hospital. “At-risk” means patients coming from nursing homes, or those headed to the intensive care unit, among other definitions.

Highly critical of health care officials who downplay the dangers of MRSA and similar pathogens, she said, “They always like to look like they’re doing something, but they’re doing nothing [in many areas]. We are where we are because of their inaction.”

In 1980, MRSA reportedly accounted for only 2 percent of all S. Aureus hospital-acquired infections reported in 300 hospitals that were part of a CDC study. More recently, MRSA is estimated to account for more than 60 percent of S. Aureus infections, according to an article in the February, 2006 edition of the magazine, “Infection Control Today.”

Across the U.S., advocates are calling for tighter monitoring of the resistant strains and much closer observance of what are known as “active detection and isolation” techniques aimed at cutting the incidence of MRSA-type infections.

Farr was a medical internist at UVA in the early 1980s, he said, when the university hospital detected rising MRSA rates and instituted “active detection and isolation” methods to keep the disease in check.

The measures include rigorous enforcement of rules on hand washing, the meticulous cleaning of equipment and hospital rooms, the use of gowns and disposable aprons to prevent doctors and nurses from spreading germs on clothing, and the testing of incoming patients to identify and isolate those carrying the bacterium.

Farr told an interviewer in 2004 that studies show that health care workers only wash their hands between patients about 40 percent of the time.

The measures have been formalized into guidelines published in 2003 by the Society for Healthcare Epidemiology of America (SHEA), authored largely by William R. Jarvis, MD, of Emory University School of Medicine, president of Jason and Jarvis Associates, and a former official of the Center for Disease Prevention and Control [CDC].

The measures worked, Farr said, and have been adopted in other selected parts of the country, including the states of Illinois, New Jersey and Pennsylvania. But unless all states, meaning all hospitals, nursing homes, VA facilities, and other health care centers begin following the same methods, MRSA infection rates will continue to grow, he believes.

As an example, Farr said, medical officials in Western Australia recently adopted the “active detection and isolation” methodology in response to rising MRSA infection rates, and the rates declined. But other parts of Australia did not follow suit, “so they spectacularly failed” to curb the disease, he said, and MRSA spread back into Western Australia.

He said some European nations, including the Netherlands and Denmark, have made it a national priority to follow the “active detection and isolation” guidelines.
Locally, hospital and community health officials say there is no requirement by the Colorado Department of Public Health and Environment to enumerate or report MRSA infections. The result, these officials say, is that there is no data on how many patients who are carriers of the bacteria, or “colonized,” as medical professional term it, are admitted to hospitals.

Hospital officials in Aspen and Glenwood Springs recently have said their best option for controlling what they admit is a growing problem is to educate the public on different personal hygiene techniques, such as washing hands frequently and avoiding the use of towels, washcloths or sports equipment that has been used by someone else.

Within the halls of local hospitals, where patients are known to contract “hospital-acquired MRSA,” the standard procedures involve isolating the patient from others, and instituting sterile-room rules requiring that everyone, both hospital staff and visitors, don gowns and gloves before entering the patient’s room to avoid picking up and carrying the bacteria into other parts of the facility.

But according to Farr and others, such measures are typically viewed as a last resort and only come into play when hospital staff learns through general testing that a patient suffers from a MRSA infection. And that, he maintains, may well be too late both for that patient and to stop the possible spread of infection.

Roughly 94,000 Americans contracted life-threatening MRSA infections, and more than 18,600 of those died in the U.S. in 2005, roughly 2,600 more than died of AIDS or HIV that year, according to the CDC. The CDC estimates that perhaps 1 percent of the U.S. population is “colonized” by MRSA bacteria and capable of spreading it to others.

At least 1 percent of Americans are carrying the bacteria on their skin, but few of them get sick, Gershman said.