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.

SV hospital seeing rise in community acquired MRSA cases

By Dana Cole
Herald/Review

Published on Friday, December 28, 2007

Hand washing is extremely important now more than ever. SIERRA VISTA — Know as Methicillin-resistant Staphylococcus aureus, or MRSA, this staph infection is extremely resistant to most antibiotics.

It has become one of the country’s most common causes of skin infection and is considered a rapidly emerging public health problem.

At one time MRSA was known as the “Hospital Superbug.”

“That’s because it was found in hospitals, nursing homes and other health care facilities,” said Ann Kuhl, infection control coordinator for Sierra Vista Regional Health Center. “But in recent years, we have seen a community acquired form of MRSA. In fact, the number of community acquired cases has jumped exponentially in the past five years.”

More than half of all MRSA cases seen at the Sierra Vista hospital are the community acquired form and have nothing to do with the hospital, Kuhl said.

“The two types look and act differently, so it’s easy for us to track,” she added. “The community acquired MRSA manifests as a skin infection and often starts out as a small red lesion that grows quickly and is generally localized.”

While hospital-associated MRSA was first identified in 1968, the community acquired form is fairly new, Kuhl said.

There are steps that can be taken to reduce the incidence of community acquired MRSA infections.

“Good hygiene is key,” Kuhl stated. “Wash your hands regularly, with soap. All open cuts or sores need to be kept clean.”

The smallest scrapes, paper cuts, animal scratches, as well as open skin lesions, are an invitation for MRSA infections. “Staph, in general, if you give it a way to enter into the body, can become a big problem,” Kuhl warns. “We just can’t emphasize thorough and frequent hand washing enough. Hand sanitizers are very effective.”

Taking basic contact precautions and keeping home environments clean also are imperative for good infection control. Clusters of community acquired MRSA skin infections have been documented in athletes participating in contact sports, military recruits, IV drug users and prisoners. Other risk factors include close skin-to-skin contact, exposure to contaminated items and surfaces and crowded living conditions.

The bacteria Staphylococcus aureus is present in many people and typically causes no problems. It’s estimated that about a third of the population carry it in the nose, throat and on the skin. But if it gets inside the body, such as under the skin, it can cause serious, potentially fatal infections. If staph infects the lungs, it can cause pneumonia.

“Staphylococcus aureus becomes a health problem when it’s resistant to commonly used antibiotics,” Kuhl said. “Staphylococcus aureus that is resistant to Methicillin is MRSA.”

More than 50 percent of the staph isolates seen by SVRHC are resistant to the usual antibiotics that are used to treat them, Kuhl said.

While most healthy people will never become seriously ill from this bacteria, it can be a health threat for young children, the elderly and people with weakened immune systems. Despite documented risk factors, Kuhl warns there are no patterns when it comes to community acquired MRSA, which further emphasizes the need for everyone to take extra precautions.

The hospital is planning a three-month-long MRSA prevention campaign, an educational program that all 800 hospital employees will be required to attend.

“We’re using this program as a reminder for our staff, emphasizing the importance of good hand hygiene and why we need to take extra precautions,” Kuhl said. “When a patient comes in with MRSA, it’s our policy to take special precautions when working with that person.”

Montgomery Village Student Diagnosed With MRSA

MONTGOMERY VILLAGE, Md. -- A student at Montgomery Village Middle School has been diagnosed with MRSA, an antibiotic-resistant strain of staph infection.

The student is the first at the school to be diagnosed with methicillin-resistant Staphylococcus aureus, school officials said.It's the 43rd case in the Montgomery County school system this year.

School officials said the student is being treated and is attending class, News4's Jane Watrel reported.

Principal Edgar E. Malker and school nurse Maureen Reges released a statement urging families of students at the school to practice good hygiene and check skin regularly for lesions.

Merry King, a middle school special education teacher in Potomac, died earlier this week from MRSA.

The Montgomery school system has had 43 cases in 31 schools this school year, primarily among student athletes, said Kate Harrison, a spokeswoman for the Montgomery County school system.

Health officials said MRSA is not found only in schools, but also in places like rec centers and health clubs.

Dozens of cases of the infection have been reported in the Washington region, but exact figures are not available because doctors are not required to report MRSA to state health authorities.

Health officials said basic hygiene can prevent the spread of the disease. Washing hands and clothes and not sharing personal articles are the best safeguards, they said.

An estimated 90,000 people in the United States fall ill each year from MRSA. It is not clear how many die from the infection; one estimate put it at more than 18,000, which would be slightly higher than U.S. deaths from AIDS.

Be vigilant against staph

WITH ABOUT 19,000 people dying nationwide each year from antibiotic-resistant staph infections, it's important to be vigilant in personal hygiene, public health surveillance and aggressive countermeasures at a level consistent with the fight against AIDS infections.

Indeed, more people die in the United States each year from staph infections than from AIDS.

Local officials confronted the deadly bacteria recently in Spanish Fort, when a high school football player developed an infection. To their credit, school officials called in a professional cleaning crew to disinfect school buildings.

Fortunately, the Spanish Fort student recovered, but others who have contracted staph weren't so lucky. A Valley, Ala., woman died in October of complications from MRSA (methicillin-resistant Staphylococcus aureus) infection, becoming the first MRSA victim in Alabama.

It's estimated that 90,000 people have MRSA in the United States at any one time, though most of the cases occur in hospitals where health care professionals take aggressive measures against any infection.

Staph bacteria, though, are often present on the skin and in nasal passages. The "super bug" drug-resistant bacteria live among easily treatable bacteria and can enter a person's bloodstream through a minor scrape or cut, or through the skin pores.

Moreover, the dangerous bacteria can live on towels and other items that have come in contact with skin, jumping onto new hosts who come in contact with them, spreading and leading to an outbreak (defined as three or more cases).

Ironically, these super bugs occur because of the medical community's aggressive use of antibiotics against normal bacteria. Because of this widespread use, some bacteria become resistant to drugs.

But staph infections can be prevented, which is where personal hygiene comes in. Health officials suggest frequent washing of hands, showering after exercise, avoiding using someone else's towel, razor or other personal items that come in contact with skin, and cleansing of exercise equipment in public gyms.

Public health officials, too, can do more by requiring more aggressive reporting of individual cases, especially those that develop outside hospitals. With public awareness, personal hygiene and public health watchfulness, outbreaks of MRSA from community sources can become a health problem of the past.



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