Editor s Note: For more on MRSA and how it affects EMS providers, check out the April JEMS Clinical Alert, “Bug Jumping: MRSA isn’t just a hospital infection anymore.”
SEATTLE, Wash.– Instead of going to her first birthday party, little Anna DeBord spent the weekend in the hospital with a superbug.
Anna had methicillin-resistant Staphylococcus aureus, or MRSA, a pathogen that has learned to thrive even when treated with the most common antibiotics. At Children’s Hospital & Regional Medical Center, doctors gave Anna more-powerful antibiotics and performed surgery on her skin infection.
But her battle with MRSA at Children’s won’ be tallied by public-health officials or show up on reports tracking infectious diseases.
Unlike mumps or measles, MRSA cases need not be reported to public-health authorities in this state, even though health officials say they’ve been aware for years of the growing threat. A study published Wednesday in the Journal of the American Medical Association estimates that the most severe infections caused by this bug kill more than 18,000 Americans a year — more than die of AIDS.
The numbers, much larger than previously believed, set off a round of finger-pointing and blame-placing.
Why aren’t all hospitals screening incoming patients, as they do in other countries, and isolating and treating those carrying the bug so it doesn’t spread? Why don’t lawmakers require hospitals and perhaps schools, nursing homes and prisons to report cases to public-health agencies so they can help control it? What has the nation’s top disease-control agency, the Atlanta-based Centers for Disease Control and Prevention (CDC), been doing while the Staphylococcus aureus bug has grown so resistant to antibiotics?
“It s inertia,” charges infection-control crusader Betsy McCaughey, chairwoman of the New York-based Committee to Reduce Infection Deaths. “For many years, it was assumed that infection was the inevitable risk you faced when you went into the hospital. Now, the evidence is compelling that as many as 90 percent of these infections are preventable through cleaning and screening.”
McCaughey, a former lieutenant governor of New York state, says “the CDC’s lax guidelines and failure to adequately count the number of hospital infections are largely to blame for this problem. They have given hospitals an excuse to do too little.”
The CDC disputes that, saying it asks hospitals to document that they’re reducing the rate of MRSA infections. But some activists say that gives hospitals too little public accountability.
Lisa McGiffert, director of Consumers Union s Stop Hospital Infections campaign, argues that MRSA can t be stopped unless it s tracked.
“Some people say, ‘We know it s a problem; we don t have to count,'” she says. “But we’ve been kind of denying it is a problem. Denial is a dangerous thing when it comes to antibiotic resistance,” because these bugs are so dangerous. “You cannot solve a problem until you re aware of the extent of the problem.”
A hospital-reporting law passed by the Legislature earlier this year does not target MRSA. Rep. Tom Campbell, R-Roy, says he’s planning to sponsor a bill in the next session requiring specific reporting of MRSA not only by hospitals but by nursing homes and other facilities.
For now, the only numbers come from voluntary efforts. In Pierce County, a years-long tracking of MRSA cases, spurred by a core group of hospital-infection specialists, public-health officials and local health providers, has produced startling results.
“Pierce County is leading the nation” in tracking, says Marcia Patrick, director of infection prevention and control for the MultiCare Health System. “We ve got stuff that nobody else has, that other places are just getting caught up with.”
Staph is a common bug, often living in people’s noses or on shower benches, bed rails or lab coats. Over the years, because of what experts say is overuse of antibiotics in people and animals, the bug has grown increasingly resistant to common antibiotics.
“We recognized a long time ago that MRSA was going to be a really hot problem,” Patrick says. “If you’re not doing surveillance, how do you know?”
As a result of the voluntary reports by Pierce County hospital systems, Patrick says, “we have data that most counties have no clue about.”
What that data shows is “very alarming,” Patrick says: Staph is becoming increasingly antibiotic-resistant, and the resistant version is much more common.
The data have pushed some providers, such as MultiCare, which operates Tacoma General Hospital, to start screening new patients for MRSA.
The efforts, along with isolating patients with MRSA and “major work on improving hand hygiene,” have helped MultiCare decrease rates of MRSA despite growing numbers overall, she says.
Experiments in this country and practices in others have shown that vigorous screening of incoming patients and other patient-safety measures can drastically reduce MRSA infections in the hospital.
But the CDC’s MRSA expert, Dr. John Jernigan, said the CDC is providing demanding guidance that is geared toward reducing MRSA rates. “Isn t that what we want?” he asks.
Although many blame hospitals for refusing to track MRSA infections, Carol Wagner, vice president for patient safety for the Washington State Hospital Association, says her organization has encouraged tracking of multi-drug-resistant organisms, including MRSA. But she adds: “It is not beneficial to track only in hospitals; it needs to be communitywide.”
For many looking at this problem, the question is whether money spent tracking and reporting could be better spent on prevention.
“Is the goal to count, or is the goal to reduce infections?” asks Jude Van Buren, an epidemiologist with the Washington State Department of Health. “The health-care dollar never really gets bigger you take from something to do something else.”
Public-health experts already know MRSA is a problem, Van Buren says. Getting more numbers “is not really going to give us any more information,” she says.
One-year-old Anna DeBord is blissfully unaware of all the debate. She came home from the hospital Wednesday and seems fine, said her mother, Liz DeBord.
Now, Liz is spraying Anna’s room with Lysol and washing all her sheets, she said. “We still have no idea, absolutely no idea, how she got it.”
Carol M. Ostrom: 206-464-2249 or [email protected]
For more information
Public Health Seattle & King County MRSA fact sheet : www.metrokc.gov/health/prevcont/mrsa.htm“Living with MRSA” booklet: www.unc.edu/depts/spice/LivingWithMRSA.pdf