Studies: Dangerous staph germ could be stopped with screening
CHICAGO -- Testing all new hospital patients for a dangerous staph "superbug" could help wipe out a germ that likely kills more Americans than AIDS, consumer advocates say and early evidence suggests.
Yet few U.S. hospitals do it, and many fight efforts to require it. Why?
Jeanine Thomas, who nearly died from the drug-resistant staph bug, says the reason is simple: "Doctors don't want to be told what to do."
The Chicago suburbanite's personal crusade led Illinois this year to become the first state to order testing of all high-risk hospital patients and isolation of those who carry the staph germ called MRSA.
Powerful doctor groups fought against it. The testing and isolation of patients would be too costly, they said. Many other germs plague hospitals that also require attention. Experts said a more proven approach would focus on better hand washing by hospital staff -- a simple measure tough to enforce.
Yet Thomas prevailed. Similar measures passed this year in Pennsylvania and New Jersey. And Thomas' national crusade to make hospitals test for MRSA and report their infection rates gained steam last week after a Virginia teenager's death from the germ and a government report estimated it causes dangerous infections that sicken more than 90,000 Americans each year and kill nearly 19,000.
Suddenly the little-known germ with the cumbersome name, methicillin-resistant Staphylococcus aureus, is getting lots of attention.
People in health-care settings, like hospitals and nursing homes, are most at risk for MRSA infections. Doctors and nurses who treat staph-infected patients and then don't carefully wash up can spread the germ to other patients. Germ-contaminated medical devices used on people having dialysis or medical procedures also can spread staph. Older patients and blacks are most at risk, according to the recent report by government researchers.
MRSA, pronounced Muhr-suh, has been around for decades and in recent years has spread to schools, prisons and crowded public housing projects. Even healthy people can carry it on their skin. It may look like a pimple or spider bite that doesn't heal, but it can turn deadly if it enters the bloodstream or morphs into a flesh-eating wound.
Yet, many infection control experts oppose required testing for it in hospitals.
Many note that MRSA is just one of dozens of risky germs that often infect people in hospitals -- particularly those with weakened immune systems or open wounds.
But Lisa McGiffert doesn't buy it. The director of the Consumers Union's campaign to stop hospital infections calls that "an argument of distraction."
"Certainly there are other superbugs and they should be tackling those, too," said McGiffert. "To eradicate hospital-acquired infections is going to take a comprehensive effort" that should include testing hospital patients, she said.
About 1.7 million Americans each year develop infections from various germs while hospitalized and almost 100,000 of them die, according to the U.S. Centers for Disease Control and Prevention.
MRSA accounts for only about 10 percent of these infections. Other worrisome bugs include C-difficile (an intestinal infection), vancomycin-resistant Enterococcus (linked with intestinal, skin and blood infections), and drug-resistant Acinetobacter (which can cause pneumonia, skin and blood infections); none of them accounts for more than 10 percent of hospital infections.
MRSA infections have hogged attention, partly because they're on the rise. And, acknowledges the CDC's Dr. John Jernigan, "MRSA likely accounts for a disproportionate amount of illness and death" because of its strength and resistance to mainline antibiotics.
CDC recommendations for fighting drug-resistant bugs list MRSA testing as an option. However, the agency says it's unclear whether that works better than other measures. Those include judicious use of antibiotics, hand washing, and wearing gloves, gowns and other protective gear.
"We don't think (testing is) a silver bullet to that problem," Jernigan said.
The Joint Commission, an independent, not-for-profit group that sets standards for the nation's hospitals, doesn't have specific rules on how to prevent MRSA.
The commission's Dr. Robert Wise said the organization wants to see evidence that MRSA testing and other measures work. He said the commission hopes to have an answer early next year and then will then decide whether to adopt new standards.
Perhaps the commission will review an experiment done in Pittsburgh. There, the Veterans Affairs hospital tested new patients for staph, using a nose swab. They isolated those who had the germ, and annual infection rates fell from about 60 to 18 cases, said Dr. Rajiv Jain.
The staph bug used to cause "occasional" deaths, but no patient has died since 2005 when testing of all patients began, said Jain, who is with the VA's MRSA prevention program.
In May, the VA began putting a $28 million testing system in place for all 155 hospitals. But it costs about $32,000 to treat one hospitalized MRSA patient, so "if you reduce infections by 50 percent, you more than recuperate the cost," Jain said.
Denmark, Iceland, Norway, and the Netherlands have reduced their MRSA rates and all test high-risk patients. In the Netherlands, that means testing foreign patients.
Opponents of mandatory testing point out that these small countries all had low rates of the germ to begin with. Hospitals in larger, more diverse nations like Britain, for example, have long had problems with MRSA.
And testing may not make sense for hospitals that treat few high-risk patients or where other bugs are more prevalent, opponents say.
"The best approach is not to have state legislators dictating how hospitals go about fighting infections, said Dr. Don Goldmann, of the Institute of Healthcare Improvement, a not-for-profit advocacy group.
At the University of Chicago Medical Center, doctors have been focusing on C-difficile bacteria, which can cause severe intestinal illness.
With Illinois' new law requiring MRSA testing, "We're having to shift gears and haven't been able to devote what we'd hoped on these other pressing problems," said Dr. Stephen Weber, the hospital epidemiologist.
At Chicago's Rush University Medical Center, lab supplies alone for the testing will likely cost about $80,000, said Stacy Pur, Rush's chief nurse epidemiologist for infection control.
"It's very labor-intensive and we would really much rather focus our efforts on infection control" measures proven to work, including better hand washing by hospital staff, she said.
But Thomas, the MRSA patient-turned-advocate, argues: "You're never going to control this with hand hygiene, because you're never going to get 100 percent compliance."
Thomas had never heard of MRSA until she slipped on ice seven years ago and broke her left ankle. That landed her in a Chicago hospital, where she believes she got the infection.
Two days after being sent home, she developed throbbing pain in her left leg. She went to the emergency room, where doctors removed her splint and found the ankle hugely swollen, black and draining pus. She was admitted and given antibiotics, but within a week the infection spread inside her body; her lungs, kidneys and other vital organs shut down.
Hospitalized for three weeks and bedridden for six months, she recovered but her ankle joint was destroyed. She formed a support group and began lobbying for the new law.
Now Thomas is working with advocates in several other states.
"We have a wave happening," she said.
And if Illinois hospitals don't comply, she may push to enact testing of all -- not just high-risk -- hospital patients.
That has been done since 2005 at three Chicago area hospitals in the Evanston Northwestern Healthcare system. There, the MRSA infection rate has dropped 60 percent, said the system's Dr. Lance Peterson.
And at the VA hospital in Pittsburgh, Jain reported an added bonus. The rates for other hospital-acquired infections also fell after MRSA testing began.
Why? The testing may have caused hospital workers to pay more attention to hand washing and other prevention efforts, he said.
Medical Writer Maria Cheng in London contributed to this report.
MRSA support group: http://www.mrsa-survivors.org