All over hospitals:
Skin scourge
MRSA, a treatment-resistant form of bacteria that spreads through direct contact, is called a greater threat to public health than SARS or bird flu.
By Alice Dembner, Globe Staff | August 21, 2006
The rapid spread of bacteria that causes skin infections in healthy people and can kill the seriously ill is spurring a search-and-destroy effort at hospitals across the nation.
Last week, Veterans Affairs hospitals, which serve millions of patients, began rolling out a program to test everyone for the bacteria on admission and discharge.
New England Baptist Hospital will screen every inpatient starting Sept. 1. Other hospitals are doing more-limited testing.
The goal is to eliminate infections caused by the bacteria, called methicillin-resistant Staphylococcus aureus, or MRSA, which is now carried by an estimated 2.3 million Americans, most of whom show no signs of illness. Hospital officials want to identify carriers to prevent them from getting sick or passing the germ to others.
``We owe it to the patient," said Diane Gulczynski, chief nursing officer at New England Baptist, which specializes in joint surgery.
At a three-day meeting in Cambridge last week that drew more than 400 infectious disease experts from across the country, leaders suggested that MRSA is now a much more immediate threat to public health than SARS or bird flu.
MRSA passes through skin-to-skin contact or shared personal items and is immune to common antibiotics. Healthy people can often shed the bacteria on their own, but those with weakened immune systems may suffer blood poisoning, severe pneumonia, and even death. Preliminary estimates by the US Centers for Disease Control and Prevention suggest that MRSA causes about 90,000 serious infections and kills 17,000 people a year.
The bug has been a particular problem in hospitals and prisons, but new research suggests it poses an increasing threat to the general population.
A study published last week in The New England Journal of Medicine found that MRSA is the most common cause of adult skin infections treated in metropolitan emergency rooms. Nearly 60 percent of skin and soft tissue infections treated at 11 university-affiliated emergency rooms were found to be caused by MRSA. No Boston hospitals were involved in the study, but local officials say they are seeing more MRSA infections.
``We're not winning the battle," Dr. Dennis O'Leary, president of the Joint Commission on Accreditation of Healthcare Organizations, told those attending the conference last week.
The antibiotic-resistant bacteria first appeared in hospitals in the 1960s and has grown to account for nearly 65 percent of all staph infections in hospital intensive care units, according to the CDC. In Massachusetts hospitals, the rate of severe infections caused by MRSA has rocketed from 4 per 100 beds to 15 per 100 beds between 2000 and 2004, according to the state Department of Public Health.
In the early 1990s, MRSA started appearing outside of hospitals, in clusters of athletes, prisoners, military trainees, and intravenous drug users. Specialists discovered that a new type of MRSA was being transmitted by the sharing of towels and razors, the touching of contaminated surfaces such as gym equipment, and by close physical contact. In most cases, the form of the bacteria picked up in the community causes skin infections -- pimples or boils -- that are often misdiagnosed as spider bites.
``Anybody is at risk," said Dr. Rachel Gorwitz, an author of the emergency room study and a medical epidemiologist at CDC. Still, the risk to most healthy individuals is small.
Despite the growth of the community strain of MRSA, about 80 percent of MRSA infections occur in hospitalized patients. Efforts to control the infections are focusing on that setting.
A large part of the effort is getting healthcare professionals to sanitize their hands between patients to prevent the spread. Despite policies mandating this easy precaution, officials said, compliance is low in many facilities.
At VA hospitals, patients entering will get a nasal swab to test for MRSA. Those carrying the bug will be isolated from other patients and treated by caregivers wearing protective gowns and gloves. Those undergoing invasive surgery, such as joint replacement and heart bypass, will be ``decolonized" -- washed with special antibiotic soap and given effective antibiotic creams for the nasal passages, which harbor the bacteria.
At the VA Pittsburgh Healthcare System, universal testing for MRSA cut infections from 20 a year to two among patients in the 140-bed acute-care unit, according to Dr. Rajiv Jain, chief of staff in Pittsburgh and leader of the national VA initiative.
At New England Baptist, all patients found to be carriers get nasal antibiotics and special soap washes. They do not get surgery until they are MRSA-free.
But not all infection-control specialists support this kind of universal screening and decolonization.
The Association for Professionals in Infection Control and Epidemiology, which helped organize last week's conference, backs such testing only in high-risk settings such as intensive care units, according to Kathy Ware, the executive director. She said the cost of testing, strain on staff, shortage of single rooms for isolation, and the potential that patients in isolation would be neglected argues against testing everyone. The CDC has not yet taken a position on universal screening.
Dr. Carlene Muto, director of infection control at the University of Pittsburgh Medical Center, said universal testing ``saves lives. This has to be required."
To spur more facilities to act, 13 states now require public reporting of hospital-acquired infections, including MRSA, according to the Association for Professionals in Infection Control and Epidemiology. Massachusetts is one of 17 other states where legislation is pending to mandate reporting.
Dr. Alfred DeMaria Jr., chief medical officer at the Massachusetts Department of Public Health, said his agency has not taken a position on the bills but added that he believes the state already has a good handle on MRSA. He said the department now collects data on severe MRSA infections from hospitals and studies trends, although it does not make public the numbers on individual hospitals. The state is planning to spend an extra $1 million this year to prevent and control infections in healthcare facilities.
Some infection control specialists believe that national reporting of MRSA could help identify the full scope of the problem and focus prevention efforts.
``We're counting cases of chicken pox and measles, for which there are vaccines," said Dr. William Jarvis, an infection control consultant who moderated part of the MRSA conference. ``We should be counting MRSA."
Alice Dembner can be reached at Dembner@globe.com.
Steps you can take to protect yourself
Disease specialists recommend taking the following steps to avoid catching drug-resistant infections and assure that the germs won't spread if you're already infected:
Don't share towels, razors, or uniforms when playing sports or working out.
Put a clean towel over gym equipment or sauna bench before using.
Shower after working out.
Keep cuts and scratches clean and covered with a bandage until healed.
Avoid hot tubs if you've got an open wound.
Wash hands regularly.
Before allowing healthcare workers to touch you, ask if they've washed their hands.
Use antibiotics sparingly.
If already infected, make sure that open wounds are covered with clean, dry bandages and that linens and clothes that may have become soiled are washed in hot water and laundry detergent and placed in a hot dryer rather than air-drying.
See a doctor if you have a skin cut that appears infected and isn't healing. Don't try to drain a boil yourself.
ALICE DEMBNER
© Copyright 2006 The New York Times Company
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