Answers sought in hospital deaths

Easton officials search for source of bacterial infection

April 02, 2002|By Diana K. Sugg and Chris Guy

EASTON - Health investigators are tracking down the source of a powerful bacterial infection linked to the deaths of six elderly patients at Memorial Hospital at Easton.

The patients are among eight infected while in the hospital from late February to the middle of last month. Memorial physicians believe the patients, all of whom were terminally ill, died of their underlying conditions, not the infection.

The bacteria, a resistant form of staph, is one of the most prevalent and dangerous hospital-acquired infections nationwide.

Memorial physicians are working with epidemiologists at the state Department of Health and Mental Hygiene and the Talbot County Health Department to determine the cause of the infection, whether all the cases are connected - and to prevent further spread of the infection.

Meanwhile, public health officials are awaiting test results from the U.S. Centers for Disease Control and Prevention to find out whether any of the 187 staff members could be carrying the infection, and whether there could be more than one strain. Samples from the eight patients have also been sent to the CDC for analysis.

The bacteria, called Staphylococcus aureus, is common in most hospitals, particularly teaching institutions. It can be spread by equipment such as stethoscopes, blood pressure cuffs and bed railings. But studies show it's most often transmitted by hospital staff who have failed to wash their hands after caring for an infected patient.

One recent study found that a significant proportion of nurses and doctors, particularly those wearing wedding rings, had bacteria on their hands.

Staph is commonly found on the skin of healthy people. Sometimes, it gets into the body, causing problems ranging from a pimple to blood infections or pneumonia. But as in Memorial's situation, staph usually affects hospital patients who are very sick or elderly, particularly those with wounds or intravenous catheters.

This particular infection is tough to deal with, because it is resistant to methicillin, the main antibiotic used to treat it. Nationwide, it's become a major problem for hospitals, affecting about 80,000 patients every year, according to the CDC.

First suspicions

Memorial's doctors first became suspicious when routine testing turned up the strain in two patients in the intensive care ward in February. When two other critically ill patients in the eight-bed ICU were found to have the infection, hospital officials alerted local and state health authorities, said Dr. John Swope, vice president for medical affairs.

State health officials later identified four other patients with the infection throughout the hospital. Six of the eight patients found with the infection died, but hospital officials said it was impossible to determine what role the staph infection might have played in their deaths. All those who died suffered from terminal conditions such as emphysema or cancer when admitted to Memorial.

"These were not previously healthy 28-year-old people," said intensive care director Dr. D. Gregg Oliver. "These were elderly, chronically ill patients. In four cases I personally treated, any kind of infection could have been the last straw for them."

According to Dr. Harold C. Standiford, medical director for infection control at the University of Maryland Medical Center, studies show this form of staph is an additional factor that causes increased length of hospital stay, morbidity and death.

One step Standiford is trying at Maryland is the use of alcohol-based hand-wash solutions, which enable health care workers to skip the sink and clean their hands by rubbing them with a gel.

Action taken

Memorial officials, who ordered Thursday that all staff members and visitors to the ICU and the nearby telemetry unit begin wearing disposable gloves and gowns, said they decided to inform the public when the extra precautions sparked rumors in Easton and the surrounding area. Some people wrongly thought patients at the hospital had anthrax or the Ebola virus, officials said.

State health officials praised Memorial's staff for promptly reporting the outbreak even though Maryland law does not require it. Since the infection is not routinely reported, state officials can't say how often such outbreaks might occur.

"The investigation has been made easy by the cooperation we've had," said state epidemiologist Dr. Ross J. Brechner. "There have been no new cases in the last 20 days, the hospital is safe, but we need to locate the cause."

The number of hospital-acquired staph infections has risen drastically over the past several years. Some intensive care units have reported that half of their patients have the infection. Experts point to trends including the widespread use of invasive procedures, the increasing level of sickness among hospitalized patients, and hospital staffers not complying with infection control practices such as handwashing.

The strain is prevalent in other health care settings, including nursing homes, and has recently started to show up in the community.

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