Getting a clean bill of health

To avoid infections, be proactive about doctors' hygiene

November 01, 2007|By Meredith Cohn | Meredith Cohn,[sun reporter]

With infections from a drug-resistant superbug rising in the nation's hospitals, as well as gyms and schools, consumer advocates say people should become more active in keeping themselves safe.

The bug is the invasive methicillin-resistant Staphylococcus aureus, known as MRSA, and it's now believed to cause up to 19,000 deaths a year nationwide.

The bacteria are carried on people's skin and in their noses but aren't trouble until they enter the bloodstream through a cut, most commonly through an incision or catheter at the hospital.

Patient advocates say prevention in the form of scrubbing -- of hands, equipment and surfaces -- is the best defense. People need to demand that proper hygiene measures aren't ignored or forgotten in hospitals and other community gathering places.

"Guidelines are inadequate, so you need to be aggressive about asking your health care providers to clean their hands and equipment in front of you," said Elizabeth McCaughey, former lieutenant governor of New York and chairwoman of the nonprofit group Committee to Reduce Infection Deaths. "If you're worried about being too aggressive, remember your life is at stake."

MRSA isn't a new bug, but deaths from infections are rising nationwide largely because overuse of antibiotics has led to drug resistance. According to an October report in the Journal of the American Medical Association, MRSA made about 94,000 people sick in 2005 and killed almost 19,000. That compares with about 17,000 deaths from AIDS. Staph infections have recently shown up in Maryland schools, and a recent federal report showed Baltimore had the highest rate of MRSA infection of nine regions studied.

Consumer advocates say the attention should push hospitals and other facilities to focus on cleaning and screening more vulnerable people -- and some federal and state legislators, including one in Maryland, say they may seek laws for more screening.

Little information on the rate of hospital prevention methods and infections is now available, and advocates say more data would allow consumers to make choices. A general infection reporting law was passed in Maryland two years ago, but public data aren't expected until the end of 2008.

Nancy Fielder, a spokeswoman for the Maryland Hospital Association, said deciding what complex data to collect has been tough. In the meantime, hospitals are taking voluntary steps to reduce infections, such as installing alcohol-based gel pumps and screening more patients.

For example, the University of Maryland Medical Center screens patients for MRSA in intensive care units and those who have been in other health care facilities within the year or have infections. Johns Hopkins Medicine added screening for two superbugs in the sickest children.

Surveys show about 70 percent of hospitals now screen some patients for MRSA, said Pamela W. Barclay, director of the Maryland Health Care Commission's Center for Hospital Services.

Which hospitals screen for superbugs isn't regularly reported. But other measures are, such as those who use antibiotics before surgery and if those drugs are appropriate.

New reports, required by law, will include information on two other processes to prevent infection: how many intensive care patients at each hospital are screened for MRSA and how many health care workers get a flu vaccine.

The reports will also call on hospitals to count how many intensive care patients with central lines get bloodstream infections of any kind. They will not count specific MRSA cases, though Barclay said the reports will expand over time to include the rate of surgery-related infections and others.

The slow pace of public disclosure nationally has rankled some. There are 19 states with laws that require reporting of infection rates but few actual reports, according to the Consumers Union's Stop Hospital Infections Campaign.

Lisa McGiffert, the campaign director, said if patients knew more, they would at least demand doctors wash their hands. A recent study showed that health care workers wash their hands less than half the time needed.

She said patients ought to also demand antibiotics before surgery, catheters be removed promptly and razors not be used to clear hair presurgery because nicks invite germs.

Michael Bennett wished he'd known more about prevention when his father went into a Maryland hospital a few years ago for a respiratory virus and died of infection. He learned from lab reports that there were six pathogens present over four months.

He later founded the Coalition for Patients' Rights in Maryland, a group pushing for better infection control. He believes a culture change is needed because some health care workers don't take necessary precautions because they think there are too many germs to fight, or there isn't time or money for higher levels of hygiene and screening.

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