U.S. Hospitals Fight Super-Bugs, Finally
In 2005, the year that a drug-resistant bacteria known as MRSA killed an estimated 19,000 Americans, Dr. Lance Peterson began an experiment in three
Jul 31, 2020183.8K Shares2.8M Views
In 2005, the year that a drug-resistant bacteria known as MRSAkilled an estimated 19,000 Americans, Dr. Lance Peterson began an experiment in three hospitals near Chicago. Peterson, infection control officer for Evanston Northwestern Healthcare, tested everyone who entered the hospitals for MRSA, and disinfected those who were carriers of the germ. Within a year, the hospitals’ rates of MRSA infections had fallen by half. Peterson estimated that nine lives were saved.
Illustration by: Matt Mahurin
Peterson’s studyis one of more than 150 showing that when hospitals actively hunt for carriers of MRSA and beef up precautions to prevent its spread, they can dramatically reduce serious infections and deaths. But despite 30 years of research showing that these “search and destroy” tactics can stop MRSA, until recently few U.S. hospitals used the procedures. Instead, they seemingly held up their hands and shrugged at an epidemic that now kills more people each year than AIDS, murder or Parkinson’s disease.
But a grassroots public accountability campaign has been mounting, with 19 state laws now requiring hospitals to tighten infection control. Finally, hospitals are starting to get tough. By late 2006, 29 percent had started so-called “active surveillance” of MRSA, according to a survey by the Association of Professionals in Infection Control. Today, close to half of our 6,000 hospitals are doing it, and most others are in the planning stages. “We’ve reached the tipping point,” says William Jarvis, an infections expert. “The public was tired of waiting.”
MRSA–methicillin-resistant Staphylococcus aureus–is the most notorious member of a group of antibiotic-resistant bacteria that have steadily colonized American hospitals over the past four decades. About a third of adults carry staph germs in our noses – usually without getting sick. But the chronically ill and elderly are particularly susceptible to staph infections, especially after surgery. And an infection involving staph resistant to many antibiotics is particularly difficult to fight.
Year after year, the percentage of drug-resistant staph infections has steadily grown, to as much as 70 percent in many hospitals. Under the infection control guidelines issued by the Centers for Disease Control in the 1980s, hospitals were instructed to isolate patients only after they were found to be infected with MRSA. Healthcare workers were supposed to wear gowns, masks and gloves around these patients, and afterwards carefully wash their hands. But those measures didn’t prevent the spread of MRSA.
Apparently, many people entering hospitals are already colonized with MRSA, but show no symptoms of infection. The best way to control hospital MRSA infections, based on decades of research that began in Denmark, is to test all high-risk patients—that is, those who’ve been in hospitals or nursing homes recently, or have diabetes or kidney problems—when they enter the hospital. In infection control jargon, this is called “active surveillance.” The CDC has been reluctant to order the procedure.
“Active surveillance” can be difficult and cumbersome. Until recently, it was necessary to isolate the patients during the 3-6 days it took for the germs collected in nasal swabs to be cultured and tested for drug resistance. Most hospital administrators were leery of a process that could lengthen hospital stays and seemed inhumane.
Recently, a high-tech tool has made active surveillance easier. For $25 each (compared to the $4 cost of preparing a traditional culture), hospitals can buy rapid-identification kits to test for MRSA. These kits, which use molecular fingerprinting technology, detect MRSA in as little as two hours.
Because they work so fast, hospitals don’t have to isolate suspected MRSA carriers. Once carriage of MRSA is determined, the patient gets nasal antibiotic ointments and is carefully washed for a few days, which is normally enough to disinfect him or her. “It’s arduous to isolate patients preemptively, and most hospitals don’t want to do it,” said Andy Guhl, vice president for hospital-associated infections at Becton-Dickinson, the biggest vendor of the tests. “With a two-hour lab test result we’re allowing the hospitals to think about infection and control a lot differently than before.”
Normally, changes in American health procedures this big take place in coordinated fashion under the leadership of the CDC. But in the case of hospital infections, the CDC didn’t lead for so long that it took a popular insurrection to make change.
The legislative remedies, pushed by groups like Consumers Unionhave changed the legal risk/benefit equation for hospitals. People with hospital infections usually lose lawsuits because of the lack of evidence that a hospital did something wrong. Under some of the new laws, hospitals could be liable if they don’t chart preventive measures, like nasal swabs and hand washing.
The insurrection against infections has many foot soldiers, most of them shocked and angry relatives of people who died in the hospital. Michael Bennett, a Baltimore contractor, started the Coalition for Patients’ Rightsafter his dad, a retired actor, died in 2004 following multiple infections and amputations after getting a hip replacement.
“The change that is taking place in hospitals on this issue has been driven by average Joes,” said Bennett. “This dysfunctional culture has killed a staggering number of patients unnecessarily, but it’s better late than never.”
Hospitals and infectious disease doctors bridle at some of the laws, which don’t provide the extra resources needed to improve surveillance of the superbugs. But it’s undeniable that outrage and legislation, rather than science, kicked reluctant hospitals into action. (So has the evidence that avoiding superbug infections can save money. See for example, this study).
Last May, the Veterans Administration became the firstmajor hospital administrator to introduce mandatory screening of high-risk patients at its 154 hospitals. In October, it began screening all incoming patients for MRSA. (Because of the spread of MRSA in prisons, gymnasiums and schoolyards, Peterson said, it’s getting difficult to pin down who is a high-risk patient. These so-called “community-acquired MRSA” infections are often quite virulent—even worse than the staph bacteria that frequent hospitals.)
Volunteer Hospitals of America, a network of 1,200 institutions, and the Hospital Corporation of America, which owns 250, began active surveillance last year as well. “Basically, everyone is doing it now,” says Jarvis. Later this year, Medicare will refuse to reimburse hospitals for infections that occur after certain types of surgery.
As a stand-alone cause of death, MRSA is currently ranked 14th in America. If you include all hospital infections, the number is closer to 100,000–number six on the mortality list, ahead of diabetes, Alzheimer’s and pneumonia. To be sure, many of these patients had underlying conditions that weakened them before the infections took hold.
Not all these infections, or deaths, can be prevented. But the tragedy of the MRSA epidemic is that it could have been stopped or at least slowed significantly, according to many infectious disease specialists who are fighting for better hospital infection control measures. And many point fingers at the CDC.
“The CDC has tracked the rapid rise, they’ve understated the problem, they’ve done too little to remedy it,” says Betsy McCaughey, a former New York lieutenant governor who has campaignedto stop hospital infections.
“There’s no doubt that the CDC is to blame for the delay,” agrees Jarvis, who spent 23 years in hospital infection at the CDC. He left the agency in 2003 after Julie Gerberding became director. Ironically, Gerberding was a hospital infection specialist at San Francisco’s General Hospital before she came to the CDC, where her first job was director of the hospital infection program.
In 2002, the Society for Healthcare Epidemiology of America, the professional group for infection control, issued guidelines that strongly recommended active surveillance and control of MRSA. But the CDC committee on hospital infections was led by Gerberding-appointed doctors who were reluctant to adopt the requirement. Some prominent infectious disease specialists were not convincedthat isolation techniques worked to slow MRSA. The committee haggled for years until issuing guidelines in 2007 that mention isolation, but without stressing it as an immediate step.
“If the CDC issues a priority recommendation, it happens overnight,” said Jarvis. “The infection control officer can throw that on his administrator’s desk, and he’ll respond. But if there’s no CDC recommendation, they’ll say, ‘Oh, it’s too much work, I don’t want to do it.’”
The CDC did not respond to two calls requesting comment. In a future story, I’ll examine some of the political problems at CDC that may have contributed to its foot-dragging on the issue.
*Update: Dr. Lance Peterson held his MRSA study at Evanston Northwestern Healthcare. An earlier version of this story called the facility Evanston Northwest Healthcare. We regret the error. *
Rhyley Carney
Reviewer
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