McCleary MRSA Prevention

The high road to MRSA prevention

An old friend and infection control nurse that I respect a great deal for her efforts told me she did not believe in legislating Infection Control.  Others on the Maine Health and Human Services Committee have made similar statements. 

I just wonder how far I would have gotten if I had continued to contact the CDC, the Maine State attorney general, the CEO of my poor deceased father’s hospital…..how far would I have gotten with improved infection control without the legislation from last year.  Considering the opposition that I have encountered to simply get Maine patients screened for MRSA, my belief is that I would not have gotten anywhere and that Maine Hospitals would not be paying as much attention to MRSA prevention as they are now …..because of legislation.

Since the early 1990s, MRSA has been a growing problem…growing out of control.  It was recognized years ago as an emerging problem but in the late 80s and early 9os, declarations of epidemics came up.  In 2003, the SHEA or Society of Healthcare Epidemiologists, presented recommendations for the control and prevention of MRSA and VRE, another deadly drug resistant infection.  Those who adapted those recommendations have succeeded in dropping MRSA rates and keeping them low.  CDC ignored this success and continued recommending hand washing campaigns and other various and inconsistent methods of control that did not work.  As a result, MRSA rates continued to climb to all time highs over the past few years.

The death of 19,000 people and infection of hundreds of thousands more did not motivate hospitals to add the SHEA recommendations to their plan to stop infections.  Those deaths, loss of limbs, loss of livelihoods, disabilities and other sad and real results of MRSA infections did nothing to move US hospitals to widely accept the success of ADI. Rather than be herded like sheep into the CDC guidelines, it seems that more would have been impressed with huge MRSA reductions after the use of ADI and broken from the CDC  “pack”.

Unfortunately, it is taking legislation to make the needed difference..  We  now have a law  in Maine and still, Hospitals, Epidemiologists, nurse leaders and others are fighting it and hoping it will just go away.  None of them have embraced screening and/or committed to isolation precautions for all patients with positive results……as a good and proven measure of prevention.  Instead they have declared it “well intentioned but ineffective”.  This declaration was made just 3 days after screening started by a leading epidemiologist in Maine.  The descriptor “Well intentioned but ineffective” could also be used for my fathers hospital care, and now he is gone.

I took the high road by seeking legislation. It is my right as a citizen of the US and the State of Maine to seek solutions through the law making process.  I know ADI will work to bring down MRSA rates in our State and I will not stop until I see every hospital in the State using it and reporting out the excellent results they are getting because of it.

There are some lower roads to consider to accomplish this goal.  One is to work on more legislation to mandate that NO HOSPITAL ACQUIRED INFECTIONS be covered by any insurance in the State of Maine.  We may have to do this through more than one agency committee, but my bet is that Medicaid, and the insurance monopolies would welcome a list of things that they would not have to reimburse hospitals for. This would mean increased savings and profits for insurance companies and hopefully less burden put upon already hurting Mainers, who can barely pay their premiums now.   Medicare has already begun this trend of payment for performance quality only and not for preventable hospital failures. I can work on that more with the Consumers Union. 

Why should anybody pay huge costs for a deadly infection that the hospital gave them.  If I could accomplish this legislation, there would be protections for insurance policy holders/ healthcare consumers/ those who drive the medical care business  too, that it would be illegal to bill them for their HAI related expenses.

The second and lowest road is litigation.  If there is a young, progressive and ambitious attorney who would take the time, I could educate him/her on how these infections are preventable and how our hospitals are not doing all they can to prevent them.  That seems like negligence on a very large scale.  It is so hard to get hurt and frightened victims to speak out against their doctors and hospitals (there is that God like aura around them you know), but if an advertisement went into all the newspapers in Maine and there was even a whiff of money to be won in a class action suit, victims would come out of the wood work.  It could be worded like this.  “If you or a loved one has been harmed by a hospital acquired infection please contact …….all cases will be considered for a possible class action suit.  There is a law in the State of Maine that mandates that all high risk populations must be screened for MRSA.  If you were not screened and got a MRSA infection while hospitalized, please contact us.”

These three options are all there are, at the present time anyway.  Consumers Union plans to work with the CDC to get MRSA recommendations rearranged in the correct effective order, but on the State level, the preceding are the options.  I prefer the high road, but I just do not know if I can trust the hospitals to do the right thing.

It is hard to trust when your precious father has been killed by inadequate MRSA prevention in his hospital.

Kathy Uncategorized Active Detection and Isolation, Add new tag, health care bills in Maine. LD 1038, hospital acquired mrsa, Kathy Day, Maine mrsa, Maine mrsa legislation, mrsa active detection Isolation, mrsa death, mrsa decolonization, mrsa disability, mrsa disclosure, mrsa handwashing, mrsa infection, MRSA legislation, mrsa liability, mrsa prevention, mrsa suffering, mrsa victims

Active Detection and Isolation for MRSA prevention and reduction has been proven successful  in all of our VA hospitals, Hospital Corporation of America facilities, Evanston Illinois trio of hospitals, and entire countries and thousands of hospitals nation and worldwide.  How can the CDC and the hospitals in Maine snub that success.  I believe if Maine hospitals had that kind of success with MRSA reductions they would be singing from the mountain tops and echoing the success all through the country.  I know there have been small successes.  Some have had limited success with preventing bacteremia.   MRSA bacteremia is only 10% of all MRSA.  All success is welcome and applauded, but we need BIG numbers, across the board reduction of MRSA infections.

Why emphasize  just MRSA they ask. We emphasize MRSA  because it is by far the biggest infection problem within and outside of our hospitals.  We do not hear about an outbreak of Community acquired VRE or C Diff.  The other MDROs can be an organism on a person on admission but it does not share the same prevalence as MRSA.  Community Acquired MRSA is evolving and growing out of control   It is moving into our hospitals and the strains are merging.  It is virulent and every bit as deadly when it becomes invasive.  Stopping MRSA at hospital doors before it moves inside is necessary.  Only ADI will do that.

Nothing excuses snubbing ADI success, but I believe that some of the following problems may be part of it.

1. Hospitals can make money on infections and they can also get reimbursed for the high priced antibiotics it takes to treat MRSA.  It is easier and more profitable for hospitals  to react to and treat infections than it is to prevent them.

2. MRSA screening and prevention will not MAKE hospitals money, like high priced MRIs do.  Maybe we can figure out a way to do an MRI to diagnose MRSA colonization or infection.  MRSA screening is proven to SAVE hospitals money though.

3. If a hospital infects you while you are vulnerable and in their care, they still get paid.  Another approach to improved  infection control, other than legislation and medical legal ways, may be to campaign insurers to STOP PAYMENT FOR  AVOIDABLE BAD OUTCOMES!   Paying for hospitals acquired infections is something I would prefer that my insurance NOT DO!  I pay my premiums, and I would like to see HAIs removed from things that they cover.  And, there needs to be protection that the burden would not be shifted to the patient either.  It all comes down to money (rather than suffering and death)  after all.  This may be the way to go about it.

4. Doctors and managers with big egos and bean counters make decisions regarding MRSA prevention.  None of the opponents of my MRSA legislation EVER touch a “dirty” infected patient.  They write policies, set budgets, write articles, do studies, study data, manipulate the number of infections, do reports, attend public hearings and meetings, manage other employees, teach, do phone consults and referrals, and God knows what else.  But NONE of them touch infected patients. NONE of them see the suffering.  None of them get near to or have actual contact with with pus, sputum, urine, feces, or other infected parts of suffering and/or dying infected patients.  They are so far detached from that , that they are never endangered by these horrors or really even around it.  Yet, they are the ones who set policy and fight effective measures for prevention.  Who gives them that right?  We do. Healthcare consumers who do not fight back give hospitals  that right. 

We need to fight back and tell our legislators that we do not accept any level of neglect from our hospitals.  We do not accept the death and suffering of our loved ones or others because they refuse to recognize scientifically proven methods of MRSA prevention. 

Support Maine LD 1687 by calling your local representatives in the State of Maine.

Kathy Uncategorized

Tomorrow at 1pm at the Cross building in Augusta Maine, LD 1687 will be heard by the Maine Department of Health and Human Services.   Our work with MRSA legislation in Maine has brought a great deal of attention to Hospital Acquired MRSA and other Hospital Acquired Infections.   We currently have high risk MRSA screening in Maine but it is “only a test”.  Our fears are that the “test” will be limited and we will still be left with no minimum standard for screening high risk patients in Maine.  The law clearly states that there will be “surveillance of all high risk populations” and this is what we expect from out hospitals.

So LD 1687 clearly outlines the necessary steps it will take to make this “test”  an ongoing  program for the purpose of increasing the safety of all patients in Maine Hospitals.  It also outlines the fact that currently we have NO accurate or honest data to use to measure the success of MRSA screening or other prevention measures.  So, we absolutely must make MRSA reporting mandatory.  Hospitals need to become  transparent and accountable for any failures in their systems.  We hear all the good things about the lives saved and how they operate as a “family”.  There is no denying that Maine Hospitals on the whole do a tremendous job, but there are failures.  When a person with no sign of infection enters the hospital and contracts an infection that kills them or disables them………that is failure.  These things can no longer be swept under the rug.  We need to acknowledge them and fix the problem that created them.

MRSA screening of high risk patients will save lives.  And reporting all infecitons will keep hospitals on their toes, but comparing their rates with national averages and also with each other within the state.

Please support LD 1687.

Kathy Uncategorized

http://www.bangordailynews.com/detail/135860.html

Below is a photo of a Hand MRSA.  Many of the infections on Vinalhaven affected the hands.

This is an update on a link I added here a few days back.  It is good to hear that the MRSA outbreak on Vinalhaven Island in Maine has been controlled.  Comments in this article make it sound like they were plagued with flea  bites. 

MRSA is a bit more serious than claimed here.  Some of these victims had to be treated with powerful IV antibiotics.  Some of them will be plagued with repeated infections and all of the victims families have been exposed within their homes to MRSA.  Simple exposure is not in and of itself a problem.  But, many of them may have become colonized.  that means they will carry the MRSA bug.  That is also not a problem UNLESS they become gravely ill and/or need hospitalization for invasive procedure. MRSA can then rear it’s ugly head and cause a myriad of problems.  Patients must make their doctor and hospital aware of their close exposure to the infection.  If the doctor does not order a MRSA screening, the patient should demand one.  If they are colonized, they can have a simple treatment that will decrease their chances of serious active infection a great deal.  And, they can be separated from patient who do not carry MRSA thus avoiding spread of the desease.

I suggested that former MRSA patients and caretakers of MRSA patients to be included in the populations to be screened by our hospitals here in Maine.  They were not included.  My opinion is that was a big mistake.  Nobody wants to incite panic, but a little bit of panic makes people pay attention and absorb important information about their health and risks to it.   MRSA status on admission to the hospitals is a very important status to be aware of.

So, it is good that the Maine CDC got right on this outbreak and worked to control it.  I just hope they added  this  important patient education (about avoiding serious infection in the future) to their investigation  process on the Island.

Kathy Uncategorized bangor daily news, hand mrsa, Maine cdc, Mrsa, mrsa colonization, mrsa infection, mrsa screening, MRSA spread, Vinalhaven Maine outbreak

My work with my MRSA bill , activism and advocacy has taken me all over Maine, to Chicago and to Washington DC twice with another trip coming up soon.  I meet with other advocates, our senators and representatives, the Consumers union, and victims regularly to help stop this scourge.   I have met many of the families in person and online.

Let me introduce you to a few.

Two of my new acquaintances  are military veterans.  One got a new hip then MRSA.  Another got a new knee, then MRSA.  The second one had to have his new knee removed and will soon have his leg bones fused and have an unbend-able knee.  If he makes it through this surgery, he will have to learn to walk again using a shoe lift and a walker.  The alternative to that was amputation and a prosthesis.  He wouldn’t hear of that.   He is 86 years old.

I met a young mother in Washington DC in November.  She got MRSA when she went into the hospital to have her baby.  She suffers with it herself, but the worst of it is her baby has it.  They have had continuous outbreaks since her baby was born 9 months ago.  She talked with me in the hotel hallway and literally cried on my wide shoulders.  Her heart is broken.  She has another child and a husband that she worries sick over. Her worry is that they will get MRSA too.  She is a very young woman who is now on SSI disability because of MRSA.

Another friend, a mutual friend of my husbands and mine, had a colonoscopy.   He had a polyp too far up to remove through the scope.  His doc said it will be a piece of cake to remove that polyp through his abdomen.  So, he did.  He got MRSA.  He had to have a long section of bowel removed and now has a colostomy.  After being treated for the MRSA, he got C Diff and spent a lot of time in the VA home locally and got treated for that with IV antibiotics.  A weeks worth was around $7000 he said, but “thankfully”  his insurance covered it. 

A mentor of mine who is also a MRSA victim, injured her ankle years ago.  She had surgery and got MRSA.  She went into sepsis and nearly died and still they were not telling her about her infection….what it was.  She has fought with the legislators in Illinois to get the first MRSA bill passed into law with mandatory Active Detection and Isolation .

I didn’t personally  know the latest victim I have become aware of, but the cause of her death was published in the local paper.  She was a beautiful 67 year old wife of a prominent local pathologist.  She at one time climbed Mount Kilimanjaro.  She was the secretary at the local medical center’s chaplains desk.  What a tragedy.

Another is an ICU RN by profession.  She contracted MRSA at work.  She has had repeated bouts of MRSA related infections.  Currently she lingering illness from recent flu and is seriously ill.  She will go to the ER this morning and we hope she gets the treatment she needs.  She had MRSA pneumonia with sepsis several years ago and she is very frightened of a recurrence. 

I could go on and on.  The stories are incredible.  These people are all intelligent, trusting and until MRSA, healthy people.   Too often the argument regarding MRSA prevention isn’t about all of these suffering patients or their families.  It is all about money and a lot about saving face.  Savings lives and stopping unnecessary suffering rarely comes into the conversation. 

MRSA is brutal, no matter how old you are or in what medical condition you are in.  We have to break the chain of infections by getting hospital screening right and educating everyone on the dangers of MRSA and how to stop the spread of the disease.

Kathy Uncategorized baby mrsa, military veterans mrsa, Mrsa, mrsa cause of death, mrsa death, MRSA legislation, mrsa Maine, mrsa pnumonia, mrsa screening, mrsa suffering, mrsa victim, new mother mrsa

http://www.workingwaterfront.com/articles/Vinalhaven-lobstermen-grapple-with-MRSA-outbreak/13521

Yesterday there was a story in the  Working Waterfront  newspaper about the 4 month outbreak of MRSA on the Island of Vinalhaven Maine.  There were approximately 1200 people on the island in the 2000 census.  2 dozen people were infected with MRSA in this outbreak.  Assuming that each of the victims is from a different family, that is 2 dozen families that may be effected.  If no family members have become infected, which is unlikely, some at least have become colonized.  This means, if those family members become vulnerable to infection because of flu or an admission to the hospital for an invasive procedure, they may encounter an active infection….a serious one.

Caretakers and household members of infected individuals should be screened for MRSA on admission to hospitals in Maine and everywhere.  This population was not included in the current MRSA screening “test” that we are currently conducting in Maine.  It is only one of the many inadequacies of this screening “test”.

If any of the victims or their families read this blog, please, for your own safety and that of others, ask for a MRSA screening if you are admitted to the hospital for anything. 

Community acquired MRSA generally presents itself as a skin infection or abscess.  But, if a persons immune system is overloaded like with H1 N1 flu, MRSA can cause pneumonia.  Some of the deaths you read about with H1N1 were caused by co infection with MRSA.

Community acquired MRSA is spreading and growing all the time.  It is getting into our hospitals undetected because of inadequate screening and then is spread in facilities.  The two genetically different strains of MRSA are sometimes merging and becoming more and more difficult to treat.

We need to stop MRSA at hospital doors.  We need to screen patients  for the purpose of “search and destroy”.  When it is detected at hospital doors, we can treat the effected patients and separate them from uneffected patients.  It’s a win win for patients. 

My guess is that the victims of MRSA on Vinalhaven are still fighting their infections.  It would not suprise me one bit if their families have been effected by these infections.  Education and knowledge fights MRSA.  The Maine CDC did investigate and control this outbreak and that is wonderful.  But the implications of this outbreak are important. 

Our hospitals must do life saving MRSA screening of all appropriate high risk populations on admission and during hospital stays.

Kathy Uncategorized

We are all watching on TV as Haiti citizens suffer.  Their family members are lost, missing or injured.  Their homes are ruined.  They have no water and they are running out of medical supplies and food. Medical care for major trauma is being redered in outdoor makeshift “hospitals”.  Their infrastructure is destroyed.   Thousands of volunteers with supplies are arriving all the time, but the airport is small and there is no control tower.  Then once they are on the ground, there is no fuel or transportation to get needed supplies to where it needs to be.  It is hard for me as a lifelong caregiver to sit by and watch this.  I see small children and babies with open wounds and broken bones and I think about my skills and how I could help if I was there. 

I can’t go and most of us can’t, but I began to think about how I can help from home.  The NNOC or National Nurses Organizing Committee is asking for nurses to volunteer through RNRN, the RN Recovery Network.  Also, they are asking for donations.    They are organizing a command center in Miami to send nurses from all over the country to go to Haiti and help. 

http://www.calnurses.org/

The NNOC represents the Maine State Nurses Association.  MSNA supported my work with MRSA with backup support from the NNOC.  I hope that in some  way, this entry on my webpage will help the NNOC with their quest for volunteers and funds to help the poor unfortunate citizens of Haiti.

Thank you.

Kathy Uncategorized Haiti citizens suffering, Haiti earthquake, Haiti tragedy, Medical aid to Haiti, Mrsa, MSNA, NNOC, RNRN

January 9 was the anniversary of my father, John McCleary’s death.  A lot of water has passed under the bridge since then.  Nothing that has happened or been accomplished with MRSA prevention will bring him back, but my part of the work was all done in Dad’s honor.

The very week of this anniversary, Maine hospitals began screening high risk patients for MRSA.  This is a huge step in the right direction.   I have spoken with several nurses from different parts of the State, but the one I was happiest to hear from was a nurse from Dad’s hometown.  I took my mother out for lunch at a local restaurant, and we ran into an old friend who is a nurse and she cared for Dad.  She said the community hospital is screening ALL admissions.  They are not obligated to do that but it is the simpler and actually more comprehensive  approach to MRSA screening than just high risk screening.  MRSA does not descriminate by age, enthnicity, race, etc.  It can and does effect all.   So, this news was great.  Further comment from this nurse was “and it is about time!”

Other big strides in MRSA prevention have been made in Maine hospitals.  I hope the quality of their programs is consistant because before last year, I know it was not.  And, my original legislative proposal to standardize MRSA prevention policy all over the State (to reflect the steps of Active Detection and Isolation) was characterized as “cumbersome and prescriptive”.  Actually it was 4 basic steps and they work  really well when done altogether.  So, that standard and mandate in all hospitals would have sealed the success of prevention for all Maine Hospitals.  Maine Hospitals still have discretion in the use of the weak CDC recommendations when they write their policies. They basically can pick and choose and they might not always choose the best parts of the CDC recommendations.  It’s pretty hard anyway considering they are ineffective (in their current order)  and a couple hundred pages long.

But, to keep this entry positive and upbeat…..Maine hospitals have progressed in their infection control approaches and policies. 

The reason I am so happy about Dad’s hospital is that my mother still lives in that community and depends on that facility for her care.   The nurses and doctors there are awesome, but last year, their MRSA  detection and prevention policy was horrid and inconsistant.  I am now more confident in their approach to MRSA prevention.

I brought my mother beautiful yellow roses (a favorite of both hers and Dad’s) the day of the anniversary of Dad’s death.  But, more importantly, I hopefully brought her a safer hospital.

Kathy Uncategorized John McCleary, Maine hospitals mrsa, Mrsa, MRSA death anniversary, MRSA high risk screening, mrsa prevention, mrsa screening

On the second day of my fathers hospital stay for hospital acquired MRSA pneumonia he slipped into shock.  This was a quiet but quick decline in his condition.  If I had not been in the hospital room with him that day, his nurse would have attributed his “drowsiness” to just being tired.  He had gone through a lot of diagnostics that morning, including a lung scan.

My mother and I arrived to visit shortly after noontime.  Dad was barely conscious.  I spoke to him several times and he just was not coming around.  I expressed my concern to his nurse, who was right there in the room.  “Oh, he is just all worn out” was her response.  She was a good nurse but she was missing a very serious event that was just starting to occur.  I asked her nicely to check his vital signs.  Dad’s blood pressure had dropped dangerously low.   It was just a matter of seconds before she had a team in his room and they began their work.  He was given a fluid challenge and drugs to get his blood pressure back up.  My mother and I sat there the entire time  shocked and puzzled about this frightening turn of events.  I kept asking the doctor what was going on.  He called this a heart attack.  I repeatedly asked why he had the fever then.  Blood cultures were drawn, but they were negative.

There is no way for me to know if he had a heart attack that day or if his body was reacting to the lethal serious bacteria in his system called MRSA.   When I look back, I suspect that the doctor knew, without a doubt, that my father was suffering the syndrome of sepsis.   This occurs commonly in patients who are suffering from a serious bacterial infection.  Blood cultures will not necessarily show the bacteria.   My father had never in his life had a heart attack.  If he did have heart damage after this scary and unexplained event, I believe it was due to the sepsis and the stress that the infection caused his old body.

Sepsis is a very serious and often times deadly event that occurs when patients contract MRSA.  It comes on quickly after the invasion of the microorganisms and treatment to reverse the sudden drop in blood pressure must be quick and effective.  In Dad’s case, after the second worst event of his newly diagnosed illness(death being the absolute worst), he did recover in the short run, but the disease killed him in the long run.

Dad was transferred from his regular bed into an ICU bed that day.  He was catheterized and MRSA infected his bladder.  About 5 days later, and after I requested a sputum culture, he was finally diagnosed with MRSA pneumonia.

The day of this suspected sepsis shock, Dad’s doctors approached my mother and me about “comfort care”.  This means that they wanted to take away all of his life sustaining medications and just give him what he needed for comfort.  This was a blow to us considering this was the very same day he had this frightening event.  I thought comfort care was offered to terminal cancer or other dying  patients.  At this point, we had no idea that MRSA was my father’s terminal diagnosis.

  Although Dad was ill enough that my mother called the priest for last rights, he was still alert and conscious.  I told the doctors they needed to ask Dad what he wanted for himself.  They did. Dad was a tough Irishman.  He was not about to give up the fight of his life at that point.  And, that was his choice to do so.

He suffered for 19 more days in that hospital.  Then he was deemed “well enough” to go to the nursing home.  He suffered for 9 more weeks.   He fought the good battle, but MRSA won.  He never lost his desire to get better and go home and he never succumbed to the doctors wishes to put him in hospice or to put him on “comfort care”.  I loved that about my father.  He let people know what he wanted and didn’t want and after he told them there was no question left in their minds about his desires.

Dad will be gone a full year tomorrow.  His suffering and death left me with this burning desire  and ambition to stop MRSA infections.  Nobody should go through what he went through because of something they caught in the hospital. 

Maine Hospitals now screen all high risk patients for MRSA.  This is just as it should be.  We need to protect our loved ones and ourselves from this devastating infection.

Kathy Uncategorized "comfort care", heart attack, hospital acquired mrsa, mrsa death, mrsa screening, MRSA sepsis, mrsa suffering, sepsis

The Maine State Nurses Association had a board meeting yesterday and invited media to attend.  We had a brief press conference and there was a good attendance.

Two of our local TV stations covered, Maine public broadcasting network and the Bangor Daily also covered this press conference. 

Here are the links to the video, audio and newspaper coverage.

My comment about the Bangor Daily news coverage is that the meeting was of MSNA and not that of just one local hospital.  The hospital that was quoted gave a negative comment about the future of MRSA screening and that it is “ineffective”.  I know for a fact that the EMMC has never used active detection and in some cases do not use isolation for MRSA. So, if this is their approach and attitude, they will indeed fail.  This screening and the other recommendations for policy change are touted as ineffective only 3 days into it, then their intention is to fail.  I do not understand fear of success, especially when it comes to patients safety and lives. 

http://www.mpbn.net/Home/tabid/36/ctl/ViewItem/mid/3478/ItemId/10474/Default.aspx

http://www.wabi.tv/news/9343/new-law-looks-to-detect-deadly-staph-infection-in-hospitals

http://www.mpbn.net/Home/tabid/36/ctl/ViewItem/mid/3478/ItemId/10474/Default.aspx

http://www.wvii.com/stories.html?sku=20100107104928

I appreciate that all of these interested and talented reporters came to the press conference and realize the significance and importance of protecting Maine patients from Hospital acquired MRSA.

Kathy Uncategorized