This is the new webpage for Maine Peoples Alliance where Mainers can tell about their healthcare experiences.  My story about my father, who died of hospital acquired MRSA pneumonia is the lead story for this new blog webpage.  Please visit and comment.  Hopefully, this opportunity for Mainers to tell their Healthcare stories will shed light on the problem of medical error and hospital infections in Maine.

Thank you.

If only this same thing could be done for the thousands of people who die each hear from Hospital Acquired Infections.  Many things are being done, but the most important one for MRSA is not being done as practice in the State of Maine.  Active Detection and Isolation is a proven method of prevention for MRSA.  Mandatory public reporting as also been successful in making hospitals accountable and transparent about these infections, and yet the Maine Hospital Association and Epidemiologists and other representatives from all Maine hopsitals have rejected and fought both of these measures.

I hope that Dr Steele is as serious about HAIs as he is about other Medical Errors. 

http://www.bangordailynews.com/detail/147267.html?comment_result=posted#comments-post

Under our new administration, and the leadership of Secretary Kathleen Sebelius, the CDC is becoming more consumer friendly.   The conversation we had two days ago was held between us (activists with the CU) and many high officials at the CDC who specialize in HAI prevention including MRSA prevention.   I was humbled by their expertise, but at the same time I was not intimidated by it.  20 years ago, I would never have expected that I …….an employee health nurse in my local medical center, who used the CDC recommendations as my bible and the Federal Registar as my mandates,  would ever be sitting where I was,  expressing my frustrations at the snail’s pace of enacting ADI for all US hospitals.

Active detection and Isolation has most recently been proven effective in our over 150 VA hospitals nationwide.  The Study was revealed at the HICPAC meeting, which I unfortunately missed most of.  The Study revealed incredible reductions of hospital acquired MRSA after using ADI in a 2 year study.  The study was a collaborative between the CDC and the VA.  Over 200 other studies prove that ADI works to stop MRSA.

All of us were asked at the end of an enlightening and exciting meeting what our feelings were about the meeting.   I told them about calling the CDC once in 1992 when I was an Employee Health Nurse at Eastern Maine Medical Center.  My project during that period of time in the early 90s was to do 2 stage TB tests on every EMMC employee.  It amounted to between 4000 and 5000 PPD or TB tests.  There was some discussion and disagreement on what exactly a positive TB test looked and felt like, so I called the CDC experts.  I remembered how daunting and intimidating that call was for me.  Never in my wildest dreams did I expect to be sitting in a conference room, having a “conversation” with top ranking CDC physicians and others,  and confidently and repeatedly expressing my personal and profession opinion on MRSA control.  The experience was humbling  and I was honored to be part of this meeting.  And, I was very grateful to be included by the CU.

I hope to return to the CDC.  I have all of my newly found passion, my research and my heartfelt sympathy and sorrow for victims and survivors of victims of MRSA.  I am not a top scientist at the CDC, but I am an expert on the human suffering that comes with deadly MRSA.  I watched what it did to my father and I have listened to the numerous stories of others or their loved ones.  This is an epidemic that must be stopped.  It is not going away, unless we take a strong stand and push it away.  It was wonderful to hear the CDC officials saying that ELIMINATION is their goal.

  There is also fear amongst nurses and other health care workers that if they are ever diagnosed as being MRSA colonized, they will lose their jobs.  This is not right or fair and needs to be addressed.   No nurse should accept the constant inadequacies of their hospitals resulting in unprotected exposures to MRSA.  Without ADI, delayed detection of colonization and infection will continue, exposures will be commonplace and outbreaks will not stop.

My sincerest thanks to the CDC for opening up this conversation, and I hope to return there soon. 

There is so much more to add to our new “Conversation”.

Nine other activists and I will attend this meeting on June 15.  Hospital acquired infections with  focus on MRSA will be the topic discussed.  CU and I share the opinion that not nearly enough is being done to stop MRSA.  ADI or Active Detection and Isolation is the answer to part of the problem.   Education for patients, healthcare workers, employers and employees are another big part of it.  We hope this meeting and conversation will be a door opener and only the beginning of many more meetings involving CU (on behalf of consumers) and  the CDC.

I do not have close relatives involved in this war.  I have many deceased uncles, a grandfather and father in law who served during WWII.  Their sacrifices are what have made our country, in large part, safe and free.

So, this Memorial Day, remember the sacrifices our ancestors have made for this country.  And, honor the young men and women who sacrifice every day while serving in dangerous places, to preserve our freedom.

The one vital thing he did not get was education/instructions about preventing spread.  When I spoke with this relative, he was on his way to the gym.  If his medical provider was worth his salt, he would have advised my relative to not go to the gym with an active draining MRSA infection.  Why wasn’t he given the information he needed to protect his family and others in social situations.

The quotes I was given from this medical provider were….”skin MRSA isn’t much of a concern, you can get it anywhere”.  I see it all the time.”   If these things are true, then why doesn’t he, or his practice and all other practices in the US hand out standard instructions on prevention of spread within the family, in the workplace and in other social situations?    All of us are vulnerable to infections.  MRSA may seem innocuous, but if left untreated or ignored for a long time, it can spread into muscle, bone, blood and lungs.  If nobody teaches us about how to avoid spread, it can invade a household and infect family members.  

I believe that EDUCATION is as important as all the other steps in MRSA prevention.  Please read the instruction sheet at this link to learn how to stop the spread of MRSA…whether it is from the community or the hospital.  It is very good.

http://www.accesskent.com/Health/HealthDepartment/CD_Epid/pdfs/MRSA_Fact_Sheet.pdf

http://www.empoweredpatientcoalition.org/patient-advocate-directory/7-advocate-directory

http://www.fiercehealthcare.com/story/four-percent-healthcare-workers-mrsa-positive/2010-04-07

The link above reveals results of a study of MRSA prevalence in healthcare workers.  Very few studies have been done regarding this subject.

Amost every nurse I spoke with at the recent MSNA convention said “all of us probably have MRSA colonization”.  One nurse in particular was very upset at the prospect of ever being screened for MRSA, because of her constant exposure to it and because if she turned up positive, it might cost her the job that she needs to support her family. 

I was surprised that only 4% of healthcare workers, both direct caregivers and remote workers were infected in this study.  That is much lower than I expected.  But, at the same time it is encouraging.  My concern is what recommendation comes from this.

As a potential Healthcare consumer , I would not want a nurse who is actively colonized with MRSA caring for me, or for a vulnerable loved one……not unless a special effective precautions are taken.     Were the HC workers who tested positive in this study decolonized or not?  The article does not tell it all.  Even if they were decolonized, we know that MRSA is transient and many of these employees may turn up positive again 3 months after decolonization. Do we retest?  Maybe more than Standard and Universal precautions are necessary when a HC worker is colonized with MRSA.  Education is absolutely necessary.  The colonized HCW should be educated about not only using meticulous Standard and Universal precautions, but also using reverse precautions at all times.  They should be told not to work when they are actively infected with a respiratory illness (or an open MRSA lesion), especially while actively coughing, sneezing and blowing their nose.   MRSA can be coughed about 4 feet into the environment. There should be paid sick leave for this, since it is work acquired.  Also, a known colonized HC worker should always wear a mask while doing invasive sterile procedures, like dressing changes and catheterizations.    So, are these the answers to this dilemma…….. to use decolonization and education about extra precautions?  I’m not 100% sure, but I do know SOMETHING definitive needs to be done and the things I have suggested here may be a start. Why doesn’t OSHA take a stand on MRSA and other work related and acquired infections.   One thing I know for sure is that we can’t continue to ignore the problem.

Now as a nurse, I have to wonder if my job is jeopardized if I am diagnosed.  Is it?  If my employer finds that I am colonized, will it affect my job.  Will I be put out of work?  Will it affect job promotions or transfers into other departments?   These are legitimate and serious concerns.  MRSA now becomes not only a threat to my health and possibly my family’s health, but it is also a threat to my livelihood!  As a member of MSNA and the NNU and a long time supporter of Nurses Unions, I am proud to say that nurses represented by a union will have some protections in place regarding employment.  My chronically colonized friend, whom I have written about a few months ago on my blog, is a non union nurse.  She was exposed at work.  Since her MRSA pneumonia and sepsis, followed by a lengthy recovery and lingering disability, she has been unable to find work as an ICU nurse.  She feels that the places who will not hire her discriminate because they know her MRSA status.  Another nurse I know tested positive in an investigation for an outbreak in her hospital.  Her employment was not affected, but the records of her MRSA colonization and her decolonization treatment for it were buried………..she was told there was no record of it.  Healthcare facilities get the right to ignore the elephant in the room regarding the risk of infectious disease to employees.  They get to decide on policy that is either good and effective or lax and ineffective.  Unfortunately, very few organizations come to the plate with the safety of their nurses in mind. 

I see many problems at many levels with all of the above.  Nobody is recognizing the fact that Healthcare workers in hospitals become colonized with MRSA.  The problem is not acknowledged or addressed.  If someone is discovered to be colonized, the records are “unavailable”.  This may be because of fear on the part of the hospitals. They fear liability for their employees, because they have become colonized (and sometimes actively infected)  on the job.  And they fear liability from patients who become infected while hospitalized.  So, the usual reaction to that fear is to keep it all a secret or sweep it under the carpet???  News alert…these problems are not going away unless the hospitals get on board with prevention. These unresolved problems feed on each other!   We cannot fix what we do not acknowledge and measure.

I believe MRSA needs to be put out there, as an issue and a problem within healthcare facilities, for both patients and employees.  Preventing spread of MRSA by screening and Isolating patients is the first step to “getting to ZERO” with MRSA infections.  Addressing employees concerns by recognizing MRSA as a work related infection and doing appropriate and timely testing, treatment and education for it is the best approach. 

Trying to hide/bury the problem, or ignoring the huge population of patients who come in the door colonized,  and who subsequently become infected is no longer acceptable.  Too many times, it takes days or weeks to diagnose an active MRSA infection in a patient.  Most of the time, the earlier causitive problem, MRSA colonization, is never even detected because there has been no screening.   By the time infection is diagnosed dozens of HC workers and family members are all exposed.  Active Detection and Isolation will prevent this from happening.

Early detection of colonization or infection, isolation of affected patients, decolonization when appropriate and education are all necessary steps toward stopping MRSA.

NO NURSE should feel that their job or their health are  jeopardized by MRSA colonization.  It is job related and should be addressed as such, but it should not be ignored.   And NO PATIENT should have the worry that proper MRSA detection and prevention of MRSA is not being used in their hospitals or that their HC giver may spread MRSA to them. 

My father’s suffering was horrible.  It started the day he collapsed with MRSA pneumonia.  The severity and the weight of the illness put him down and and kept him down.    His unnecessary and preventable  illness and death motivated me to do something to help others to avoid MRSA.  And now that work is taking me even further into activism to help direct healthcare reform money and policies  to  benefit the most vulnerable of all …the elderly and the most gravely ill patients of all ages.

My recent experience with the Maine Campaign for Better Care made me aware of just how important and exciting the new Healthcare Reform law is.  We all know it isn’t perfect.  My perfect HC plan would eliminate ANY profits on the backs of sick and suffering people.  I believe it is immoral to profit that way.  But, as we all know, there will still be profit. We have to make the best of the HC reform we got.  the MCBC’s goal is to focus on improved quality and accessibility of care for the elderly and for severely ill and handicapped people of all ages.  The plan for doing this is still in the formative stages, but many capable members of this group will set about at this work soon.  They will identify, categorize and work on problems..  Their approach will involve better coordination of care for all.  Redundant, repetative and unnecessary “care” and or diagnostics will hopefully be minimized or eliminated.  Volume or “more care” doesn’t  equal quality or safe care.  They will also work on better communications between patients and their providers.  This group will put the patient at the hub of their own care.  What a concept!!  They will empower patients and encourage patients to question their healthcare providers and pave the way for better communications.

I love the concept of all this.  I find it very exciting and way overdue.  If the MCBC does a public campaign asking for suggestions and stories  from everybody, please contribute to their ideas and their effort in general.  It is everybody’s chance to help direct and influence policies of the HC reform law.  The MCBC is bringing the new law to every citizen in Maine and will ask for their help.  In turn, Maine may set precedent on policy because only 5 States are running this campaign.

www.wcsh6.com/video/default.aspx?bctid=82703859001#/Local/Patient+advocates+want+to+shape+reform/49383985001/49452227001/82703859001