When my bill passed into law last spring, there was a stipulation that the Maine Quality Forum would “define” what populations were at high risk for MRSA in Maine, for the purposes of screening. This task was assigned to us by the Maine Health and Human Services Committee. I attended meetings for 5 months and I worked diligently between meetings researching this subject. I presented a solid list of known populations at risk for MRSA. I gathered this information from the CDC information and hundreds of other sources. I never attended a meeting uninformed or unprepared.
I withstood stonewalling, dishonesty, reluctance and downright hostility in these meetings. I took verbal beating repeatedly and with grace. Without the refereeing of our leader and my dedicated Maine State Nurses Association collegue, my pursuit of safer hospitals in Maine would have been much more difficult. There is no doubt in my mind that they were trying their best to wear me down. They thought “she will go away afer a while”. Wow, they do not know me.
The Maine Hospital Association and their associates, APIC (infection control professionals), and the MQF DO NOT WANT TO DO HIGH RISK SCREENING FOR THEIR PATIENTS. They will tell you they are already doing it, or it is too expensive, or it is too cumbersome, or there is no need because they are improving handwashing,….my goodness, I can’t begin to complete the list of excuses I have heard. The fact is that the MHA and APIC have lobbyists and money and they are fighting this effective approach to MRSA prevention tooth and nail. These associations and the MQF are the very people who should be making our hospitals safer.
What this all really boils down to is that Hospitals and doctors do not want to be told what to do. Another thing they don’t want is to be liable for an excellent MRSA Prevention program. If patients have an increased expectation of hospitals and Active Detection and Isolation becomes standard practice in Maine, they will be held to it! This means increased litigation for MRSA victims if the hospital fails to meet the standards. Well, hells bells, why not? Maine Hospitals are responsible if patients become infected on their watch. They either improve safety or they are liable and there will be lawsuits!
Maine hospitals think they are doing a bang up job with MRSA prevention. While I do recognize that some efforts are being made to stop MRSA, it is not nearly enough. Why just last week I talked with a woman who had over 100,000 dollars in medical bills after her hospital discharge . She got MRSA, C Diff, and pseudomonas during an over 100 day stay at the local hospital. She is still paying her bills off and she still suffers ill effects from those infections, but fortunately, she survived. Another person asked my son for my contact information because her father died 2 weeks ago with MRSA, same hospital. So, although they are doing SOME things to improve prevention, they are not stopping the infections.
One reason for this is that their screening protocol is not wide enough, and that is likely the same problem in all the hospitals in Maine who are still seeing new infections regularly.
Another reason is that they continue to room infected or colonized patients with uninfected pateints. I brought this up at the last MQF meeting and I got jumped on by 3 or 4 nurses all with similar excuses, including one that basically said that CDC says it is ok. This a recipe for disaster. Your local infection control nurse will tell you that “patients do not spread MRSA, hands do”. Yes, I agree, this is so. But contaminated instruments, uniforms, bathroom facilities and other environmental contamination also spreads disease, with the help of hands. And do not ever feel safe about the air you breath. MRSA can be coughed 3 to 4 feet when a patient has MRSA pneumonia. I have also read articles that air ventilation systems have tested positive for MRSA. So, without effective air filtration, MRSA can spread that way too.
Another reason MRSA spreads is because doctors are rationing out treatment to interrupt colonization. They get to pick and choose the patients who will get this simple treatment before invasive procedures. The arguments for rationing is that there is some antibiotic resistance, or that MRSA can come back or any number of other excuses. The reality is that they are playing God in deciding who will have the advantage of simple decolonization ….if it will be you, or your neighbor or someone esle…. according to what procedure you are having. This seems unethical to me. If I am having a gut surgery and I have MRSA colonization, I want the treatment. I will take my chances at resistance or that it might come back after I heal. LET ME DECIDE my own fate. This witholding of effective treatment to prevent active infection smacks of the “Sarah Palin” death panel referrence. Not that I ever believed anything that Sarah Palin said. My guess is that if any of the doctors who participated in our MQF work group had MRSA colonization and needed surgery, they would be pushing the antibiotic ointment up their noses and scrubbing their bodies with Phisohex frantically and frequently before anybody touched them!
There are many reasons that Maine hospitals are not stopping MRSA. These are just a few and they are the ones I have addressed in my legislative proposal.
I would love to see an ambitious investigative writer start calling all of our hospitals. Their first question could be “how many patients in your hospital have MRSA now?” Second question, “how many of those patients came into the hospital with those infections?” Third question, “what is the prognosis for those patients?” How long will those patients suffer from these infections? “Is every MRSA colonized and infected patients isolated from other patients?” “How high is your handwashing compliance?” “Have your MRSA infections rate dropped or gone up in the past 10 years?” “Are you aware of the Veterans Administration MRSA screening program and it’s success in dropping MRSA Infections?” I want to do this investigation myself, but I have observed how close to the chest ANY MRSA information is guarded within these facilities. I sat in meetings with representatives from hospitals all over the State and I don’t know any of the answers to any of these questions. THIS IS THE BIGGEST DIRTIEST SECRET OF ALL IN MAINE HOSPITALS. And the secret is closely guarded. Each hospital’s representative in those meetings should have very proud CEOs. They didn’t spill the beans on any useful numbers for the MQF group.
Two days ago, a unilateral and sudden decision was made by our MQF leader to do a “study”. This decision was made with no plan, no deadline, no consultant, and no requirements. After 5 months of pounding out a good solid list of high risk populations for screening, our work group’s direction changed. It was announced, not suggested. So, all of a sudden the MQF became a dictatorship, not a work group. While all of the logistics and details of this “study” are being worked out and the study done and the analysis made and resulting recommendations are decided, Maine patients at high risk for MRSA will continue to be admitted to our hospitals without screening. The expense of this test could be spent on a new effective screening program for all of our hospitals It is bogus and it is nothing but a stall tactic. The hospitals believe they have won a battle of some sort. If I thought for one minute that battle was against MRSA, I would not be writing this blog entry. It is a power battle they think they have won. MRSA prevention has little to do with it.
MRSA screening saves lives and stops suffering. It is the first step in preventing MRSA infections. Patients with undetected MRSA will continue to be admitted to Maine hospitals, and be roomed with uninfected patients. Infections that can be prevented with simple decolonization treatment will continue to happen. Rates will not drop. And after a hospital allows this to happen to you, you will get the bill for the damages. You will be billed for care rendered as a result of a preventable infection.
This study is a delay tactic. This allows Maine hospitals to stall the inevitability of effective high risk MRSA screening. This allows hospitals to continue doing exactly what they are doing now and that is not enough. I hold the MQF , the Maine Hospital association and Maine hospitals responsible for every single new MRSA infection that occurs in Maine hospitals while they are messing about with a study. This is not what was expected of us in our work group…….we need to start screening now…and without further delay.
I will never give up this fight. It is much to important to everybody. My motivation comes from my grief and I will continue to grieve a long time for my special father who was infected by his trusted hospital and died as a result.