For about a year, I worked toward safer and more effective MRSA prevention in Maine Hospitals.  I proposed the very things that I learned of from MRSA prevention experts (Infectious disease doctors who have written recommendations, nurses, microbiologists, advocates and activists) , and hospitals who have practiced Active Detection and Isolation to stop the MRSA growth in their facilities.  But, Maine hospitals and  infection control  practitioners obstructed ADI.  It was even a struggle to get them to comply with the new State Law to screen high risk populations.   The entire process was contentious and arduous.  It was also controlled by people who do not do direct care of infected patients.

Not all of the populations who are at risk for acquiring MRSA when hospitalized were included in the current MRSA “prevalence test” in Maine.  The populations that are included are 1) patients who have been in the hospital or nursing home within the past 6 months, including transfer patients, 2) all ICU patients 3) Prisoners, 4) dialysis patients. 

The ones who were not included are  1) Immunocompromised patients, ie patients with diabetes, Cancer, HIV/AIDS,  and those on medications that render them immunocompromised, 2) Patients who are facing surgery involving implants, ie. Orthopedic joint replacement surgery, Cardiac valve replacement, Neurosurgical shunt placement, 3) Patients who are IV drug users, 4) Patients with open infectious appearing wounds.  Other populations are more susceptible to MRSA too, including the elderly, who are more prone to Hospital Acquired MRSA, and the young who are more prone to Community Acquired MRSA (those in contact sports, day care centers, close living quarters like dormatories).  All of the patients in this paragraph are known to be at  increased risk for getting MRSA, yet, Maine hospitals and their representatives fought against screening for them.

So, since only a part of the effective approach of ADI (and that part was severely diminished)  was accepted as law in Maine, what can you do to protect yourself from MRSA if you must go into a Maine hospital?

Ask your doctor for a simple nasal and/or wound culture.  This simple cheap test may save your life.  If you know you are scheduled for a hospital admission, do this test about 10 days prior to admission.  This allows time for the culture to come back and for decolonization treatment if necessary. After the culture is done, be sure to follow up on results because not all lab results are reported back in a timely way. This simple test, and treatment if necessary could save you from unnecessary suffering and/or death.

Why won’t your hospital just do this for you without you having to request it?  That is such an excellent question. Actually, during this current prevalence test, some hospitals are screening all new admissions.  But, for the ones who are not,  I have my own theories about why they just won’t do it without a request, none of them flattering.  The problem of MRSA and many other  hospital acquired infections has been brewing and growing in our hospitals for years.  The multidrug resistant infections have come front and center and increased mostly for the past 10 to 15 years.  There has been a complacency and helplessness attached to these infections and not a whole lot was done until very recently to STOP THE INFECTIONS.   I believe that the reason hospitals do not want to screen you for MRSA unless forced to by law or after a hospital has had a significant or deadly outbreak of the infections, is they are afraid of liability. 

They  do not want to be liable for proper rooming of patients to avoid spread of disease.  They want to continue to room colonized or infected patients with other patients, and not tell either one of their infection status.  This way they can fill beds, wash hands,  and hope for the best…..meaning…perhaps the infection won’t spread.  But, if it does, they can tell the patient that they probably brought the infection into the hospital with them. Without a screening culture, I guess they could actually say that and get away with it.  With a negative screening, will it would be less easy to blame the patient for his own infection.  This sounds negative and cruel, but I have spoken with enough victims to know that these things do happen, and they happen often.  I do not believe that hospitals intentionally infect patients, but they do not use all of the necessary steps available to STOP INFECTIONS NOW!  And when somebody becomes infected they are not entirely honest about the name of the infection or the origin of it.

So, go get that screening before you are admitted to the hospital.  If your admission is planned, get it early enough to have results and treatment if necessary BEFORE your admission.  Have family members bring in hand sanitizer for you and for your visitors and bring in disinfecting wipes for frequently touched surfaces.  Don’t share things, with your roommate.  Be sure anyone who touches you does so with clean hands.  Nobody should have to ask for clean hands, but it is a fact of life.  Just ask and don’t be bashful.  If you are too ill, have a patient advocate with you to ask and do these things  for you.These are some things that keep you in control of your own well being while hospitalized.

And finally, don’t linger.  The sooner you go home, the less your risk for infection.

Admittedly, I have not read the entire Healthcare Reform bill.  But, I am aware of several inclusions regarding patient safety and hospital acquired infections.  Unless these things were excised from the bill that passed the House on Sunday, they are still in there.

The Healthcare bill’s approaches to infection prevention and patient safety  included many approaches.  One approach was that the lowest performing hospitals will get their medicare reimbursement dropped by 2%.  And why not?  Actually that percentage would most likely be higher if Medicare just refused to reimburse for any hospital acquired infections.  If hospitals are unable to care for people, particularly the elderly, without infecting them, Medicare  (and other rinsurers)  should not pay and neither should the patients.

I am so happy for the millions of citizens who now will be empowered and able to get healthcare insurance.  I attended a meeting with the Maine Insurance Commissioner a few weeks back.  She was hearing stories from Maine citizens about their private Anthem insurance policies.  Anthem was greedily pursuing a hefty 23% increase in premiums from these already hard hit customers.  Some had policies that cost them over $10,000 a year and they had over $10,000 deductibles to meet.  That is not healthcare insurance, that is homeowners insurance.  It is the only way those people cold protect their homes and other belongings if they got sick.  And some of them already were sick.  Anthem had lawyers in the hearings so they could protest or object to what these hard hit customers were saying. It was despicable when they objected.

Finally, the Anthems of the country will be forced into fairness, and competition.  Medicare for all would have been my choice for Heathcare reform, but the HC bill that passed on Sunday will suffice, for now.  Now we can get on with the business of actually providing good, safe, affordable Health Care.

This was always an easy holiday for me to remember.  My father’s middle name was Patrick for a reason.  His birthday was Saint Patrick’s Day.  He would be 85 years old today.

In his younger days, he loved to play guitar, sing and play harmonica.  He was a great dancer as well.  I loved watching my mother and him dance when I was younger.  They moved as one.  I could never follow my father the way she did.  He was so smooth and they glided beautifully together. 

At the AARP meeting at Christmas, there was a singer and a piano player.  They played and sang old favorites of the people there, most of them a generation before me!   When they played “Can I have this Dance for the Rest of My Life”, an elderly couple, probably in their 80s like my parents got up to dance.  It made me remember how beautifully my mother and father danced together.    It was heartbreaking and I had to leave the Christmas party. 

Who knows how much longer my father would have lived?  He already had some physical limitations, but he was getting around fairly well and living at home.  His home and my mother were the only two things he wanted.  He loved all of his family, but he thrived with her in his home.

He had a nice long life and he saw all of his children have their own families and do well.  His death would have been so much better for him and for my mother and family if he had drifted off one night in his sleep in his own bed,  and had never been forced to leave his home because of an unnecessary devastating preventable infection…..an infection that robbed him of every last bit of strength he had.   The acuity of my grief has eased but the sense of injustice just never goes away.

My goal, with the help of other activists, legislators, and hopefully hospitals is to stop the horrors of Hospital Acquired infectons with all of the necessary steps to do so.  Nobody should be robbed of their life and their loves  by HAIs.

Happy Birthday Dad.  I love you.

http://www.themha.org/advocacy/LD1939.htm

This link to the Maine Hospital Association’s page and their stand on public reporting in 2008 shows how long they have been fighting meaningful public reporting of Hospital Acquired Infections.
This lengthy and detailed argument written by Mary Mahew (who I became quite familiar with at Health and Human services committee hearings) touts the existing public reporting that is already done through the Maine Quality Forum. There is quite a long list of “reportables” that are made public by the MQF, but if one takes the time to examine the type of those reports, hardly any of it is OUTCOME reporting. Most of the “reportables” are process measures like giving antibiotics at the right time, cutting hair correctly prior to surgery, etc. Only one reportable actually discloses infections and those are Central line infections.
CLABSIs are only 10% of all MRSA infections.
The infections reported on the MQF are a very tiny representation of the number of infections in our hospitals.
Other infections include SSI (surgical site infections) UTI (urinary tract infections) pneumonia, meningitis, mediastinitis after open heart surgery, osteomyelitis, meningitis and oh so many others….all can be caused by MRSA and other microorganisms that hospitals can grow and spread.
It’s obvious why the MHA doesn’t want to report these infections. It will force hospitals to expose their sore spots and may hurt the bottom dollar. But, thier job is to make people better, not sicker. Nobody should ever go into a hospital for a simple problem and because of infection that is not controlled in the hospital, they get sicker and suffer or die. It is absolutely not excusable.
Also, if hospitals are mandated to report and the reports are public, they will COMPARE, COMPETE and IMPROVE.
MRSA and other Hospital Acquired infections can no longer be hidden under the protective shroud of the MHA, Hospital administrations, Epidemiologists, and others. They need to be brought out into the light of day, exposed, and conquered. Hospitals cannot afford, financially or with loss of reputation, to ignore the number of patients who suffer and die each year from preventable infections.
The CDC, and other infection control agencies now support public reporting of all hospital acquired infections. The MHA needs to reevaluate their public reporting stand and be prepared to expose Maine Hospitals’ underbellies…for the good of patients.

My husband, Mike and I spent the afternoon meeting at a reception for John Richardson, Democratic Candidate for Governor of Maine.  His exerience and his plans are very exciting.  He envisions a healthcare plan similar to Memic, the revision plan for workmans compensation in the State.  The plan would be affordable for everyone, no matter what income and it would be non profit.

His wife Stephanie Gross is an Ob/GYN doctor at the Mid Maine Medical Center.  She and I talked at length about MRSA.  Her hospital, to my suprise, has been screening everyone for MRSA for 2 years.  This was very impressive because that means somebody there already knows the importance of screening for prevention, and they knew it before I began my work in Maine. 

This pair is exciting and will do well for the State.  Please  look at John’s webpage to learn more.

http://www.johnrichardsonformaine.com/

The  Maine Health and Human Services Committee had the opportunity on Tuesday, March 9, to remove the veil of secrecy from MRSA in the State of Maine.  It did not happen.  The suggestion was made that public, mandatory MRSA specific reporting through the National Heath Safety Network (CDC administered) be started.   They didn’t do it.  They missed the opportunity to make hospitals accountable and transparent.   Secrecy, lack of disclosure and accountability have historically been problems with MRSA.  These problems remain in Maine.   Many other States are reporting to NHSN.  ARRA funds were sent to Maine to encourage us to report to NHSN.  Over 20 hospitals have sent staff to be trained to do this reporting……..

BUT…in Maine the reporting that is proposed by the Maine CDC, for MRSA, is not to begin until 2012, is ONLY a proposal, and is  not mandated and the results will not be public.  What good is that to anyone except hospitals and the Maine CDC?  What will the result of such reporting be?  Not much..it is voluntary, secretive and useless and inaccessable for consumers.

Public reporting forces hospitals to COMPARE, COMPETE AND IMPROVE.   The March 2010 Consumer Report article regarding public reporting of hospital acquired bacteremia  proved that.

In January next year, we will go back, armed with the results of the MRSA prevalence test, experience from this past year dealing  with dishonest, but powerful hospitals and their lobby, and the fact that MRSA is still alive and well in our hospitals ………and we will fight for MRSA prevention in the form of Active Detection and Isolation and patient safety in Maine.   We will also fight to remove the shield of secrecy and deceipt that shields our hospital (from any accountability)  by proposing mandatory, public, MRSA specific reporting in the State of Maine.

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.