McCleary MRSA Prevention

This past week, I was invited to attend the first ever conversation between the CDC and consumers about Hospital Acquired Infections.  This meeting is a result of determination from the Consumers Union leaders to involve consumers in decisions affecting patient safety.  And why not.  Consumers pay for insurance benefits, and the care they receive when “serviced” by hospitals and clinics. It is time for patient centered care.   Hospital acquired infections are failures of providers to give safe high quality care. 

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.

This weekend, we all honor and remember those who served in our military to protect our country and our freedom.  I spoke with my friend today who’s daughter serves in Iraq as an RN in a multi trauma ICU.  Her base has been struck with 3 rockets recently and some were wounded.  My friend worries every day about her daughter, who is also a wife, sister, aunt,  and mother of two boys.  I can only imagine my friend’s worries and her daughter’s every day dealings with the horrors of war.

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.

Another member of my family was diagnosed with MRSA on Saturday.  Thank goodness it is skin MRSA.  He had lumps under his breast for 3 to 4 weeks.  One got to be about an inch and  a half across and stuck up about 3/4 of an  inch.  After it drained there was a hole left.  A second good sized one started and then a third. He is pretty tough and kept thinking it would go away, but after speaking with a triage nurse (not me this time) he decided to see someone.  He was treated in a stand alone clinic and diagnosed with MRSA.  He got an antibiotic and some ointment.

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

A strong fellow advocate has added me to her nationwide list of patient adovocates and activists.  Please visit Helen’s webpage and find an advocate in your area.

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. 

I am sitting home today, sick with a cold.  I will certainly survive my little virus, but it is keeping me down today.  I can only imagine being sick, gravely sick, day after day.  I have been blessed with good health and I have never had an ongoing illness with daily ongoing suffering.    In my work as a nurse I was confronted with the suffering of others every day.  But, I never considered that I could do much about it outside the constraints of my hospital practice.  I have found my voice, my bravado and my true calling.   The older I get, the more I realize that so many suffer.  They not only suffer the pain of ongoing illness, they also suffer the frustration of lack of or inadequate insurance. Because of lack of insurance, they do not get the care they need, so the suffering persists and gets worse.  Their finances suffer.  They suffer the emotional pain of knowing they may never get better.  Their physical and emotional pain and suffering is multi tiered and never ending.

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.

Please follow the link below to see other advocates and me as we help launch this noble campaign..

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

I returned yesterday from a meeting with the hardest working group in Maine,  the Maine State Nurses Association.  They not only care for patients, face to face and day to day, they work for ways to better advocate for their patients.  They fight for better and safer care through patient practice committees and with legislative work.  They actively lobby for better/safer practices for nurses and for patients. 

Who better to advocate for patients?  We know that there is a necessity for managment nurses, but they are not in direct contact with patients.  They do not hear the complaints of patients who feel they are not getting good enough care or long enough attention.  They do not see or ease  the suffering of patients and they do not interact with the families of the suffering.  They are in the middle, between the bugetary constraints of top executives and the demands of patients.  So, managment nurse just don’t “get it”.  MSNA nurses GET IT!

The nurses I talked with and listened to, both as speakers and as individuals over the past two days are the best.  They keep themselves abreast of the latest nursing skills and science.  They belong to committees to improve patient care.  They take legislation to Maine legislators and Federal representatives for improved nurse:patient ratios,  and to promote single payer insurance, and safe lifting practices for nurses and their patients.  This is just the tip of the iceburg.

Last year they lobbied for my legislative proposal for MRSA prevention in the State of Maine.  I talked with a lot of nurses over the two day period.  I expected some criticism of the new law and instead got praise, enthusiasm, and hundreds of questions.  I believe most of them understood the need for change and improved infection prevention. These nurses are so engaged and progressive.  They welcome change that will improve quality and safety for their patients and themselves.

I ran into an old friend from a small town hospital that I helped to organize a union in the early 80s.  She said she thought the interest in their union is waning.  My response was “let me at em”.   I hope to go there with some of the other original members of that union and tell the young nurses what it was like without a union.  I’ll tell them how any reason was good enough to fire you.  How fickle and unfair management was and how acceptable it was to ‘play favorites”.   I will tell them how it took almost 3 years and 2 votes to get that union.  It was hard fought and not easily won.  The political climate did not favor unions in the early 80s.   The NLRB held up the union for a very long time.

MSNA is now part of the CNA, NNOC, NNU, which is emerging as the biggest nursing union in the country.  Power means improvements for patients and nurses.  Empowered nurses means empowered patients.

So, the two days at the MSNA NNU (National Nurses United) event were awe inspiring and stimulating.  I hope to stay in touch with several of them and  I hope to exchange knowledge with them.