McCleary MRSA Prevention

People ask me what I would do to help stop Hospital acquired infections. It’s been 10 years today since my father died of HAI. Right after he was infected with MRSA, I started researching the causes, the prognosis, the incubation period, prevention, spread and prevalence of these infections. The subject is complex and broad, but these are a few of my ideas about how we can actually make a huge dent in this problem.

1. Get a more accurate count of infections and the deaths caused by them and make it public. Transparency and accountability will lead to better funding and actions to stop this scourge.

a. Develop a way for patients or their family members to report their own infections, because we know hospitals and other healthcare facilities are not reporting all of their infections

b. Require that all infections that contribute to a death, be listed as a cause of death (COD) on death certificates in every State.

2. Require Hospitals/LTCs/Dialysis centers/Surgical Centers to post any current outbreaks on their websites and in plain view for incoming patients.

a. “Outbreak” must be defined first.  Currently ‘outbreak’ means something different according to what infection is being discussed.

3. Rapid screen patients for MRSA and other common infections on emergency admission, or a week in advance of planned admissions. Practice Universal precautions without exception. Postpone elective surgery until the patient has been decolonized.  Contact precautions must be followed without exception for all MRSA colonized and infected patients. All other precautions according to the offending infection must be followed to a tee, by all staff and visitors and this must be enforced.

4. Put everyone in their own room, preventing spread of infection from one patient to another in the same room.

5. Clean up Hospitals and the equipment in them. Assign each patient their own frequently used equipment, ie. Blood pressure cuffs, wheelchairs, walkers, etc.

6. Handwashing all around every time, before and after touching,  nurses, doctors, xray and lab  techs, visitors, and anyone else who touches patients.

7. Help patients to understand their own role in prevention of infections, examples are  handwashing, general hygiene, covering wounds, good nutrition/hydration, covering coughs, not wearing slippers that have been on dirty floors into their bed.

8. Give the Federal and State CDCs regulatory powers. This way, instead of writing recommendations, they can write requirements. Every hospital that is held accountable for infections that they caused, will say “we met the CDC recommendations” and/or “We met the standards of care”.  And they may have met some of them, but certainly not all of them because they don’t’ have to…none of the recommendations are mandated.

Also, the CDC would not have to wait until crisis to go into places with known problems. An invitation would not be needed. Places with known infection outbreaks and/or ongoing infection issues could be visited and problems remedied without waiting for permission to enter. Not a single patient should become infected because the CDC is waiting for an invitation to help the facility.

9. Stop paying Hospitals and other Healthcare facilities for the costs of these infections.  Nobody should have to pay ONE PENNY for an infection they caught while in a facility. Penalties are not enough.  Stop payment from any source patients, insurances or the Federal Government.

This is my short list of ideas. They were gleaned from all sorts of experts and meetings on the subject of infections.  If these things had been in play when my father was hospitalized for rehab for a simple ankle fracture, I sincerely believe his infection would have been prevented.  Two other community members had already died of hospital acquired MRSA infection the same month he was admitted. No outbreak was declared and nothing was ever reported on a State level about that.  No extra precautions or steps were taken to stop the hospital MRSA outbreak.  There was no consistency with handwashing, gloving or precautions even after his infection was diagnosed.  With some hard work and dedication to patients, we can stop this from happening to others.

http://www.pressherald.com/2016/05/07/mainers-call-for-more-data-to-help-prevent-medical-errors/

This morning the Portland Press Herald had this article on the front page.  The  high numbers of vulnerable sick and injured patients who die not because of their illness, but because of preventable harm is just not acceptable.  It makes me crazy that  1/4 to 1/2 million people die unnecessarily every year in the US.   Dad died in 2009, after his hospital infected him with MRSA, but he was not counted in any of the voluminous data that I read.   He suffered a great deal and died within several weeks of the infection.

I have worked, as a volunteer, in Maine and nationally since Dad’s death, to help stop this epidemic of needless deaths.  Just last week, on May 4, there was a Patient Safety conference in Augusta Maine sponsored by the Maine Sentinel events team.  I asked several times for the agenda and details for this event, so I could register and attend.  None were sent.  Then I was told that there was such an overwhelming response to this event that it was “sold out”. I could only attend if there was a cancellation.  There were no cancellations.   I was very disappointed because the patient’s voice is essential to any discussions about them or about Patient Safety.  So I asked again for an agenda so I could advise the organizers about where it would be good for them to include the patient’s voice.  None was received.   Since I got nowhere with this, I wrote to the Commissioner of the Department of Health and Human Resources of Maine, and expressed my disappointment that the State would have such a conference without inclusion of the patient’s voice.  I would be very surprised, but pleased to hear back from our Commissioner.

Coincidentally, on May 4, the very day that I was excluded from a Maine Patient Safety conference that was held about an hour away from my home, a reporter from the Portland Press Herald called me because of a recent report from Dr Marty Makary, of Johns Hopkins, that healthcare harm is the third leading cause of death.  This was not news to me, but I was certainly happy to have the opportunity to talk with this bright reporter.  He also sent a photographer to my home and this became a front page article on May 7, today.  I am very grateful to this reporter and his newspaper for recognizing the importance of awareness on this issue.

We all know the old saying “there is more than one way to skin a cat”.   Well apparently, there is more than one way to get the  word out on Medical errors and preventable healthcare harm. I missed the opportunity to bring the patient’s voice to the Patient Safety conference in Augusta, but my voice was shared with thousands of others on the front page of the Portland Press Herald this morning.  Although this is an unpleasant and for some an unpopular subject, all of us, as a society must talk about this openly and often,  and demand better.

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When I read my invitation to the recent (September 23 and 24) US Department of Health and Human Services meeting regarding HAI prevention , it stated this was a meeting of “experts” to discuss progress in reducing Hospital Acquired Infections.   Websters online dictionary definition of expert  is “ one with the special skill or knowledge representing mastery of a particular subject “.  I seriously wondered if I would be out of my element at this meeting.

Other experts there were doctors from Medical schools, hospitals, and the CDC, epidemiologists, hospital representatives of all professions,, nurses, respiratory therapists, representatives from CMS (Centers for Medicare/Medicaid, SHEA, APIC and so many others.  How did I fit in?

The Consumers Union Safe Patient Project invited me as part of their ‘team’.   Each of us in our group of 12 (out of 160 DHHS event attendees) has a personal experience with Hospital acquired infection or medical error.  We have all taken on the task of making improvements and reducing risk to medical consumers in our own States and/or country.  We sat at tables with all of the experts at the event and most of us had equal opportunity to speak our minds.  WE ARE EXPERTS!  I soon realized this.  Not only are we experts, we are a group of well prepared, educated, aware and in touch advocates for all Medical Consumers.  All of us have stayed by the bedside of a loved one while they suffered because of HAI or medical error, and some of us saw them die of HAI.   One of our members had an infection herself and is still suffering the long term disability, pain, surgeries and loss caused by it.  We saw the underbelly of the hospitals.  We witnessed inadequate infection precautions and isolation.  We saw our loved ones go from being  independent to becoming totally dependent upon the care the hospital provided, inadequate or not.  We watched the rapid decline of our loved ones’ health status and felt the helplessness and eventually hopelessness of the situation.  We saw how caregivers avoided eye contact and conversations because of their guilt, shame and sometimes ignorance.  We saw lack of disclosure of the full facts about the infections and descrimination against our loved ones because of the infection the hospital gave them.  Above all, we saw the real raw suffering and we suffered too.

 Not all of what we had to say was welcomed in these meetings, but every bit of it needs to be said, repeatedly if necessary.   In the talk of data, numerators and denominators, data mining, process measures, prevention, technical and physical science, improvement or lack of improvement, remaining goals and work, cost, barriers to success, standardization of recommendations, etc etc etc, the suffering because of HAIs is almost never brought up. Also, the urgency of the problem in very rarely mentioned.

 My CU colleagues and I bring the talks back to the PATIENTS and VICTIMS during these discussions.  We make them remember our loved ones and ourselves, and the suffering and grief HAIs have brought to us.  We all do it with intelligence, compassion, and eloquence.  We are EXPERTS about what HAIs do to trusting vulnerable patients and we will continue to remind the other experts about why they do their work.

Zero HAIs is the only goal to set for these horrible infections.  And 100% compliance on preventative bundles, handwashing and other preventative measures is the only level of compliance we will accept. 

Thanks again to the CU for bringing me into this Union of Experts.

I was recently invited to attend the first ever Conversation between the CDC and the Consumers Union.   I have affiliated myself with the CU and other powerful selfless MRSA prevention advocates during the past few years.  There isn’t much that these activists don’t know about the fight for better MRSA Prevention.

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”.