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.

After 5 years of this work to improve healthcare safety and quality, I have become very  weary. From my perspective, things are not improving very quickly.    It seems I have become a magnet to strangers who have had tragic healthcare harm experiences.  Many of these tragedies involve death and disability.  Here are a few of the recent stories that complete strangers have shared with me in an airport, a hairdressers shop and on the phone.   I am privileged that they trust me with their stories and that they have confidence in me to make a difference.

1.  A woman in her late 40s sat next to me at the DCA (Washington DC) airport.  I offered her a Wet One wipe to clean her hands after she ate a Cinnabon roll, and so the conversation started.  She had mesh implanted for a  prolapsed bladder.  She said  “It has ruined my life”.  She is unable to have sex because of the pain and her husband divorced her.  She makes frequent trips to a GYN office (not the one who did her surgery) for exams and reconstructive surgeries.  That doctor told her that she repairs the many messes that her original doctor makes, but “you didn’t hear that from me” follows her comments.  One doctor will not rat out another. She knows at least 4 other women who had similar surgical mesh outcomes (done by the same doctor) in my region who  would share their stories.  I encouraged her to talk with a local news reporter and I connected her with the reporter and others who can help her and the other victims of this local doctor to share their horrible stories.  They can help to prevent this from happening to other women.

2. A hairdresser in my usual salon approached me when I was getting my hair cut a few weeks ago.  She told me about her 77 year old Aunt, who was still an employed nurse, and who fell and broke her femur recently.  She had surgery in one of my local hospitals.  Within a day or so, she was critically ill with MRSA and sepsis.  That Hospital said they couldn’t give her the care she needed so they transferred her to the other Hospital in town.  She died within one week because of infection/sepsis.  She was infected during her surgery.  Then she told me about her sister.  She had the sling placement surgery for her sagging bladder.  This was done by a GU surgeon.  She had excruciating pain after the surgery and made repeated visits to the Medical center ER for treatment.  She was readmitted several times, but her surgeon kept insisting that there was nothing wrong, and there was no infection and she was discharged each time to suffer more at home.  Her regular family doctor later detected something wrong with her heart. She was referred to a cardiologist, who told her there was nothing wrong with her heart.  Finally she was admitted to the hospital again, in sepsis.  The infection from her sling surgery had become systemic and affected her heart and she died.  This debacle happened over a 3 month period, more than sufficient time for this infection to be diagnosed and treated.    She was 36 years old and left a 4 year old child behind.  Heartbreaking.

3. A retired RN who was an OR nurse in a local hospital, called me after I was in a newspaper article recently.  I had been quoted in the paper about the death of a new Mom who died of necrotizing faciitis within a week of giving birth to her first baby.  This nurse felt a need to tell me about her observations of 2 surgical cases involving NF during her career as a nurse. She described the surgeries to me in detail and they were horrific.  One was a nosocomial (contracted in the hospital) post operative infection and he died.  The other patient was transferred to Boston and he survived. She also told me about how her hospital hired people from a paper mill layoff, who were immediately placed in her OR.  They had no orientation, certification or experience.  They might have been a floor sweeper in the mill before they landed in her OR.  She was ordered to teach them to scrub in.  WHAT??!!  No training, no knowledge of sterile technique, no familiarity with anatomy, instruments etc.  Mill worker to scrub tech with nothing in between.  No wonder people are getting infected in that OR…and who knows what else is happening there.

The pain, grief and suffering at the hands of healthcare providers continues.  In some cases it is repetitive, untethered and unpunished.  It is horrible and unacceptable and although I am weary and disgusted that these things continue to happen,  I know I can never give up.  My heart breaks for these victims and their survivors.  I extremely grateful to  them for trusting me with their stories.

Things that I recognize in these three women’s stories are provider arrogance, dismissal of suffering and pain, lack of respect for patients,  secrecy, protection of one doctor by another,  lack of accountability, missed diagnosis and misdiagnosis, failure to rescue,  failure to fund appropriate safety measures and training, cheap labor,  license to continue doing the same harmful things over and over, no accountability, devalued life.  Where else in society does ongoing harm to human beings,  that sometimes causes death,  go  unreported, unpunished and uncontrolled.  Repetitive harm is criminal.  And those who continue to hide it are complicit in the crimes.

This has to stop.

The study results released today by the Office of the Inspector General of the DHHS about Medicare patients is very disturbing.  ONE IN SEVEN medicare hospital inpatients suffered harm because of medical error/or infection.  This is huge. It is unacceptable and it is a big secret from most unsuspecting patients being admitted to the hospital.  Although half of our States have mandated reporting for medical error, not even all of those accurately report medical errors/hospital acquired infections.

How do we change this?  First of all we make them report it.  Mandatory public reporting of medical error and hospital acquired infections is a must.  Without transparency and accountability, there will be no change.   Mistakes and deadly infections will continue to be swept under that dirty rug and paltry investments in prevention will continue.  Second, we support improved staffing at our local facilities.  Safe staffing equals safer patients.  Third, we pressure our legislators to support any and all Safe Patient legislation, including prevention legislation,reporting legislation, patients rights legislation and informed consent legislation.

At the  recent Consumers Union Safe Project summit,  ad campaigns to educate people who are entering the hospital were discussed.  Having blind trust in our hospitals and doctors and other caregivers is a very naive way to conduct one’s self when hospitalized.  Educate yourself about your condition and help others who cannot do that for themselves. Ask if the surgery/treatment/medications are necessary and if there are alternatives.  Get second opinions.  Check out your Doctor’s history and experience.  Ask for your hospitals record on medical error and infections.  Finally take a patient advocate with you.  If you will be impaired physically and/or mentally because of your surgery or medical condition, ask a trusted loved one or friend to be your advocate. Don’t sign your consent for treatment or surgical procedure until you are perfectly clear on all the risks, including infections. Carry a journal for yourself or your advocate to use to document who visited you in the hospital and for what reason, list your medications, etc.  And make sure all of your caregivers, and visitors are washing their hands before touching you.

Don’t count on your hospital to do it all for you….as much as you would like that.  Take a stand for yourself or your loved one. Be prepared and educated.  You will be safer because of it.

http://oig.hhs.gov/oei/reports/oei-06-09-00090.pdf

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.

http://hc4.me/quality

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.

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.

In the midst of heated debate about health care reform, our noble legislators are going on a month long vacation.  While many thousands of people are losing their healthcare insurance every day, the debate will stop until our entitled legislators are well rested and tanned. Oh, and lest we forget, if they get a sunburn or a sprain on vacation, they are covered by a very generous insurance package.

Healthcare reform is so needed and so overdue, and yet our leaders just take off and enjoy themselves. Those who oppose HC reform think this delay will hurt the reform act.   Part of reform is to improve the quality of our healthcare by reducing medical errors and hospital acquired infections.  Congresswoman Jackie Speier’s HR 2739 will be part of the reform if we are successful.  So until HC reform happens, not only are US citizens losing healthcare insurance every day, the healthcare consumer will continue to receive treatment in our nations hospitals, most of them having  inadequate infection control and rising numbers of preventable infections. 

Millions of American citizens fight every day with insurers who deny claims because of a pre existing ailment, or any other reason they can come up with.  Millions of others have no insurance at all and hundreds of thousands contract preventable infections because there is no solid mandate to prevent them.  Many thousands of those exposed to MRSA and other hospital acquired infections will die or become disabled.  Our healthcare system is in a mess and healthcare consumers suffer because of that every day.

President Obama continues to work every day, campaigning and fighting for Health Care reform, but our lawmakers need a vacation.  I admire our new president for knowing his priorities.

If just one senator or one representative had to be hospitalized and then contracted MRSA while there, that would be it.  We would have measures to stop MRSA infections.   I wouldn’t wish a MRSA infection on my worst enemy, but it is fact.  Unless someone is personally effected by the horrible infections that can be contracted in our hospitals, they are unaware and uninterested.  It is our job as families, vicitims, healthcare consumers, and others to MAKE THEM AWARE!   The staff of both of Maine’s representatives are aware because a staff member in the House caught MRSA in the gym in their office building, and because other activists and I informed them.  MRSA came close to them, and to their place of work .  They know they are not immune, and that nobody is.

Make your representatives work, the long hard hours it takes, to make a difference through healthcare reform, and to make our hospitals safer.