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Posts Tagged ‘hospital acquired mrsa’

Missing Dad on Thanksgiving

November 23rd, 2012 No comments

Whenever I whip cream or potatoes, I think of Dad.  He was a man who loved to eat!  Potatoes and whipped cream were two favorites.  I stashed a lot of leftover potatoes after our Thanksgiving dinner and thought, if Dad was here, these would not be going back into the fridge.  Family and food were my father’s favorite two things.  When I put leftover whipped potatoes  into the fridge, I asked my mother “Where is Dad when we need him?”

Dad’s suffering after he was infected at his small town hospital was long and difficult.  But, the most difficult thing for my family to witness was his complete loss of  appetite.  For his entire life, he was a hearty eater and loved his food, in  large portions.  He never had a problem with cholesterol, and that was a miracle.  I love to eat too, but I could never imagine packing away meals like he could.  It took him as long to prepare his mound of potatoes as it took for the rest of the family to finish eating.   We all use to laugh about that.  Potatoes, gravy, meat, vegetables….oh, didn’t he love a big meal.  He loved his deserts too, but he also ate fruit and veggies.  I guess there just was not a food he didn’t love.

He wasn’t selfish about his food.  He grew up during the depression and in  poverty.  Rare old photos of him reveal a  thin child dressed in ragged clothing.  Meals were sparse and often meatless.  So, as an adult, he not only relished food, he absolutely loved sharing food.  When any of us said we had enough to eat he would say “Oh come on, have some more!”  This generosity made him feel good I think, and proud that he could provide more then enough food for his family, unlike his parents for him and his siblings.  They squabbled over food. 

I remember when Dad was in the nursing home during his last few weeks of life. My mother and my family were very concerned about his loss of appetite and a lot of weight.  He shared his dreams about food and said he would love some Hersey’s chocolate.  We brought it to him, but he could not eat it.  He gagged on it.  One day he said he thought he could eat a tuna sandwich with onions.  I didn’t want to bother the Nursing Home kitchen with special requests, so I went a got the stuff and made him that sandwich.  Same thing..unable to eat it.  When he couldn’t eat a Maine lobster and butter (his absolute favorite!), we knew the outlook was very bad for Dad.  This  starvation went on for about 3 months.

Aside from the fact that Dad became totally dependant on others for his daily activities and was rendered a bedbound patient overnight because of preventable infection,  this alarming loss of appetite and weight was the absolute hardest thing to watch.  My poor Dad. 

Who knows how long Dad would have lived if he hadn’t been infected with MRSA?  He managed fairly well at home, with my mothers help.  She cooked healthy balanced meals for them every day.  He still drove his car and did a few errands.  They both had visited in my home, 70 miles from their home,  just a week before he fell and broke his ankle, and needed rehabilitation (during which he was infected).    He ate well, he was engaged with all of us and our lives and little kids  loved him and his sense of humor.  He got around. He didn’t move fast, but he did what he needed to do  without assistance. He was upright and mobile, just using his cane.

All of his independence was taken away by preventable infection.  That is just plain wrong and should not have happened.  Although Dad had ongoing health problems, he managed ok before MRSA.  Recently I found myself in a position to tell Dad’s story and describe his condition.   I was asked  if he was frail. I’m not sure how I answered but I have given that some thought.  NO, before MRSA he was not frail.  My perception of a frail person  is someone who is bent over, constantly wobbly on the feet, and always needing assistance to do about anything.   It  took his trusted community hospital less than 2 weeks to drop Dad  dead in his tracks and land him in bed permanently with a multi drug resistant infection. He had clear uninfected lungs when he went into the hospital.  After he was infected, he never walked again.  He lost is appetite, his strength, his ability to stay at home and eventually his life.  It was his  trusted community Hospital and MRSA that turned him into a helpless frail man.  Before that he was living independently with my mother in their own home.  Although he had problems with occasional falls, generally he did ok.  His determination and my mothers dedication kept them both going.

We missed Dad at our Thanksgiving table again this year. 

 Dad, I hope you are upright and strong, surrounded by loving  family,  funny little kids and that they served whipped potatoes and chocolate cream pie where you are now.

Lori Nerbonne, co-founder of New Hampshire Patient Voices

April 14th, 2010 No comments

Mycollegue, Lori Nerbonne RN, and fellow Patient Safety activist wrote this excellent synopsis about MRSA after her recent research.  I found it to be very organized and very well done, so asked if I could share it here on my webpage.

1.  Community Acquired and Healthcare Acquired are two different genetic strains
2.  CA MRSA is defined by the fact that it is a MRSA in someone who HAS NOT been exposed to a healthcare setting recently.
3.  HA MRSA is defined by the fact that you were recently or currently exposed to a healthcare setting .  It is not showing up in many patients until they get home from the hospital (they acquired it in the hospital) but this doesn’t make it ‘CA-MRSA’…it is still HA-MRSA that is now out in the community.
4.  CA-MRSA is largely treatable if recognized in time—not so with HA MRSA; much harder to treat
5.  You can have CA-MRSA when you go into the hospital and then get HA-MRSA, which can make you very sick
6.  Co-infections are causing serious illness in death 
7.  When you have large volumes of people bringing CA-MRSA or HA-MRSA into the hospital as carriers, you have a real problem and vice versa…when they are going home with it (and not being told which is often the case).  It’s like water pollution—it’s all being dumped into the same reservoir and colonizing many people
8.  It takes a commitment from hospitals and nursing home on a geographic level (in the same community or region/state) to have the greatest impact on reduction strategies because of this ‘dumping’ scenario I described above.
9.  Screening is an obvious aid in reducing MRSA because it identifies who is carrying it into facilities and who is still colonized before they go home.  It provides the crucial piece of information that is needed to first identify the host (the basis of surveillance in any contagious disease) so they can then be treated before they infect others either directly or via healthcare worker vectors.
10.  Hospital/Facility politics is a big reason why there isn’t screening/ADI:  Surgeons don’t want to be “told what to do”, hospitals don’t want to invest in extra staff and supplies that would be necessary, and they don’t want to implicate themselves/their facility if a patient is negative on admission and then positive after admission.
11.  We have CA and HA MRSA in hospitals (and many other bugs)…but the real ‘take home’ from this is not that “people are bringing it in”…..it’s that hospitals are failing to identify, isolate, and treat those who are bringing it in, thereby putting more and more patients and healthcare workers at risk of harm or death.  CA-MRSA can become virulent in sick patients.  Hospitals are filled with sick patients, so CA-MRSA can be deadly once it’s inside the four walls of these facilities; especially if patients get co-infections with HA-MRSA or other bugs (Klabsiella, etc)

Maine Hospital Association stand on public reporting 2008

March 15th, 2010 No comments

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.

The High Road to MRSA Prevention

March 4th, 2010 1 comment

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.

MRSA Sepsis or Heart attack?

January 8th, 2010 15 comments

On the second day of my fathers hospital stay for hospital acquired MRSA pneumonia he slipped into shock.  This was a quiet but quick decline in his condition.  If I had not been in the hospital room with him that day, his nurse would have attributed his “drowsiness” to just being tired.  He had gone through a lot of diagnostics that morning, including a lung scan.

My mother and I arrived to visit shortly after noontime.  Dad was barely conscious.  I spoke to him several times and he just was not coming around.  I expressed my concern to his nurse, who was right there in the room.  “Oh, he is just all worn out” was her response.  She was a good nurse but she was missing a very serious event that was just starting to occur.  I asked her nicely to check his vital signs.  Dad’s blood pressure had dropped dangerously low.   It was just a matter of seconds before she had a team in his room and they began their work.  He was given a fluid challenge and drugs to get his blood pressure back up.  My mother and I sat there the entire time  shocked and puzzled about this frightening turn of events.  I kept asking the doctor what was going on.  He called this a heart attack.  I repeatedly asked why he had the fever then.  Blood cultures were drawn, but they were negative.

There is no way for me to know if he had a heart attack that day or if his body was reacting to the lethal serious bacteria in his system called MRSA.   When I look back, I suspect that the doctor knew, without a doubt, that my father was suffering the syndrome of sepsis.   This occurs commonly in patients who are suffering from a serious bacterial infection.  Blood cultures will not necessarily show the bacteria.   My father had never in his life had a heart attack.  If he did have heart damage after this scary and unexplained event, I believe it was due to the sepsis and the stress that the infection caused his old body.

Sepsis is a very serious and often times deadly event that occurs when patients contract MRSA.  It comes on quickly after the invasion of the microorganisms and treatment to reverse the sudden drop in blood pressure must be quick and effective.  In Dad’s case, after the second worst event of his newly diagnosed illness(death being the absolute worst), he did recover in the short run, but the disease killed him in the long run.

Dad was transferred from his regular bed into an ICU bed that day.  He was catheterized and MRSA infected his bladder.  About 5 days later, and after I requested a sputum culture, he was finally diagnosed with MRSA pneumonia.

The day of this suspected sepsis shock, Dad’s doctors approached my mother and me about “comfort care”.  This means that they wanted to take away all of his life sustaining medications and just give him what he needed for comfort.  This was a blow to us considering this was the very same day he had this frightening event.  I thought comfort care was offered to terminal cancer or other dying  patients.  At this point, we had no idea that MRSA was my father’s terminal diagnosis.

  Although Dad was ill enough that my mother called the priest for last rights, he was still alert and conscious.  I told the doctors they needed to ask Dad what he wanted for himself.  They did. Dad was a tough Irishman.  He was not about to give up the fight of his life at that point.  And, that was his choice to do so.

He suffered for 19 more days in that hospital.  Then he was deemed “well enough” to go to the nursing home.  He suffered for 9 more weeks.   He fought the good battle, but MRSA won.  He never lost his desire to get better and go home and he never succumbed to the doctors wishes to put him in hospice or to put him on “comfort care”.  I loved that about my father.  He let people know what he wanted and didn’t want and after he told them there was no question left in their minds about his desires.

Dad will be gone a full year tomorrow.  His suffering and death left me with this burning desire  and ambition to stop MRSA infections.  Nobody should go through what he went through because of something they caught in the hospital. 

Maine Hospitals now screen all high risk patients for MRSA.  This is just as it should be.  We need to protect our loved ones and ourselves from this devastating infection.

MRSA high risk screening test in Maine

January 6th, 2010 1 comment

236_nasal_swab_2719292_188x156_January 4, 2010 marked the first day of screening high risk patients for MRSA in Maine Hospitals.  This is a huge step in the right direction.  Many Maine Hospitals ramped up their infection control policies long before January 4.  This screening is much wider than most of our hospitals have been screening.  My hopes and my supporters hopes are that this program will be successful and with all of the other necessary steps for prevention,  hospital acquired MRSA will pretty much disappear in Maine.

We do have concerns about this screening. It does not address endemic MRSA, which is MRSA that is already present within a hospital.  Admission screening only tells us what the patients MRSA status is on admission.  It does not tell us if they contract the disease while hospitalized.  That is very important if we are to address the spread of the disease.  Also, several high risk populations have been left out of the list of high risk patients to be screened during this test. Representative Adam Goode and I have addressed these issues in our new legislative resolution. 

Another major concern is that at the end of this “test”  (6 months) our hospitals will be right back to what they were doing prior to this “test”.  6 months is absolutely not long enough to screen and expect significant results.  In this way, this “test” may be self limiting.

All of our country’s VA hospitals screen everybody on admission, again a week later of if they are transferred to ICU, periodically (weekly) and again on discharge.  It has helped the VA hospitals drop MRSA rates by over 70%.  It has been so successful at  the VA that they are now merging their MRSA program into their long term care facilities.

The VA success is amazing.  My question is why aren’t all US hospitals doing exactly the same thing.   If you asked your local hospital they would say…”oh, it costs too much”.  I have never read an article about a successful MRSA program where hospitals did not benefit financially from the drop in MRSA rates.  The programs are worth every penny of start up costs.  The savings in human suffering and death are staggering.

My hope is that Maine Hospitals are taking the epidemic of MRSA seriously.  I believe they are.  Change is difficult for all of us.  But, if this screening, and the new infection control programs our hospitals have are taken seriously, our hospitals can become the safest in the country.

Consumers Union, Safe Patient project, Maine Screening program

December 2nd, 2009 No comments

On November 17 and 18, I attended an event sponsored by the Consumers Union, Safe Patient Project, titled “To Err is Human, To Delay is Deadly”.  Other activists and advocates very similar to me, attended and participated in panels.  Victims and organizers also attended.  The CU has the momentum to make  difference for patients and their safety.

I was inspired by the work and the level of dedication of these activists.  Most of us work alone with no funding and our goal is simple, to protect vulnerable patients from harm when they are being treated in our nation’ or State’s hospitals or by our doctors. It is little to ask or expect.  We pay a huge premium for care and we deserve the best.

The work of the Maine Quality Forum MDRO metrics group regarding MRSA  has culminated in a plan for a “Point Prevalence Test” .  This is the approach they have chosen rather than just going ahead with a good solid MRSA screening program.  During this ”test” we will screen known high risk populations for MRSA only on admission  for 6 months.  Then each and every hospital will report their results.  If at those hospitals, any population tests less than 7% positive screenings, they will eliminate that high risk population from the populations to be screened from that point on.  This sounded reasonable until I figured out that only 5% MRSA positives of the over 4000  transfer patients to EMMC has each year would be 200 patients colonized that would be admitted with  undetected MRSA colonization. (Only 1% would be 40 patients).   200 or more patients would go into EMMC each year colonized with MRSA colonization facing a myriad of procedures, or surgery, or other risky events that could leave them infected and disabled or dead.  Colonized patients are 7 times as likely to suffer an active MRSA infection.   200 patients would not be isolated and so could spread MRSA to other patients who are roomed with them.  This is not acceptable.   The goal should not be to do a test and eliminate high risk populations for screening purposes. The screening program should have the goal of finding all colonized patients.  Any percent of patients testing positive should validate a high risk population for screening purposes. On top of that,one single MRSA active hospital acquired infection in any population should trigger the beginning testing in that new high risk population.

If however there are no positive MRSA screenings in any particular high risk population after a full year, it would be reasonable then to eliminate them from screening.  If  in that facility, any patient in that High Risk population or any other population has an active hospital acquired infection at any time beyond that, that population should be added back into the high risk screening program.

So, after all these months of debating and negotiating in the MQF, we now have a plan that has potential to self destruct within the next 6 to 9 months. We also have a plan that has no method of determining efficiency.  Screening on discharge is the only way we would know if a pateint has become colonized or infected while hospitalized.  Our law says that  “hospitals will do surveillance on high risk patients”.  It does not specify that the surveillance would be only on admission.  Most patients are at increased risk for colonization or infection because they going into the hospital or a particular hospital department.  We should re screen these patients one week into a hospital stay or on admission into the ICU, and on discharge.  THIS ADDITIONAL SCREENING IS THE GUAGE ON HOW EFFECTIVE INFECTION CONTROL FOR MRSA IS IN A FACILITY.  It is exactly what the VA hospitals all across the country are doing.

6 months isn’t  enough time to evaluate if the screening and the other preventative recommendations are stopping MRSA or even decreasing it.  It will take a year or two to know if a program is working.  Of course, most of my proposal for Active Detection and Isolation was tossed in HHS committee hearings.  In it’s place the ESO (Epidemiologically Significant Organism) draft was accepted.  It is a generic prevention program that may help, but it really does not clearly address specifics of MRSA prevention.  The specifics are in there, but  they are obscure and subject to interpretation.  ADI specifially outlines the steps necessary to stop MRSA.  All of ADI was included in my original proposal but it was considered “too cumbersome” for our hospitals.  That’s too bad, because it works when enacted.  It will take at least 2 years to see if this ESO draft and this limited MRSA testing will work.  I am not confident that it will.  One can hope it will……

This work is frustrating.  Advocates and Activists don’t have access to accurate numbers of MRSA and infections or deaths because of it.   Most of us have a family member that has either died or become disabled because of it, or have had MRSA ourselves. Because of our loss and troubles we have come in contact with many MRSA victims or their survivors, but we never have the actual numbers of patients effected by this horrible scourge.   Keeping the number of infections a secret by not reporting them (and making the numbers public )allows hospitals the advantage of knowing the “data” and the rest of us are kept in the dark. This puts anyone like me, who is  trying to improve patient safety with work toward prevention, at a disadvantage.   This secret keeping about data doesn’t have anything to do with prevention or saving lives…it has to do with power and control and elitism.  It also has to do with lack of transparency and disclosure. And it has to do with outright fear.  Hospitals are more afraid of liability than they are of almost anything else.   I did not know the rate of patients who test positive in current MRSA screening programs in Maine hospitals when I agreed to the 7% rule.  Since the day of that meeting, I have written to both of the biggest medical centers in Maine.  One responded but did not answer my question and the other did not respond.  So much for transparency or collaboration.

I have all kinds of time.  I am retired.  I don’t require a paycheck.  I have a home office…my laptop, my printer, my phone  and my lazyboy.  So, I am prepared to keep working at MRSA prevention until I believe Maine hospitals have it right. I do not believe they have it right yet.  When rates drop and our hospitals are safe and infection free, we will all know we have it right.

World MRSA Day, emotional and educational

October 5th, 2009 No comments
World MRSA Day

World MRSA Day

On October 1, my husband Mike and I attended the innaugural World MRSA Day at Loyola University in Chicago.  I was invited there by my friend and mentor Jeanine Thomas.  She is the pioneer of MRSA Activism and Advocacy  in the US.  She works tirelessly on the State , the Federal and worldwide  levels on MRSA Prevention and activism. 

We witnessed a first time event of this sort.  Experts in MRSA prevention, MRSA victims, lawmakers, and the Illinois Hospital Association leaders attended and participated in this event.  Jeanine knew how sad an event of this sort could be so she also interjected music.  We were entertained by a  bagpiper, a blues singer and a tabernacle choir singer and pianist.  They were all uplifting. 

The doctors who spoke were encouraging and progressive.  Dr William Jarvis is undoubtedly the most recognized MRSA prevention expert in the US.  His presentation was honest and alarming at the same time.  His passion regarding MRSA prevention  is evident.  He is an honest expert who is not afraid to tell the truth about the scope of the problem.  He knows what needs to be done to conquer the problem.  This was a refreshing change from some of the doctors I have met and worked with in Maine.  A statement he made about the CDC’s most recent number of deaths because of MRSA stood out.  The 19,000 deaths that CDC claims to be fact a few years ago only includes “invasive” MRSA.  I learned something.  It does not include surgical site MRSA .   So adding those to 19,000 would dramatically increase that number. 

The most moving speaker of the day was Ken.  Ken’s 2 month old daughter Madeline died just a few years ago with MRSA.  While a photo of his sweet baby girl was projected onto a large screen above his shoulder, Ken told of his experience.  It has been a few years since this happened, but he is still obviously emotionally raw over this horrible time in his life.  She had been an underweight preemie twin.  Her brother is fine, but Madeline became ill with MRSA after discharge, and died shortly after.  Ken told us that there is a happy part of his story.  He and his wife were blessed with a baby girl this year.  They expressed their concerns about MRSA to her doctors.  She was tested and she was colonized with MRSA.  This early screening for their new baby gave doctors the red flag they needed to decolonized the new baby and she has tested MRSA free the last three times.   Screening possibly saved this tiny new baby’s  life!

Jeanine has gathered a group of impressive supporters for MRSA prevention with Active Detection and Isolation.  I spoke with a leader in the Illinois Hospital Association, an Illinois representative and others.  She is an amazing force and her event demonstrated that.

It still amazes me how contentious the subject of MRSA prevention  is.  All of us advocates and activists want is a simple cheap screening and the appropriate steps for those who test positive.   Screening saves lives.  The number of medical screenings done every day every year for any number of purposes is astounding, and yet hospitals in Maine balk at  this inexpensiv screening for an infection that can and does kill and maim patients.  They insist that they have the solution in handwashing and other steps.  They do not.  They have watched the rate of MRSA infections rise for many years, alarmingly so for 15 years.  They have not stopped or stalled the infections yet.  But, ADI, the proven approach ,is available and they snub it.

So, because of  I know there is a way to stop MRSA,  I will continue this quest.  My Irish is up.  My father is gone because of pathetic infection control .  I will work on this until our supporters and I am satisfied that Maine hospitals are doing all that they can to stop MRSA infections.

Breath of Fresh Air, Maine Medical Center

September 24th, 2009 1 comment

I was invited to Maine Medical Center for a presentation and introduction on their MRSA and other Multi Drug Resistant Organism prevention program.  I read their program/policy online prior to my visit , so I was prepared to be impressed.  I was not disappointed.  Almost all of the important components of my original multifaceted approach to MRSA prevention, as proposed to the Maine Health and Human Services committee, are in MMCs program.  And, they are successful with it.  The passion of the presenter was very obvious.  His desire to succeed, determination and tenacity with a prevention program has obviously made  MMC and the entire region around MMC safer from MRSA and other MDROs.

Time, money, staff, supplies, administrative support and all the other necessary stuff of prevention has been made available to MMC.  And it has paid off.  The graphs displaying increased hand washing and decreasing infections were proudly displayed at todays presentation. And, remember that active surveillance of high risk populations  is an integral part of their program.   We went to a couple of floors in the hospital to see how they stocked personal protective gear and to also see the number of hand gel dispensers there are.  Their hand washing compliance scores for each floor are displayed as you walk off the elevator.  We spoke with staff members of both the floors that we visited who participate in this excellent program.  MMC has drawn in staff from all departments to participate and promote this program.  There is ownership of the program.  That is the culture change that is necessary for MRSA control.  MMC has a program that they can be very proud of.

As in all things Maine related, there are two Maine’s.  There is the Portland and Southern Maine and then there is “the rest of the State”. or the other Maine.  Remote northern, eastern and down eastern Maine do not enjoy the same resources or support that Southern Maine does.   There are still a number of Maine hospitals who do no MRSA screening at all or inadequate screening.  And many of  these hospitals do have MRSA.  I have heard that few hopsitals in Maine do not have MRSA.  Is this possible?  I don’t think anybody would outright lie about that, but on the other hand, if complacency rules, it is just a matter of time for them to have MRSA.  There are high risk patients everywhere.  Contrary to popular belief, Mainers do travel outside the confines of their small towns.  Also, small town hospitals all refer to larger  hospital referral centers, where there is MRSA.  So, no hospital is without risk from MRSA.

All of this being said.  I am very grateful to the representatives of MMC for having this presentation for the MQF, and the others of us who are advocating for MRSA prevention. It was very generous of them to do this.

  I wish the same standards and passion for MRSA control for the rest of Maine.   And I stand strong that Active Detection and Isolation is the minimum standard that all Maine hospitals must use to stop MRSA.  That begins with high risk screening and awareness.  We have the law and now we must see that it is enforced and quickly.  Delay is not acceptable.  MMC would not have had to change much at all  if my entire legislative  proposal had passed.  Their program is excellent.  But, we all know such standards are not equal in all Maine’s hospitals.  I don’t think MRSA prevention and safety for patients should vary between Portland and their entire region and the “other” Maine hospitals.  All Maine citizens should enjoy the same level of safety.

High risk screening must start now.

Maine Quality Forum Decision, LETS DO A STUDY

September 18th, 2009 2 comments

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.