McCleary MRSA Prevention

What’s different now?  How are we doing?  Have we made progress in Patient Safety?

Its hard to tell. I don’t have sophisticated ways to measure the results of my work.  There is a difference though.  I am received differently than I was 7 years ago.   It will actually be 8 years ago this fall that Dad became infected with MRSA while rehabilitating in his small community hospital.

When I busted onto the scene in 2009 in Augusta Maine to fight for MRSA screening and isolation of patients who are being admitted to Maine Hospitals, I had to get my feet under me.  I didn’t know how politickin’ was done.  I didn’t “know” people.  I was an obscure grandmother, wife, mother, daughter.  I hadn’t worked in nursing for quite a while.  What I did know is that what happened to my father should never, ever happen to anyone.  With that knowledge, and powerful passion fueled by grief, I forged my way.

There was sympathy, and understanding, but there was inconceivable push back.  The greatest push back came from the Maine Hospital Association, their members and even some healthcare professional groups!  That was astounding to me.  I thought we would all be on the same side…the side of the patients.  We all want safe care, don’t we?  Well they want it, but they don’t want it to COST anything.  Cheap or free MRSA prevention would be good for them.  They also wanted it without looking bad for causing infections.   This means that my work could go on  if I didn’t tarnish the polished image of hospitals.  REALLY?

The push back did not deter me. I forged ahead and I still do.

I just got back from the CDC in Atlanta, GA.  This was my third trip.  My first trip in 2010 blew me away.  I was a bit intimidated, because the CDC wrote the bible of infection prevention and that was part of my job as an employee health nurse.  In fact, I was pretty nervous when I called there for expert advice, as a working nurse.  To be a guest there, as part of a larger group of healthcare consumers/patients was a little overwhelming.  I spoke out, but not with a lot of conviction or confidence.  The second time was better.  THIS time…watch out!   I had no qualms about speaking up, and often.  I BELONG there.  My colleagues, each and every one of them affected by healthcare harm related to infections, or medications, were all equally confident, informed and eloquent in their comments, questions and ideas.

The CDC staff that organized our meeting knew exactly what they were doing.  We met on the premise that this would be a discussion.  None of us were rushed through our introductions or our stories.  We each had equal opportunities to offer questions, solutions, and ideas.  Top leadership, including Dr Thomas Frieden, Director of the CDC,  introduced themselves, and briefly talked about their work and programs, and then we talked.  We had a real exchange.

Fresh new ideas around Sepsis, HAI prevention and treatment, Multi drug resistant organisms, Antibiotic use and stewardship, Death Records reform and so many more very important issues in Patient Safety were covered.  I learned so much, but I also brought the nursing perspective.  Programs, mandates, policies and recommendations are essential, but without proper bedside staffing levels in all healthcare settings, they will not work.   We will not get to ZERO infections without adequate  nurse staffing.

There were no commitments made during our meeting, and I do understand that it is not that simple.  But, tons of notes were taken during our conversations.  We also populated large idea boards on the wall.  I look forward to the compilation of all of this material.

Before the meetings, 4 other amazing colleagues were photographed and videotaped for the CDCs blog and other use.  While we waited our turns, a random CDC employee came by asking what we were doing there.  When we told him he said  “oh ya, I had a surgical infection and sepsis too!”  then he shared his story.  This happens everywhere we are.  Everybody has a tragic infection story about themselves, a loved one or a good friend.  We want those stories to go away…we don’t want everyone to have an infection story.

I am grateful for the opportunity to visit the CDC and I look forward to working with them more in the future.

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.