McCleary MRSA Prevention

I was surprised to read that the Vinal Haven,  Maine  MRSA outbreak continues.  It was declared by the previous Maine Public Health director that the outbreak was controlled last fall.

When I spoke to one of the Island’s MRSA victims, he told me that it had spread into at least one young family last fall.  He also stated that in his opinion that the outbreak originated in the mainland hospital rather than on lobster boats.  It then spread amoungst the lobster men on lobster boats.  I cannot confirm this, but since 85% of MRSA is Health care associated, I do not doubt him.

Aggressive MRSA education for the public and for Health care providers is necessary.  Also, aggressive screening, isolation and other preventative measures in our hospitals and all health care settings are necessary if we are ever going beat this horrible infection.

http://www.bangordailynews.com/story/Midcoast/MRSA-infections-persist-on-Vinalhaven,155268

If you or a family member have suffered a hospital error or hospital acquired infection, please fill in this anonymous survey.  The page is self explanatory.

http://www.empoweredpatientcoalition.org/report-a-medical-event

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.

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

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.

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.   

Congresswoman Jackie Speier, California, introducing HR 2937

Jeanine Thomas, MRSA Survivors Network

The above link is coverage of the event in Washington DC with Congresswoman Jackie Speier, who introduced a MRSA prevention bill on June 24, 2009.

I participated in this event by telling my fathers unfortunate story.  Others present had suffered with MRSA and survived or they had lost someone to MRSA.

This event was very important to me and to MRSA prevention.  I networked with others who have done advocacy for MRSA victims and with those who had lost loved ones because of MRSA.  This bill will stop the scourge of MRSA in our hospitals with screening, isolation and precautions. 

Please contact your State representatives to support this bill.

I my previous post, I mentioned that humans carry MRSA two ways, colonization and actual infection with the accompanying symptoms, according to what part of the body it affects.

So, why is it important to screen hospital  incoming patients for MRSA?

When we are admitted to the hospital, we have no control over who we are roomed with, how well the housekeepers clean, if the staff washes their hands, or many other safety factors.  We can stay alert or ask a friend to and keep on top of those things, but if somebody is roomed with us who has MRSA in their nose or somewhere else on their body, we can’t control that.  We are forced into living with and sharing facilities with a stranger, not knowing what they are in the hospital for unless we ask them ourselves.  I know of two people who found out their roommates had MRSA and it was only a short time later that they had it too.  This is just plain unacceptable.

I live with the suspicion that my father was roomed with a patient with MRSA.  3 of his roommates had respiratory infections, all of them with chronic lung problems and at least one of them came from a nursing home. They all predeceased Dad.   ALL of them were at high risk for MRSA, but NO SCREENING was done at his hospital and so they do not detect MRSA except when they do what is called “CLINICAL” cultures.  Patients are often 4 or  6 or 10 days into their infections before the difinitive diagnosis of MRSA is made and that diagnosis is made with a CLINICAL culture.   Then it may be several days (or never) before anybody discloses to the patient that they have it.  During that time, no special precautions are taken and the germ is spread with wild abandon.  It gets onto the doctors clothing and hands, onto the nurses scrubs, ….it gets carried to the nurses station and onto the computers, off it goes to the Physical Therapy room and into Xray, to the MRI machine and onto the lab techs box she carries, and around and around it goes.  No wonder there is inadequate control over MRSA in Maine hospitals.

Screening on admission, of high risk patients, will alert the hospital, the caregivers and the patient that they are carrying MRSA.  This may be just colonization, but that is significant in and of itself.  It means they have no signs of infection, but the germ is growing in thier nose, or a body crease, or open sore or on their skin.   And they can spread it around.

Large numbers of colonized patients are admitted to hospitals every day that are not detected.  This is both a risk to those patients and to the other patients they are  roomed with. We can’t continue to keep our heads in the sad about colonized patients.  Both CDC and SHEA, the so called experts of disease control, state that colonized patients as well as infected patients need to be isolated and contact precautions used.  That means a separate room and handwashing, gloves, gowns and masks (as needed)  on or between every patient contact.  Yet, it is impossible to abide by that recommendation.  Why?  Because without screening, we will not know if they are colonized. 

Patients who are colonized with MRSA are at a significant increased risk of getting a full fledged infection.  They are also reservoirs of MRSA for spread to other patients, Healthcare workers and the environment.  Without knowing who is colonized and enacting the proper contact precautions, MRSA gets spread all over the place and there is no way to control it.

We screen, we isolate and we protect…both the colonized patient and the other patients.  No MRSA prevention program will work without high risk screening /Active Detection and Isolation.