McCleary MRSA Prevention

I am sitting home today, sick with a cold.  I will certainly survive my little virus, but it is keeping me down today.  I can only imagine being sick, gravely sick, day after day.  I have been blessed with good health and I have never had an ongoing illness with daily ongoing suffering.    In my work as a nurse I was confronted with the suffering of others every day.  But, I never considered that I could do much about it outside the constraints of my hospital practice.  I have found my voice, my bravado and my true calling.   The older I get, the more I realize that so many suffer.  They not only suffer the pain of ongoing illness, they also suffer the frustration of lack of or inadequate insurance. Because of lack of insurance, they do not get the care they need, so the suffering persists and gets worse.  Their finances suffer.  They suffer the emotional pain of knowing they may never get better.  Their physical and emotional pain and suffering is multi tiered and never ending.

My father’s suffering was horrible.  It started the day he collapsed with MRSA pneumonia.  The severity and the weight of the illness put him down and and kept him down.    His unnecessary and preventable  illness and death motivated me to do something to help others to avoid MRSA.  And now that work is taking me even further into activism to help direct healthcare reform money and policies  to  benefit the most vulnerable of all …the elderly and the most gravely ill patients of all ages.

My recent experience with the Maine Campaign for Better Care made me aware of just how important and exciting the new Healthcare Reform law is.  We all know it isn’t perfect.  My perfect HC plan would eliminate ANY profits on the backs of sick and suffering people.  I believe it is immoral to profit that way.  But, as we all know, there will still be profit. We have to make the best of the HC reform we got.  the MCBC’s goal is to focus on improved quality and accessibility of care for the elderly and for severely ill and handicapped people of all ages.  The plan for doing this is still in the formative stages, but many capable members of this group will set about at this work soon.  They will identify, categorize and work on problems..  Their approach will involve better coordination of care for all.  Redundant, repetative and unnecessary “care” and or diagnostics will hopefully be minimized or eliminated.  Volume or “more care” doesn’t  equal quality or safe care.  They will also work on better communications between patients and their providers.  This group will put the patient at the hub of their own care.  What a concept!!  They will empower patients and encourage patients to question their healthcare providers and pave the way for better communications.

I love the concept of all this.  I find it very exciting and way overdue.  If the MCBC does a public campaign asking for suggestions and stories  from everybody, please contribute to their ideas and their effort in general.  It is everybody’s chance to help direct and influence policies of the HC reform law.  The MCBC is bringing the new law to every citizen in Maine and will ask for their help.  In turn, Maine may set precedent on policy because only 5 States are running this campaign.

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.

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.

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.

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.

Secretary Kathleen Sebelius, HHS, addresses audience at Orono Maine meeting

Kathy Day discussing John McCleary's MRSA death with Kathleen Sebelius

I was invited by Maine AARP to attend a meeting with Kathleen Sebelius with only about 50 other attendees.  I represented the local AARP at this meeting.  I was not called on to ask my carefully prepared question, but the discussion(in above photo) one on one was better.  Secretary Sebelius is very well versed on healthcare reform.  She told me about the stimulus money sent to all the States for enhanced infection control programs in hospitals.  She said that MRSA and other medical errors are “definitely on the radar”.  While she gave no specifics about MRSA, her sincerity and accessability  makes me confident that MRSA and other hospital errors and infections will be addressed.

Let’s just hope they will be addressed aggressively.  For way too many years, infections have grown in types and numbers year after year.  Without a reverse trend, what will happen?  More death, suffering, disability.  More anger and distrust in our Healthcare facilities.  A wave of litigation from fed up victims and/ or their families.  All of this is preventable with an aggressive mandatory approach to MRSA elimination.

The stories I heard at today’s forum moved me tremendously.  One of the panel members with a lengthy horribly terrifying story was a neighbor who lives about 6 houses away from me.  I had no idea of her troubles.  Mostly we heard about insurance, lack of or inadequate coverage, high deductibles or loss of benefits, and resulting financial ruin because of medical expenses.  Every citizen in this country has a right to healthcare.  Nobody should be sent home because they lack coverage if they have an illness or injury that requires hospitalization.

But, Healthcare reform proposals must also address quality and patient safety.  I hope I got that point across today.

The web page I am directing you to here is how CW Speier addressed Congress regarding health care reform.

I liked the way she describes the fact that hospitals spew out these MRSa infections that kill people or drastically alter their lives and there is no one making them change. See the following quote from Jackie Speiers address on Health care reform and MRSA.

I want to tell you a dirty little secret. It’s a dirty little secret about health care that no one wants to talk about, and it’s about medical errors, and we have known about it for decades. The Institute of Medicine put out a report that said there are 100,000 deaths in America every year because of medical errors; 100,000 deaths.

What we need to do, furthermore, is put the protocols in place so that we can stop these infections from occurring and we can stop the deaths as well.

She says it well doesn’t she?  I often make the same comparison with hospitals and restaurants…if restaurants served up food that killed people they would be shut down.  Hospitals literally get away with murder…..at least the ones who will not change their approach to MRSA and other Hospital Acquired infections.  Please watch CW Jackie Speier and get your representatives to support or co sponsor this bill, HR 2739, regarding MRSA prevention.

http://www.c-spanarchives.org/congress/?q=node/77531&id=9013445

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.