McCleary MRSA Prevention

People ask me what I would do to help stop Hospital acquired infections. It’s been 10 years today since my father died of HAI. Right after he was infected with MRSA, I started researching the causes, the prognosis, the incubation period, prevention, spread and prevalence of these infections. The subject is complex and broad, but these are a few of my ideas about how we can actually make a huge dent in this problem.

1. Get a more accurate count of infections and the deaths caused by them and make it public. Transparency and accountability will lead to better funding and actions to stop this scourge.

a. Develop a way for patients or their family members to report their own infections, because we know hospitals and other healthcare facilities are not reporting all of their infections

b. Require that all infections that contribute to a death, be listed as a cause of death (COD) on death certificates in every State.

2. Require Hospitals/LTCs/Dialysis centers/Surgical Centers to post any current outbreaks on their websites and in plain view for incoming patients.

a. “Outbreak” must be defined first.  Currently ‘outbreak’ means something different according to what infection is being discussed.

3. Rapid screen patients for MRSA and other common infections on emergency admission, or a week in advance of planned admissions. Practice Universal precautions without exception. Postpone elective surgery until the patient has been decolonized.  Contact precautions must be followed without exception for all MRSA colonized and infected patients. All other precautions according to the offending infection must be followed to a tee, by all staff and visitors and this must be enforced.

4. Put everyone in their own room, preventing spread of infection from one patient to another in the same room.

5. Clean up Hospitals and the equipment in them. Assign each patient their own frequently used equipment, ie. Blood pressure cuffs, wheelchairs, walkers, etc.

6. Handwashing all around every time, before and after touching,  nurses, doctors, xray and lab  techs, visitors, and anyone else who touches patients.

7. Help patients to understand their own role in prevention of infections, examples are  handwashing, general hygiene, covering wounds, good nutrition/hydration, covering coughs, not wearing slippers that have been on dirty floors into their bed.

8. Give the Federal and State CDCs regulatory powers. This way, instead of writing recommendations, they can write requirements. Every hospital that is held accountable for infections that they caused, will say “we met the CDC recommendations” and/or “We met the standards of care”.  And they may have met some of them, but certainly not all of them because they don’t’ have to…none of the recommendations are mandated.

Also, the CDC would not have to wait until crisis to go into places with known problems. An invitation would not be needed. Places with known infection outbreaks and/or ongoing infection issues could be visited and problems remedied without waiting for permission to enter. Not a single patient should become infected because the CDC is waiting for an invitation to help the facility.

9. Stop paying Hospitals and other Healthcare facilities for the costs of these infections.  Nobody should have to pay ONE PENNY for an infection they caught while in a facility. Penalties are not enough.  Stop payment from any source patients, insurances or the Federal Government.

This is my short list of ideas. They were gleaned from all sorts of experts and meetings on the subject of infections.  If these things had been in play when my father was hospitalized for rehab for a simple ankle fracture, I sincerely believe his infection would have been prevented.  Two other community members had already died of hospital acquired MRSA infection the same month he was admitted. No outbreak was declared and nothing was ever reported on a State level about that.  No extra precautions or steps were taken to stop the hospital MRSA outbreak.  There was no consistency with handwashing, gloving or precautions even after his infection was diagnosed.  With some hard work and dedication to patients, we can stop this from happening to others.

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.

My work with my MRSA bill , activism and advocacy has taken me all over Maine, to Chicago and to Washington DC twice with another trip coming up soon.  I meet with other advocates, our senators and representatives, the Consumers union, and victims regularly to help stop this scourge.   I have met many of the families in person and online.

Let me introduce you to a few.

Two of my new acquaintances  are military veterans.  One got a new hip then MRSA.  Another got a new knee, then MRSA.  The second one had to have his new knee removed and will soon have his leg bones fused and have an unbend-able knee.  If he makes it through this surgery, he will have to learn to walk again using a shoe lift and a walker.  The alternative to that was amputation and a prosthesis.  He wouldn’t hear of that.   He is 86 years old.

I met a young mother in Washington DC in November.  She got MRSA when she went into the hospital to have her baby.  She suffers with it herself, but the worst of it is her baby has it.  They have had continuous outbreaks since her baby was born 9 months ago.  She talked with me in the hotel hallway and literally cried on my wide shoulders.  Her heart is broken.  She has another child and a husband that she worries sick over. Her worry is that they will get MRSA too.  She is a very young woman who is now on SSI disability because of MRSA.

Another friend, a mutual friend of my husbands and mine, had a colonoscopy.   He had a polyp too far up to remove through the scope.  His doc said it will be a piece of cake to remove that polyp through his abdomen.  So, he did.  He got MRSA.  He had to have a long section of bowel removed and now has a colostomy.  After being treated for the MRSA, he got C Diff and spent a lot of time in the VA home locally and got treated for that with IV antibiotics.  A weeks worth was around $7000 he said, but “thankfully”  his insurance covered it. 

A mentor of mine who is also a MRSA victim, injured her ankle years ago.  She had surgery and got MRSA.  She went into sepsis and nearly died and still they were not telling her about her infection….what it was.  She has fought with the legislators in Illinois to get the first MRSA bill passed into law with mandatory Active Detection and Isolation .

I didn’t personally  know the latest victim I have become aware of, but the cause of her death was published in the local paper.  She was a beautiful 67 year old wife of a prominent local pathologist.  She at one time climbed Mount Kilimanjaro.  She was the secretary at the local medical center’s chaplains desk.  What a tragedy.

Another is an ICU RN by profession.  She contracted MRSA at work.  She has had repeated bouts of MRSA related infections.  Currently she lingering illness from recent flu and is seriously ill.  She will go to the ER this morning and we hope she gets the treatment she needs.  She had MRSA pneumonia with sepsis several years ago and she is very frightened of a recurrence. 

I could go on and on.  The stories are incredible.  These people are all intelligent, trusting and until MRSA, healthy people.   Too often the argument regarding MRSA prevention isn’t about all of these suffering patients or their families.  It is all about money and a lot about saving face.  Savings lives and stopping unnecessary suffering rarely comes into the conversation. 

MRSA is brutal, no matter how old you are or in what medical condition you are in.  We have to break the chain of infections by getting hospital screening right and educating everyone on the dangers of MRSA and how to stop the spread of the disease.

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.

Yesterday, I passed the nursing home where my father suffered for 9 weeks with MRSA pneumonia.  He died shortly after the holidays on January 9, 2009.  His passing was very sad but welcome after we had watched him gradually and progressively fade away.  His body weight was just falling off, steadily and alarmingly,  and his physical and emotional strength was gone.

This year will be our first Christmas without him.  In the weeks preceding Christmas last year, my mother and I and my brothers kids all tried to think of things that might please him, while he was in his lonely isolation room in the Nursing Home. Most years anything with chocolate  or other sweet foods would totally satisfy him.  He had an appetite that wouldn’t end.  Last year,   my brothers kids put together a collage of photos for his bare walls.  He had a profound hearing loss from the necessary antibiotics, so he had difficulty hearing his TV.  I picked up a new digital TV for him that we thought could have an amplifier device added to it to help him hear.  It didn’t work, so we brought back his older one so he could hear it a little.  Then we got him one of those amplifier devices that you see on TV.  When Mum or us kids weren’t there, the TV was all he had….other than his caregivers that is.

I brought in a big fake poinsettia, and somebody brought by a little crocheted ornament to hang on his drawer handle.  All of these things made his room more festive, but he didn’t care.   He wanted to be with my mother at home.  He pleaded and he bargained with us all the time.  He would ask, “If I eat, would I be able to go home?”  “If I walk, would I be able to go home?”   The sad fact was that he couldn’t do either.  He couldn’t even sit up or turn over in bed on his own.   His illness and the powerful drugs he needed for it made him unable to do either, eat or walk.  At times, I think his caregivers thought he was being difficult…they thought he wouldn’t walk or eat.  I am convinced now, after reading stories of others who have suffered through deadly MRSA  that he just plain COULDN”T eat or walk.  The disease and the treatment took away his strength and his appetite. 

My mother and I considered taking him home.  For him to come home, we would need help.  My mother was 82 at that time.  I am 60.  I am big and strong, but I could not do all that my father needed done alone.  He had become a complete care bedbound patient when he became ill with MRSA.  He needed so much care and of course there was the problem of him still being colonized and coughing up huge amounts of sputum.  How do we go about caring for him at home without putting my elderly mother at risk for MRSA herself?  Hospice would help, for perhaps an hour or two a day.  The logistics of taking Dad home were overwhelming.  He never came home and it broke his heart and ours.

So, although all of us did what we could to cheer Dad up on the holidays last year, the only thing that worked was our visits and especially my mothers constant presence at his side.  He needed her more than anything else, including medicine.  The medicines never worked.

I drove by his nursing home yesterday.  The Christmas lights are there and the front of the building is festive, but none of that hides the suffering going on inside.  My selfish comment to my husband was…”I am so glad that Mum and I are not still going in there all the time”.  I miss Dad more than anyone can imagine, but I do not miss seeing him suffer and I don’t miss the frustration of not being able to make him healthier or happier. 

These intimate details of the suffering and frustrations of dying MRSA patients and their families are the facts of life and death with MRSA.  It is impossible to know the pain of the disease unless you have had it yourself or you have helped care for someone you love only to see them  suffer and die from it.  These are the details that we must get across to law makers, the CDC, healthcare providers and others who can make a difference in MRSA prevention.

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.

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.

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