Posts Tagged ‘mrsa screening’

Lori Nerbonne, co-founder of New Hampshire Patient Voices

April 14th, 2010 No comments

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

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

Going into hospital? Protect yourself from MRSA.

March 31st, 2010 No comments

For about a year, I worked toward safer and more effective MRSA prevention in Maine Hospitals.  I proposed the very things that I learned of from MRSA prevention experts (Infectious disease doctors who have written recommendations, nurses, microbiologists, advocates and activists) , and hospitals who have practiced Active Detection and Isolation to stop the MRSA growth in their facilities.  But, Maine hospitals and  infection control  practitioners obstructed ADI.  It was even a struggle to get them to comply with the new State Law to screen high risk populations.   The entire process was contentious and arduous.  It was also controlled by people who do not do direct care of infected patients.

Not all of the populations who are at risk for acquiring MRSA when hospitalized were included in the current MRSA “prevalence test” in Maine.  The populations that are included are 1) patients who have been in the hospital or nursing home within the past 6 months, including transfer patients, 2) all ICU patients 3) Prisoners, 4) dialysis patients. 

The ones who were not included are  1) Immunocompromised patients, ie patients with diabetes, Cancer, HIV/AIDS,  and those on medications that render them immunocompromised, 2) Patients who are facing surgery involving implants, ie. Orthopedic joint replacement surgery, Cardiac valve replacement, Neurosurgical shunt placement, 3) Patients who are IV drug users, 4) Patients with open infectious appearing wounds.  Other populations are more susceptible to MRSA too, including the elderly, who are more prone to Hospital Acquired MRSA, and the young who are more prone to Community Acquired MRSA (those in contact sports, day care centers, close living quarters like dormatories).  All of the patients in this paragraph are known to be at  increased risk for getting MRSA, yet, Maine hospitals and their representatives fought against screening for them.

So, since only a part of the effective approach of ADI (and that part was severely diminished)  was accepted as law in Maine, what can you do to protect yourself from MRSA if you must go into a Maine hospital?

Ask your doctor for a simple nasal and/or wound culture.  This simple cheap test may save your life.  If you know you are scheduled for a hospital admission, do this test about 10 days prior to admission.  This allows time for the culture to come back and for decolonization treatment if necessary. After the culture is done, be sure to follow up on results because not all lab results are reported back in a timely way. This simple test, and treatment if necessary could save you from unnecessary suffering and/or death.

Why won’t your hospital just do this for you without you having to request it?  That is such an excellent question. Actually, during this current prevalence test, some hospitals are screening all new admissions.  But, for the ones who are not,  I have my own theories about why they just won’t do it without a request, none of them flattering.  The problem of MRSA and many other  hospital acquired infections has been brewing and growing in our hospitals for years.  The multidrug resistant infections have come front and center and increased mostly for the past 10 to 15 years.  There has been a complacency and helplessness attached to these infections and not a whole lot was done until very recently to STOP THE INFECTIONS.   I believe that the reason hospitals do not want to screen you for MRSA unless forced to by law or after a hospital has had a significant or deadly outbreak of the infections, is they are afraid of liability

They  do not want to be liable for proper rooming of patients to avoid spread of disease.  They want to continue to room colonized or infected patients with other patients, and not tell either one of their infection status.  This way they can fill beds, wash hands,  and hope for the best…..meaning…perhaps the infection won’t spread.  But, if it does, they can tell the patient that they probably brought the infection into the hospital with them. Without a screening culture, I guess they could actually say that and get away with it.  With a negative screening, will it would be less easy to blame the patient for his own infection.  This sounds negative and cruel, but I have spoken with enough victims to know that these things do happen, and they happen often.  I do not believe that hospitals intentionally infect patients, but they do not use all of the necessary steps available to STOP INFECTIONS NOW!  And when somebody becomes infected they are not entirely honest about the name of the infection or the origin of it.

So, go get that screening before you are admitted to the hospital.  If your admission is planned, get it early enough to have results and treatment if necessary BEFORE your admission.  Have family members bring in hand sanitizer for you and for your visitors and bring in disinfecting wipes for frequently touched surfaces.  Don’t share things, with your roommate.  Be sure anyone who touches you does so with clean hands.  Nobody should have to ask for clean hands, but it is a fact of life.  Just ask and don’t be bashful.  If you are too ill, have a patient advocate with you to ask and do these things  for you.These are some things that keep you in control of your own well being while hospitalized.

And finally, don’t linger.  The sooner you go home, the less your risk for infection.

John Richardson for Maine, Governor

March 14th, 2010 No comments

My husband, Mike and I spent the afternoon meeting at a reception for John Richardson, Democratic Candidate for Governor of Maine.  His exerience and his plans are very exciting.  He envisions a healthcare plan similar to Memic, the revision plan for workmans compensation in the State.  The plan would be affordable for everyone, no matter what income and it would be non profit.

His wife Stephanie Gross is an Ob/GYN doctor at the Mid Maine Medical Center.  She and I talked at length about MRSA.  Her hospital, to my suprise, has been screening everyone for MRSA for 2 years.  This was very impressive because that means somebody there already knows the importance of screening for prevention, and they knew it before I began my work in Maine. 

This pair is exciting and will do well for the State.  Please  look at John’s webpage to learn more.

Vinalhaven, Maine MRSA outbreak, controlled

January 30th, 2010 No comments

Below is a photo of a Hand MRSA.  Many of the infections on Vinalhaven affected the hands.


This is an update on a link I added here a few days back.  It is good to hear that the MRSA outbreak on Vinalhaven Island in Maine has been controlled.  Comments in this article make it sound like they were plagued with flea  bites. 

MRSA is a bit more serious than claimed here.  Some of these victims had to be treated with powerful IV antibiotics.  Some of them will be plagued with repeated infections and all of the victims families have been exposed within their homes to MRSA.  Simple exposure is not in and of itself a problem.  But, many of them may have become colonized.  that means they will carry the MRSA bug.  That is also not a problem UNLESS they become gravely ill and/or need hospitalization for invasive procedure. MRSA can then rear it’s ugly head and cause a myriad of problems.  Patients must make their doctor and hospital aware of their close exposure to the infection.  If the doctor does not order a MRSA screening, the patient should demand one.  If they are colonized, they can have a simple treatment that will decrease their chances of serious active infection a great deal.  And, they can be separated from patient who do not carry MRSA thus avoiding spread of the desease.

I suggested that former MRSA patients and caretakers of MRSA patients to be included in the populations to be screened by our hospitals here in Maine.  They were not included.  My opinion is that was a big mistake.  Nobody wants to incite panic, but a little bit of panic makes people pay attention and absorb important information about their health and risks to it.   MRSA status on admission to the hospitals is a very important status to be aware of.

So, it is good that the Maine CDC got right on this outbreak and worked to control it.  I just hope they added  this  important patient education (about avoiding serious infection in the future) to their investigation  process on the Island.

Let’s talk about MRSA victims I know

January 29th, 2010 5 comments

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.

Anniversary of John McClearys death

January 11th, 2010 2 comments

dozen-yellow-rosesJanuary 9 was the anniversary of my father, John McCleary’s death.  A lot of water has passed under the bridge since then.  Nothing that has happened or been accomplished with MRSA prevention will bring him back, but my part of the work was all done in Dad’s honor.

The very week of this anniversary, Maine hospitals began screening high risk patients for MRSA.  This is a huge step in the right direction.   I have spoken with several nurses from different parts of the State, but the one I was happiest to hear from was a nurse from Dad’s hometown.  I took my mother out for lunch at a local restaurant, and we ran into an old friend who is a nurse and she cared for Dad.  She said the community hospital is screening ALL admissions.  They are not obligated to do that but it is the simpler and actually more comprehensive  approach to MRSA screening than just high risk screening.  MRSA does not descriminate by age, enthnicity, race, etc.  It can and does effect all.   So, this news was great.  Further comment from this nurse was “and it is about time!”

Other big strides in MRSA prevention have been made in Maine hospitals.  I hope the quality of their programs is consistant because before last year, I know it was not.  And, my original legislative proposal to standardize MRSA prevention policy all over the State (to reflect the steps of Active Detection and Isolation) was characterized as “cumbersome and prescriptive”.  Actually it was 4 basic steps and they work  really well when done altogether.  So, that standard and mandate in all hospitals would have sealed the success of prevention for all Maine Hospitals.  Maine Hospitals still have discretion in the use of the weak CDC recommendations when they write their policies. They basically can pick and choose and they might not always choose the best parts of the CDC recommendations.  It’s pretty hard anyway considering they are ineffective (in their current order)  and a couple hundred pages long.

But, to keep this entry positive and upbeat…..Maine hospitals have progressed in their infection control approaches and policies. 

The reason I am so happy about Dad’s hospital is that my mother still lives in that community and depends on that facility for her care.   The nurses and doctors there are awesome, but last year, their MRSA  detection and prevention policy was horrid and inconsistant.  I am now more confident in their approach to MRSA prevention.

I brought my mother beautiful yellow roses (a favorite of both hers and Dad’s) the day of the anniversary of Dad’s death.  But, more importantly, I hopefully brought her a safer hospital.

MRSA Sepsis or Heart attack?

January 8th, 2010 15 comments

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

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

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

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

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

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

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

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

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

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

MRSA high risk screening test in Maine

January 6th, 2010 1 comment

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

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

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

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

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

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

Congresswoman Jackie Speier introduces MRSA bill in Washington DC

June 30th, 2009 2 comments

Congresswoman Jackie Speier, California, introducing HR 2937

Congresswoman Jackie Speier, California, introducing HR 2937

Jeanine Thomas, MRSA Survivors Network

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.

Governor John Baldacci, signing Maine LD1038

June 10th, 2009 1 comment
LD 1038 signing ceremony

LD 1038 signing ceremony

Maine Governor Baldacci signs Maine LD 1038 MRSA bill
Maine Governor Baldacci signs Maine LD 1038 MRSA bill

June 10, 2009 at 2pm, Governor John Baldacci celebrated the signing of several Healthcare bills. LD 1038 was amongst those bills.  It is a much abbreviated version of the original, but screening of high risk patients for MRSA remains.  It will now be law.  I will work diligently with the Maine Quality Forum, the same group that fought to get this bill killed, to have an effective and comprehensive MRSA prevention plan ready by October 1, 2009.

My hope is to begin screening of high risk patients on admission and during hospital stays on October 2, 2009.  This approach will protect patients from getting a serious infection themselves, and it will help to stop the spread of undetected MRSA in hospitals. Patients with positive MRSA tests will be housed separately from those who do not have MRSA. This screening  and isolation will decrease the possibility of acquiring an infection while in the hospital.

In the hospital we have no control over who we are roomed with.  If we go into the hospital, we trust them to room us with somebody who is not a health danger to us.  If we are roomed with a MRSA patient, that increases our risk for infection a great deal.  We share the same bathroom, sometimes the same phone and other devices in that room.

Hospitals need to prepare for a new effective MRSA prevention program that begins with screening of high risk patients.  I am optimistic that hospital staffs

 will embrace this approach because they KNOW that the infeciton control practices that their hospitals are practicing today are not stopping these MRSA infections.   Active Detection and Isolation is a proven approach to prevent MRSA.

Today was indeed a day to celebrate…a new approach to prevention of MRSA in Maine hospitals.