Saturday, October 27, 2007
News

Clear and present danger

Health care-related infections kill about 99,000 Americans each year

Josh Nahum survived a sky diving accident, but not his stay in a hospital.

The 27-year-old son of Armando Nahum of Mableton fractured his skull and broke his thigh while sky diving in Colorado. Hospitalized, the young man was recovering until microscopic bacteria infected his body. One round of antibiotics knocked that infection out, but another took over. His temperature spiked to 103 degrees. Josh lapsed into a coma, became a ventilator-dependant quadriplegic and in less than two weeks was dead.

Josh’s killer was MRSA, or what is sometimes phonetically referred to as “mersa,” shorthand for methicillin-resistant Staphylococcus aureus—a bug that has evolved to resist common antibiotics. More than 94,000 people suffered invasive MRSA infections in 2005, and according to a report published earlier month, Centers for Disease Control and Prevention officials estimate that of those, 18,650 died.

Victoria Nahum’s grief at her stepson’s death was compounded when she learned that his infection is often spread by unwashed hands.

“My family is devastated that he died,” she says. “Not from his accident, but from an infection that he caught afterward. That’s the hard part to get past.”

FROM HOSPITALS TO SCHOOLS AND GYMS

It’s no big secret that many patients contract illnesses from hospitals and health care workers. Such health care-associated infections in general, called nosocomial illnesses, infect an estimated 1.7 million patients in U.S. hospitals and kill 99,000 patients each year, according to the CDC. That’s all nosocomial illnesses combined. But drug-resistant staph, or MRSA, has made the leap outside of hospitals and is increasingly being spread among otherwise healthy people who have not been in contact with health care facilities, according to a report in the Oct. 17 issue of the Journal of the American Medical Association ( JAMA).

Reports of MRSA in school populations across the nation are plentiful. A school in Virginia shut down after cases were reported there in October. In middle Georgia, a Johnson County school was recently sanitized after two cases turned up. In Fulton County, a third-grader at Dolvin Elementary, a sophomore at Milton High School, a Taylor Road Middle School sixth-grader and a Centennial High School junior volleyball player have all told school officials they’ve had MRSA. But even before learning about the students’ bouts with MRSA, officials were planning to teach school administrators about how the potentially lethal bacterium is spread, says system spokeswoman Susan Hale.

Meanwhile, hospitals continue to battle the infections their environments nurture. The parents of a 7-week-old girl recently told an Atlanta TV station that their baby, born premature, died of MRSA contracted at Children’s Heathcare of Atlanta (CHOA) at Scottish Rite. Paul Spearman, director of infectious disease at CHOA, says he couldn’t comment on the child’s death, but hospital officials have continued their efforts to combat the spread of infection.

“Actually, MRSA is something we’ve known about for almost 40 years,” says Spearman. “It’s a problem that at one time was limited mostly to the hospital setting. But it has in more recent years moved into the community.”

MRSA has become the most frequent cause of skin and soft tissue infections among emergency room patients, according to a report by CDC researcher R. Monina Klevens featured in JAMA. Klevens and her co-authors, including Grady Memorial Hospital’s Susan Ray, collected data on invasive MRSA in Atlanta and eight other U.S. communities in 2005 to determine how widespread the infection was. In Atlanta, researchers found 1,165 cases in 2005.

The scientists found that in about 27 percent of the cases, people got the infections while patients in hospitals. About 14 percent got the infection in the community. And about 58 percent got the infection after a health care encounter, such as emergency-room visits or outpatient surgical procedures.
 
“Invasive MRSA disease is a major public health problem and is primarily related to health care but no longer confined to acute care,” the JAMA report concludes. “Although in 2005 the majority of invasive disease was related to health care, this may change.”

Strains of MRSA acquired outside of hospital and health care settings may be virulent and more dangerous to otherwise healthy people than staph strains common in hospitals, says Spearman.

Staph bacteria are found all over in the environment, but this particular strain has mutated and become resistant to being killed by methicillin, an antibiotic in the penicillin family, says Steven R. Katkowsky, director of the Fulton County Department of Health and Wellness.

“In my opinion, we have used antibiotics so frequently that we have actually assisted in the ability of bacteria to mutate and become resistant,” he says.

HOW PEOPLE GET IT AND WHAT IT LOOKS LIKE

The bacteria enter the body through cracks in the skin, such as cuts or scrapes. It can also be contracted by sharing a soda, using another person’s towel, sharing soap or using sweaty exercise equipment, says Katkowsky ,who says this is something to think about at the gym: “It always bothers me when the person in front of me doesn’t wipe down.”

A MRSA infection may look like a spider bite, blister, boil or pimple. Often red and swollen, the infection may accumulate pus or be sore, according to Children’s Hospital officials.

“MRSA can be a challenge to treat,” says Spearman. “The organism is resistant to many common antibiotics, but can still be effectively treated if it is recognized. The best treatment is prevention, which simply requires good hygiene.”

As is the case at many other health care facilities, Children’s Healthcare of Atlanta Pediatric Hospital is stepping up programs to remind health care workers to wash their hands, Spearman says. Each Children’s Healthcare patient room has a dispenser with hospital-grade, alcohol-based hand sanitizer. And the hospital has a campaign to remind workers to be vigilant about hand-washing. Both Spearman and Katkowsky are adamant that patients should feel free to ask doctors, nurses or other healthvcare workers if they’ve washed their hands before being examined.

“That would only help us,” says Spearman. “If it’s important to the public and the patients, doctors will see that it’s important. Only a good thing.”

Reiterates Katkowsky: “If a doctor walks into a room, or any health professional, to examine you, and does not wash their hands in your presence, you can, in a very polite way, ask them to do it. In a very nice way.”

The Consumers Union, publishers of Consumer Reports, has called on hospitals nationwide to disclose publicly how diligent their workers are at hand hygiene. The union supports a bill introduced by U.S. Rep. Tim Murphy (R-Pa.) that would require hospitals and surgical centers to report publicly one or more types of health care-acquired infections, annual reports of infections, and a pilot program to help some hospitals develop anti-infection programs.

“Every day, 50 Americans die from MRSA because hospitals aren’t doing enough to protect patients from these deadly infections,” says Lisa McGiffert, director of the Consumers Union’s Stop Hospital Infections campaign.

Fulton County schools advise student athletes and others to prevent the spread of MRSA by frequent hand-washing, using clean towels and keeping wounds clean and covered, avoiding contact with open wounds, says Hale.

Such precautions can prevent MRSA, the flu and other potentially deadly infections, says Victoria Nahum, who founded the Safe Care Campaign after her stepson’s death last year. Through speeches and a Web site (www.safecarecampaign.org), Victoria and Armando work to educate the public about preventing infections in medical settings.

“The American medical community has alerted us to Avian flu,” says Nahum. “Nobody here in the U.S. has died of Avian flu. But 99,000 people die of health care-acquired illness and 18,000 die of community-acquired MRSA. This is a threat that is a clear and present danger and yet, we know very little about it.” SP

Dr. Spearman and Children’s Healthcare of Atlanta offer the following tips for parents to help prevent MRSA and other illnesses:

Wash both hands with soap and water often.
Clean gym and sports equipment before use.
Keep cuts and scrapes clean and covered with a bandage until healed.
Avoid touching other people’s wounds or bandages.
Wash clothes with hot water and laundry detergent.
Avoid sharing personal items such as towels or razors.

Why doctors, nurses and other health care workers don’t wash their hands, according to the Association of Professionals in Infection Control and Epidemiology:

• Dry hands and skin irritation from over-washing.
• Time constraints from working in an intensive care unit.
• A lack of soap and/or paper towels.
• The belief that gloves replace the need for washing
• Sinks being far away

Fulton County School System’s recommended guidelines for preventing MRSA

• Shower and wash with soap and water immediately after practice, competition and training.
• Don’t share personal care items such as bars of soap, towels and razors, uniforms, and sports equipment that directly touch the body.
• Take home practice clothes, towels and other linens every day, using clean practice clothes every day at school.
• Wash practice clothes, uniforms and other sports-related linens in hot water and laundry detergent. A hot dryer, rather than air drying, also helps kill bacteria.
• Wipe down athletic equipment and materials with sanitizer regularly.
• Notify coaches, athletic trainers and the school’s clinic staff of any wounds that are potentially infected.
• Keep all wounds clean and covered and avoid contact with others’ open wounds, or anything that could possibly be contaminated by infection (boils, blisters, etc).
• Wash hands frequently with soap and water, especially after practice, competition and training.

For more information:
www.Safecarecampaign.org