Procedure brings controversy but could become more commonplace as MRSA spreads.
By Mary Ann Roser - AMERICAN-STATESMAN STAFF - Monday, July 30, 2007
Worried about the spread of a superbug that no longer responds to penicillin and some other common antibiotics, hospitals across the country — including some in Central Texas — are starting to test new patients for the bacteria and isolate those identified as carriers.
Some hospitals even isolate patients who are at risk of being carriers of MRSA, or methicillin-resistant Staphylococcus aureus, a bacterium that experts say has become drug-resistant largely because of overuse of antibiotics.
The Seton Family of Hospitals, the largest health system in Central Texas, says it isolates people at high risk of carrying MRSA but hasn't decided whether to do testing. St. David's HealthCare hospitals and Cornerstone Hospitals say they test high-risk patients and isolate those who test positive for the bacteria.
The bacterium, which in recent years has taken root in some football locker rooms and jails, causes infections that look like a pimple or spider bite. The wound usually clears up after treatment, often with vancomycin, one of the strongest antibiotics, or by draining the abscess.
But MRSA can invade the bones, joints, blood, heart valves and lungs, creating a potentially lethal infection for the elderly or people with weakened immune systems.
Hospitals, which are full of people who fit that description, have seen MRSA infections spiral. A broad survey of the nation's health care facilities found that 34 out of every 1,000 hospital patients had active MRSA infections, and an additional 12 were carriers, the Association for Professionals in Infection Control and Epidemiology reported last month.
The report's author, Dr. William Jarvis, and MRSA expert Dr. Lance Peterson, a physician and epidemiologist at Evanston Northwestern Healthcare in Evanston, Ill., said that although the report did not examine death rates from MRSA, a conservative estimate is that 10 percent of hospital patients with the infections die.
Jarvis is a consultant and former director of a program specializing in hospital infections at the U.S. Centers for Disease Control and Prevention.
Health care experts are divided over how far hospitals should go to detect and contain the bacteria. There are no national requirements, and the CDC offers basic guidelines but recommends that hospitals decide for themselves the best approach.
"Some places across the country screen everybody; some just look at their high-risk populations," said Joanne Dixon, director of infection control at Seton. "We need to make a sound decision here."
Evanston Northwestern's three hospitals, which admit 40,000 patients a year, became the first in North America to test all patients for MRSA two years ago, Peterson said.
At the end of the first year, in July 2006, it found 1,260 MRSA infections, 90 percent of which were picked up in the hospital, Peterson said. Once the hospital began testing all patients and isolating those who were infected or carrying MRSA, the number dropped to 80, Peterson said.
"You have to do a lot of surveillance," he said, adding that the testing program costs $600,000 a year.
The infection control association's report found that just 28 percent of the facilities it surveyed test patients for MRSA.
And Peterson said that up to 30 percent of people in some high-risk groups are MRSA carriers and may not know it. High-risk patients include anyone receiving invasive procedures — from dialysis to heart surgery — that could give the bacteria an opening and those transferred from places where MRSA can be easily spread, such as nursing homes, jails and other hospitals.
"If we had this level of avian influenza on Earth, we'd have everyone screaming," Jarvis said. "I'm hoping it is a wake-up call to . . . hospital administrators and CEOs of hospitals that it's a very significant problem that we now have evidence-based data on how we can reverse it."
The association has urged hospitals to be more aggressive about MRSA.
President Denise Murphy said facilities getting the best results in controlling the bacteria identify the hot spots in their facilities for spreading MRSA, test high-risk patients and take extra precautions with those who test positive, stress good handwashing procedures by staff members and disinfect patient rooms daily.
Seton, which operates seven acute-care hospitals in Central Texas, has been isolating patients at high risk for the bacteria since 1996, Dixon said. Seton said positive MRSA tests at its hospitals have increased 11 percent in the past three years.
St. David's HealthCare, which operates five acute-care hospitals in Central Texas, started testing patients at high risk for MRSA in May, following a policy its parent company, HCA, instituted nationwide.
The hospitals swab a patient's nose to test for the bacteria, said Karen Degtoff, infection control coordinator at St. David's.
If the test shows that the patient is an MRSA carrier, he or she is put in isolation, which means staff members take special precautions when treating the patient, such as wearing a gown and gloves. Visitors also are instructed to wear protective garb, Degtoff said.
The patients may be restricted to their rooms, depending on their condition and whether their recovery depends on walking. Those who leave their rooms are told to wear a gown and gloves, hospital officials said.
Dr. Steve Berkowitz, chief medical officer for St. David's HealthCare, said that since testing started, 11 percent of patients facing high-risk procedures, such as heart bypass or orthopedic surgery, have tested positive for MRSA.
But not all doctors agree with what local hospitals are doing, and some patients have been downright bewildered.
Norman Tolpo, 71, of Austin said he was put in isolation after testing positive as a carrier for MRSA while he was a patient at St. David's Medical Center in Austin in early June.
Tolpo said he found the restrictions baffling and inconsistent. He protested to the staff that he didn't have an active infection and asked why all incoming patients — and the staff — weren't tested.
Even without an active infection, a person who is a carrier can still spread MRSA, he was told.
"Let's say they get nasal secretions on their hands and they shook the hand of a nurse," Berkowitz said. "It could still be spread to another person."
Michael Killiam, Tolpo's family practice physician, said Tolpo has raised some valid points. "If you're going to be consistent, you've got to test everybody," Killiam said.
The CDC does not recommend testing hospital staff members, and hospital officials said they think proper handwashing and protective garb is enough.
And Murphy, the association president, doesn't endorse testing all patients.
"We believe you need to use finite resources wisely by doing a risk assessment," said Murphy, who said she lost her mother to a hospital infection. "If we had all the money in the world, it would be different."
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