Staph Superbug May Be Infecting Patients

By MIKE STOBBE – Associated Press - Monday, June 25, 2007
ATLANTA - A dangerous, drug-resistant staph germ may be infecting as many as 5 percent of hospital and nursing home patients, according to a comprehensive study.
At least 30,000 U.S. hospital patients may have the superbug at any given time, according to a survey released Monday by the Association for Professionals in Infection Control and Epidemiology.
The estimate is about 10 times the rate that some health officials had previously estimated.
Some federal health officials said they had not seen the study and could not comment on its methodology or its prevalence. But they welcomed added attention to the problem.

"This is a welcome piece of information that emphasizes that this is a huge problem in health care facilities, and more needs to done to prevent it,"

said Dr. John Jernigan, an epidemiologist with the U.S. Centers for Disease Control and Prevention.
At issue is a superbug known as Methicillin-resistant Staphylococcus aureus, which cannot be tamed by certain common antibiotics. It is associated with sometimes-horrific skin infections, but it also causes blood infections, pneumonia and other illnesses.
The potentially fatal germ, which is spread by touch, typically thrives in health care settings where people have open wounds. But in recent years, "community-associated" outbreaks have occurred among prisoners, children and athletes, with the germ spreading through skin contact or shared items such as towels.
Past studies have looked at how common the superbug is in specific patient groups, such as emergency-room patients with skin infections in 11 U.S. cities, dialysis patients or those admitted to intensive care units in a sample of a few hundred teaching hospitals.
It's difficult to compare prevalence estimates from the different studies, experts said, but the new study suggests the superbug is eight to 11 times more common than some other studies have concluded. The new study was different in that it sampled a larger and more diverse set of health care facilities. It also was more recent than other studies, and it counted cases in which the bacterium was merely present in a patient and not necessarily causing disease.
The infection control professionals' association sent surveys to its more than 11,000 members and asked them to pick one day from Oct. 1 to Nov. 10, 2006, to count cases of the infection. They were to turn in the number of all the patients in their health care facilities who were identified through test results as infected or colonized with the superbug.
The final results represented 1,237 hospitals and nursing homes - or roughly 21 percent of U.S. inpatient health care facilities, association officials said.
The researchers concluded that at least 46 out of every 1,000 patients had the bug.
There was a breakdown: About 34 per 1,000 were infected with the superbug, meaning they had skin or blood infections or some other clinical symptom. And 12 per 1,000 were "colonized," meaning they had the bug but no illness. Most of the patients were identified within 48 hours of hospital admission, which means, the researchers believe, that they didn't have time to become infected to the degree that a test would show it. For that reason, the researchers concluded that about 75 percent of patients walked into the hospitals and nursing homes already carrying the bug. "They acquired it in a previous stay in health care facility, or out in the community," said Dr. William Jarvis, a consulting epidemiologist and former CDC officials who led the study.
The infection can be treated with other antibiotics. Health care workers can prevent spread of the bug through hand-washing and equipment decontamination, and by wearing gloves and gowns and by separating infected people from other patients.
The study is being presented this week at the association's annual meeting in San Jose, Calif., but has not been submitted for publication in a peer-reviewed medical journal.
See also:
Association for Professionals in Infection Control & Epidemiology
The CDC's Web page on MRSA
Source: Associated Press/AP Online

Two FW hospitals among nation's deadliest for heart patients

Baylor All Saints, Huguley say they respect U.S. study, but numbers may mislead
By JASON ROBERSON - The Dallas Morning News -Friday, June 22, 2007
Fort Worth is home to two of the nation's deadliest hospitals for patients being treated for heart failure: Baylor's All Saints Medical Center and Huguley Health System, according to a report from the U.S. Department of Health and Human Services.

After reviewing data on 4,500 hospitals across the country the department's Centers for Medicare & Medicaid Services division released a list of hospitals it said are performing either better or worse than the nation's average mortality rate for patients treated for heart attacks or for heart failure. The report did not list the national averages, nor did it reveal how far off a hospital was from those averages.

All Texas hospitals performed at the national average for heart attacks while five Texas hospitals made the Health and Human Services list for heart failure.
Hendrick Medical Center in Abilene and Christus St. Michael Health System in Texarkana also performed worse than average.

Meanwhile, Houston's Memorial Hermann Healthcare System was the only Texas hospital to do better – with a lower mortality rate than the national average.

The mortality numbers were based on a year's worth of hospital admissions, from July 1, 2005, to June 30, 2006.

The Centers for Medicaid & Medicare Services says it will use the report to help motivate hospitals to improve their quality.

In fiscal year 2008, ending September 2008, poor performing hospitals must show improvement in order to receive full Medicare and Medicaid reimbursements. Health and Human Services will tighten the "pay for performance" incentive measures it has used since 2003.

Executives and spokespeople at Texas' losing hospitals spoke of their hopes to do better. No one disputed the findings.

But a Huguley Health System spokesman said the numbers are somewhat misleading. After receiving news of their mortality ranking on June 11, Huguley hospital administrators pulled the files of deceased patients submitted for the study.

Of the 29 deaths occurring during the study, 10 people were already in hospice care before their heart failure, suggesting they were expected to die, while one was 100 years old and another 98 years old, said Huguley spokesman Kurt Adamie.

"What's weird is that we just received an award from the Texas Medical Foundation two weeks ago for clinical excellence," Mr. Adamie said. He added that Huguley, by just two deaths, missed the bell curve separating average performing hospitals from those performing worse than the national average.

The largest Texas hospital with a higher mortality rate than average is Baylor All Saints.

"Patients should be reassured that there is oversight; people are concerned and we're working to make the necessary improvements," said Dr. Clyde Yancy, medical director of Baylor's Heart and Vascular Institute. "I respect the overall study. Obviously we have to take a look internally."

In a letter obtained by The Dallas Morning News, the Centers for Medicare & Medicaid Services gave hospitals the following disclaimer to its report:

"It is important to note that while your hospital, your state and the national crude mortality rates are all reported here for your reference, they are not directly comparable as they have not been risk-adjusted to account for patient differences, nor have any hospital adjustments been made to account for differences in sample sizes."

In an interview, Dr. Yancy said that adjusting for patient risk factors (such as the number with complicated cases) might have altered the findings.

Still, the report helped identify which areas of heart care need improvement at All Saints, he said.

Since the Fort Worth hospital was on par with the nation for heart attack treatment, Dr. Yancy said he targeted heart failure care with comprehensive educational programs for nurses in February.

Heart failure is the result of any number of diseases that prevent the heart from pumping blood normally. A heart attack is a type of heart failure where too little blood reaches the heart, resulting in damage to the heart's muscle.

Baylor's All Saints Medical Center has scored high in some state quality rankings. According to recent data from the Texas Department of State Health Services, Baylor All Saints' overall in-hospital mortality rate is the fourth lowest among more than 60 Dallas and Fort Worth area hospitals.
At the Hendrick Medical Center in Abilene, which also performed below average, marketing director Karen Brittain said patients should look at a variety of quality indicators. She added that her hospital was recognized as a Blue Distinction Center of Cardiac Care by Blue Cross/Blue Shield of Texas.

"But we certainly welcome any data sources that help us get better," Ms. Brittain said.

Houston's Memorial Hermann Healthcare System, which the Department of Health and Human Services ranks as one of the nation's best, was the only Texas hospital to have a lower than average mortality rate for heart failure patients.

"We as a hospital system are so focused on clinical quality for our patients that we take every guideline endorsed by cardiology societies to heart and work on those every day, so that every patient with a heart attack, every patient with heart failure, gets every known beneficial therapy,"

said Dr. Michael Shabot, chief quality officer.

Dr. Shabot said officials at the hospital were not surprised by their high ranking, having come to expect accolades. "In some ways we're competing with ourselves," he said.

Dr. Shabot did not take issue with the report's assessments.
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