Friday, October 26, 2007

State must push for MRSA tests

State must push for MRSA tests

By BETSY McCAUGHEY First published: Thursday, October 25, 2007

The recent Journal of the American Medical Association report that more people in the United States are killed by super-bug staph infections than by HIV should spur state lawmakers into action.

Some 18,000 people die from methicillin-resistant Staphylococcus aureus (MRSA) infections each year, according to the report, and 85 percent of victims pick up the germ in hospitals and other health care facilities.

The death toll is significantly larger than previous estimates. Why?

Because it is based on patients' actual laboratory results rather than on what hospitals tell families or report on the death certificate. Many families that lose their loved one to a hospital infection are horrified to find that the death certificate says something else.

At last, MRSA victims are being counted. But exposing the size of the problem isn't enough. Other states are requiring hospitals to move aggressively against these infections. Hospitals in New York are doing too little.

In August, Illinois Gov. Rod Blagojevich signed a law requiring hospital patients to be routinely tested for MRSA. New Jersey and Pennsylvania passed similar legislation last summer.

The MRSA test is noninvasive, a simple skin or nasal swab. In 2003, a committee of the Society for Healthcare Epidemiology of America urged hospitals to initiate screening programs.

Hospitals such as Brigham & Women's in Boston, Johns Hopkins in Baltimore, Evanston Northwestern in Illinois, University of Pittsburgh in Pennsylvania, and Veterans' Administration medical centers are leading the way. But most hospitals in New York have been slow to act, and New York lawmakers have been even slower.

Why is MRSA testing needed?

Patients who unknowingly carry MRSA shed it in tiny particles on bed rails, wheelchairs, blood pressure cuffs, stethoscopes and the floor under their beds. They don't realize they have it, because the germ doesn't make you sick unless it gets inside your body through a catheter, a surgical incision or other open wound, or a ventilator.

MRSA can live for many hours on surfaces and fabrics. Doctors and other caregivers who lean over an MRSA-positive patient to change a dressing or do an examination often pick up the germ on their lab coats and transmit it to their next patient.

When a nurse wraps an inflatable blood pressure cuff around your bare arm, the cuff frequently contains live bacteria, including MRSA, left behind by a previous patient. Being in a room previously occupied by a patient unknowingly carrying MRSA puts you at risk.

Holland, Denmark and Finland once faced soaring rates of MRSA hospital infections, and nearly eradicated them. How?

By identifying patients carrying MRSA and taking precautions to prevent the germ from spreading to other patients on hands, equipment and clothing.

These precautions work in America, too. The University of Pittsburgh-Presbyterian Medical Center reduced MRSA infections by 90 percent, using screening and the same follow-up precautions.

Can hospitals afford to screen for MRSA?

They can't afford not to. When a patient develops an infection and has to spend many additional weeks hospitalized, the hospital isn't paid for most of that additional care.

"Virtually all published analyses" show that screening and follow-up precautions cost far less than treating hospital infections, according to the medical journal Lancet (September 2006). Most importantly, screening saves lives.

Screening also protects patients who have MRSA, because once you know that you carry it on your skin, added steps can be taken before and during your surgery to prevent the bacteria from getting inside your body.

New York lawmakers should enact a screening law. In addition, they should insist that all hospitals are inspected for cleanliness. MRSA spreads from patient to patient on unclean hands and inadequately cleaned equipment. Restaurants are inspected yearly for cleanliness, but not hospitals. Not even operating rooms. That's absurd.

Finally, there's the truth gap that the JAMA report exposed. Many more patients have been dying from MRSA than hospitals let on. New York already has enacted a hospital infection reporting law, but its value will depend on truthfulness. When hospitals fail to deal honestly with families about what killed their loved one, there ought to be a penalty.

Betsy McCaughey, a former New York lieutenant governor, is the founder and chairwoman of the nonprofit Committee to Reduce Infection Deaths

Times Union