By Victor Epstein
(Bloomberg) -- Missy Baker recalls the moment when she realized that her football-playing son, Boone, didn't just have the flu.
"He told me he was paralyzed,'' Baker said. "I said, `What do you mean? I just saw you walk to the bathroom two hours ago." And he said, `Mom, I can't move my arms or legs."
Sixteen-year-old Boone, a wide receiver for Texas's Austin High School, was suffering from a recurrence of methicillin- resistant staphylococcus aureus, or MRSA, which his doctor said he got through an abrasion from playing on artificial turf, Baker said.
Texas has artificial turf at 18 percent of its high school football stadiums, according to Web site Texasbob.com. It also has an MRSA infection rate among players that is 16 times higher than the estimated national average, according to three studies by the Texas Department of State Health Services.
"This is a disease that can kill you,'' said Carolina Espinoza, a graduate epidemiology student at the University of Texas in Houston, who helped conduct one of the studies. "If I were a football player, I would be alarmed."
MRSA is a virulent strain of drug-resistant staph bacteria that plagued hospitals for decades and migrated into the general population in recent years, said Edward Septimus, an infectious disease specialist at Methodist Hospital System in Houston. Without proper treatment, it can spread to internal organs and bones after reaching the bloodstream, causing organ failure, he said.
In October, the deaths of a Brooklyn boy and a Virginia youth were blamed on MRSA infections.
At least 276 football players were infected with MRSA from 2003 through 2005, a rate of 517 for each 100,000, according to the Texas studies. The U.S. Centers for Disease Control and Prevention in Atlanta reports a rate for the general population of 32 in 100,000.
Football players often become infected at the site of a turf burn and are misdiagnosed, said David Smith, co-author of a study showing that MRSA-related hospitalizations in the U.S. more than doubled from 1999 to 2005.
"The turf burns themselves are just the kind of minor skin injury that MRSA can exploit,'' said Elliot Pellman, medical liaison for the National Football League, which also has had infections among its players.
Football dominates high school sports in Texas, which has more participants than any other state. Seventy-four schools have stadiums seating more than 10,000. The sport provides 22,041 full-time jobs and generates $2.88 billion in annual spending, said Ray Perryman, president of Perryman Group, a Waco economic and financial analysis firm.
Football also produces more MRSA infections than any other sport, said Marilyn Felkner, the epidemiologist who led the Texas studies. The department wasn't able to obtain enough data to establish a statistical link between artificial turf and MRSA infections, she said.
"So many schools had at least one case,'' Felkner said of a 2005 report showing 76 high school athletic departments with MRSA infections. "It was more schools than we would have thought.''
In Collin County, which includes parts of Dallas and Plano, six high schools had more than two infected athletes this fall, said Janet Glowicz, county epidemiologist.
MRSA causes more deaths than any of the 51 infectious diseases tracked by the CDC, including AIDS, according to CDC data. The agency doesn't require medical professionals to report MRSA cases.
Texas plans a pilot program next year making MRSA a reportable illness in three regions, said Bryan Alsip, assistant health director for San Antonio.
Researchers including Septimus blame MRSA's spread on overuse of antibiotics. A CDC report in the Journal of the American Medical Association showed that MRSA caused three times more infections than previously thought.
"This is an epidemic,'' Smith said. His report was published by the CDC in the December edition of Emerging Infectious Diseases. "It's a big problem, and it's likely to get bigger.''
Smith said the public needs to hear more about MRSA. There is no benefit in alarming people, but they have a right to know that it is a serious situation, he said.
Spreading MRSA can be prevented by frequent hand washing, covering scratches and turf burns, disinfecting whirlpools between uses, and not sharing towels or razors, the Texas health department advises.
Mike Carroll, head athletic trainer at Stephenville High School near Fort Worth, said he tells coaches to avoid saying "staph'' when they see a possible infection.
"You want people to be educated, but you don't want to create a sky-is-falling mentality,'' Carroll said.
Baker said she was shocked to learn how pervasive MRSA is. It's also persistent: Boone was originally diagnosed in October 2006, and the infection returned last January. He had three surgeries to remove infected tissue and spent three weeks in the hospital.
While Boone resumed playing football this season, fear of another relapse haunts the family. Some survivors continue to carry the bacteria, according to doctors and the CDC.
Baker said she and her husband spent a sleepless night when Boone developed a skin infection that looked like a spider bite.
"We were both wide awake and shaking with fear,'' she said. The wound cleared up the next day.
By Victor Epstein
(Tara Parker Pope for The New York Times)
Everyone knows hand washing is important. But a new study shows how washing your hands often, and at the right time, can have a big impact on your family’s risk for getting sick.
Most studies on hand washing focus on medical and food service workers. But this month’s American Journal of Infection Control focuses on washing hands at home as a way to stop infections from spreading. Several studies show hands are the single most important transmission route for all types of infections.
Even though most people know to wash their hands after using the toilet or handling a diaper, studies suggest many people are still ending up with germs, particularly those spread by feces, on their hands after leaving the bathroom or caring for a baby.
One study looked in homes of infants recently vaccinated against polio. After vaccination, the virus is known to shed in the baby’s feces. Researchers found the virus on 13 percent of bathroom, living room and kitchen surfaces. While the virus from the vaccine didn’t pose a health risk, the study shows how feces-borne viruses can travel through the home.
Another study found that in homes where salmonella cases had been diagnosed, the bacteria were still lurking in toilet bowls three weeks after the outbreak. Water splashing on the toilet seat was a source of contamination.
Doorknobs, bathroom faucets and toilet flush handles are key sources of germ transmission in the home. That’s why people should focus on cleaning such surfaces regularly and always wash hands after touching them. In one study, a volunteer touched a door handle that had been contaminated with a virus. He then shook hands with other volunteers, and further tests showed he had spread the virus to six people.
The study authors note that the timing of hand washing is key. It’s obvious to wash hands after using the toilet, after sneezing or before eating or handling food. Other crucial times for hand washing are after changing a diaper or cleaning up after a pet, or after touching garbage cans, cleaning cloths, cutting boards, dish rags and utensils that may have come into contact with raw food.
While it may be hard to believe that something as simple as regular hand washing can make a difference in your family’s health, consider what happened in Hong Kong during a 2003 outbreak of SARS, a severe and potentially deadly form of viral pneumonia. The outbreak triggered extensive public and community health measures promoting basic hygiene, including regular hand washing. Not only was the SARS outbreak contained, but other cases of respiratory illnesses, including the flu, dropped sharply.
New York Hospitals Expand Efforts To Reduce Infections
By E.B. SOLOMONT
Staff Reporter of the Sun
A coalition of New York hospitals that has been working to reduce hospital-acquired infections is expanding its efforts, just as the state Department of Health prepares to publicly report infection data for the first time next year.
The 60-hospital group plans to focus on the bacterial infection, Clostridium difficile, as well as the safety of mothers and babies just before birth and immediately after.
In broadening the coalition's focus, its organizers said they hope to change the culture of hospitals and to improve the quality of health care. The new effort also calls for educating front-line hospital staff — everyone from physicians to housekeepers — on infection control.
"As we focus on small initiatives, they'll be able to morph these initiatives into broader ways to tackle things that happen that shouldn't," the vice president of quality and patient safety at the Greater New York Hospital Association, Terri Straub, said. The effort will be underwritten by a two-year $500,000 grant from the United Hospital Fund to the GNYHA Foundation.
Hospital-acquired infections represent a serious problem around the country. Nationwide, patients develop an estimated 1.7 million infections each year.
Regional infection data is not available for New York, although hospitals here spend an estimated $2 billion each year treating preventable infections, according to a New York-based group, the Committee to Reduce Infection Deaths. On average, hospitals spend between $25,000 to $70,000 treating each infection. Recognizing the cost and the health toll of such infections, the coalition of New York hospitals began in 2004 to focus on reducing bloodstream infections associated with a type of intravenous hookup called a central line. Since then, the collective infection rate among the participating hospitals has dropped, according to data obtained from the United Hospital Fund and GNYHA, which spearheaded the collaborative. In April 2007, hospitals reported monthly infection rates of 1.76 for every 1,000 central line days, down from 5.01 in June 2005, the organizations reported.
As part of the new effort, the UHF and GNYHA will also train physicians as Quality Fellows, who would become advocates for quality improvement at their own institutions. "We wanted to try to develop a cadre of physicians in these hospitals who were basically going to quality boot camp to learn the principles, skills, tools, and strategies that broadly apply to quality improvement," the project director of the United Hospital Fund's Quality Strategies Initiative, Rachel Block, said.
Organizers said other important components of a sought-after culture change include standardizing communication among staff, and educating front-line employees regarding infection control.
For example, individuals who transport patients play a pivotal role, Ms. Straub said. "Transporters had no idea that their failure to clean a stretcher properly could impact a patient's outcome… So when they hear what a great role they have they might start to think differently," she said.
So far, the collaborative does not have plans to directly address the spread of methicillin-resistant staphylococcus aureus, a bacteria that made headlines as a "super-bug" this fall after a Brooklyn boy died from the bacterial infection. However, organizers said they hoped the initiative would have a "spillover effect" that would reduce MRSA and other infections.
From the Concord Monitor
The more steps in a procedure and the more procedures that must be done, the more likely it is that one step will be forgotten. Sometimes no harm is done. But in flying a plane, defusing a bomb or performing a medical procedure, skipping one step can prove fatal. That step could be as simple as a harried physician forgetting to wash his hands.
Some 80,000 to 100,000 people die each year from infections acquired in a hospital, according to federal estimates. Many of those deaths result from "line infections" that occur when a pathogen is introduced into the bloodstream by a catheter inserted into a vein or artery. Line infections, which in one hospital led to an average of $61,000 in additional charges, add billions each year to the nation's health care bill.
In the current issue of The New Yorker, Atul Gawande, a surgeon and Harvard Medical School professor, explains how in 2001 a doctor developed a program that reduced the line infection rate to near zero in the hospitals that adopted it. The basic tool used by that doctor, Peter Pronovost of Johns Hopkins Hospital, was the checklist.
The steps on Pronovost's checklist are simple: wash hands with soap; clean the patient's skin with antiseptic; cover the patient with sterile drapes; wear a sterile mask, hat, gown and gloves; and place a sterile dressing over the catheter line.
Pronovost tested the effectiveness of his list in several facilities, including an inner-city Detroit hospital whose intensive care unit saw a steady influx of gunshot victims. That hospital had a whopping 11 percent line infection rate. Within a year, using the checklist, the rate fell to zero, thanks in good measure to empowering nurses to call a halt if doctors forgot a step. By eliminating line infections, the hospital calculated that it had prevented 43 infections and eight deaths and saved $2 million.
New Hampshire's intensive care units already have low line infections rates. The state's 26 hospitals had just 28 in the first six months of 2006. Though the hospitals aren't using Pronovost's list, they follow a similar protocol. But the right rate, state epidemiologist Jose Montero says, should be zero. Almost all such infections are preventable, though when they occur, it's not always easy to determine whether the intensive care unit rather than an ambulance crew or emergency room staff was to blame.
Next month, the state is launching a pilot program in six facilities, including Concord Hospital, to track not just line infections in ICUs, but also whether antibiotics are administered prior to surgery and how often knee replacement surgery results in an infection. Hospitals with the lowest rates will be studied to see what they do right. Then that information will be shared with other hospitals so they can change their procedures.
Checklists like the one that has practically eliminated line infections in the hospitals that use them have been developed for a number of medical procedures - like care of patients who need a ventilator to help them breathe, for example. More lists are being developed all the time.
Unfortunately, Gawande reports, though line infection checklists could be in use nationwide within two years, hospitals have been slow to adopt them. That shouldn't be the case in New Hampshire, and thanks to efforts already undertaken and others under way, it doesn't look like it will be. The faster medical science advances, the more valuable the humble checklist - the same tool shoppers use - becomes. When doctors can do so much, there's so much to remember.
The True Scale of Health Care Acquired Infections:
The World Health Organization reports that at any given time, over 1.4 million people worldwide are suffering from infections acquired in hospitals including hospitals in the United States.
As many as 10% of patients admitted to modern hospitals in the developed world acquire one or more infections.
The risk of health care-associated infection in developing countries is 2 to 20 times higher than in developed countries. In some developing countries, the proportion of patients affected by a health care-acquired infection can exceed 25%.
By CHERIE BLACK
As she walks with her mother into the front lobby of Children's Hospital and Regional Medical Center in Washington state, a 3-year-old girl reaches above her head to squeeze some hand sanitizer into her hand. The kiosk prominently placed in the middle of Giraffe entrance lobby is taller than she is, but almost instinctively, the toddler knows to slather the antibacterial sanitizer over her tiny hands.
Before MRSA -- methicillin-resistant Staphylococcus aureus -- seeped into everyday conversations and the public wondered where the antibiotic-resistant bug would strike next, Washington hospitals were looking at ways to reduce infections within their walls.
The solution: Wash your hands.
The surprise: That so few health care professionals were regularly doing so.
MRSA, which has been common in hospitals for years, more recently began spreading outside hospital settings. Still, about 85 percent of cases take place in health-related settings, according to the federal Centers for Disease Control and Prevention.
The CDC's October report estimating that more than 90,000 Americans are sickened annually by MRSA, and nearly 19,000 die from it each year, caused mild panic and questions about what can and should be done.
In 2005, the Washington Hospital Association started a program to reduce infections. The next year, a formal hand hygiene program was launched, with patient participation in mind. Patients are encouraged to ask their doctors if they've washed or sanitized their hands before an appointment. The association also measures how much soap and sanitizer a hospital uses by counting empty bottles and comparing that number to how many patients spend the night at the hospital. They then send each hospital a monthly report.
The voluntary program involves about half the hospitals statewide, said Carol Wagner, the association's vice president for patient safety. The rest of the hospitals are using observational methods to help increase hand hygiene, she said.
The Washington Hospital Association "took this on two years ago when MRSA wasn't all over the news," Wagner said, noting a 35 percent average increase in hand hygiene compliance among hospitals in just under two years.
"Hand hygiene seems like it would be easy, but it's a cultural and physical behavior. It's a compliment to physicians that patients are participating in their care."
A 2002 CDC-published "Guidelines for Hand Hygiene in Health Care Settings" said the reasons staff members gave for not washing up regularly were not enough time, a lack of soap and paper towels, sinks inconveniently located, and patient needs taking priority over hand washing. They also believed there was a low risk of catching an infection from a patient.
Enter alcohol-based sanitizers. The guidelines showed that not only did sanitizers do a better job of disinfecting hands than soap alone, they took less time to use and were more accessible than sinks. According to the guidelines, during an average eight-hour shift, a nurse spends 56 minutes washing his or her hands with soap and water. A hand sanitizer consumed 18 minutes of the shift.
At Children's, an observer in 2001 collected data that showed about a 60 percent compliance for hand washing, said Dr. Danielle Zerr, medical director of infection control.
That "wasn't a huge surprise it's 40 to 60 percent in studies nationwide, but we wanted to attack this vigorously and get our rates up," Zerr said. "It's challenging for busy health care workers to spend the time required to frequently wash hands with soap and water. Alcohol hand sanitizers take much less time and have helped us improve hand hygiene."
Gels -- and spies -- can be credited for increased compliance at Children's, which now is up to 88 percent. The hospital has been anonymously observing and recording staff hand hygiene in all units for the past six years after realizing they should be keeping track of compliance, Zerr said.
Children's Hospital has hand gel dispensers inside and outside each room.
There's also a competition between nurses, physicians and other staff members to see who does the best with hand hygiene. Children's added hand gel dispensers to the outside and inside of all patient rooms.
"This year, hand hygiene is a hospital safety goal and we're looking more into holding people accountable for their practice," Zerr said.
"Increased awareness and concern about infections is what's driving this program. Certainly there are situations where the vast majority of the time we can reach 100 percent (compliance)"
Evergreen Medical Center in Kirkland is at or above 90 percent compliance, according to the monthly hand washing reports the hospital receives from the state.
A Washington State Hospital Association brochure is also placed in the handbook given to patients and their families. Physicians and staff also wash their hands in front of patients in rooms or treatment areas whenever possible.
Virginia Mason Medical Center launched a "wash your paws" campaign with employees last month. Buttons in University of Washington and Washington State University colors were passed out to employees which say, "Ask if I washed my paws." The idea is to encourage patients, guests and employees to constantly be aware of hand hygiene. The hospital will begin tracking compliance in 2008 in hospital departments and clinics.
Since September of last year, a hand hygiene committee has met monthly at the University of Washington Medical Center to see what can be improved. The hospital also is involved in the state's initiative and scored 85 percent compliance for the month of October, said Estella Whimbey, the hospital's associate medical director.
"The fundamentals of infection control are hand and respiratory hygiene," Whimbey said.
"It's the most important factor in reducing infections and is our No. 1 priority. Once we do that, everything else falls into place."
By Steven J. Spear and Donald M. Berwick
The choice between expanding health coverage and controlling healthcare costs is a false choice based on a false assumption: that resources committed to healthcare are used efficiently and effectively. The mistaken notion makes budgeting the key decision and masks a much better alternative. There is ample evidence that better care could be provided to more people at lower cost if care delivery were organized in a more sophisticated fashion.
Today, healthcare is delivered as it was 50 years ago, when only a limited range of illnesses could be detected and treated, and when even the most sophisticated treatments involved only a few professionals. Professionals were organized in silos: nurses in one, various types of doctors in others, and so forth. Grouping by peers afforded the benefits of professional association, such as sharing knowledge, setting standards, and camaraderie, and, for simple treatments, ad hoc, informal coordination across silos was adequate, management of patient information was simple, and piece-rate payment - paying a certain amount for each person's time - worked fine.
Medical science has advanced dramatically. Once-terminal diseases are now manageable - like AIDS - and even curable - like many cancers. But, care delivery, information, and payment systems have not kept pace with the science. Professionals are still organized in silos, despite the pressing need to integrate their work into coherent processes; information is still fragmented, despite the benefits of holistic views of patients; and payment is still piece-rate even though practitioners are no longer in any meaningful sense independent of each other.
The consequences are destructive. Too little preventive care increases the need for chronic care. Ineffective chronic care for diabetes, heart disease, and depression increases the need for costly acute care of limited effectiveness, and which often causes needless harm. The chance of being injured by hospital care is greater than one in 10, and the chance of accidental death due to mismanaged care is about one in 300. Problems are so pervasive that Medicare announced it will withhold payment for fixing some of the problems created by defects in care.
Needless suffering from badly delivered care is tragic; squandering hundreds of billions of dollars is unconscionable. In part because of these inefficiencies, the United States spends twice as much on care, per capita, as other developed nations do. US government spending alone on healthcare is enough to buy all of the healthcare per capita in many developed nations.
There is an alternative. Some organizations have started emulating outstanding nonhealthcare organizations in actively managing how the process, information, and payment pieces mesh together. The results have been sometimes spectacular.
Pioneers have reduced rates of hospital-acquired infections, falls, medication errors, and other complications - symptoms of fragmentation - by 90 percent and more, saving thousands of lives and hundreds of millions of dollars. Ascension Health, the largest Catholic healthcare system in the United States, reports pressure ulcer rates in its 67 hospitals 93 percent lower than the national average, birth injury rates 74 percent lower, and patient falls 86 percent lower. Virginia Mason Medical Center in Seattle targeted its Gastroenterology Department, freed capacity, saved millions of dollars in capital investments, and increased access by 50 percent. It taught its migraine patients how to avoid and manage recurring pain, thereby reducing emergency department visits for this by 50 percent, with sharp reductions in expensive imaging, contrary to trends for the broader, non-VMMC population of migraine sufferers. Mayo Clinic has reported more than a 50 percent drop in rates of medical injuries to patients in all three of its flagship hospitals. Hospitals that have adopted better processes to deal with 11 common challenges - such as acute heart attacks, patients on ventilators, early identification of deteriorating patient conditions - championed through the Institute for Healthcare Improvements 5 Million Lives Campaign, have documented major improvements in outcomes.
If these stories were national norms, not exceptions, the benefits to patient well-being and to costs would be staggering. Getting there need not be a fantasy. Hospitals, nursing homes, dialysis units, ambulatory surgery centers, and physician offices can improve the reliability of its own processes, and their coordination with other organizations, in managing preventive, chronic, acute, and urgent care. Medical, nursing, pharmacy, and other professional schools can complement medical science training with training in managing complex work systems, preparing their graduates to be excellent in their roles, and also in tying the pieces together in total systems of patient care. Insurers, employers, and other payers can change their buying patterns, to demand and reward coordination and uncompromising process excellence across the entire care continuum. Since the public sector is the nation's largest payer, and it supports large medical schools, it can insist on system improvement.
This is a hard sell. The wonk factor is high. Focusing on improving the processes by which care is delivered lacks the rhetorical punch of advocating for universal coverage. Making healthcare processes better is more diffuse work, done at the organizational level, not through dramatic legislative, regulatory, or fiscal flourishes. It requires leaders to get into the nitty-gritty of patient care, finding deficiencies in current approaches, confronting professional norms and habits that overvalue autonomy, tolerate unscientific variation in practice, and undervalue cooperative behaviors, and making continual improvements. But a strong link exists between the moral obligation of universal care for Americans and the hard work of redesigning and improving healthcare processes. Indeed, given the costs and waste in the healthcare status quo, redesign may be our only sustainable route to justice and financial solvency.
Schools closing for scrubbing. Sports cancelled. Worried school officials, worried parents. Confusion, conflicting advice, uncertainty.
So what's the story with MRSA? MRSA- methicillin resistant staph aureus has become a household word. MRSA used to be a hospital germ, seen in patients who were frequently hospitalized or in long-term care, especially those with medical tubes. Often, it wasn't particularly harmful; however, with time the germ has evolved, and some varieties of MRSA can now cause severe illness.
In the last five years MRSA infections have occurred in the community among people who have no history of recent hospitalizations.Community-associated or CA-MRSA infections often start as skin and soft tissue infections. Many people think they have a "spider bite" or "bug bite." The skin infections have been described as "boils" or even "little volcanoes." While resistant to methicillin, CA-MRSA can be treated by a number of antibiotics that can be given by mouth. Septra and clindamycin are two frequently used drugs. With small skin infections, often just opening and draining the abscess will work just fine.
So why all the concern? In rare cases, MRSA can cause life-threatening infections. It can cause pneumonia, a serious lung infection, or get into the bloodstream and cause a bloodstream infection called sepsis. In a few cases, the infection is so severe that the person dies from it. This is a small number of people compared to the number with treatable skin and soft tissue infections or those who have the organism on their skin but have no symptoms of infection at all. There are other germs that can do the same thing, too.
What can you do to protect yourself and your family?
Handwashing is the most important way to protect yourself against MRSA, colds and flu, and even upset stomachs and diarrhea. Most of the germs that cause illness get on our hands, then we put our hands in our mouths, rub our eyes or nose and put those germs into places that can make us ill. Warm, running water, soap and friction for 20-30 seconds, scrubbing all hand surfaces, will remove most of those harmful bugs. If soap and water aren't available, use an antiseptic hand cleaner that contains at least 60% alcohol.
A clean environment helps stop the spread of disease, too. Kids and adults in schools, day cares and other close quarters touch a lot of shared surfaces. Think about the pencil sharpener, door knobs, desks, tables, books and the many things we touch throughout the day. Keeping surfaces clean and cleaning on a regular basis is a good way to prevent transmission of germs. In sports and gym classes, it's very important that equipment that comes in contact with kids gets disinfected between and after uses. Wrestling and tumbling mats, protective helmets and pads, any shared clothing, etc., must be sanitized after each use. Schools and gyms should have a written policy on WHO is to do this, WHEN this is to be done, WHERE cleaning will take place, WHAT they will clean with, and HOW the item will be cleaned.
After sports or gym class, kids need to take a shower with soap. Who doesn't forget that first after-gym shower! Not only should everyone shower, towels shouldn't be shared. Once the person has dried off, the towel goes into the hamper or the gym bag to go home for laundering. All sports clothing and gym suits must be laundered after each use. That "lucky shirt" will be just as lucky clean as full of germs. Probably luckier, because the wearer is less likely to get an infection!
What happens if you get a MRSA infection? First, be sure to see your healthcare provider. MRSA infections are nothing to fool around with. Your provider may open the wound and drain it and give you instructions for caring for the wound while it's healing. Small wounds often do NOT need antibiotics, so you may or may not get a prescription. If you DO get antibiotics, be sure to take them exactly as prescribed. Remember, it's the last few pills that kill the hardiest bugs, so don't stop taking them until the pills are all gone. If your infection gets worse, or you have a fever, seek medical attention.
To prevent spread to others, be sure to keep your wound covered with a bandage that doesn't leak. Hands should be washed thoroughly before and after changing the dressing. Used dressings should be placed in a plastic bag that is tied up and then placed in a wastebasket. It is safe to go to school or work as long as the dressing will stay in place and not leak during the school or work day. If the wound is leaking and the drainage can't be contained, stay home until it gets manageable. If the drainage gets worse, seek medical attention.
by Michelle Beaver, Infection Control Today
Ideally, infections would pack up and go to Pluto. But since that’s not going to happen, infection control practitioners (ICPs) will continue to be busy with outbreak surveillance. Fortunately, several programs can save valuable time and remove uncertainty and inconsistency when it comes to tracking methicillin-resistant Staphylococcus aureus, Clostridium difficile, and other unwanted visitors.
Good automated surveillance systems can detect potential outbreaks early on, and provide that information to ICPs and epidemiologists clearly and quickly. This allows staff members to move fast and in a focused fashion.
An automated surveillance system is useless, however, without savvy staff members at the helm, says Salah Qutaishat, PhD, CIC, FSHEA, an epidemiologist and director of infection prevention and control at Premier Inc. healthcare alliance. Premier is a hospital performance improvement alliance with 1,700 participating not-for-profit hospitals and health systems nationwide. Its administrators collect and analyze clinical and financial data from its member hospitals, organize committees, sponsor seminars and conferences, and share best practices.
“An astute clinician is the most important element in detecting potential outbreaks and they are essential in providing guidance and direction in the prevention and control of these outbreaks,” Qutaishat says. “Automated surveillance systems are a supplement to the talent and expertise of these clinicians.”
Systems allow ICPs to be more efficient and to spend their time, “finding ways to prevent infections rather than digging through paper laboratory reports trying to identify them,” Qutaishat adds. The amount and extent of resources ranges widely between facilities, however, says Runa Dhar Whitaker, a director at RL Solutions, a software company that provides software systems to hospital and healthcare facilities.
“Surveillance may be for outbreaks, but may also be for a range of other things, such as day-to-day infection control and assessing how to prevent infections,” Dhar Whitaker says. “Typically, ICPs are unable to do as much surveillance or preventative contact as they would like to, but it does depend heavily on the facility, because some hospitals have one ICP per 100 beds, (while) others have one per 300 beds. Also, the range of tools provided for ICPs varies from none (other than Microsoft Excel) to some hospitals with in-house information that can provide a lot of support.”
And what is the bane of existence for most ICPs in regard to outbreak surveillance?
“Usually it is the frustration of not having sufficient resources to do the preventative and post-outbreak isolation etc., that is required to minimize the spread of the infection,” Dhar Whitaker says. “However, related to this is the frustration of having to do manual file creation and surveillance when this work could be done by a computerized system. Anything that will allow an ICP to get more time dealing with the issues on the ground is of help.”
What Does Automated Surveillance Do?
Surveillance systems monitor patient cultures. They use rules and algorithms to identify pathogen patterns and to realize when control limits have been exhausted, says Jeff Hodson, RN, BSN, CIC. He is also product manager for the TheraDoc® Infection Control Assistant®.
“Early recognition of pattern variance helps the ICP to stop an outbreak in progress, or possibly prevent an outbreak from occurring,” Hodson says.
The programs should also export data to Microsoft Excel, Microsoft Access and other programs. This type of efficient data management frees ICPs from manually reviewing laboratory and patient data, and instead allows them to focus their efforts on education and interventions, says G.T. LaBorde, a vice president of Cardinal Health, MedMined™ Services.
Efficient data management should include real-time, customizable event monitoring and reporting across an entire health system, according Med- Mined™ Services product designers. They suggest that surveillance programs should not require manual data entry. Furthermore, the programs should include patient details from present and past, and information on patient location, physicians, organism resistance, etc.
“The ability to have this electronic data and to be able to do surveillance across the hospital with the press of a button and then tie that data to financial data really has the ability to elevate infection control to really a different level in the organization,” LaBorde says.
“My advice is to think big about what you’d really like your department to be and do, not just limit it to data crunching and reporting,” LaBorde adds. “It may be that what technology or certain solutions allow you to do is change your whole department.”
It is becoming common knowledge that hospital-acquired infections (HAIs) cost the healthcare system dearly. Reducing infections requires an investment, but is worth it in the long run, both financially and in patient health.
Some automated surveillance systems help make the business case for infection prevention, and can convince the powers that be to invest in ICP resources. LaBorde says that MedMined™ Services customers often see an increase in their full-time equivalents (FTEs) when surveillance materials prove to administrators the financial impact of infections.
“You think, ‘Well, if you spend budget money to buy an electronic service then you wouldn’t be able to then justify additional FTEs — you’ve already spent your budget money,’” LaBorde says. “But what we find is that when you have this comprehensive surveillance methodology and you can tie that to the financial outcomes of the facility, you are able to illuminate for hospital administrators how big a problem this is not just to patient care but also to the bottom line of the hospital.”
Technology should not threaten jobs — it should support them.
“Some ICPs worry that technology will take their jobs away and really the opposite is true,” LaBorde says. “What our clients have seen is a net increase in staffing because they’re able to measure things objectively and financially justify infection control efforts.”
Once MedMined™ clinical tools identify an HAI, they tie that data to the hospital’s accounting system. This answers questions such as, “’What are the increased costs and length of stay and unprofitably when a patient gets an infection in that facility,’” LaBorde says. “’Who is the payor and how often does that happen? We can really have a conversation about the financial impact using (the hospital’s) own data. That becomes very important because the best hospitals are ones where the infection control team includes not only infection control practitioners, but the medical staff, central service and administration on one team.”
Such financial analysis and data presentation gets management excited and spurs the idea that it’s everyone’s responsibility to prevent infections, LaBorde says.
“You can take the data that gets generated from these tools and then that data gets fed into an environment to change behavior and improve outcomes,” he adds. “If that data doesn’t really motivate anyone outside the infection control office, then the investment you’ve made and the technology is useless. It’s only if you can marry the identification of opportunities to improve, with changing the entire culture of the hospital to act on those opportunities, that you get significant improvement.”
The basics of outbreak surveillance are the same nationwide, but each facility may have different needs. Plans should therefore have room for adjustment, says Qutaishat.
“Each hospital should have an infection control annual plan that constitutes the infection prevention blueprint for that facility,” he says. “This plan should be flexible enough to allow adjustment based on changes in the epidemiologic profile of the facility and the community. The staff should look at these automated surveillance systems as an extension of their existing annual infection control plan.”
Automated surveillance can be a rare break for the typically-overworked ICP.
“I think infection practitioners have ever-increasing areas of responsibility or demands on the department without an equal increase of resources with which to accomplish all of it,” LaBorde says. “One way that electronic surveillance is helping them to meet these multiple demands on their time is by making the day-to-day surveillance activities much more efficient.”
One specific program, data mining surveillance by MedMined™, is a patented methodology that identifies emerging issues in areas that may not be obvious.
“It watches your back for problem areas that you may not have suspected,” LaBorde says.
Several programs exist, and finding the right one for your facility means asking a lot of questions. This is not a short-term decision, LaBorde says.
“Shopping for a system may mean several things,” he says. “When you pick a company … understand that your information systems will change over time. It’s not really a static purchase. You really need to pick a company that has a history of success and stability and a commitment to the (infection control) community.”
LaBorde also suggests that consumers look at the total costs when choosing a product. For instance, does the sticker price include hardware, installation and training, or are those additional costs?
“You really can’t compare sticker price to sticker price,” he says. “You have to dig below and say, ‘What are the ownership costs over three or five years of using this, both internally and through what we pay the vendor?’”
Hospitals should involve ICPs and epidemiologists when they are shopping for an electronic solution, Hodson says.
“The ideal solution will continuously review and apply logic, algorithms, and rules to the data immediately (not in batch files), provide alerts to any variance in data patterns or for an organism of concern, compare susceptibility patterns for antimicrobials as part of the identification process, provide automated statistical comparison, and create reports that include complete data comparisons, descriptions and graphs that are commonly used by the ICP and public health communities,” Hodson says.
He suggests that shoppers pay special attention to how the software identifies multi-drug-resistant organisms, especially those that colonize.
No matter how great any product sounds, consumers should take their time before making a decision.
The MedCard by MedMined™ is one option for internal and external HAI reporting. Benchmarking capabilities allow hospitals to compare infection rates (type and location) by unit, hospital-wide and to other facilities throughout the country, product literature states.
The MedMined™ antimicrobial management reports trends, monitors process improvement actions and shows whether an issue is resolved. The alert classes can be customized.
Another product, TheraDoc’s Infection Control Assistant (ICA), provides continuous automated surveillance for unusual patterns of hospital-acquired and community-acquired microorganisms.
The ICA alerts the ICP immediately when usual, expected thresholds are broken and a possible outbreak has been identified. It identifies clusters of microorganisms for the ICP based on a number of factors, including antibiotic susceptibility patterns.
The ICA also provides patient data including vital signs, microbiology, lab, pharmacy, bed and surgery history.
TheraDoc also offers the Antibiotic Wizard® to help clinicians choose the right drug for each infection.
“TheraDoc allows ICPs to enter infections into the database in the absence of a clinical culture,” product managers state. “This is often seen in surgical site infections when a patient is culture negative, but has been treated for a surgical site infection by their physician. “This provides the most accurate data for reporting.”
A critical question to ask when looking for a surveillance system is, “What is the ease of use, and how will your company assist in training?”
Education is an essential component of the Premier program, says Qutaishat.
“The training includes technical aspects of using our automated system,” he says. “We also partner with facilities to establish plans focused on enhancing intervention efficiencies.”
LaBorde agrees that the relationship a hospital has with a surveillance product distributor should not end with the purchase.
“We provide services to hospitals, not just a piece of software or a tool,” LaBorde says. “We supplement all of those technologies with clinical and financial experts who help hospitals make sure that all of this technology is used to maximize its benefits to patients and the bottom line of the hospital.
“Part of our service is quite a lot of training prior to the go-live moment of the technology so that they’ll know what to expect and basic ways to use it,” LaBorde adds. “After that go-live time — which is about 60 days after the contract is signed — there is a lot of hands-on training on how to use different elements of it.”
Good technology should never be difficult to use and shouldn’t be intimidating, LaBorde says.
“Unfortunately, not all technology is engineered right,” he adds. “That’s why a lot of what we do has services wrapped around it … so that the tools don’t get in the way of doing the real job of teaching and the interventions that prevent infection.”
Hospital staff members and administrators are seeing that automation is needed throughout facilities, not just for infection control and epidemiology, Qutaishat says.
“At the present time, many hospitals continue to use paper medical records and handwritten progress notes that may add to the burden of interpretation of information contained within these records,” he says.
“Significant progress in enhancing patient safety and preventing healthcare- acquired infections can only be realized when automation is available at these facilities. …The goal is to transform infection control programs to move closer to the bedside.”
The biggest trend that LaBorde sees is that hospital staffs want to know more than ever before about the infections in their facilities.
“The CMS rule changes that will (soon) be effective will reduce the payments from Medicare to hospitals when HAIs occur,” LaBorde says. “Those rule changes don’t limit the infections to just those in critical care areas.
Those rules apply to patients throughout the facility, (which means) those hospitals that have previously employed targeted surveillance methodologies really will be at a disadvantage in terms of preventing infections in all the areas where CMS is about to stop paying for them. It is increasing the demand for ways of electronically identifying all the infections in a hospital so that administrators have a scope of how big a problem is and how best to address it.”
Surveillance is also changing in that fewer hospitals rely on good old fashioned pencils and notepads.
“The crudest method is the one that has been in place for the last 30 years, which is infection control practitioners spending a lot of time being chart abstractors and manually digging through piles of patient data, making their own judgments as to which patients have HAIs and then manually doing the computations and the graphing that flow from those numbers,” LaBorde says.
“I think most practitioners that I’ve spoken with want to be free from the paper chase because they know there are things going on in the hospital that they could improve but many are frustrated because they don’t have the time or the resources to get freed up from that daily paper chase to do all the interventions that they would like to do,” he adds. “It’s also bad for hospitals because there is inherent subjectivity to human beings making that determination of infection.”
Indeed, electronic surveillance trends support the ICP, Hodson says. “Hospitals without electronic assistance often require the ICP to request reviews of microbiology data to confirm any suspicions of variable patterns of pathogens,” he says. “This means that someone from the microbiology lab has to review and hand count numbers of isolates for any given set of criteria. Most often the entire process takes weeks to confirm any suspicions, or too often, the outbreak is well under way and includes several patients before measures are put in place to control it.
“If an ICP has the ability to look at microbiology lab data electronically, it can still be a slow process of importing data into spreadsheets, applying statistical process, and generating findings,” he adds.
With so many products on the market and so many differences in how humans can interpret results, inconsistency in reporting can be a big problem.
Groups of people can look at the same patient charts and come up with vastly different infection data, according to LaBorde.
“That inconsistency makes things like public reporting very doubtful,” he says. “How do you know it was counted the same way in hospital A as it was in hospital B? The data is not consistent and it’s really not the best that it can be.”
MedMined™ has a patent-pending electronic method of identifying infections that gives consistent data between hospitals, LaBorde says. Many infection control systems still rely on the practitioner to decide whether there was an outbreak, and that’s a problem, he adds.
“(Some systems) simply do the calculations and the graphing that flow from that, so you still have this inconsistency between hospitals or even in the same hospital, potentially,” he adds.
MedMined™ works with about 250 hospitals. The data is standardized.
“We ‘clean and map it’ so that when you apply the same algorithms that determine whether something is likely an HAI, you are doing it on data that is consistent between hospitals,” LaBorde says. “If each hospital did its own installation, even if you apply the same algorithm, if the way that you cleaned and mapped that data isn’t consistent, then the electronic algorithm is going to yield different numbers.”
WASHINGTON - The aggressive antibiotic-resistant staph infection responsible for thousands of recent illnesses undermines the body's defenses by causing germ-fighting cells to explode, researchers reported Sunday. Experts say the findings may help lead to better treatments.
An estimated 90,000 people in the United States fall ill each year from methicillin-resistant Staphylococcus aureus, or MRSA. It is not clear how many die from the infection; one estimate put it at more than 18,000, which would be slightly higher than U.S. deaths from AIDS.
The infection long has been associated with health care facilities, where it attacks people with reduced immune systems. But many recent cases involve an aggressive strain, community-associated MRSA, or CA-MRSA. It can cause severe infections and even death in otherwise healthy people outside of health care settings.
The CA-MRSA strain secretes a kind of peptide - a compound formed by amino acids - that causes immune cells called neutrophils to burst, eliminating a main defense against infection, according to researchers.
The findings, from a team of U.S. and German researchers led by Michael Otto of the National Institute of Allergy and Infectious Diseases, appeared in Sunday's online edition of the journal Nature Medicine.
While only 14 percent of serious MRSA infections are the community associated kind, they have drawn attention in recent months with a spate of reports in schools, including the death of a 17-year-old Virginia high school student.
Both hospital-associated and community-associated MRSA contained genes for the peptides. But their production was much higher in the CA-MRSA, the researchers said.
The compounds first cause inflammation, drawing the immune cells to the site of the infection, and then destroy those cells.
The research was conducted in mice and with human blood in laboratory tests.
Within five minutes of exposure to the peptides from CA-MRSA, human neutrophils showed flattening and signs of damage to their membrane, researchers said. After 60 minutes, many cells had disintegrated completely.
‘‘This elegant work helps reveal the complex strategy that S. aureus has developed to evade our normal immune defenses,'' Dr. Anthony S. Fauci, NIAID director, said in a statement. ‘‘Understanding what makes the infections caused by these new strains so severe and developing new drugs to treat them are urgent public health priorities.''
Dr. George G. Zhanel, a medical microbiologist at the University of Manitoba in Canada, said the study was the first he had seen that identifies the peptides involved.
This shows at least one of the reasons CA-MRSA is able to cause serious problems, Zhanel, who was not part of the research team, said in a telephone interview. Findings like this may help lead to better treatments, such as ways to neutralize the peptides or to activate the immune system to defeat them, he added.
Dr. Lindsey N. Shaw of the division of cell biology, microbiology and molecular biology at the University of South Florida, also was enthusiastic about the research.
‘‘Specifically identifying a factor which seemingly makes CA-MRSA more pathogenic than HA-MRSA is a real find,'' Shaw, who was not part of the research group, said via e-mail. The ‘‘molecules identified in the study are indeed novel.''
Zhanel noted that while hospital-based MRSA seemed to concentrate on ‘‘sick old people,'' the community-based strain can break out in on sports teams, prisons, cruise ships and other places where people are not necessarily sick or have weakened immune systems.
In a worrisome development, he noted that the more aggressive strains have started appearing in hospitals.
Dr. Clarence B. Creech, an assistant professor of pediatric infectious disease at Vanderbilt University, said every time scientists find a new way that staph uses to make people sick, ‘‘we open up the field of developing new vaccine targets and new drug targets.''
‘‘This is one of the papers we can look to as we develop new vaccines and drugs,'' Creech, who was not part of the research team, said in a telephone interview.
The research was funded by the National Institutes of Health, the German Research Council and the German Ministry of Education and Research.
Henry I. Miller
There is a constant war between pathogenic bacteria and humans, and the microbes seem to be winning. New data from the Centers for Disease Control (CDC) indicate the incidence of serious invasive infections from a strain of bacteria resistant to most first-line, commonly used antibiotics was higher than previously thought. The CDC estimates methicillin-resistant Staphylococcus aureus (MRSA) kills 18,000 Americans each year and causes serious infections in more than 90,000.
The phenomenon is not new, but reports of outbreaks in schools across the nation and the death of a high school student in Virginia earlier this month have focused national attention on the problem.
The medical community has been worried for years about growing antibiotic resistance in many kinds of bacteria. Especially if an infection is contracted in a hospital — in a surgical wound, for example, or in the form of pneumonia — there is a high probability the bacteria responsible will be resistant to one or more antibiotics, and the outcome is often deadly. Almost 2 million patients contract infections in U.S. hospitals each year — approximately 4½ percent of admissions — and 100,000 die, according to earlier data from the CDC.
The death rate in such cases is alarmingly high not because the patients initially are gravely ill, but because hospital germs increasingly are resistant to multiple antibiotics: About 70 percent of those infections are resistant to at least one drug, so the infections are hard to treat. In many cases, we"re already out of good second- or third-line alternatives that are effective, can be administered by mouth and have few side effects, so we must resort to drugs that are inconvenient to administer or have significant toxicity.
Many bad bugs are spreading beyond our hospitals into the greater community. Bacteria are masters of evolutionary adaptation: Given sufficient time and exposure, they use a variety of clever genetic and metabolic tricks to resist any drug we invent. There is no antibiotic in clinical use today to which some resistance has not developed. A future with few effective antibiotics would be treacherous; many of today's routine medical procedures, from surgical operations to chemotherapy, would be far more dangerous if we permit the bacteria to outwit us.
To combat this public health emergency, important initiatives are under way by both government and the private sector to promote more sparing and intelligent use of antibiotics. Regulators and livestock producers are collaborating to reduce the amounts of antibiotics used to prevent disease in livestock, and many HMOs have adopted policies that restrict antibiotics to infections that seem unequivocally to be caused by bacteria. (For example, patients should not routinely get antibiotics for colds, which are caused by viruses, not bacteria.)
The CDC is promoting four strategies to prevent antibiotic resistance in health-care centers — prevent infection, diagnose and treat infection, use antimicrobials wisely, and prevent transmission — but federal officials have paid little attention to the flip side of the problem: the shortage of new antibiotics.
Twenty years ago, about a half-dozen new antibiotics would appear on the market each year; now it's at most one or two. For decades we've relied largely on new variations on old tricks to combat rapidly evolving pathogens: Most antibiotics in use today are chemically related to earlier ones discovered between 1941 and 1968. During the last 38 years, only two antibiotics with truly novel modes of action have been introduced — Zyvox in 2000 and Cubicin in 2003, the latter of which must be infused intravenously.
Market forces and regulatory costs have exacerbated the antibiotics drought. Until about a decade ago, all the major pharmaceutical makers had antibacterial research programs, but they have dramatically trimmed or eliminated these efforts, focusing instead on more lucrative drugs that treat chronic ailments and lifestyle issues: drugs for lowering cholesterol and treating erectile dysfunction, for example. Whereas antibiotics cure a patient in days, and may not be required again for years, someone with high cholesterol or erectile dysfunction might pop expensive pills every day for decades. Moreover, drug development has become hugely expensive, with the direct and indirect costs to bring a drug to the U.S. market now averaging about a billion dollars. Only about a half-dozen new antibiotics are now in late-stage clinical trials.
To address this public health threat, we need multiple strategies. In the short term, improved infection-prevention procedures at hospitals would have a tremendous impact. A pilot program at the University of Pittsburgh found that screening tests, gowns and other precautions that cost only $35,000 a year saved more than $800,000 a year in infection costs. A review of similar analyses published last year concluded that screening for MRSA bacteria both increases hospital profits and saves lives.
Longer term, we need to adopt the kinds of critical policy reforms suggested by the Infectious Diseases Society of America to spur new drug development. Among them: expediting the publication of updated guidelines for clinical trials of antibiotics, including a clear definition of what constitutes acceptable surrogate markers as endpoints; encouraging "imaginative clinical trial designs that lead to a better understanding" of antibiotics' efficacy; and the exploration of animal models of infection, in vitro technologies and microbiological surrogate markers to reduce the number of efficacy studies required.
In addition, regulation needs to be more enlightened. Regulators should grant accelerated review status to priority antibiotics and be more sensitive generally to the critical need for new antibiotics.
The two novel antibiotics that have been introduced since 2000 won't be enough to keep rapidly mutating pathogens at bay for long. Once resistance appears, it will spread rapidly. Unless we create economic and regulatory incentives for companies to develop antibiotics, it's unlikely we'll see many more wonder drugs in the near future. That's something to think about next time you contract bronchitis, or are hospitalized for elective surgery.
Henry I. Miller, a physician and molecular biologist, is a fellow at Stanford University's Hoover Institution and a former official at the National Institutes of Health and the Food and Drug Administration.
by Deborah Brunswick
NEW YORK (CNN) -- Just days before his death, the Brooklyn, New York, middle-school student who died from an antibiotic-resistant staph infection had visited a hospital with skin lesions and was treated with allergy medicine, according to the family's lawyer, Paul Weitz.
Omar Rivera, 12, a New York seventh-grader, died of drug-resistant staph on October 14. Omar Rivera's mother, Aileen, took the 12-year-old boy to Kings County Hospital in Brooklyn because she had been dissatisfied with the treatment he received at a clinic, Weitz told CNN. He said the hospital treated him with Benadryl, a common anti-allergy medicine.
According to hospital spokeswoman Hope Mason, Omar did not show signs of a staph infection when he was treated at the hospital.
"I can confirm the child was brought to the emergency room after midnight on Friday, October 12. He was treated for non-MRSA-related conditions and was released," said Mason. "We will be closely examining whether more could have been done to detect the infection at that time."
MRSA is short for methicillin-resistant Staphylococcus aureus, and is responsible for more deaths in the United States each year than AIDS, according to new data. The germ resists all but the most powerful antibiotics.
Omar, a seventh-grader at Intermediate School 211, was pronounced dead on October 14 at Brookdale Hospital.
Twenty-five to 30 percent of the population carry the staph bacteria -- one of the most common causes of infection -- in their bodies, according to the Centers for Disease Control and Prevention. While such infections are typically minor, invasive MRSA infections can become fatal, because they are caused by drug-resistant staph.
By Dave Moller
To help stop the spread of staph infections, hospitals including Sierra Nevada Memorial are gearing up to adopt stricter cleansing procedures for visitors and patients.
The added precautions - in addition to policies that have been in place for years - come after some well-publicized outbreaks of community-acquired staph infections called "superbugs" that are resistant to most drugs.
A recent American Medical Association report also outlined the dangers of superbugs.
"This is getting to be a bigger issue all the time," said David Witthaus, laboratory manager at SNMH.
Sierra Nevada hospital's parent, Catholic Healthcare Wast, plans to combat staph with stricter cleansing procedures and checks of all Intensive Care Unit patients for the staph bacteria, Witthaus said. He called it a "smart, forward-thinking kind of a move, because it's not going to get any better."
Staph bacteria usually are harmless, and about one-third of all Americans carry it on their nose and skin, according to the Mayo Clinic. But staph can cause mild skin infections in healthy people, who can also spread it even if they don't get sick.
Experts also are worried because the community-acquired staph will cause more problems with people most vulnerable to it, including the young who don't have fully developed immune systems and people whose immunity is damaged, such as HIV patients. These people and others who have wounds or are in health care can develop serious skin infections or pneumonia, which sometimes can be fatal.
Staph infections often start out looking like small red bumps that can appear to be pimples, spider bites or boils, according to the Mayo Clinic. But they can burrow into the body and cause infections in bones, wounds, lungs, the heart valves, joints and the bloodstream.
Concerns also are being expressed about long-term care facilities and hospitals harboring the community-acquired strain and passing it on within and outside of hospitals.
About 94,000 Americans have the community-received staph, the American Medical Association estimated in its recent report. The figure was alarming, because annual deaths tied to superbugs could exceed those from AIDS.
Procedures have been in place for years at Sierra Nevada to stop the spread of hospital-acquired and community-acquired staph infections, according to Allan Finlay, the hospital's infection control practitioner.
When staph does show up, it's most often the community-acquired type, Finlay said. The finding, coupled with national concern about the community-acquired strain, is prompting Catholic Healthcare West to revamp its staph policy.
Starting Nov. 1, a pilot program will begin where all ICU patients will be checked for hospital-acquired and community-acquired staph, Finlay said.
"We'll probably do it throughout the hospital eventually," Finlay said. "This is a complex program, and we want to protect the ICU patients first because they're most at risk."
If a patient is found to have staph, they will be put in strict isolation, Finlay said. The policy already is in place. Now, however, people in contact with them will be issued sanitary gloves and gowns that will be disposed of when they leave the room "so we don't carry the staph to the next person," Finlay said.
The hospital will also do a more thorough job of cleansing rooms that staph-infected patients have occupied, Finlay said. Routine checks will be performed after cleanings to see if they meet muster.
Again, the hospital cleans the rooms thoroughly now, but a lengthy checklist will be introduced "so that we're more disciplined and to not miss anything," Finlay said.
The last part of the new plan is the easiest and perhaps the most important - a stringent hand-cleaning program throughout the hospital.
"We've been doing that for years" with doctors and staff, Finlay said.
Soon, the hospital will include patients and visitors in the hand-washing program, because they could have community-acquired staph, creating a weak link in the prevention chain.
The program will include compliance measurement, "so we'll have the data and statistics to work from" for improvement, Finlay said.
"You see those alcohol wipes and hand sanitizers all over now, just like in the hospital," Finlay said. People should avail themselves in order to protect each other from staff infections and many other bugs, Finlay said.
By Carol M. Ostrom
Seattle Times health reporter
ERIKA SCHULTZ / THE SEATTLE TIMES
Anna DeBord, 1, is back home after spending five nights in a hospital with the superbug.
Instead of going to her first birthday party, little Anna DeBord spent the weekend in the hospital with a superbug.
Anna had methicillin-resistant Staphylococcus aureus, or MRSA, a pathogen that has learned to thrive even when treated with the most common antibiotics. At Children's Hospital & Regional Medical Center, doctors gave Anna more-powerful antibiotics and performed surgery on her skin infection.
But her battle with MRSA at Children's won't be tallied by public-health officials or show up on reports tracking infectious diseases.
Unlike mumps or measles, MRSA cases need not be reported to public-health authorities in this state, even though health officials say they've been aware for years of the growing threat. A study published Wednesday in the Journal of the American Medical Association estimates that the most severe infections caused by this bug kill more than 18,000 Americans a year — more than die of AIDS.
The numbers — much larger than previously believed — set off a round of finger-pointing and blame-placing.
Why aren't all hospitals screening incoming patients, as they do in other countries, and isolating and treating those carrying the bug so it doesn't spread? Why don't lawmakers require hospitals — and perhaps schools, nursing homes and prisons — to report cases to public-health agencies so they can help control it? What has the nation's top disease-control agency, the Atlanta-based Centers for Disease Control and Prevention (CDC), been doing while the Staphylococcus aureus bug has grown so resistant to antibiotics?
"It's inertia," charges infection-control crusader Betsy McCaughey, chairwoman of the New York-based Committee to Reduce Infection Deaths. "For many years, it was assumed that infection was the inevitable risk you faced when you went into the hospital. Now, the evidence is compelling that as many as 90 percent of these infections are preventable through cleaning and screening."
McCaughey, a former lieutenant governor of New York state, says "the CDC's lax guidelines and failure to adequately count the number of hospital infections are largely to blame for this problem. They have given hospitals an excuse to do too little."
The CDC disputes that, saying it asks hospitals to document that they're reducing the rate of MRSA infections. But some activists say that gives hospitals too little public accountability.
Lisa McGiffert, director of Consumers Union's Stop Hospital Infections campaign, argues that MRSA can't be stopped unless it's tracked.
"Some people say, 'We know it's a problem; we don't have to count,' " she says. "But we've been kind of denying it is a problem. Denial is a dangerous thing when it comes to antibiotic resistance," because these bugs are so dangerous. "You cannot solve a problem until you're aware of the extent of the problem."
A hospital-reporting law passed by the Legislature earlier this year does not target MRSA. Rep. Tom Campbell, R-Roy, says he's planning to sponsor a bill in the next session requiring specific reporting of MRSA not only by hospitals but by nursing homes and other facilities.
For now, the only numbers come from voluntary efforts. In Pierce County, a years-long tracking of MRSA cases, spurred by a core group of hospital-infection specialists, public-health officials and local health providers, has produced startling results.
"Pierce County is leading the nation" in tracking, says Marcia Patrick, director of infection prevention and control for the MultiCare Health System. "We've got stuff that nobody else has, that other places are just getting caught up with."
Staph is a common bug, often living in people's noses or on shower benches, bed rails or lab coats. Over the years, because of what experts say is overuse of antibiotics in people and animals, the bug has grown increasingly resistant to common antibiotics.
"We recognized a long time ago that MRSA was going to be a really hot problem," Patrick says. "If you're not doing surveillance, how do you know?"
As a result of the voluntary reports by Pierce County hospital systems, Patrick says, "we have data that most counties have no clue about."
What that data shows is "very alarming," Patrick says: Staph is becoming increasingly antibiotic-resistant, and the resistant version is much more common.
The data have pushed some providers, such as MultiCare, which operates Tacoma General Hospital, to start screening new patients for MRSA.
The efforts, along with isolating patients with MRSA and "major work on improving hand hygiene," have helped MultiCare decrease rates of MRSA despite growing numbers overall, she says.
Experiments in this country and practices in others have shown that vigorous screening of incoming patients and other patient-safety measures can drastically reduce MRSA infections in the hospital.
But the CDC's MRSA expert, Dr. John Jernigan, said the CDC is providing demanding guidance that is geared toward reducing MRSA rates. "Isn't that what we want?" he asks.
Although many blame hospitals for refusing to track MRSA infections, Carol Wagner, vice president for patient safety for the Washington State Hospital Association, says her organization has encouraged tracking of multi-drug-resistant organisms, including MRSA. But she adds: "It is not beneficial to track only in hospitals; it needs to be communitywide."
For many looking at this problem, the question is whether money spent tracking and reporting could be better spent on prevention.
"Is the goal to count, or is the goal to reduce infections?" asks Jude Van Buren, an epidemiologist with the Washington State Department of Health. "The health-care dollar never really gets bigger — you take from something to do something else."
Public-health experts already know MRSA is a problem, Van Buren says. Getting more numbers "is not really going to give us any more information," she says.
One-year-old Anna DeBord is blissfully unaware of all the debate. She came home from the hospital Wednesday and seems fine, said her mother, Liz DeBord.
Now, Liz is spraying Anna's room with Lysol and washing all her sheets, she said. "We still have no idea, absolutely no idea, how she got it."
Carol M. Ostrom: 206-464-2249 or firstname.lastname@example.org
October 18, 2007
School districts in at least six states have reported students infected with Methicillin-resistant Staphylococcus aureus. Three youths have died as a result of the infections.
Ashton Bonds, 17, of Bedford, Va., died Monday as a result of the infection. Boscawen Elementary preschooler Catherine Bentley of Salisbury, N.H., and Shae Kiernan, 11, of Vancleave, Miss. both succumbed to the infection last week.
School officials at one North Carolina high school said Thursday at least six football players are infected with MRSA (MUR'-suh). And in West Virginia, at least seven students at three different schools have been diagnosed with it. Two teens in Connecticut have also have the infection.
School officials in upstate New York, Connecticut and New Hampshire have sent letters home to parents informing them of recent cases. Meanwhile cases have prompted schools in Indiana, Virginia and West Virginia to sanitize facilities, particularly locker rooms and gyms where the germs are most easily spread.
The concern is because MRSA doesn't respond to penicillin and other antibiotics. It can be spread by skin-to-skin contact or by sharing an item used by an infected person, particularly one with a cut or abrasion. A number of the cases have involved student athletes.
The Centers for Disease Control and Prevention reported this week that MRSA infections are a major public health problem and more widespread than previously thought. A government study out this week said more than 90,000 Americans could get the "superbug" each year.
This was underscored in a stunning report by CDC researchers published in the Journal of the American Medical Association that says MRSA infections ultimately could kill more people annually than AIDS. The report says the deadly strain killed nearly 19,000 Americans in 2005 and suggests such infections may be twice as common as previously thought, according to its lead author, Dr. R. Monina Klevens.
In recent years, so-called superbug staph infections have been spreading through schools, hospitals, prisons and athletic facilities, CDC officials said.
The bacteria often is carried on the skin and in the noses of healthy people and can be spread by skin-to-skin contact or sharing an item used by an infected person, particularly one with an open wound.
"Essentially, what has happened here is that MRSA was, at one time, pretty much confined to patients in hospitals, and these were patients that were seriously ill," said Dr. Pascal James Imperato, the former commissioner of public health for New York City. "Now we know, there’s also a community-acquired strain of MRSA. That doesn’t mean that it hasn’t always existed. It’s just that now, we have become knowledgeable about it."
The MRSA strain is believed to have evolved through several biological mechanisms, including the overuse of antibiotics, said Imperato, chairman of the Department of Preventive Medicine and community health director of the Master of Public Health program at SUNY Downstate Medical Center.
All 21 school buildings in Bedford County, Va., were being scrubbed and sanitized Wednesday following the death of Bonds.
The schools, all in Bedford County, Va., were closed after students there launched a protest over unsanitary conditions Monday, using text messages and social networking sites.
The students took Bedford County Schools Superintendent James Blevins on a tour Tuesday of Staunton River High School to show him how unclean it was, in particular the
Michael J. Martin, superintendent of schools for SAU 46, which includes Boscawen Elementary, told the Union Leader that once they were advised of Bentley’s illness, the district worked closely with the state department of health to make sure students were not at risk.
"Initially they said there was no reason to be concerned. Then we heard about the report of the death in Virginia, so we contacted the department of health again. They reassured us there was no change," Martin said.
Kiernan, 11, was buried on Monday. The funeral took place in Kiernan’s hometown of Vancleave, a small community in Jackson County, Miss.
In the majority of cases, children are at no higher risk for the infection than the general population, Imperato said. But the bacteria do thrive in locker rooms and gymnasiums, he said.
"This scenario sets up the perfect scenario for the organism to invade the skin," he said. "In this setting, you have sweat and good exposure to skin. With youths who play football or lacrosse, the skin might also be cut or scraped, making the skin more vulnerable."
The best method of prevention is staying clean. Frequent hand-washing is a good way to prevent the spread of MRSA. And youths, as well as adults, who participate in sports or any type of physical fitness program should shower immediately after.
"Good old-fashioned cleanliness serves as the best barrier to these organisms," he said. "Just washing with ordinary soap and water is enough to remove any of the organisms that may have colonized in the skin."
About one-quarter of invasive cases of staff infection involve patients in hospitals and more than half are related to the health care industry, occurring in people who recently had surgery or were on kidney dialysis, according to the CDC study.
Officials still do not know how the infections were spread that killed the three youths. Ashton Bonds played football at one time, which would have required him to use the school’s locker room and athletic facilities, but school officials said he was not playing this year.
The Associated Press contributed to this story
What is community-associated MRSA (CA-MRSA)?
Staph and MRSA can also cause illness in persons outside of hospitals and healthcare facilities. MRSA infections that are acquired by persons who have not been recently (within the past year) hospitalized or had a medical procedure (such as dialysis, surgery, catheters) are know as CA-MRSA infections. Staph or MRSA infections in the community are usually manifested as skin infections, such as pimples and boils, and occur in otherwise healthy people.
How common are staph and MRSA infections?
Staph bacteria are one of the most common causes of skin infection in the United States and are a common cause of pneumonia, surgical wound infections, and bloodstream infections. The majority of MRSA infections occur among patients in hospitals or other healthcare settings; however, it is becoming more common in the community setting. Data from a prospective study in 2003, suggests that 12% of clinical MRSA infections are community-associated, but this varies by geographic region and population.
What does a staph or MRSA infection look like?
Staph bacteria, including MRSA, can cause skin infections that may look like a pimple or boil and can be red, swollen, painful, or have pus or other drainage. More serious infections may cause pneumonia, bloodstream infections, or surgical wound infections.
Are certain people at increased risk for community-associated staph or MRSA infections?
CDC has investigated clusters of CA-MRSA skin infections among athletes, military recruits, children, Pacific Islanders, Alaskan Natives, Native Americans, men who have sex with men, and prisoners.
Factors that have been associated with the spread of MRSA skin infections include: close skin-to-skin contact, openings in the skin such as cuts or abrasions, contaminated items and surfaces, crowded living conditions, and poor hygiene.
How can I prevent staph or MRSA skin infections?
Practice good hygiene:
1. Keep your hands clean by washing thoroughly with soap and water or using an alcohol-based hand sanitizer.
2. Keep cuts and scrapes clean and covered with a bandage until healed.
3. Avoid contact with other people’s wounds or bandages.
4. Avoid sharing personal items such as towels or razors.
Are people who are positive for the human immune deficiency virus (HIV) at increased risk for MRSA? Should they be taking special precautions?
People with weakened immune systems, which include some patients with HIV infection, may be at risk for more severe illness if they get infected with MRSA. People with HIV should follow the same prevention measures as those without HIV to prevent staph infections, including practice good hygiene, cover wounds (e.g., cuts or abrasions) with clean dry bandages, avoid sharing personal items such as towels and razors, and contact their doctor if they think they have an infection.
Can I get a staph or MRSA infection at my health club?
In the outbreaks of MRSA, the environment has not played a significant role in the transmission of MRSA. MRSA is transmitted most frequently by direct skin-to-skin contact. You can protect yourself from infections by practicing good hygiene (e.g., keeping your hands clean by washing with soap and water or using an alcohol-based hand rub and showering after working out); covering any open skin area such as abrasions or cuts with a clean dry bandage; avoiding sharing personal items such as towels or razors; using a barrier (e.g., clothing or a towel) between your skin and shared equipment; and wiping surfaces of equipment before and after use.
What should I do if I think I have a staph or MRSA infection?
See your healthcare provider.
Are staph and MRSA infections treatable?
Yes. Most staph and MRSA infections are treatable with antibiotics. If you are given an antibiotic, take all of the doses, even if the infection is getting better, unless your doctor tells you to stop taking it. Do not share antibiotics with other people or save unfinished antibiotics to use at another time.
However, many staph skin infections may be treated by draining the abscess or boil and may not require antibiotics. Drainage of skin boils or abscesses should only be done by a healthcare provider.
If after visiting your healthcare provider the infection is not getting better after a few days, contact them again. If other people you know or live with get the same infection tell them to go to their healthcare provider.
Is it possible that my staph or MRSA skin infection will come back after it is cured?
Yes. It is possible to have a staph or MRSA skin infection come back (recur) after it is cured. To prevent this from happening, follow your healthcare provider’s directions while you have the infection, and follow the prevention steps after the infection is gone.
If I have a staph, or MRSA skin infection, what can I do to prevent others from getting infected?
You can prevent spreading staph or MRSA skin infections to others by following these steps:
1. Cover your wound. Keep wounds that are draining or have pus covered with clean, dry bandages. Follow your healthcare provider’s instructions on proper care of the wound. Pus from infected wounds can contain staph and MRSA, so keeping the infection covered will help prevent the spread to others. Bandages or tape can be discarded with the regular trash.
2. Clean your hands. You, your family, and others in close contact should wash their hands frequently with soap and warm water or use an alcohol-based hand sanitizer, especially after changing the bandage or touching the infected wound.
3. Do not share personal items. Avoid sharing personal items such as towels, washcloths, razors, clothing, or uniforms that may have had contact with the infected wound or bandage. Wash sheets, towels, and clothes that become soiled with water and laundry detergent. Drying clothes in a hot dryer, rather than air-drying, also helps kill bacteria in clothes.
4. Talk to your doctor. Tell any healthcare providers who treat you that you have or had a staph or MRSA skin infection.
By Rob Stein
Washington Post Staff Writer
Wednesday, October 17, 2007
A dangerous germ that has been spreading around the country causes more life-threatening infections than public health authorities had thought and is killing more people in the United States each year than the AIDS virus, federal health officials reported yesterday.
The microbe, a strain of a once innocuous staph bacterium that has become invulnerable to first-line antibiotics, is responsible for more than 94,000 serious infections and nearly 19,000 deaths each year, the Centers for Disease Control and Prevention calculated.
Although mounting evidence shows that the infection is becoming more common, the estimate published today in the Journal of the American Medical Association is the first national assessment of the toll from the insidious pathogen, officials said.
"This is a significant public health problem. We should be very worried," said Scott K. Fridkin, a medical epidemiologist at the CDC.
Other researchers noted that the estimate includes only the most serious infections caused by the germ, known as methicillin-resistant S taphylococcus au reus (MRSA).
"It's really just the tip of the iceberg," said Elizabeth A. Bancroft, a medical epidemiologist at the Los Angeles County Department of Public Health who wrote an editorial in JAMA accompanying the new studies. "It is astounding."
MRSA is a strain of the ubiquitous bacterium that usually causes staph infections that are easily treated with common, or first-line, antibiotics in the penicillin family, such as methicillin and amoxicillin. Resistant strains of the organism, however, have been increasingly turning up in hospitals and in small outbreaks outside of heath-care settings, such as among athletes, prison inmates and children.
On Monday, Ashton Bonds, 17, of Lynch Station, Va., succumbed to MRSA, prompting officials to shut down 21 Bedford County schools today for cleaning to prevent further infections. The infection had spread to Bonds's kidneys, liver, lungs and the muscle around his heart.
The MRSA estimate is being published with a report that a strain of another bacterium, which causes ear infections in children, has become impervious to every approved antibiotic for youngsters.
"Taken together, what these two papers show is that we're increasingly facing antibiotic-resistant forms of these very common organisms," Bancroft said.
The reports underscore the need to develop new antibiotics and curb the unnecessary use of those already available, experts said. They should also alert doctors to be on the lookout for antibiotic-resistant infections so patients can be treated with the few remaining effective drugs before they develop serious complications, experts said.
MRSA, which is spread by casual contact, rapidly turns minor abscesses and other skin infections into serious health problems, including painful, disfiguring "necrotizing" abscesses that eat away tissue. The infections can often still be treated by lancing and draining sores and quickly administering other antibiotics, such as bactrim. But in some cases the microbe gets into the lungs, causing unusually serious pneumonia, or spreads into bone, vital organs and the bloodstream, triggering life-threatening complications. Those patients must be hospitalized and given intensive care, including intravenous antibiotics such as vancomycin.
In the new study, Fridkin and his colleagues analyzed data collected in California, Colorado, Connecticut, Georgia, Maryland, Minnesota, New York, Oregon and Tennessee, identifying 5,287 cases of invasive MRSA infection and 988 deaths in 2005. The researchers calculated that MRSA was striking 31.8 out of every 100,000 Americans, which translates to 94,360 cases and 18,650 deaths nationwide. In comparison, complications from the AIDS virus killed about 12,500 Americans in 2005.
"This indicates these life-threatening MRSA infections are much more common than we had thought," Fridkin said.
In fact, the estimate makes MRSA much more common than flesh-eating strep infections, bacterial pneumonia and meningitis combined, Bancroft noted.
"These are some of the most dreaded invasive bacterial diseases out there," she said. "This is clearly a very big deal."
The infection is most common among African Americans and the elderly, but also commonly strikes very young children.
"We see these cases all the time," said Robert S. Daum, a pediatric infectious-disease specialist at the University of Chicago. "In the last five weeks, I've taken care of five children who were sick enough to be hospitalized and require intensive care."
Studies have shown that hospitals could do more to improve standard hygiene to reduce the spread of the infection. Individuals can reduce their risk through common-sense measures, such as frequent hand-washing.
In the second paper, Michael E. Pichichero and Janet R. Casey of the University of Rochester in New York documented the emergence of an antibiotic-resistant strain of another bacterium known as Streptococcus pneumoniae, which causes common ear infections. Although all 11 children identified in the Rochester area with the microbe so far were successfully treated, five required an antibiotic approved only for adults, and one child was left with permanent hearing loss.
The researchers attributed the emergence of the strain to a combination of the overuse of antibiotics and the introduction of a vaccine that protects against the infection.
"The use of the vaccine created an ecological vacuum, and that combined with excessive use of antibiotics to create this new superbug," Pichichero said.
by Sean Kenniff/CBS News
A new study finds an infection found in hospitals may be more common and deadly than first thought. The Superbug is dangerous because most antibiotics can't kill it.
At Long Island College Hospital nurses take no chances when a patient gets the super staph infection MRSA. Nurse Eileen Abruzzo says, "We place the patient on isolation immediately." Isolation is a private room with dedicated equipment. Isolation is necessary because MRSA can spread quickly. It often starts on the skin but can lead to a deadly blood infection and most medicines won't stop it.
Dr. Daveed Frazier explains how strong it is. "You can hit it with this antibiotic and that antibiotic will not kill this infection." According to a new study, MRSA is more common and deadlier that first thought. Researchers estimate that in one year there were more than 94,000 infections resulting in an astounding 18, 600 deaths.
"That's extraordinarily high," says Dr. Frazier. "If you say there's a 20 percent death rate, that's shocking, that's almost unheard of."
The death rate is so high because MRSA usually attacks sick and elderly patients already susceptible to infection. And while it's most common in hospitals, that's no the only place you'll find it.
A rash of MRSA cases has shown up among student athletes. On Tuesday a Virginia High School Student died from MRSA causing local officials to shut down 21 schools for cleaning. The bug seems to spread in locker rooms.
Dr. Frazier has this advice. "Don't share razors. Don't share towels. Don't share soap with other individuals." MRSA can be treated with powerful intravenous drugs, but prevention is the best practice. Lots of hand washing is the most effective way to stop the spread of this deadly bug.
By LINDSEY TANNER, AP Medical Writer
Wednesday, October 17, 2007
Chicago (AP) --
More than 90,000 Americans get potentially deadly infections each year from a drug-resistant staph "superbug," the government reported in its first overall estimate of invasive disease caused by the germ.
Deaths tied to these infections may exceed those caused by AIDS, said one public health expert commenting on the new study. Tuesdays report shows just how far one form of the staph germ has spread beyond its traditional hospital setting.
The overall incidence rate was about 32 invasive infections per 100,000 people. That's an "astounding" figure, said an editorial in Wednesday's Journal of the American Medical Association, which published the study.
Most drug-resistant staph cases are mild skin infections. But this study focused on invasive infections — those that enter the bloodstream or destroy flesh and can turn deadly.
Researchers found that only about one-quarter involved hospitalized patients. However, more than half were in the health care system — people who had recently had surgery or were on kidney dialysis, for example. Open wounds and exposure to medical equipment are major ways the bug spreads.
In recent years, the resistant germ has become more common in hospitals and it has been spreading through prisons, gyms and locker rooms, and in poor urban neighborhoods.
The new study offers the broadest look yet at the pervasiveness of the most severe infections caused by the bug, called methicillin-resistant Staphylococcus aureus, or MRSA. These bacteria can be carried by healthy people, living on their skin or in their noses.
An invasive form of the disease is being blamed for the death Monday of a 17-year-old Virginia high school senior. Doctors said the germ had spread to his kidneys, liver, lungs and muscles around his heart.
The researchers' estimates are extrapolated from 2005 surveillance data from nine mostly urban regions considered representative of the country. There were 5,287 invasive infections reported that year in people living in those regions, which would translate to an estimated 94,360 cases nationally, the researchers said.
Most cases were life-threatening bloodstream infections. However, about 10 percent involved so-called flesh-eating disease, according to the study led by researchers at the federal Centers for Disease Control and Prevention.
There were 988 reported deaths among infected people in the study, for a rate of 6.3 per 100,000. That would translate to 18,650 deaths annually, although the researchers don't know if MRSA was the cause in all cases.
If these deaths all were related to staph infections, the total would exceed other better-known causes of death including AIDS — which killed an estimated 17,011 Americans in 2005 — said Dr. Elizabeth Bancroft of the Los Angeles County Health Department, the editorial author.
The results underscore the need for better prevention measures. That includes curbing the overuse of antibiotics and improving hand-washing and other hygiene procedures among hospital workers, said the CDC's Dr. Scott Fridkin, a study co-author.
Some hospitals have drastically cut infections by first isolating new patients until they are screened for MRSA.
The bacteria don't respond to penicillin-related antibiotics once commonly used to treat them, partly because of overuse. They can be treated with other drugs but health officials worry that their overuse could cause the germ to become resistant to those, too.
A survey earlier this year suggested that MRSA infections, including noninvasive mild forms, affect 46 out of every 1,000 U.S. hospital and nursing home patients — or as many as 5 percent. These patients are vulnerable because of open wounds and invasive medical equipment that can help the germ spread.
Dr. Buddy Creech, an infectious disease specialist at Vanderbilt University, said the JAMA study emphasizes the broad scope of the drug-resistant staph "epidemic," and highlights the need for a vaccine, which he called "the holy grail of staphylococcal research."
The regions studied were: the Atlanta metropolitan area; Baltimore, Connecticut; Davidson County, Tenn.; the Denver metropolitan area; Monroe County, NY; the Portland, Ore. metropolitan area; Ramsey County, Minn.; and the San Francisco metropolitan area.