Contact Isolation in Practice in S.C.

Piedmont Medical Center in South Carolina is at the head of a national charge to prevent the spread of the antibiotic-resistant staph supergerm MRSA.

For now, people visiting Piedmont's critical care patients must wear sterile gowns and latex gloves until patients are found to be free of the MRSA germ. The practice, which started in August, will expand to the rest of the hospital, possibly by the end of January.

MRSA, or Methicillin-Resistant Staphylococcus Aureus, is spread by skin-to-skin contact. People who are ill or whose immune systems are compromised are more susceptible than healthy people. For them, it can lead to pneumonia and other serious infections, including in the bloodstream or at surgical sites. The germ can be deadly.

Piedmont's battle against MRSA begins with "contact isolation," which involves placing the patient in a room and taking a nasal swab test for the germ. It takes about 48 hours to get results. Meanwhile, hospital staff and visitors to the room must wear disposable gowns and gloves, which immediately afterward are placed in a disposal bin.

"I think we're doing what everybody else should be doing," said Dr. Craig Charles, Piedmont's infectious disease specialist. "We're trying to stop it in its tracks. "Research has shown if you put a greater effort to identifying it and take precautions to prevent it from spreading, you can prevent people from getting it and reduce the pain and suffering," he said.

Assuming the test returns negative, visitors no longer have to wear gowns and gloves. It is recommended that they return to normal precautions of washing hands or using an antibacterial lotion when entering and leaving the patient's room. If the test returns positive, an antibiotic ointment is used in the patient's nose and under the nails. The patient takes baths in chlorhexadine soap. After 10 days, the MRSA infection should be eradicated.

Visitors aren't tested for the germ because the hospital only has legal authority to test patients. A major goal of contact isolation is preventing visitors from carrying the germ from a patient's room to hospital public areas.

PMC is in a consortium with the Duke Infection Control Outreach Group of Duke University Medical Center in Durham, N.C. Those in the consortium share information on MRSA and compare data. "Probably in the future, more hospitals are going to try to do this," said Dr. Deverick Anderson, an infectious disease fellow at Duke. "At this point, most hospitals only do it in specific situations. A lot of focus is on critical care areas."

In October, the U.S. Centers for Disease Control and Prevention issued new guidelines "to halt the rising rates of drug-resistant infections" with "aggressive steps." The guidelines cover all drug-resistant bacteria, but they cite MRSA as "a good example" of a germ with increasing antibiotic resistance. It refers to MRSA as "a growing problem in hospitals and health-care facilities."

The Institute for Healthcare Improvement has recommended "contact isolation" while testing for MRSA, Anderson said. The association just released a campaign called "Five Million Lives" to decrease harm to patients when hospitalized. Active surveillance for MRSA is one of six targets.

Anderson called MRSA "definitely one of the worst infections you can get in a hospital."

"There's a new type emerging in the past four or five years that is causing skin infections," he said. "We would hope to come up with ways to control it, but right now, it's headed in the wrong direction." Fifteen years ago, only people who spent significant time in a hospital got MRSA, Charles said. Then cases emerged in athletic teams and other communities outside hospitals, and standard antibiotics didn't work.

It is bacteria's nature to evolve for survival. "If you keep pressuring them with antibiotics, they will keep evolving," Charles said. Penicillin was a wonder drug when it was invented, but the medical community ultimately discovered it didn't kill staph germs. Methicillin was developed as the anti-staph penicillin. In the mid-1980s, MRSA developed resistance to methicillin.

Another antibiotic, Vancomycin, was developed to combat MRSA. Charles said there now are cases in Japan where MRSA is Vancomycin-resistant. There have been six such cases in the United States, Anderson said. "It's a moving target," he said.

Ironically, some bacteria have evolved to the point they are no longer resistant to older antibiotics that have not been used for a while, Charles said. However, MRSA is not one of them.

Bacteria live in colonies, and most family and friends have been exposed to the same colonies of bacteria. Therefore, visitors do not have to wear face masks, and hugging patients in contact isolation is OK.

Clothing and hands, especially hands, are major carriers. Hands spread germs to doors, counters and elevator buttons, and on throughout the hospital. Hospital staff recommend washing the hands or using a sanitary lotion every time you enter or leave a patient's room, regardless of whether the patient is in contact isolation.

Piedmont has not yet identified unusual clusters of MRSA. If it does, it will research common circumstances for the source. Like most hospitals, Charles said, Piedmont has had isolated cases where MRSA contributed to a patient's death.

PMC is studying the cost of buying disposable gloves and gowns that contain an impenetrable plastic. The gloves and gowns would be distributed to staff and visitors at the 288-bed hospital. A box of 100 gloves costs $4.24 and gowns $7.80 for a package of 10, said hospital spokeswoman Myra Joines. For a critical-care patient, staff use an estimated 50 gowns and 100 gloves a day. That does not include visitors. Hospital officials expect it to be well worth the expense.

"It's the right thing to do," Charles said. "Every dollar spent on infection control saves $5 and countless lives. If you prevent one serious hospital-acquired illness, you pay for the whole program."

By Karen Bair - The Herald, Rock Hill, South Carolina - Updated 12/24/06