The Bugs Among Us

Are you a bit slack about washing your hands? You won't be after reading this book on the life and times of the most successful - and deadly - life form on the planet: the lowly germ.

Consider the germs that author and microbiologist Philip Tierno Jr. spots on a sweep of New York City's more elite locales: the bar at a posh Manhattan hotel teems with Strep D, a bacterium found in feces; the shower at a high-priced gym sports germs that cause pneumonia; and flesh-eating bacteria are just waiting to say hello on the handset of a Madison Avenue pay phone.

Fortunately, most people's immune systems are strong enough to fight off these microscopic monsters. But not when it comes to killers like the Ebola virus. Tierno sketches a frightening hypothetical scenario in which a United Nations official returns to New York from Africa unknowingly infected with Ebola. When he collapses in a public restroom, he passes on the deadly virus to two strangers who help him to his feet. One man exits the restroom without washing his hands and soon becomes infected. The other fastidiously cleans his hands and thus washes the virus down the drain.

"What makes this important is the fact that eighty percent of all infectious illnesses, from the common cold to flesh-eating bacteria and lethal viruses like Ebola, are transmitted by touch," writes Tierno, who serves as the director of clinical microbiology and diagnostic immunology at New York University Medical Center and Mt. Sinai Medical Center. "In this light, hand washing emerges as a public-health issue that is every bit as serious as smoking, if not more serious."

He's not exaggerating. Reaching out and touching someone can kill. For instance, as many as 100,000 people a year in the United States die from infections they contract in hospitals. How does this happen? Often it's simply because doctors and nurses fail to properly wash their hands and thus pass on germs from patient to patient, according to Tierno. The annual cost of treating these infections: $4.5 billion. And bugs that may give a resident of Europe a bout of diarrhea can be deadly in developing countries where residents lack access to clean water and are constantly exposed to high concentrations of dangerous microorganisms from inadequate sewage systems. Millions of Third World children still die every year from diarrhea-related illnesses.

You might recognize Tierno's name from his appearances on Oprah and his investigative work for 20/20 and other television programs. A sort of Carl Sagan of inner space, Tierno has a light touch and has written an accessible scientific book that doesn't overwhelm readers with jargon. Instead, he mixes history, science, and anecdotes from everyday life to tell you everything you ever wanted to know about germs but were afraid to ask. It can make for fascinating reading, and Tierno includes practical advice on protecting yourself and your family from germs and the diseases they cause.

The Secret Life of Germs is timely on two fronts: Globalization means that once unknown and geographically remote diseases like Ebola fever are a mere plane ride away from millions of people. Second, the post-September 11 anthrax attacks have brought biological terrorism as close as your mailbox.

But it would be a mistake to think that all germs are the enemy, stresses Tierno, who helped solve the mystery of toxic shock syndrome in the 1980s. In fact, our lives are utterly dependent on germs. Friendly bacteria help digest our food, and others neutralize dangerous germs. Without bacteria to decompose organic matter, every square inch of the Earth would soon be piled sky-high with dead animals and plants, writes Tierno. And though we try mightily to minimize our contact with germs, there's simply no escaping them. Your intestine alone, for example, contains billions and billions of germs. The same is true for your skin, nose, and teeth.

That said, Tierno's tour of a typical germ-infested home is sure to make your skin crawl. Roll out of bed in the morning and your feet hit a carpet chock full of sloughed-off skin cells, fungi, and mites. That's nothing compared to what awaits you in the bathroom. If you flush the toilet without closing the lid, aerosolized fecal matter can fly as far as 20 feet, landing on combs, towels and toothbrushes. The bathroom is a virtual germ hothouse, with bacteria growing on wet bars of soap and sponges. Down in the laundry room, germs can take a ride in the dryer and in all but the hottest washing machine water and emerge none the worse for wear. You can guess what goes on in the kitchen, with all that inviting food offering an endless bacterial smorgasbord.

At home, at least, germs stay more or less all in the family. At the office, however, you're sharing the germs your colleagues leave on phones, computer keyboards, and copy machines. And any parent knows what germ-factories schools can be.

You can't escape germs, but you can minimize the risk of them making you and your family sick. To that end, Tierno offers what he calls a Protective Response Strategy, written in bullet form at the end of relevant chapters. It's commonsense advice -- wash your hands, cover your mouth when you sneeze, and so on -- sometimes taken to an extreme. Following Tierno's strategy no doubt will limit exposure to nasty bugs. But your friends and coworkers might think you've turning into a latter-day Howard Hughes if you adhere to Tierno's public-restroom protocol and use paper towels to turn off the water tap and grip the doorknob when you exit. His detailed instructions for cleaning your anus after a bowel movement are unlikely to be adopted by the masses. Still, with surveys showing that most of don't even bother to wash our hands after using the toilet, or are content to dribble some water on our fingertips, Tierno's message needs to be heard.

Unfortunately, there's not much individuals can do to protect themselves against germs manipulated by humans for evil ends. In an eerie foreshadowing of the bioterrorism incidents that followed September 11 attacks, Tierno imagines a disgruntled government laboratory technician flying a crop-dusting plane toward New York City and releasing a payload of anthrax. (The Secret Life of Germs was published two months after September 11, and although there's a brief mention of the terrorist strikes, the chapter on bioterrorism appears to have been written prior to the anthrax attacks.) Tierno recommends that the public be inoculated against diseases like anthrax and that doctors and other health workers be educated to diagnose and treat diseases likely to be related to a bioterrorism attack.

The chances of dying from bioterrorism, however, are minuscule compared to the risk of contracting a life-threatening infection in, say, your local hospital. The best way to protect yourself is also the simplest. "The bottom line is that clean hands can be the most powerful weapons for health on Earth," Tierno insists.

So now that you are done reading this review and have picked up god knows how many germs from your computer keyboard, go wash your hands!

A Review by Todd Woody
CONSUMER HEALTH INTERACTIVE
The Secret Life of Germs: Observations and Lessons From a Microbe Hunter
By Philip M. Tierno Jr., PhD

Todd Woody is a former senior editor at The Industry Standard, where he also covered the Internet health care business. His work has appeared in The New York Times, the San Francisco Chronicle, Columbia Journalism Review, and other publications.

The Secret Life of Bacteria

Bacteria seem to have a limitless capacity to surprise us. They are found living off boiling sulphur on the ocean bed and feeding off rocks deep within the Earth's crust. Once we thought we could control them with antibiotics; then they fought back by developing resistance. Now it seems that they have been making us ill all the time in ways we were not even aware of. New findings suggest that conditions as different as kidney stones, obsessive compulsive disorder, Tourette's syndrome, heart disease and arthritis may all be the result of hitherto unrecognised bacterial infections.

Years ago, a Finnish researcher - Olavi Kajander of Kupio university - caused a stir when he suggested that kidney stones could be caused by a type of tiny bacteria, found in the blood of humans and cows, which build a hard mineral shell round themselves for protection. The coats of these nanobacteria, so-called because they are only 0.1 micrometers long, are made out of a similar sort of material to that found in kidney stones. This set Kajander wondering whether the two were connected. He examined 30 kidney stones and found that they all contained the bacteria. "Not proof," he admits, "but it's strong evidence." Dr Dennis Carson of the University of California, San Diego, has suggested that nanobacteria may also be implicated in other disorders, such as heart disease, some tumours, and dementia caused by excess calcium deposits in the brain.

In fact, bacteria have been turning up as the unsuspected cause of chronic infections ever since 1982, when two young Australian physicians, Barry Marshall and Robin Warren, isolated bacteria from patients with ulcers or gastritis (stomach inflammation). They made the radical proposal that a spiral-shaped bacterium, later named Helicobacter pylori, causes gastritis and possibly ulcers. At the time no one took them seriously; everyone "knew" that ulcers were caused by stress.

It was a neat coincidence that the pylori-ulcer link was made exactly 100 years after Heinrich Koch discovered the link between bacteria and tuberculosis, dismissed at the time because everyone believed an excess of emotions caused tuberculosis. In fact, it was not until February 1994 that the pylori-ulcer connection was officially recognised by the medical profession.

Acceptance was so slow partly because ulcers fail to conform with our notion of an infectious disease. Infections, with some exceptions such as leprosy and tuberculosis, are acute. You have a swelling, inflammation, maybe pain, maybe a fever, you are ill for days or a few weeks at the most, and then you either die or recover. But it now seems that such chronic conditions as arthritis, hardening of the arteries and even cancer may be linked with bacteria.

Pylori, for instance, seems associated with stomach cancer - having pylori increases the risk about sixfold - but there must be other factors, since only 1 per cent of people with pylori get stomach cancer. About 50 per cent of patients with lymphoma, an uncommon form of stomach cancer, do seem to be cured when pylori is wiped out with antibiotics.

Findings like these prompted the International Conference on Emerging Infectious Diseases, held in Atlanta by America's Centers for Disease Control, to devote a session to chronic diseases and bacteria earlier this year. One of the new villains of the occasion was Chlamydia pneumoniae, well known for causing pneumonia, which is now accused of being involved in some cases of arthritis and asthma, and, more seriously, heart disease.

In the last few years this bug, once thought to live only in the nose and throat, has been found taking up residence in the fatty "plaques" that accumulate on the insides of blood vessel walls when the arteries fur up. Research by Dr Sandeep Gupta, of St George's hospital in London, found that patients with evidence of pneumoniae infection were as much as four times more likely to suffer further heart problems over an 18- month period - a difference that vanished after the patients were given a three-day course of antibiotics.

The experts are still cautious about declaring that pneumoniae is helping to build the plaques, rather than just living in them, but the case for the prosecution is getting stronger. A recent experiment by Dr Robert Molestina, at the University of Louisville in Kentucky, has shown that pneumoniae causes cells from the artery wall to produce molecules called chemokines. These are chemical cries for help, and attract the defence team of the immune system, which produce inflammation - the way the body normally deals with infection. Researchers are now trying to clarify why the inflammation does not clear up, as it does with most infections.

In fact, inflammation is at the bottom of this new connection between bacteria and chronic diseases. The origins of a number of conditions that involve long-term inflammation, such as arthritis, Crohn's disease (in the gut) and ulcers have always been mysterious, but now bacteria that cause food poisoning, such as salmonella and campylobacter, are turning out to be likely culprits, at least in some cases.When it is the brain that gets inflamed, behaviour can be affected, which accounts for the even more surprising link between bacteria and psychiatric disorders such as autism and anorexia. The villain of this connection is streptococcus, another bacteria that normally gives you a sore throat. But in rare cases children produce antibodies against the infection, which then destroy cells in an area of the brain known as the caudate nucleus of the basal ganglia. From PET scans we know that this is a region of the brain that is hyperactive in people with obsessive compulsive disorder (OCD). The basal ganglia are involved in the control of movement and emotion.

Dr Susan Swedo, a neuroscientist at the American National Institute of Mental Health, has discovered that a significant proportion of OCD patients suffered from a severe "strep" infection in childhood. She has christened this link Pandas - paediatric autoimmune neuropsychiatric disorders associated with streptococcus - and the panda has now become the mascot of the American OCD support groups.

Now this oddly specific link between streptococcus and the caudate nucleus has been suggested as a possible cause for Tourette's syndrome, a condition that gives sufferers an overwhelming compulsion to repeat certain actions or phrases, often obscene ones. Earlier this month Dr Harvey Singer, of the Johns Hopkins University School of Medicine in Baltimore, Maryland, wrote an article in the British Journal of Medicine pointing out that Tourette's can first appear following strep infection, and it can get much worse if you already have it. She reported a study that found streptococcus antibodies in this area of the brain in a groups of children with Tourette's, compared to none in the brains of a normal group.

Dr Singer is following in the steps of other American researchers who have also found evidence of these antibodies in the blood of patients with autism and with anorexia, both conditions involving strong elements of compulsion and obsession. No one is suggesting this is the only cause. but Dr Mae Sokal, of the Menninger Clinic in Topeka, Kansas, has reported success in treating "elevated antibody anorexics" as they are known, with a course of antibiotics has lead to dramatic improvement.

It seems that bacteria still have plenty of surprises in store for us.

Newspaper Publishing PLC
Provided by ProQuest Information and Learning Company
by Jerome Burne

Infection Prevention is Everyone's Job

Almost one in 10 patients in Scotland's main hospitals are carrying a secondary infection such as MRSA, according to new figures. The study found hospital associated infections (HAI) in acute hospitals cost the health service £183m a year.

Health Secretary Nicola Sturgeon said it was the most comprehensive study ever undertaken into the extent of infections in Scotland's hospitals. She said infections are most prevalent in elderly, medical and surgical wards.

The survey carried out by Health Protection Scotland, included every patient in all of Scotland's acute hospitals and in a sample of community hospitals. It recorded the presence of all types of infections on the day of the survey. It found that prevalence of HAI was 9.5% in acute hospitals and 7.3% in community hospitals.

Ms. Sturgeon said the infection rates were a serious problem that had to be tackled.

"9.5% of patients in Scottish acute hospitals have some form of HAI," she said. "And the £183m cost to the NHS together with the massive human cost is unacceptable." Ms. Sturgeon said the survey meant Scotland now had a more comprehensive picture of secondary infections than any other country in Europe.

The health secretary warned that the comprehensive nature of the survey meant Scotland's rates of HAI may appear worse than elsewhere. But she insisted like-for-like comparisons with countries like England and Norway showed Scotland's rates were similar. She said a task force set up to tackle the problem would now examine the case for introducing an MRSA screening programme. It would also target skin and soft tissue infections, reducing blood stream infections and would try and use additional data to tackle infection rates in medical and elderly wards.

Ms Sturgeon added: "Tackling hospital infections is not just the job of hospital staff. Everyone has a key role to play in preventing the spread of infection - patients, visitors and staff alike."

The survey found almost all of the infections of the superbug clostridium difficile were found in elderly and medical wards.

Previous studies have only managed to estimate the scale of the problem.

Tory health spokeswoman Mary Scanlon said: "I hope that the HAI taskforce will recommend procedures to include healthcare acquired infections on a death certificate when it has been a significant contributory cause of death."

Labour's health spokesman Andy Kerr said: "Nicola Sturgeon's commitment to reducing hospital acquired infections in Scotland's hospitals is undermined by the SNP's long history of knee-jerk reactions and their inability to understand complex health issues."

Cathy Miller, a nurse based at Glasgow Royal Infirmary, said part of the problem was due to nurses having to wash their own uniforms. "This is the most penny-pinching thing I have ever heard," she said. "Now is that tackling hospital acquired infections when we're doing things like that?"

She said nurses were doing the best job they could with the staffing levels available, and added that contracting out cleaning services to private companies had not helped the matter.

Prof Curtis Gemmell, a national adviser on MRSA and hospital infections, said the problem had been made worse by improper use of antibiotics.

He said: "The organism has developed resistance to many of the antibiotics we use in hospital."

Active Surveillance Works in Pittsburgh

PITTSBURGH (UPI)

The Veterans Affairs hospital in Pittsburgh says simple precautions can keep deadly drug-resistant infections at bay.

The hospital said there were just 17 cases of methicillin-resistant Staphylococcus aureus, or MRSA, last year, compared to an average 60 before the aggressive campaign started, The New York Times said Friday.

Nurses swab the nasal passages of every arriving patient to test for drug-resistant bacteria, isolating those infected in special rooms behind red painted lines.

The newspaper said every room has dispensers of foamy hand sanitizer, blood pressure cuffs are discarded after use and each room is assigned its own stethoscope.

The U.S. Centers for Disease Control and Prevention projected one of every 22 patients will get an infection while hospitalized and 99,000 would die.

A recent survey found less than a quarter of U.S. hospitals screen patients for bacterial colonies in any methodical way.


From United Press International
07/27/20

Swabs in Hand, Hospital Cuts Deadly Infections

An excerpt from The New York Times

PITTSBURGH - At a veterans’ hospital here, nurses swab the nasal passages of every arriving patient to test them for drug-resistant bacteria. Those found positive are housed in isolation rooms behind red painted lines that warn workers not to approach without wearing gowns and gloves.

Every room and corridor is equipped with dispensers of foamy hand sanitizer. Blood pressure cuffs are discarded after use, and each room is assigned its own stethoscope to prevent the transfer of microorganisms. Using these and other relatively inexpensive measures, the hospital has significantly reduced the number of patients who develop deadly drug-resistant infections, long an unaddressed problem in American hospitals.

The federal Centers for Disease Control and Prevention projected this year that one of every 22 patients would get an infection while hospitalized - 1.7 million cases a year - and that 99,000 would die, often from what began as a routine procedure. The cost of treating the infections amounts to tens of billions of dollars, experts say.

But in the past two years, a few hospitals have demonstrated that simple screening and isolation of patients, along with a relentless focus on hygiene, can reduce the number of dangerous infections. By doing so, they have fueled a national debate about whether hospitals are doing all they can to protect patients from infections, which are now linked to more deaths than diabetes or Alzheimer’s disease.

At the Veterans Affairs hospital in Pittsburgh, officials say the number of infections with a virulent bacterium known as methicillin-resistant Staphylococcus aureus, or MRSA, dropped to 17 cases last year from an average of 60 before the program started. The 40-bed surgical unit that began the experiment in 2001 has cut its infection rate by 78 percent.

Such results are not unprecedented. Several European countries, including the Netherlands and Finland, have all but eliminated MRSA through similarly aggressive campaigns. But at many American hospitals, experts say, high infection rates have been accepted as a cost of doing business. Barely a quarter of American hospitals screen patients for bacterial colonies in any methodical way, a recent survey found.

“People don’t believe it’s in their institution, and, if it is, that it’s too big to do anything about, that you just have to accept it,” said Terri Gerigk Wolf, director of VA Pittsburgh Healthcare Systems. “But we have shown you can do something about it.”

Three state legislatures, including Pennsylvania’s, broke ground this year by passing bills to require that hospitals routinely test high-risk patients, like those in intensive care units. But some infection-control experts warn that such regulations may have unintended consequences, including lesser care for patients who linger in isolation. Studies have found that patients in isolation are seen by hospital staff members half as frequently and tend to suffer more from falls, bed sores and stress.

Dr. John A. Jernigan, a MRSA expert at the disease control agency, said there was “a legitimate scientific debate” about whether hospitals should devote precious resources to screening every patient.

“It is a daunting problem, and it has been a recalcitrant problem,” Dr. Jernigan said. “We’re starting to see encouraging results. But I think we’ve been so stuck in this argument about what works and what doesn’t that people have not put programs in place.”

The problem of infections in hospitals is growing. MRSA has been a particularly troublesome pathogen since its emergence in the United States in 1968. Resistant to a number of antibiotics, it can cause infections of surgical sites, the urinary tract, the bloodstream and the lungs, leading to extended hospital stays.

MRSA can be brought into hospitals by patients who show no symptoms, and it then thrives in settings where immune systems are weakened and where incisions provide inviting ports of entry. It now accounts for 63 percent of hospital staphylococcus infections, up from 22 percent in 1995.

Johanna Sullivan Daly, a 63-year-old Brooklyn woman, developed MRSA and other infections after surgery to repair a broken shoulder in 2004, said one of her daughters, Maureen J. Daly. Ms. Daly said that just before her mother’s discharge from a Manhattan hospital, she watched a doctor remove her dressings with bare, unwashed hands.

Five days later, her mother developed intense pain and they went to have her wound examined. “When the dressing came off,” Ms. Daly said, “I saw this - I can’t describe the smell, it was the foulest thing - just this greenish fluid coming out of her arm, oozing and oozing.”

Soon after, her mother developed a high fever and then lost the ability to move her limbs, Ms. Daly said. She spent several months on a ventilator before dying in a nursing home. The hospital bill came to $600,000 for what was to have been a $40,000 procedure.

“I have lost friends to breast cancer, to AIDS, to car accidents, to things we don’t have answers to,” she said. “That I lost my mother to someone not washing their hands or cleaning a hospital room properly is disgusting to me.”

The disease control agency projected seven years ago that the added annual cost of treating infected hospital patients was nearly $5 billion. Now officials there believe it may approach $20 billion, or 1 percent of the nation’s $2 trillion health care bill. Other experts put the number above $30 billion.

As at other hospitals experimenting with rigorous controls, the Pittsburgh veterans hospital has found that preventing infection is cost-effective.

Dr. Rajiv Jain, the hospital’s chief of staff, said its infection control program cost about $500,000 a year, including test kits, salaries for three workers and the $175-per-patient expense of gloves, gowns and hand sanitizer. But the hospital, which has a $431 million budget, realized a net savings of nearly $900,000 when the number of infected patients fell, Dr. Jain said.

The V.A. began phasing in the program at each of its 140 acute-care centers in March.

Dr. Richard P. Shannon, who championed a program to reduce catheter infections at Allegheny General Hospital in Pittsburgh, was able to show administrators that the average infection cost the hospital $27,000. He demonstrated that reimbursement payments for weeks of extended treatment were not keeping pace with actual costs. “I think it was assumed that hospitals didn’t mind treating these infections because they were getting paid for it,” Dr. Shannon said.

A major emphasis at the Pittsburgh hospitals has been hand hygiene. Studies have consistently shown that busy hospital workers disregard basic standards more than half the time. At the veterans hospital, where nurses have taken to pushing elevator buttons with their knuckles, annual spending on hand cleaner has doubled.

State governments, which reimburse hospitals for infection-related costs through Medicaid and other insurance programs, have taken notice and are beginning to impose new mandates.

Eighteen states now require hospitals to publish their infection rates. Last month, legislatures in New Jersey and Illinois approved bills that would make those states the first to require hospitals to screen all intensive-care patients for MRSA.

Here in Pennsylvania, Gov. Edward G. Rendell recently signed a bill requiring MRSA screening of certain high-risk patients. Mr. Rendell did not, however, win legislative approval to end state reimbursements to hospitals for the treatment of infections and to test all hospital patients for drug-resistant bacteria.

It is the screening and isolation of patients that draws the most debate. Screening presents an upfront cost for hospitals, and administrators worry that keeping patients in isolation will further clog emergency rooms and reduce the quality of care. Some researchers believe that improving hygiene and surgical practices alone may be equally effective.

In guidelines released last year, the centers recommended that other precautions be taken first and that hospitals resort to screening high-risk patients if they cannot otherwise reduce their infection rates. The guidelines are endorsed by the American Hospital Association, which believes that hospitals must be able to tailor plans to varying needs.
 
July 27, 2007
By KEVIN SACK

Drug-Resistant Infections Spur 10X Jump in Hospital Stays

July 27, 2007

Hospital stays for MRSA (methicillin-resistant staphylococcus aureus) jumped nearly 10-fold in the decade since 1995, the U.S. Agency for Healthcare Research and Quality said Wednesday.

There were 368,800 hospitals stays among MRSA-infected patients in 2005, up from 38,100 in 1995, the agency said.

MRSA is resistant to frequently used antibiotics, including amoxicillin and penicillin, the AHRQ said in a statement. It's often acquired by hospitalized patients who have had surgery or have weakened immune systems, but the agency noted a significant increase in the infection's incidence among otherwise healthy people.

(Information excerpted from) http://nursetips.blogspot.com

More than 50% Increase in MRSA in Maine

July 27, 2007
PORTLAND, Maine (AP): Growing numbers of Mainers are contracting a staph infection that is resistant to commonly used antibiotics.

The specific infection, methicillin-resistant Staphylococcus aureus (MRSA), strikes an estimated 1.2 million people nationwide each year, resulting in death for tens of the thousands of the most vulnerable, according to a new study from the Association for Professionals in Infection Control & Epidemiology.

In Maine, hundreds of people are infected with the bacterium. The actual number of cases is hard to pin down because hospitals aren't required to report staph infections to the state.

But one indicator comes from NorDx, which provides laboratory testing services in southern Maine. NorDx found that 822 people contracted MRSA last year, up from about 535 in 2000. More than a 50% increase.

Don Piper, chief medical technologist for NorDx, said some of the rise is due to NorDx's increasing volume of work. Still, the numbers are significant and worrisome because front line antibiotics don't work on the bacterium, he said.

"The treatment requires antibiotics that are less effective and may have more side effects," Piper said.

MRSA, which has been called a "superbug," accounted for about 2 percent of all staph infections in the 1970s, according to the Association for Professionals in Infection Control & Epidemiology. It now accounts for more than 60 percent, the association said.

While MRSA is harmless when on the skin or inside the nose, a break in the skin can allow the germs to enter and multiply. The result can range from a painful boil to a bloodstream infection; it can also lead to pneumonia.

Hospitals in Maine say they are seeing more MRSA cases, which they attribute to a rise in a new strain of the bacteria found in community settings. People are spreading MRSA by sharing equipment and personal items such as towels and gear at homeless shelters, fitness center and schools.

The Cumberland County Jail and the Maine State Prison had outbreaks two years ago affecting nearly a dozen inmates. Bowdoin College had three cases over the past school year and at one point closed down several athletic facilities after a football team member was infected.

Years ago, most cases were of elderly people who underwent many hospital procedures and were often under a long-term care, said Kim Ware, infection control coordinator at MaineGeneral Hospital in Augusta, which treated 38 cases of community MRSA last year, up from 14 in 2005.

"What we're seeing now are young people who have not had any exposure to the hospital or to long-term care," she said.

Darcie Tocco, a 24-year-old restaurant cook in Portland, recently noticed a small bump on her thigh that started out looking like a little pimple but grew to the size a penny and got so hard that it felt like a pebble was lodged under her skin.

When she went to the emergency room at Maine Medical Center a couple of weeks ago, she discovered that she had contracted MRSA.

She has since learned that the best way for people to reduce the risk of staph infection is to keep their hands clean, keep cuts and scrapes clean and covered until healed, avoid contact with other people's wounds or bandages, and avoiding sharing personal items such as towels or razors.

"The only thing you can really do is have really good hygiene," Tocco said.

Communication Now Part of the Cure

Retired Boston physician Jonathan Fine became a patient advocate in 2004 when he realized communication between doctor and patient is often the first casualty of a major illness. Miscommunication puts patients at greater risk of becoming victims of preventable medical errors, according to a report this year by the Joint Commission, a national hospital accreditation organization. And the Institute of Medicine reports that medical errors cause up to 98,000 deaths a year.

The problem is so widespread that the federal government, non-profit agencies and individual advocates, including Fine, are working to improve communication practices at hospitals.

Three years ago, Fine's close friend was hospitalized for congestive heart failure and pneumonia. "I went to see him, and he looked like death warmed over," Fine says. "He was pale and gasping for breath. I really thought he might die right then and there."

Seeing that his friend was too weak to talk to his doctors, Fine, 75, immediately started taking notes, asking questions and relaying information. The first night, he slept on the hospital floor.

Fine realized that night that having an advocate to act as "eyes and ears" for a patient debilitated by illness is crucial. "There are so many patients who can't speak for themselves because they're in pain, or frightened, or feeble, or under the influence of medication or drugs," he says.

Language barriers, even in English

In 2005, Fine started Bedside Advocates, a Massachusetts organization that enlists volunteers to act as patient "guides" through the confusing terrain of the health care system. Fine's job is often to "translate" information from doctors, even for those patients who are fluent in English.

"Patients will turn to someone like me and say, 'What did the doctor just say?' " he says. "They're afraid to ask questions, and if they do ask questions, they don't understand the answers."

Hospitals often employ teams of specialists, which can present a daunting communication challenge, according to Mark Meaney, president and chief executive of the National Institute for Patient Rights and author of 3 Secrets Hospitals Don't Want You to Know: How to Empower Patients.

Specialized care means that a patient must communicate with a different doctor for each body part that is affected by their illness, such as the heart or the liver. Often, Meaney says, specialists focus too closely on the area of the body in which they specialize and fail to diagnose the "whole" patient.

Patients, Meaney says, are often left feeling confused, frustrated and unsure of who's in charge of their care.

Evaluation and improvement

Hospitals, however, will soon be held accountable for how well their doctors communicate with patients. The results of a new nationally standardized patient satisfaction survey, known as the Hospital Consumer Assessment of Health Providers and Systems, will be posted online by the Centers for Medicare and Medicaid Services next year. Hospitals must begin collecting the data beginning this month or lose a portion of critical Medicare and Medicaid funding, CMS officials say.

The data will widely reflect hospitals' performance when it comes to doctor/patient communication, and the assessment will standardize the reporting criteria across the nation.

"During this hospital stay, how often did doctors listen carefully to you?" the survey asks. "How often did doctors explain things in a way you could understand?"

The new standardized data, which will be available to the general public at hospitalcompare.hhs.gov, can help patients make more informed health care decisions, says Melvin Hall, chief executive of Press Ganey Associates, a health care performance measurement company. "Patients will now have the opportunity to vote with their feet, which is to say, 'This hospital is not meeting my needs. Therefore, I'm going to go somewhere else.' "

Some hospitals are not waiting to begin improving communication.

"The main thing we're trying to do is listen to our patients," says Faye Deich, chief nursing officer at Sacred Heart Hospital in Eau Claire, Wis. The hospital, which ranks in Press Ganey's top 1% for patient satisfaction, has hourly nursing rounds, strict behavioral standards for doctors and follow-up phone calls with patients after they have been discharged.

"We ask each patient what good care means to them, and that's communicated to the staff," Deich says. "If patients know you are there for them, they are more likely to tell you if something doesn't seem right."

Whether improvement measures take place at the government level or at the bedside, Fine says, the bottom line is making sure patients voice their concerns.

"Be assertive without being obnoxious. If there's something on your mind, speak up. If you don't understand something, ask the doctor to explain it to you."

By Erin Donaghue, USA TODAY

Staph Infection Plagues Hootie and the Blowfish

Source: The Associated Press
Article Launched: 07/17/2007

COLUMBIA, S.C. - Hootie & the Blowfish is again delaying the start of its summer tour as lead singer Darius Rucker recovers from a staph infection in his left knee.

Rucker has undergone three surgeries to clear the infection and is still trying to rehabilitate the knee, the band said in a statement released Tuesday.

The band will cancel four shows and postpone eight more. They already postponed the first 13 shows of the tour that was supposed to begin on June 29.

The tour will now start Aug. 10 on Hilton Head Island. Hootie & the Blowfish will keep a date to play three live songs July 20 in their hometown of Charleston as part of "The Early Show" on CBS.

The canceled shows are in Roslyn, Wash., Jacksonville, Ore., Ventura, Calif., and Turlock, Calif. The postponed shows are in Kelseyville, Calif., Temecula, Calif., Anaheim, Calif., San Diego, Livermore, Calif., Glendale, Ariz., Tucson, Ariz., and Albuquerque, N.M.

Facts About Antibiotic Resistance

Disease-causing microbes that have become resistant to drug therapy are an increasing public health problem. Tuberculosis, gonorrhea, malaria, and childhood ear infections are just a few of the diseases that have become hard to treat with antibiotic drugs.

Though food-producing animals are given antibiotic drugs for important therapeutic, disease prevention or production reasons, these drugs can cause microbes to become resistant to drugs used to treat human illness, ultimately making some human sicknesses harder to treat.

About 70 percent of bacteria that cause infections in hospitals are resistant to at least one of the drugs most commonly used to treat infections. Some organisms are resistant to all approved antibiotics and must be treated with experimental and potentially toxic drugs.

Some research has shown that antibiotics are given to patients more often than guidelines set by federal and other healthcare organizations recommend. For example, patients sometimes ask their doctors for antibiotics for a cold, cough, or the flu, all of which are viral and don't respond to antibiotics. Also, patients who are prescribed antibiotics but don't take the full dosing regimen can contribute to resistance.

Unless antibiotic resistance problems are detected as they emerge, and actions are taken to contain them, the world could be faced with previously treatable diseases that have again become untreatable, as in the days before antibiotics were developed. This is not a pleasant health scenario.

What to do?

1.) The basic rule is to avoid using antibiotics unnecessarily.
2.) Take your meds until the bottle is empty, or however long your doctor specifies.
3.) Ask your doctor if he/she is prescribing the most specific antibiotic possible. Targeted, or "narrow-spectrum," antibiotics will kill the offending bug without sparking resistance among other bacteria living in the patient, as broader-spectrum drugs might.
4.) Be logical and use the common antibiotics first. If they work, there will be no need to expose the bugs to more exotic drugs, which serve as a second line of defense.
5.) Consider reducing the widespread use of antibiotics in animal feeds.

A Short History of Vancomycin

Vancomycin was first isolated by E.C. Kornfeld (working at Eli Lilly) from a soil sample collected from the interior jungles of Borneo by a missionary. The organism that produced it was eventually named Streptomyces orientalis. The original indication for vancomycin was for the treatment of penicillin-resistant Staphylococcus aureus.

The compound was initially labelled compound 05865, but was eventually given the generic name, vancomycin derived from the word "vanquished". One advantage that was quickly apparent was that staphylococci did not develop significant resistance despite serial passage in culture media containing vancomycin. The rapid development of penicillin-resistance by staphylococci led to the compound being fast-tracked for approval by the FDA in 1958. Eli Lilly first marketed vancomycin hydrochloride under the trade name Vancocin.

Vancomycin never became first line treatment for Staphylococcus aureus for several reasons:

1.) The drug must be given intravenously, because it is not absorbed orally. 2.) β-lactamase-resistant semi-synthetic penicillins such as methicillin (and its successors, nafcillin and cloxacillin) were subsequently developed. 3.) Early trials using early impure forms of vancomycin ("Mississippi mud") which were found to be toxic to the ears and to the kidneys; these findings led to vancomycin being relegated to the position of a drug of last resort.

In 2004, Eli Lilly licensed Vancocin to ViroPharma in the U.S., Flynn Pharma in the UK and Aspen Pharmacare in Australia. The patent expired in the early 1980s and generic versions of the drug are also available under various trade names.

Hawaii Highest in MRSA

HONOLULU (AP) July 10, 2007

Hawaiian hospitals, rehabilitation centers and long-term care facilities are reporting the nation's highest infection rate for a dangerous, drug-resistant staph germ.

In Hawaii, 91 patients out of one thousand had contracted the superbug compared with 46 per one thousand patients overall.

Maine, New York and South Carolina also reported high rates of infection.

The germ, called Methicillin-resistant Staphylococcus aureus, can't be tamed by certain common antibiotics.

It is potentially fatal and can be spread by touch.

It is associated with sometimes-horrific skin infections, but it also causes blood infections, pneumonia and other illnesses.

The germ typically thrives in health care settings where people have open wounds.

(Copyright 2007 Associated Press. All rights reserved)