$25 Manicure Turns Into $80,000 in Medical Bills

By Sabra Gertsch
SEATTLE -- Cheryl Woolf began suspecting something was wrong when she left the nail salon.

"A $25 manicure turned into $80,000 in medicals," she said.

Woolf rarely gets her nails done, but with a big occasion approaching she treated herself to a little primping on a fateful day nearly four years ago. But the manicure turned out to be no treat.

"Felt something weird. l pulled back and I looked down and saw that my fingers were bleeding," she said. Her right middle finger was the worst.

"I knew something was wrong," she said. Three months later, Woolf found herself in a terrifying situation. "I couldn't walk. I was screaming. I thought if I quit breathing, the pain would stop. That's how bad it was," she said

Woolf was suffering from Methicillin-resistant Staphylococcus aureus (MRSA), an antibiotic-resistant type of staph infection -- deadly bacteria that feed on open wounds. She had never heard of it before it launched an attack on her system.

"No, they didn't tell me; I knew I was going to die," she said. Woolf says a hand specialist tried to remove the nail on her middle finger. "Piece of metal, a small sliver of metal came out of my finger," she said. Her doctors diagnosed her with pneumonia and sent her home with antibiotics. But the pain persisted. "My primary care physician says, 'Why are you complaining so much? (I said) 'Because it hurts. I don't know what's wrong,'" said Woolf.

No one may have listened at first. But after five visits to the emergency room, someone began listening to Woolf. By then, her right lung was full of MRSA-infected fluid."I said, 'What is that?' And they said, 'That's what's coming out of your lung,'" Woolf said.

The nail shop in Snohomish County now has a new owner, but in 2007 Woolf filed a lawsuit against the former owners and reached a private settlement.

According to Washington state licensing records, Phuong. Q. Tran violated safety and sanitation rules and was fined $500 on at least one occasion. But that's not the end of the story; Woolf's run-in with MRSA led to something else. "The silver lining in the cloud was they found cancer," she said. Woolf had also been suffering from breast cancer, and because she was under treatment for MRSA, her doctors detected it early.

"Thinking how really lucky I am. There's a purpose. I guess something kept pulling me back here," said Woolf.

MRSA can look like a spider bite, abscess or boil. It's more deadly than AIDS in the U.S., but it should not be a threat if it is treated right away.

Flu or No Flu - Wash Your Hands

May 12, 2009

Fear of swine flu is fading, but there are still plenty of reasons to wash your hands frequently.

The list of infections that can spread via unwashed hands reads like the Biblical plagues, including staph, strep, salmonella, E. coli, hepatitis, MRSA (methicillin-resistant Staphylococcus aureus), colds, flu and norovirus -- the infamous cruise-ship bug.

The importance of hand washing has been known since 1847, when a doctor named Ignaz Semmelweis suspected that maternity patients were dying in his Vienna hospital because med students treated them right after working on cadavers. When he instituted hand-cleaning, the deaths fell sharply.

The Centers for Disease Control and Prevention says hand washing is the most effective way to stay healthy. But many people don't do it often enough, or long enough, to be effective. Here's a guide:

The swine flu headlines have brought attention to the importance of hand-washing. Health columnist Melinda Beck describes the best way to wash off germs and protect against sickness.

When to do it. Wash your hands every time you use the bathroom. Every surface presents an opportunity for germs to hitchhike out. "Who thinks to clean the latch on the inside of the stall door? Try nobody," says Jim Mann, executive director of the Handwashing for Life Institute, which advises food-service providers around the world on best hand-hygiene practices.

Also wash your hands whenever you change a diaper, pick up animal waste, sneeze, cough or blow your nose; when you take public transportation, insert or remove contact lenses, prepare food, handle garbage and before eating. Few people are as conscientious as they should be. Mr. Mann recalls being in meetings to discuss hand hygiene: "Everybody shakes hands. You finish the talk, and everybody runs for the food line. Nobody washes their hands."

How to do it. Soap and water is the gold standard. In a recent study in the journal Clinical Infectious Diseases, researchers in Australia doused the hands of 20 health-care workers with human H1N1 flu virus. Soap and water removed slightly more virus than three alcohol-based hand rubs. When volunteers didn't clean their hands, most of the virus was still present an hour after exposure.

It's the mechanical process of washing that's so effective. Soap molecules surround and lift the germs, friction from rubbing your hands loosens them, and water rinses them down the drain.

Experts recommend using warm water -- mainly for comfort, so you'll wash longer. Use liquid soap if possible. Bar soaps can harbor germs, though they'll likely rinse off with water.

Use enough soap to build a lather. Lace your fingers together to cover all the surfaces. Rub the fingertips of one hand into the palm of the other, then reverse. Keep rubbing for as long as it takes to sing "Happy Birthday" twice. (Some experts prefer "Row, Row, Row Your Boat." But any tune will do as long as it lasts at least 15 seconds.)

"The typical 'splash and dash' that most people do doesn't do anything," says Mr. Mann.

Rinse thoroughly. Residual soap can make hands sore. Leave the water on while you grab a paper towel and use it to shut off the faucet. Take it with you to use on the door handle as well.

Drying lessons. Many hand-hygiene experts are down on hand dryers -- chiefly because few people have the patience to dry completely and end up wiping their hands on their clothes. "That's fine -- unless your pants have been down around your ankles in the stall," Mr. Mann says.

Air dryers can also blow remaining germs as far as six feet away.

Antibacterial soap? In 2005, a Food and Drug Administration panel voted 11-to-1 that antibacterial soaps are no more effective at keeping people healthy than regular soap. There may be some downside too. Some antibacterial ingredients like triclosan leave a residue on the skin that continues killing some bacteria. Critics worry that the remaining bacteria could become resistant, not only to soap but also to antibiotics. "To our knowledge, it's not happened, but it's theoretically possible," says Elaine Larson, a professor in the schools of nursing and public health at Columbia University. Another problem with antibacterial soap, she says, is that it gives people a false sense of security. "People think, 'Ah -- it's antibacterial. So the germs are gone.' That's a false perception," Dr. Larson says.

Hand sanitizers. It's not often that a personal-care product gets a presidential endorsement. Some drug stores sold out after Barack Obama echoed the CDC's recommendation that people use alcohol-based hand sanitizers when soap and water aren't available to help stop the spread of swine flu.

Experts say they must be at least 60% alcohol to kill germs. "Alcohol ruptures their cell membranes -- it causes them to explode," says Dr. Larson, although she notes that if your hands are visibly dirty, soap and water is much preferable.

Curiously, the FDA does not allow over-the-counter hand sanitizers to claim they kill viruses. The CDC's recommendations are based on information published since the FDA ruling, showing that alcohol-based sanitizers are effective at killing viruses, specifically the H1N1 strain, says Nicole Coffin, a CDC spokeswoman.

Can you overdo handwashing? Yes. "Try to strike a balance between being obsessive-compulsive and being reasonable," says Dr. Larson. "And if there is some kind of outbreak like with the flu or SARS, then there is reason for more caution."

Email healthjournal@wsj.com.
Printed in The Wall Street Journal, page D1

Report: Flesh-eating Bug Kills Cruise Ship Passenger in Hours

USA Today 5/8/09

The British media today is abuzz over the story of a cruise ship passenger killed by so-called flesh-eating bacteria.

The BBC says 58-year-old Raymond Evans died within hours of showing symptoms of the disease, necrotising fasciitis, while on an unnamed cruise ship in the Mediterranean two months ago.

The news outlet says the passenger's widow testified this week in an inquest into the death that Evans had injured his knee when it gave out during a walk in a port. The ship's doctor, who examined the injury after the couple returned onboard, prescribed him antibiotics, but despite the treatment the knee continued to deteriorate and eventually was consumed by a "blotchy blackness" that spread to his chest, elbow and fingers.

The BBC says Evans was admitted to the ship's in-house hospital and, upon arrival in Alexandria, Egypt, rushed to a hospital on land. But he died within hours from multiple organ failure.

A pathologist at the inquest suggested Evans could have picked up the bacteria on the ship. "It could not have been anything to do with his initial knee injury because this progresses within hours," the pathologist said.

Doctor, Did You Wash Your Hands?

Despite national campaigns encouraging patients to take an active role in improving hospital safety, many patients aren’t comfortable asking doctors challenging questions about their care.

British researchers gave surveys to about 80 surgical patients asking them how they would feel about asking doctors or nurses various questions. The questions ranged from simple factual questions like, “How long will I be in the hospital?” to more challenging questions such as, “Have you washed your hands?” The patients were asked to rate their level of willingness to ask the questions on a scale of 1 to 4, with 4 indicating they would be very willing to pose the question to their doctor or nurse.

Basic questions to doctors about length of hospital stay, time off work and details about the procedure were easy for patients to ask and received high marks, scoring on average 3.4 points, according to the report, which appeared in the journal Quality & Safety in Health Care.

But questions aimed at improving patient safety and reducing medical errors were far more difficult for patients to ask, receiving an average score of just 2.4 points. Questions that received low marks included:

“Who are you, and what is your job?”

“I don’t think that is the medication I am on. Can you check please?”

“Have you washed your hands?”

“How many times have you done this operation?”

Although patients were slightly more willing to ask challenging questions of nurses, scores remained low. However, the survey suggested that if a doctor instructs a surgical patient to be sure and ask about safety issues like hand washing and medication, patients found it far easier to ask challenging questions. Women also were more likely to ask challenging questions than men, the study showed.

The study authors said the findings suggest patients are worried about insulting their doctors by asking safety-oriented questions. For patient safety programs to be effective, doctors and nurses need to communicate to patients that challenging questions are a good thing.

“Patients need to feel they can ask questions that may be perceived as challenging without causing offense to those involved in their health care treatment,” the study authors wrote.