On How The State Gave Me MRSA (Part III), Or, The "Let's Fix It" Edition

Imagine that you’re a Presidential candidate running for office in today’s electoral environment. Now imagine if you came before the American public and informed them that you were aware of an event that would kill as many Americans as died on 9/11...and that you had the knowledge in hand to stop it in its tracks.

And that you could do it again—six times a year—year after year after year.

And to make the story better...you could save the taxpayer money doing it.

You think the voters would be in favor of that?

Well, voters, get ready to be in favor of that; because today I bring to you a relatively cheap, relatively easy plan that will save more than 18,000 American lives a year.

How do we do it?
By making MRSA in the healthcare system a virtual thing of the past.

Follow along and you’ll leave with useful facts, solid answers ...and examples of how the plan is already working.

So what is MRSA?

MRSA (Methicillin-resistant Staphylococcus aureus) is the name for a group of staph bacteria types that have become resistant to one or more antibiotics. All are resistant to penicillin.

MRSA, it should be noted, is not the only problem here. There are other drug-resistant organisms that lead to a variety of Hospital-Acquired Infections (HAIs), or if you prefer the technical term, nosocomial infections.

CA-MRSA are “community acquired” strains, commonly affecting people in jails, gyms and schools, and other “close contact” environments. These strains most commonly present as boils, pimples or blisters.

They are relatively easily spread, and cause almost 15% of MRSA fatalities.

“Health care–associated Community-onset “ or “Hospital-Onset” MRSA (the two of which can be referred to as “Hospital Acquired” or HA-MRSA), on the other hand, are less easily spread, but can infect the organs, causing organ failure, or the lungs, causing death by pneumonia, or the blood, causing blood infections and toxic shock syndrome.

While HA-MRSA bacteria cause 85% of all MRSA infections, as the two names imply, not all infections occur in hospitals. Other health care settings, such as nursing homes (the “Community” part of “Community-onset”), are actually responsible for about 2/3 of that total.

Those workers bring the bacteria home, by the way ...and about 1/3 of the family and roommates who come in close contact with an infected worker themselves become infected...which, in fact, is what happened to me.

(The Girlfriend is a nurse in the employ of the State of Washington; the Residential Habilitation Center where she works is the home of the poor infection control practices that caused our problem...and all of this is described in complete detail in Parts I and II of this story.)

Not only does MRSA kill with great alacrity, it’s expensive to boot.

How expensive?
Consider this, from the Committee to Reduce Infection Deaths...

A new study based on all the hospital infections reported in Pennsylvania in 2005 dramatizes this enormous economic burden. The average charge for patients who developed an infection ($173,206) was nearly four times as high as for patients admitted with the same diagnosis and severity of illness who did not contract an infection ($44,367). The 11,688 infections reported added over two billion dollars in hospital charges that year. That's in one state alone!

...or this, from the US Department of Health and Human Services:

On average, hospital stays for MRSA infections cost $14,000, compared with $7,600 for all other stays, and the length of hospitalization was more than double—10.0 days for MRSA infections versus 4.6 days for all other stays.

So up to this point we’ve covered the basics: what MRSA is, how it affects the body--and the fact that it diverts a lot of resources that could be used for better things.

But this was advertised as the “let’s fix it” part of the story...and it’s time to deliver on that promise. Which brings us to the good news.

This is a problem that can be stopped—or nearly so--and it can be done fairly simply...and in a way that pays for itself over time.

Here’s what we need to do:

First, you gotta treat MRSA and the other HAIs as soon as they appear in the healthcare system. That means screening each and every person admitted for treatment to hospitals.

The UK's National Health Service (NHS) is moving to adopt this policy nationwide; and their strategy calls for a staged approach: 100% testing for everyone admitted to Intensive Care Units and other “special” care units, all patients being scheduled for surgery, patients on dialysis, cancer patients, those with previous MRSA history, and those admitted to hospitals from nursing homes.

Not on that list? Emergency and other non-elective admissions. The NHS is recommending those patients be put in a “consider infected until proven otherwise” category. The idea is to treat those patients immediately upon admission with antibiotics and other treatments until negative MRSA test results can be obtained at a later time (a “rapid results” test exists that can return results in as little as five hours at a cost of roughly $10 per test...but it currently has problems detecting all MRSA strains).

Nursing home residents are also not on that list. Again, turning to the UK, there is data suggesting 20% of nursing home residents are “persons of concern”, for want of a better term; and that screening of all residents of nursing homes should be considered.

This costs money up front, because isolation facilities need to be provided for the new admissions that either tested positive or for whom test results are not yet received, but the NHS believes over the long term the savings outweigh the costs.

University College Hospital, London was able to reduce their infections by 38% in 12 months, just through screening...and they saved almost $400,000 after expenses.

A 38% reduction in infections could represent about 6000 lives saved annually in the US.

Once you are treating people with HAIs, you need to prevent transmission to others; which brings us to the obvious number two part of the solution: handwashing.

If just the staff in a hospital is diligent about handwashing, it is estimated HAIs would drop by 30%, even if no other treatments were applied to patients. Now hospitals are taking it one step further by introducing handwashing stations for visitors.

This is fantastic from a return on investment perspective: inexpensive handwashing could remove 30% of the cost of these infections from the national healthcare budget (estimated to be greater than $5 to $10 billion annually...which I’m guessing is a bit on the low side) ...and do it for the cost of keeping the hand sanitizer dispensers filled.

Not to mention you save another 6000 lives in the US every year.

Surprisingly, handwashing is hard to reinforce and compliance rates are hard to keep high, which is why so much research exists on the subject. One of the most interesting “reinforcements” I’ve seen to create compliance so far is the approach of Cedars-Sinai in Los Angeles, who took cultures from the hands of their doctors, photographed the results...and used the pictures as screensavers on the hospital’s computers.

The third leg of the infection control stool?
Keeping things clean.

Here’s a good example: your doctor has just finished examining another patient, enters your room, does a quick hand wash, puts on gloves...and then puts the same stethoscope on your chest that was just on that other patient without cleaning it first.

Another: the nurse enters the room, on go the gloves, and the gloved hand immediately grabs the privacy curtain, pulls it closed...and then touches you.

The curtains are likely contaminated (splashes and sprays of body fluids and airborne bacteria are the usual suspects) and equipment surfaces require rigorous disinfection. Because of the hazardous environment the types of materials used to make counters and cabinets in a hospital room affect infection control, and, because of budget pressures, the housekeepers that kept on top of all this in times past are often more “short staffed” than ever.

Gowns, gloves, and other protective equipment need to be in place as well and used properly by the staff, which also seems obvious, but for some reason, isn’t.

If we universally adopt these three concepts (screening, handwashing, and housekeeping) we can expect results...and we can expect them quickly.

At Allegheny General Hospital the rate of MRSA infection in their ICU was reduced to zero—in 90 days—by aggressively applying these recommendations.

The University of Pittsburgh Medical Center reached 90% reductions in their ICUs and includes outreach to patients in their efforts.

The Committee to Reduce Infection Deaths offers this tantalizing success report:

“Two community hospitals in Charleston, South Carolina, demonstrated that targeted surveillance—testing only patients deemed at high risk, such as patients recently hospitalized, living in a nursing home, or with kidney problems—produces more modest reductions in infection and lower financial returns. This is not surprising, because a significant number of patients carrying MRSA go undetected. The costs of targeted surveillance, including laboratory tests and supplies such as gowns and gloves, cost $113,955 and yielded just over a 10 to 1 return, saving the hospitals $1,548,740 in avoided treatment costs.”

Dramatic long-term success has been seen in reducing HAIs in the Scandinavian countries, but it is important to recognize that they have the advantage of universal health care; which means cost issues do not keep patients out of the system as they do in the US. Absent such a system of our own, near-zero is an unattainable goal.

That said, it is possible in today’s healthcare environment to reduce HAIs in hospitals by at least 50%, and to reduce them 90% or more in ICU settings.

Not only can it be done, it can be done in a way that returns money to the system instead of drawing it out.

There are 18,000 more reasons to move on this as well...every year...and in the end, that’s the cost we really need to consider.


Author’s Note: We’re not done yet. Next time I will encourage you to remind a Governor that this matters, point you to some of the States that are already acting on this issue, and direct you to a safety checklist you can use to protect yourself in the hospital.