Monday, February 20, 2006
Legislation Would Help Hospitals Curb Deadly Bacterial Infections
ANNAPOLIS — When Michael Bennett's 88-year-old father caught the flu in the winter of 2004, Bennett took him to the hospital, just to be safe. He has regretted the decision ever since.
"He was just feeling miserable. So I said 'OK, let's do it'," said Bennett, a resident of Pikesville. "It was the worse mistake I ever made."
He said the hospital was where flesh-eating bacteria got into his father's leg, which later had to be amputated, and where his father caught an antibiotic-resistant strain of bacteria that eventually killed him five months later.
"My father was tortured for months by these infections," said Bennett. "It was only when I got the medical records that I discovered what he had."
Bennett's is one of a growing number of stories of people who go to hospitals to get well but instead are infected with antibiotic-resistant bacteria. The stories have attracted the attention of Maryland lawmakers who see hospitals as the frontlines for fighting the spread of resistant bacteria and other illnesses.
Legislators have proposed two laws they hope will help make hospitals safer. One would require hospitals to publicly disclose the numbers of people who get an infection from being in the hospital. The other would require hospitals and nursing homes to screen patients for antibiotic-resistant bacteria and implement hygiene protocols to prevent the spread of those bacteria.
According to the Centers for Disease Control, about two million people every year contract infections in hospitals and of those, 90,000 die from them. Of the bacteria that cause those infections, 70 percent are resistant to at least one of the drugs used to treat them.
"It's a major, major problem in hospitals today," said Senator Paula Hollinger, D-Baltimore County. "We're on our last antibiotic and bacteria are resistant to it."
Hollinger, a former nurse, has proposed a law that would require hospitals and nursing homes to adhere to the hand washing and hygiene guidelines of the Society for Healthcare Epidemiology of America. It would also require hospitals and nursing facilities to screen patients for antibiotic-resistant bacteria when they first check in, using a protocol laid out in the guidelines.
When people test positive for a resistant strain of bacteria, they would be separated from other patients, and special hygienic measures would be taken to keep the infection from moving to other patients and hospital workers.
The surveillance program would focus on two widespread and deadly strains of bacteria usually referred to as MRSA and VRE. A program similar to the one being proposed by Hollinger at the University of Pittsburg Medical Center was found to reduce MRSA infections in the medical center's intensive care unit by 90 percent.
MRSA is a strain of staphylococcus aureus that is resistant to a variety of powerful antibiotics, including methicillin and vancomycin. It is often found on the skin and in the noses of healthy people. But when it gets under the skin through scratches or surgical wounds it can cause boils and deep tissue infections that persist for months. Infections that get into the blood stream or the lungs can be fatal.
"MRSA is in every hospital in the United States, just lurking there," said Lisa McGiffert, senior policy analyst for Consumers Union, a New York-based consumer advocacy organization.
The other organism the program would focus on, VRE, is a bacterium typically found in the stomach that has evolved a resistance to vancomycin. Bennett said that his father's death certificate cited organ failure caused by VRE as the cause of death.
(Bennett declined to identify the Maryland hospital in which he believes his father contracted the bacteria. He says he is planning to sue the hospital.)
VRE is a hardy species that can travel from patient to patient on the hands of hospital workers, the method of transmission that experts say is the primary way disease spreads through hospitals.
Hollinger's bill would also require hospital workers to follow stringent hand-washing and hygiene guidelines. She said her nursing training emphasized hand hygiene as crucial to stemming the spread of microbes.
"The first rule was wash your hands, wash your hands, wash your hands," she said.
Failure to follow appropriate hand hygiene is the leading cause of the spread of antibiotic-resistant organisms, according to the CDC.
The principal of survival-of-the-fittest best describes how bacteria evolve resistance to antibiotics. Some bacteria are naturally resistant to antibiotics and thrive and multiply after their weaker competitors are killed.
Repeated and improper use of antibiotics is one of the major reasons for the development of resistance, according to experts. Taking antibiotics for a viral infection such as a cold or flu, for example, does nothing to fight the infection, and encourages the development of antibiotic-resistant strains of bacteria.
Sometimes patients improperly medicate themselves, taking antibiotic they were given for an earlier infection but did not finish - a behavior that also encourages antibiotic resistance. But doctors also contribute to the problem by bowing to pressure from patients and improperly prescribing antibiotics.
One study cited by the CDC found that doctors were over five times more likely to prescribe antibiotics to a child if they perceived that the child's parents expected the medication.
According to McGiffert the growing problem of antibiotic-resistance has cast some much needed light on the issue of the spread of disease in hospitals.
"This has been a problem in the health care system that has been hidden from the public," she said.
Consumers Union also supports a bill that would require Maryland hospitals to publicly disclose cases where people catch a disease while in the hospital. The information would be included on the hospital report cards that are already required by state law.
The bill's sponsor, Delegate Shane E. Pendergrass, D-Howard, said she learned from her father, a bacteriologist, that hospitals could be dangerous places.
He once told her when she was pregnant to get out of the hospital as quickly as possible after her baby was born to avoid infection.
Pendergrass said consumers need a way to find out how many people have caught diseases in a particular hospital.
"If you have a choice to go to a hospital that has infections and one that doesn't, which one would you go to?" she said. "It gives me as the consumer access to information about hospitals and a way to compare them."
Supporters of Pendergrass's bill, including the Maryland Hospital Association, believe it will encourage hospitals to adopted practices that reduce the spread of disease among health-care workers and patients.
"Hospitals look at how they compare to their peers," said Pageen Townsend, the senior vice president of the Maryland Hospital Association. "Nobody wants to be at the bottom."
Michael Bennett agrees that the public reporting measure would help people find out if their local hospital or nursing home has a problem and that it might encourage them to improve their hygiene practices. But reporting alone, he said, will not fix the problem.
In fact, he said one reason he does not disclose the name of the Maryland hospital where he says his father contracted the bacteria that killed him is that vilifying any one hospital would shift the focus away from a problem he thinks almost all U.S. hospitals need to face up to. He thinks the best way to fight the spread of disease is to implement the surveillance programs required by Senator Hollinger's bill.
"I'm not against public reporting, I just believe the effort needs to go to saving lives right off the bat," he said.
The Capital News Service Contributed to this report.