Tensions Rise Over Publicly Disclosing Superbug

It’s unclear how one of the deadliest, most prolific pathogens will be identified – if at all – when hospital-acquired infection rates become public in January 2010. That’s because hospitals get to play a large role in deciding what to tell you.

April 23, 2009 -- Dee Dee Vallier gets calls and emails almost every day from people who were either affected personally or had a family member affected by a multi-drug resistant Staph infection.

Known as MRSA (methicillin resistant Staphylococcus aureus) or the superbug, the skin infection most often occurs at hospitals. And it can kill.

Vallier, a longtime infection awareness advocate, runs the group Americans Mad and Angry based in Hood River. By far, MRSA infections are the most common thing she hears about.

“It’s the one that actually really turned this healthcare-acquired infection activism into something that’s made the Congressional leaders listen,” Vallier said.
 
When advocates pushed the Oregon legislature in 2007 to join 24 other states in requiring public reporting of healthcare-acquired infections, MRSA was one of their major targets.
 
Oregon hospitals began submitting infection reports last January. But it’s still unclear just how MRSA infections will be identified – if at all – when the reports become public in January 2010. That’s because hospitals get to play a commanding role in deciding what to tell the public. 

Details left to committee 

Absent from House Bill 2524, which established the Oregon program, were the details. That was left up to an advisory committee of hospital and other healthcare facility representatives as well as a single consumer advocate: Dee Dee Vallier.
 
The committee fell under purvey of the Office of Health Policy and Research, and for much of last year and into this year has operated relatively unnoticed. In the next few months the committee faces a crossroads: How to report MRSA?

As the name implies, MRSA resists the drugs used to fight other types of Staph infections. Mortality rates for MRSA, though difficult to determine, are generally greater than other pathogens acquired at a healthcare setting. They are also one of the most prolific and therefore get the most noticed.

Jim Dameron, advisory committee co-chair who also administers the Oregon Patient Safety Commission, said the MRSA reporting issue is actively being debated. “We haven’t struck a deal yet on whether (the reports released next year) will show what percentage of infections are caused by MRSA,” Dameron said.

The state will have that ability because MRSA infections are identified in the reporting guidelines laid out by the National Healthcare Safety Network, which gathers the information for the Centers for Disease Control. The Oregon program then draws the data from the CDC.
 
MRSA infections within the tri-county area surrounding Portland are decreasing, based on the only source of publicly disclosed infection data in the state reported to the Oregon Office of Disease Prevention and Epidemiology. In 2004, there were more than 25 MRSA infections per 100,000 patients, while in 2007 there were less than 20. About 13 percent of cases were fatal.
 
Dameron said regardless of how the MRSA debate shapes out, the public will be well served by the reports. 
 
“What’s being reported and will be publicly available next year is going to be useful in and of itself and as a proxy for how well the hospital is doing overall,” Dameron said. “The question is what’s the best thing to report to push folks to reduce the number. It’s a start. We’re taking an incremental approach.”
 
For starters, hospitals will report surgical site infections that occur from a coronary bypass graft or a knee prosthesis procedure. They will also report all central line infections that occur in the intensive care unit. 

Complications arise 

Oregon hospitals (and hospitals in general) have always been leery of publicly reporting infection rates as evidenced by strong lobbying pressure against the concept in previous legislative sessions. For one thing, it makes hospitals look bad. Infections are typically caused by failures of healthcare workers to properly wash their hands or by overusing antibiotics. 
 
But infection rates can be confusing or misleading because it’s often difficult to identify where the infection was acquired. Though most MRSA infections occur at hospitals, community-acquired MRSA represent roughly 12 percent of cases and growing, according to the CDC. Even in hospital-acquired cases, often patients enter the hospital carrying the MRSA pathogen on their skin.
 
For each of these reasons – and because it’s so deadly and prolific – MRSA infections tend to be among the most controversial to report.
 
The Oregon Association of Hospitals and Health Systems isn’t taking a position, according to Diane Waldo, director of quality and clinical services. Waldo, like those representing hospitals on the advisory committee, urged caution on how MRSA is singled-out, but said hospitals were not resistant to report it separately.
 
“The jury is still out on the best way to screen for MRSA and to manage it. The experts are divided in approach,” said Waldo, a nurse who heads the association’s surgical care improvement project. “We’re going to take a step back and look at all multi-drug resistant bacteria.”
 
Reporting MRSA separately at this point doesn’t make sense, said Dr. Woody English, epidemiologist at Providence St. Vincent Medical Center. “We need to have confidence that we can define what we’re talking about. At this point, we do not.”
 
“The thing with MRSA and effective management is it takes everybody,” Waldo said. “It’s not just a hospital or a community issue. Everybody needs to know what it is, how it’s transmitted and how to take appropriate precautions.”
 
One approach would be to screen every patient who walks through the door, which the Portland VA tried to do. “What they found was it was extremely labor intensive, it was very expensive and it didn’t do a whole lot of good,” said Sean Kolmer, research and data unit manager at OHPR.
 
Hospitals prefer to screen selectively those patients at most risk for MRSA.
 
“Hospitals want to do the right thing,” Waldo said. “But they don’t want to rush to do something just so they seem responsive. We’ll be dealing with this for a long time.” 

Take Action 

The next meeting of the Health Care Acquired Infections Advisory Committee will be 1 pm, May 12, Portland State Office Building, 800 NE Oregon St. Room 1E. Click here for agenda and meeting materials from the most recent March meeting.
 
Future meetings will be listed here.
 
For more information visit StopHospitalInfections.org
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Comments

David, given your obvious interest in MRSA and the whole subject of HAI's, I invite you to go to the American Journal Of Infection Control (online if you don't currently subscribe) and look at the "Articles In Press" in the current (May 2011) edition. Once you bring it up on-screen you will see the first article listed is a peer reviewed study entitled: Effectiveness of a Novel Ozone-Based System for the Rapid High-Level Disinfection of Healthcare Spaces and Surfaces". The journal article itself refers to an emerging infection control technology known as AsepticSure. While the testing and clinical studies published in the article relate to "confined space" scenarios, the developer of AsepticSure is at an advanced stage in designing applications to deal with CAMRSA "hotspots" as well, such as: school locker rooms, gymnasiums, hotels, cruise ships etc. Dr Michael Shannon (former Canadian Deputy Surgeon General) and Dr Dick Zoutman are just two of the string of eminent professionals working on this technology. On the science side, you'll be very intrigued to note that for the first time ever, 100% microbial kill rates measured as minimal reductions rates ranging from 6 - 7.9 log are being consistently achieved against spores including: MRSA, VRE, E.coli, P. aeruginosa, C.difficile and B.subtilis. 100% kill rates at these logs are unprecedented and open up the very real possibility of attacking CAMRSA as well. If this is of interest to you, you could also do some good due diligence on the science behind the Asepticsure development by checking out the website of Medizone International. Dr Zoutman is presenting AsepticSure to the World Health Organization-sponsored "First International Conference On Prevention & Infection Control" in Geneva at the end of June. So clearly, this is a development in the fight against superbugs and HAI's that warrants more than just a cursory glance. If you'd like to explore the possibility of doing a story on this ground-breaking, peer-reviewed technology, email me privately (email address supplied) and I will put you directly in touch with the scientists involved. Hope you find this of interest.