There is a Killer Out There, Stalking Us All

The superbug MRSA is killing patients in American Hospitals. In Europe? Not So Much


We are at Risk

By now, most have heard of MRSA, or Methicillin-Resistant Staphylococcus Aureus.This is a bacterial infection, most commonly referred to as a staph infection, that is often fatal. It is highly resistant to the drugs we have available to us and is getting more so over time.

How bad is this? Take a look at the numbers. Each year, about 90,000 Americans are infected with MRSA. Many are children and others with weak immune systems. About 20,000 die from it every year. In other words, if you get the infection, you have close to a 1 in 4 chance of dying from it. Not great odds to contemplate. That 20,000 number is more people than die from AIDS every year in America. It’s about how many we lost in the entire Vietnam war. Most of these infections happen in our hospitals. Sound serious enough?

This became a focus for me recently when my wife needed to spend a couple of days in the hospital for surgery. We have a great hospital here; the evidence of taking MRSA seriously was everywhere. Nevertheless, I found this to be my number one concern – more so than the surgery itself. I counted the hours until I could get her out of what I considered a potentially dangerous exposure zone.

There are Several Factors of Concern

The fact that this risk is so deadly is concern enough, but there are other factors that are equally concerning.(1) This bug is adapting – it is ever more drug resistant. (2) One is most likely to get the infection in a hospital or similar setting. (3) It is not unusual for an outbreak in one hospital to spread to other medical facilities in the region. Think about all the doctors, suppliers, and others who spend time in several such places. (4) America’s infection rates are higher than those in Europe.

It was this last factor that caught by eye. There is no organic reason why the problem would be worse in America than in another region. Such a pattern would indicate they are doing something right that we are not. What is going on?

It is possible that our fixation as consumers with antibiotic soaps plays some role. Using such products poorly, which I expect most users do, is like sending a bacterium to the gym to bulk up. Over time, they get stronger and more resistant. But this is likely a marginal factor. The real problem may be the lack of uniform standards and enforcement in hospitals.

This is not to say that hospitals are callous about such risk. Even a casual search shows lots of procedures and cautions in place. But what one does not find are either a rigorous national protocol for prevention or enforcement. The thing that seems to be missing in most places is any real teeth in enforcement mechanisms. There is not much in the way of good monitoring or punishment for failing to follow best practices.

I read where a doctor responsible for hospital administration said something I found odd. He said that while they wanted to have good process, they were leery of “one size fits all” solutions. That probably makes sense for social policy, but for medical procedures? This is, after all, mostly a matter of science. We know what works.

Call me simplistic, but I bet the following. A doctor who picked up a $1,000 fine and annotation in his file for failing to wash up properly would be less likely to sin again.

What Options Do You Have?

So, what can you do as an individual? Not a lot, since this is an institutional type of issue. Expect zero interest or support from this Administration at the Federal level. But you can hope for more at the state and local level. That is worth your engagement and lobbying.

Individual institutional standards are inadequate. As one source noted, hospitals are not isolated islands. We need regional standards, then national. Engage and lobby your legislators and regulators to take this on. If your hospitals or local medical professional groups have public meetings, attend. Make the case for regional policies and enforcement.

And there is something important you can do as an individual patient or patient advocate. If you are in a medical setting, keep two things in mind. One, for the time you are there, those people work for you. Assert some justified authority. Two, remember this is a life-threatening infection. You could be facing a higher than 20% mortality rate. What is more important – offending someone by seeming to be pushy or staying alive? When someone comes in the room to examine you, give an injection, change the sheets, etc., request they wash up first if they did not do so upon entering.

If they refuse or indicate they “washed before entering,” don’t be shy about insisting. Let them know you are hyper concerned about the risk of infection and so must insist on washing up now. If they still refuse, do not accept the service. Let the hospital know they refused to follow your request. Word will get around that a washup is required every time someone enters your room. If the room does not have a good hand cleansing station, that is another issue to raise.

We should all be lobbying for comprehensive national standards and strict compliance policies. In the meantime, be the squeaky wheel requiring wash ups and stay well.

      Bill Clontz

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