Hospitals need to come clean about infections and what's causing them.
copyright Jessica Snyder Sachs, as originally appeared in The [Newark] Star-Ledger
Our neighborhoods are in a panic over news reports about MRSA, or methicillin resistant Staphylococcus aureus. There's no doubt that this nasty bug has moved into our communities and our schools. But the deadliest threat from MRSA--and an alphabet soup of other drug-resistant bacteria--remain behind the doors of our local hospitals. Eight-five percent of MRSA infections occur during or following a stay in a healthcare facility.
The sad truth is that our hospitals have become dangerous places to be sick. Even routine surgical procedures bring the risk of potentially deadly infections involving hospital-bred bacteria. Infections picked up in health-care settings kill an estimated 99,000 Americans each year, more than twice as many as die in car crashes. It's a problem that has grown dramatically worse by the decade, as our antibiotic-infused medical centers became breeding grounds for drug-resistant bacteria.
In addition to MRSA, other increasingly common hospital superbugs include a viciously toxic strain of Clostridium difficile, bred from the bacterium that commonly causes post-antibiotic diarrhea; vancomycin resistant enterococcus (VRE), a virtually untreatable bug bred from a harmless member of our intestinal microflora; and Actinobacter baumannii, another near-unstoppable microbe, this one recently introduced into our hospitals in the infected wounds of soldiers returning from Iraq, Afghanistan, and before that, Kuwait.
The good news is that a half century of dangerous secrecy is starting to come to an end. This year New Jersey joined New York and Connecticut in the ranks of at least 22 states with some sort of mandate for the reporting of hospitals infections. These laws represent a step in the right direction. But few ask hospitals to differentiate infections caused by "ordinary" bacteria and those caused by highly drug resistant superbugs. New Jersey is one of these exceptions, with a new law on the books requiring specific reporting of hospital MRSA.
The importance of such reporting laws goes beyond a consumer's desire to steer clear of a medical center plagued with abysmal infection control. Worse, fifty years of secrecy have left public health officials guessing as to the arrival and spread of deadly new strains of drug-resistant bacteria in our hospitals.
The current situation with C. difficile illustrates the problem. Since 2003, C. difficile deaths have dominated news in Canada and the United Kingdom. British tabloid headlines like "Toe Nail Surgery Nearly Killed Me" refer to the common scenario wherein someone checks into the hospital for a routine procedure, receives antibiotics, and promptly contracts this drug-resistant invader.
Public outcry in Canada and the UK produced tremendous political pressure to address the problem in those countries. Even today, British lawmakers are quick to call the government's health minister before Parliament for public castigation when quarterly hospital reports of either MRSA or C. difficile rates fail to show improvement.
Ironically, in 2005, medical detectives traced the origins of the toxic C. difficile strain wreaking havoc in Canada and the U.K. to the United States, where hospitals had been heedlessly experiencing deadly outbreaks for at least six years. "We had no idea what was going on," admitted the chief of infection control at the University of Pittsburgh Medical Center, which in 2005 belatedly reported that its own C. difficile death toll had begun a dramatic ascent in January 2000.
Once forced to examine and deal with their superbug problems, hospitals can make great strides. This month, a once-chastened University of Pittsburgh Medical Center reported that it has brought its C. difficile rates down by more than 70 percent with an aggressive combination of tactics that include requiring doctors to get permission from an antimicrobial management team before prescribing the kind of powerful antibiotics known to raze the body's good bacteria and, so, leave a patient vulnerable to C. difficile and other drug-resistant bacteria.
Once their dirty secrets are out, other medical centers can likewise begin sharing and comparing infection control efforts. To that end, the first round state laws requiring hospitals to report infections in a general way do not go far enough. Our state legislators need to ride the current wave of public concern about supergerms to pass further legislation requiring hospitals to report on infection problems on a bug by bug basis--starting with their most dangerous and drug-resistant bacteria.
Jessica Snyder Sachs, a contributing editor to Popular Science and Parenting magazines, is the author of Good Germs, Bad Germs: Health and Survival in a Bacterial World.
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Once forced to examine and deal with their superbug problems, hospitals can make great strides. here