There’s a so-called “super bug” spreading rapidly in hospitals and elsewhere in America. It’s known by the tongue-snarling label methicillin-resistant staphylococcus aureus — or (thankfully) MRSA. It’s a virulent bacterium that has developed robust defenses against common antibiotics such as penicillin. People can become infected in schools or other community settings, but the super bug is most commonly acquired in health-care facilities, such as hospitals and nursing homes. MRSA is transmitted much the same way other bugs are. A patient rubs his nose before shaking hands with the doctor who comes in for an examination. The doctor then carries the bacteria to another patient on her hands or on equipment she’s handled. The numbers are chilling: Nearly 11,000 Illinois hospital patients were infected last year, a 54 percent increase in just three years, according to the Illinois Hospital Association. Nationally, MRSA strikes about 126,000 hospital patients annually and kills 5,000 to 17,000.
What to do about it? In Illinois, there’s a move in the legislature to require testing for MRSA in all intensive-care and “at risk” patients, such as those transferred from nursing homes. Those who test positive must be isolated in some way. The bill also requires strict enforcement of hand-washing regimens by medical personnel — something that, astonishingly, still isn’t done regularly at all hospitals. It also requires reporting of MRSA cases to the Illinois Department of Public Health. The goal is to identify people who are potential reservoirs of infection — not all who carry the bug show symptoms — and to stop them from passing it on. No one can argue with that. MRSA screening and isolation can reduce infections in hospitals, particularly during outbreaks. Some hospitals already do it routinely, as do more than 150 intensive care-units in federal VA hospitals.
It’s telling that the Illinois Hospital Association has endorsed the legislation. President Ken Robbins said this is about more than MRSA. It’s a “shot across the bow” of every hospital, Robbins said, a warning that the public thinks hospitals are not doing nearly enough to stop the spread of hospital-borne disease. In other words, if the hospitals were doing a better job on their own, there would be no need for such laws. Agreed.
That said, however, mandatory screening in all hospitals is a blunt instrument. Some hospitals may need to be bludgeoned to finally get the message, but some are doing a good job. Many infectious disease specialists argue convincingly that the proposed law focuses too much attention on one super bug, potentially draining resources away from treating many others. The proposed law doesn’t take into account that some hospitals probably have the problem under control and some don’t. Or that some have other problems that they need to address more urgently.
The better way to attack this is to set thresholds and force screening and isolation only in those hospitals that fail to control MRSA effectively on their own. That approach allows hospitals latitude to target other infectious bugs.
There’s another way to help blunt this epidemic: with information. Illinois is readying the launch of a hospital “report card” that promises to provide hospital infection data.
A hospital that knows it will be fairly contrasted and compared to its competing hospitals on infection rates is a hospital that will work even harder to get those infections under control. Even if patients can’t understand the numbers, administrators can. So can insurance companies. Making these figures easily accessible and understandable to the public is part of a potent cure for hospital ineptitude or inaction.
Everyone who enters a hospital for treatment takes some risk. That is magnified, unforgivably, when the hospital isn’t acting aggressively enough to prevent virulent bugs such as MRSA from spreading.
